I don’t want to serve as an apologist for diagnosticians, but I need to make a few comments. First, misdiagnosis is not “abuse” in that its intent is not to harm. Second, my auto mechanic, garden consultant, dentist, GP, computer guy, and every other professional I’ve ever dealt with as a class makes just as many errors of “diagnosis,” and does just as much pretending that s/he understands what’s going on, as any group of psychiatrists. In some cases, the consequences could have been much more dire. My point is that there is not an evil psychiatric cabal rubbing its hands and cackling with glee because it has successfully misdiagnosed a vulnerable person. Finally, don’t even get me started on how frequently people lie and misrepresent their physical and mental state, including what drugs they’re taking, and then get upset when the diagnostician can’t read their minds. Sure, professionals have obligations and sometimes blow it, though usually not intentionally. Patients also have obligations, and are, as a group, much less likely to understand the consequences of misrepresenting or underrepresenting their state.
Making a mistake in diagnosis is just a mistake, that’s true. But when future doctors build on that mistake, and insist that this condition is who you are, and prescribe drugs that don’t work (and in many cases make the symptoms worse) and threaten to cancel your disability if you don’t get with the program, and laugh in your face when you talk about deep, hurtful things that have happened to you…that’s abuse.
All shrinks are doctors, and doctors by nature have a God Complex. They have very bad people skills. It’s inherent in the profession, and probably a result of the intense training they must undergo to earn that M.D. (I’m generalizing here, of course.) However, the disconnect is that so-called mental illness is NOT like a cancerous tumor that can be removed, or a fuel injection system that needs to be overhauled. Mental illness IS the person, and every person is unique. Nobody is 100% schizophrenic, OCD, bipolar, whatever. Those are just labels created by doctors to fulfill their need for order.
(BTW, autism isn’t a mental illness. It’s a pervasive developmental disorder. Even the DSM-IV says so.)
I agree. The real conspiracy is centered in the multi-billion dollar drug industry. Don’t get me started on them. 
Been there, done that. But sometimes when you suddenly do want to get help, and work together to solve the problem, these doctors assume that you’re just playing the same games you’ve always been playing. They don’t get the concept that people can spontaneously change. Once a schizophrenic, always a schizophrenic. :rolleyes:
I read her site. The person who wrote those words is not someone who was a moderately to severely autistic child. They simply do not have those communication skills by definition. And while not officially part of the definition, a hallmark of even high functioning autism is a relative deficiency in abstract thinking skills relative to concrete memorization of specific information. Individuals with schizophrenia can write like that, and the systematic oppression/genocide themes, as she evinces, such as with her expressed distrust of what people will do with the genetic information once collected, fit with paranoid delusions common in schizophrenia. I am not diagnosing her, mind you, just saying what is and what is not consistent.
I’ll let your stereotypes of all doctors slide, my God-complex gives me that power, but I will agree with you about the place of labels.
“Autism”; “Asperger’s”; “ADD”; etc. are all just labels, just words. They are not who any individual is. They are artificial boxes to shove the huge variety of humanity into for the sake of ease in communication. Often they provide a good shorthand: “my child has moderately severe autism” can be more efficient than saying ten minutes of how the child is severely language delayed, socially impaired, narrow focused, extremely sensitive to some sensations, unaffected by others, and prone to outbursts with changes of routine. With those five words I know not to shocked if the child engages in some hitting of himself as a way of self-soothing and my approach as a general pediatrician asked to take care of the acutely ill child will be slower. I will be able to predict that examining and communicating with the child with particular approaches will be more likely to make for a nontraumatic exam than others. With just five words a parent has told me all that. Sometimes the shorthand is inaccurate for that individual. Then you need to use some longhand. I must tell you that I need to spend a fair amount of time with patient families discussing the utility and lack of utility of labels. Many of us have this ancient thought process that the act of naming something magically gives us power over it. It does not. An appropriate label can suggest interventions because those interventions have worked for others with a similar constellation of strengths and weakness. It can help predict what may happen in the future. It can open doors to services that would otherwise be more difficult to obtain. But ultimately the individual is who they are and not the label. The best approach will be based on individualizing care to the strengths and weakness of that individual whether the label is OCD, Autism, SID, or YabbaDoitis.
Well, I won’t let it slide. KGS obviously has had some bad experiences. That doesn’t validate his generalizations. Injecting this kind of argument is counterproductive in such an interesting thread. I’m learning quite a bit from the professionals who have responded. Thanks.
So…perhaps “the definition” needs to be looked at?
What if a patient presents you with an “autistic-like” condition, meeting every single critieria of the DSM-IV except these abstract thinking skills? Is it possible for an autistic child to learn abstract thinking skills, either on their own or through a regimen of therapy & medication? Or do you automatically assume these “autistic-like” conditions are a completely unrelated syndrome, completely unrelated to the ASD spectrum?
This is true, accurate labels are important. But it’s also important to consider the social stigma attached to those labels. Don’t you agree?
For example – what do you think of the Virginia Tech shooter and his mental condition? When it happened, an early report said he was diagnosed with autism. But according to the linked Wikipedia article, he had a condition called “social mutism”, which (to me) sure sounds a heckuva lot like Asperger’s. And then there’s all the CNN/48 Hours/MSNBC specials with “expert psychiatrists” declaring him a paranoid schizophrenic. What’s your take?
Yes. In which case report the offender to his/her licensing board. I’m sorry that you’ve had bad experiences, but vilifying and insulting entire professions is not useful or accurate, and doesn’t demonstrate such great people skills yourself.
I just want to thank monstro for posting such an interesting link. Very thought provoking, not just about autism, but about the "right to be different (even annoyingly and disturbinly so) without being labeled as defect".
I’ll accept that my “people skills” need work. As for “vilifying entire professions”…well, let’s just agree to disagree, as it’s not really germane to this thread. Deal?
Works for me.
Its an interesting site, but like others my initial response is to be dubious that the person is experiencing severe autism in the way Ive met other people experiencing it in my work, and the writing does come across more as schizophrenia impression wise, but diagnosing on the basis of writing isnt really a very good idea so an impression is all that can occur.
The obvious response to me is ‘extraordinary claims require extraordinary evidence’. The person in question is essentially claiming theres a huge misunderstanding of autism at a basic theoretical level and that their understanding of it is superior.
As others point out even if she is correct for herself, her extrapolation to many other people with the same diagnosis seems like a pretty huge assumption. Is her experience atypical, typical, misdiagnosis, some form of fictitious disorder, outright fibbing, what?
Basically theres a lot of possibilities, but not enough information to really make much of a guess. Even the supposed former diagnosis of schizophrenia isnt well documented.
It makes it hard to do much with it by itself.
Otara
Because of one person for whom the definition is imperfect? That would be a pretty bad idea. Our diagnostic categories are imperfect, and don’t adequately describe each individual. But they are the best description of the most common features for each disorder, and they function pretty well when examined empirically, as well as in clinical practice.
If they meet all the criteria for the disorder, they meet the criteria for the disorder. One reason why the criteria stand up pretty well is because you rarely see someone showing fluid abstract thinking when meeting all the other criteria.
Well, there isn’t really any well-demonstrated pharmacotherapy for autism. However, children with PDD can show improvement over time, which may be accelerated by ABA or discrete trial training types of interventions.
I agree with
[Sorry, I had some problem with my laptop, and my previous post was submitted early.]
I agree that it is not possible to form a reasonable diagnosis on the basis of a reading of this person;'s description. However, in general, it wouldn’t be particularly hard to distinguish between a psychotic disorder and a pervasive developmental disorder. The former would probably have an onset in mid to late adolescence or young adulthood. The latter would be evident very early in a child’s development. Delusions or hallucinations would be unlikely in PDD, but would be essential in a psychotic disorder. I could see how a diagnosis, rarely employed, of schizoid personality disorder could possibly be mistaken, if you saw an adult with PDD and didn’t have a good history on them.
Not for one person, no. But if a group of people (even a small group) present a condition that appears more autistic than psychotic, but differs on a few key points…doesn’t that suggest the “key points” need to be examined more closely?
Besides, the DSM-IV is not written in stone. Far from it. Autism wasn’t recognized as separate from schizophrenia until 1965, and Asperger’s Syndrome wasn’t even included until 1994. Also, schizophrenia used to be considered completely separate from bipolar disorder, until a new definition (schizoaffective disorder) was created. The current definition of Asperger’s Syndrome, as it stands right now, states that schizophrenia and Asperger’s cannot exist in the same person – one condition contraindicates the other. I would not be surprised if that changed in the near future. See what I’m getting at here?
Not for a “small group.” First of all, one person doesn’t make a small group. I can’t say for a hypothetical condition what the number of people I’d want to see would be, but I’d say that if it got to a point that we can reliably distinguish two groups based on those given features, it would be appropriate to develop some more specified criteria or a diagnostic subclassification.
No, not really. It seems that as we improve on our understanding of these things, we improve the diagnostic categorization of them. Isn’t that appropriate? I know I wouldn’t want a stubbornly static DSM. So, what is your point here?
Well…for one thing, it irks me when a member of the profession offers a diagnosis based solely on a person’s website, without ever meeting the woman or knowing anything else about her medical history. It sounds to me like DSeid is saying, “She knows how to type, therefore she must be schizophrenic and not autistic.”
Perhaps I’m hung up on the definition of “abstract thinking skills”. What does that mean, exactly?
Well, I can’t say much about that, but given two possible diagnoses and a sample of nuanced writing, I’d say that is more consistent with one and not the other.
Well, I don’t have a succinct definition, but it contrasts with concrete thinking. Abstract thinking includes an ability to understand subtle nuances, humor, double entendres, sarcasm, the ability to make inferences… Kids with PDD have a hard time in social interactions, in part, because they don’t get these things. A great deal of the negotiation of social interactions involves picking up on unstated rules, observing the subtle facial, verbal and other such cues of others, and responding appropriately.
Another element is that kids with PDD often experience elevated stress looking at human faces, so they avoid doing so. An interesting study I saw once tracked the eye movements of adults with autism while watching “Who’s Afraid of Virginia Woolf.” The scene involved three people - a man and a woman having a discussion in the foreground and another woman, IIRC, in the background. I believe that the woman in the background was romantically involved with the man in the foreground. While a control group showed a triangle pattern as they followed the conversation between the two in the foreground and also checked the character in the background for her reaction to the discussion, people with autism simply looked back and forth between the moving lips of the two characters in the foreground, not picking up on the implications of the discussion for the relationship and affective response involving the third person in the scene.
Great to hear that autism is a ‘spectrum’ disorder, with some of those diagnosed with it being almost indistinguishable from the avarage person on the street, but others. This really helps the claims that it’s caused by a single, as yet undocumented, biological problem THAT much easier to understand.
Obviously though, all autistics have no sense of humour and can’t examine the emotions people are feeling people’s emotions, because they’re autistic, and an autistic by definition can’t have a sense of humour or emotion or he isn’t an autistic! We don’t need to have any real, empirical biological evidence that the autistic brain differs from that of the avarage person, because it’s obvious their brains are different; I mean, come on, they’ve got no sense of humour or emotion, they must have brain dammage!
Great to hear a doctor suggest that such disorders are ‘simply lables’, and not indicative of the person beneath except to explain a facet of them easily and to help group them, but you’ve got to remember the stigma that goes with these lables, and the way they’re treated by the majority of the population as REAL dieseases, that define a person completely.
Did I forget to mention that I’m (alledgedly) an autistic?
Of course, I’ve learned how to laugh and make friends (and to type!) in the decades since my diagnois, so they must’ve got it wrong, and I must be a sociopath or a schitzophenic or something, mustn’t I?
I thought it was a rather impressive site. Of course I’m an easy audience. Practically preaching to the choir, as it were.
POINT: Since, as has already been pointed out, no diagnosis of a specific form of mental pathology is of any spectacularl reliability, and even the categories themselves aren’t too well nailed down, anyone who catches one diagnosis and then gets independently evaluated elsewhere may get a different dx the second time around.
POINT: The diagnostic categories are phrases within a human vocabulary; like any other words, you could seek to define them prescriptively (how some book, whether DSM-IV or Oxford Unabridged Dictionary, says they should be used) or descriptively (how they have, in fact, been used as experienced by those with the fortune of wearing them as labels). And to break it down further, a person who has been given any such diagnosis and received treatment (in both the medical and social senses) may opt to say “they diagnosed me as a ____ but they were wrong, I’m not”, or “they diagnosed me as a ___ just as they’ve diagnosed so many others along with me, but they are wrong about all of us, we are not what they say about us and it’s not ok to treat any of us like that, so it’s a freaking witch-hunt”, or “I am a ____, so diagnosed, but hey it does not mean or should not mean what you think it means”. The first option claims misdiagnosis (oops) and lays claim to a horrid personal trauma (“they had me marked down as one of those ___, and I got treated the way it would only be ok to treat one of Them, and that sucked for ME!”) but with no solidarity with others who have been through the same. It were a mistake, an accident. The second options make the difficult claim that the entire profession that is applying these diagnostic labels is delusional and that the recipients thereof are unremarkable plain old human beings aside from having been the random victims of those dangerous shrinky people going around designating folks as ____. The third option most fully embraces a descriptive use of the term: the true meaning of ____ comes from how it is used when I (and the other folks so labeled) get diagnosed as such, and treated as such; when I speak I speak as a ____, rather than content that either I alone or that all of us collectively are not what they say I am / we are.
POINT: If one happens to have received multiple diagnostic labels and/or have been treated on an involuntary basis under multiple auspices at multiple different times, it can often be an in-good-faith condensation of one’s own story to pick one such label, one such setting, and concatenate the central parts of the various experiences as if it were a single unified experience. Maybe that is not such a hot idea, you’re welcome to hold that opinion or draw that conclusion. But I’ve done it. I have spoken often on the board of experiences with involuntary psychiatry as a person diagnosed paranoid schizophrenic. I refer to myself as a schizophrenic fairly often. And yet the first time my belt & shoelaces were taken from me and I was locked behind iron doors as a designated crazy-person, it was “manic-depressive” that they wrote on my charts. It was my second incarceration of that nature where I obtained “paranoid schizophrenic” as my dx. In most cases it starts out as a consideration for the attention-span of the folks I’m speaking to: I can make the salient point without explaining how it was that I came to go through the damn mill twice, in two different settings, receiving separate diagnoses. Some people might be interested in that level of detail but many will not. (And to be frank, I fear that too much detail makes the tale harder to swallow by people who are considering all this for the first time).
So I’m inclined to give her the benefit of the doubt as far as what they called her, when they called her that, and to what extent which of the experiences she was subjected to were suffered by her as a consequence of which diagnostic label.
In many cases, that is impossible.
I was also given an incorrect label once and the wrong medication. The result was the most painful experience I’ve ever had. It’s impossible to imagine.
But when the right diagnosis was made and the appropriate medication provided, I returned, in part, to being the person I set out to be twenty-five years before. The kind of counselling that I have had – brief sessions focused on the present rather than the past – has been enormously practical also.
monstro, sorry for the hijack. I keep hoping to have some understanding of high functioning autistic minds because I want to know how to teach/reach/appeal to the grandchild of a friend.