** First of all, they were kept on the antipsychotics for weeks and months at a time.
Secondly, blunting people’s will and initiative may well be convenient for the people dealing with them, but it can’t be considered a healthy improvement by any rational standard. Psychological therapy is NOT about molding people to fit what we want them to be.
** Now, give us an objective and non-ideological definition of “legitimate authority”.
** “Despite his wishes”? No, that seems to be entirely consistent with what they want. Not wishing to obey an arbitrary authority figure sounds like moral principle to me.
** The choices aren’t fine by whose standard? They’re able to make choices just fine – they’re simply not acceptable to you and others who assert power over them.
yes, change in behavioral patterns doesn’t happen overnight; welcome to reality.
For a kid who assaults his mother then later feels guilty about it and has no clue how he got so angry; a medication that slows him down enough to think about it first is definitely an improvement.
you would know what psychological counseling is “supposed to be”…how?
Parents. Law enforcement. Teachers. Is it too ideological to think that parents should have authority over their children? What about teachers over their students?
Yes, that’s partially what makes it a disorder. It’s not like we’re dealing with Chucky here. These are (generally) people who possess morality that is contrary to the behaviors that get them in trouble. THEY DON’T WANT TO BE THIS WAY. We’re not talking about the zapatistas in Chiapas rising up against an opressive and corrupt system, it’s not like this is a band of kids marching on washington. We’re talking about a child hurting people he loves (almost) instinctively and he hates himself for it.
There’s nothing arbitrary about parents. Teachers? somewhat arbitrary for the first couple of weeks maybe. Cops? Don’t they go through some sort of training or something? They wear a uniform usually don’t they? Sounds pretty purposeful to me.
What “arbitrary” authority figures are you talking about?
The choices aren’t fine by ANYBODY’S standards (sociopaths excluded). Most importantly, they’re not fine by the kid’s standards. He knows he’s doing something wrong.
Lemmie repeat that:
he knows he’s doing something wrong.
get it through your skull to the thinking/understanding part:
he knows he’s doing something wrong.
By his own measurement, by his own moral code, he knows what he’s doing is harmful to himself, others, his future, whatever.
That kid I mentioned throwing a chair? I know him, I didn’t make that up. I was his favorite staff member before and after he hucked the chair at me. Depakote helped him alot.
The neat freak that wouldn’t make his bed? I know him too.
I’ve known at least a hundred of them (kids diagnosed with ODD).
“simply not acceptable to you and others…” -good one. Could you point me to the situation in which it is acceptable to throw a chair at someone you like and respect?:dubious:
My point is, you have no idea what you’re talking about. Ok, I take that back. You have very little idea what you’re talking about and you would do well to admit it so maybe you can learn something instead of arguing an ignorant viewpoint.
** The problem is not that this change is desired and sought-after by the people in question. Therapy is often forced on teenagers, who are then forced to become “healthy”.
** This isn’t a mere sedative. All antipsychotics, even the relatively less potent atypicals, have serious effects on higher cognition.
** Ever hear of the Hippocratic Oath?
** Is it too ideological to think that not all parents and teachers are capable of wielding authority appropriately? Is it too unreasonable to recognize that the world is full of idiots who hide behind “legitimate authority”?
** This is not an aspect of the diagnostic criteria for ODD. The disorder includes anyone who defies authority consistently and “unreasonably” in the eyes of the diagnostic physician.
** Ooh, everyone wearing a uniform is obviously someone to obey. They must have carefully analyzed the situation and reached a wise and intelligent decision about how the world must work, 'cause their clothes are spiffy. :rolleyes:
** And which ones are the sociopaths? (Do you know what a circular argument is?)
These kids generally are aware that they’re acting in ways contrary to society’s dictates. That is not the same as doing something wrong.
Which is why so many “sufferers” of ODD need to be forced into treatment. They want treatment, but they just can’t bring themselves to seek it out because they’re crazy.
[paging Nurse Ratchett… will Nurse Ratchett report to room 309 please?]
I’m not nearly as happy about psychology’s successes as I’m concerned about its failures – and abuses.
Again, you know this how? You know what these kids desire? Mind reader are ya? Medical and dental treatment are also often forced on people (although without a cite, I’m highly dubious of your assertion since you obviously have little if any firsthand knowledge of our subject).
What isn’t a mere sedative?
I have heard of said oath, I didn’t take it nor does any psychotherapist. That’s for doctors. Psychiatrists don’t do much psychotherapy anymore. You still haven’t addressed how you are so knowledgeable about the aims of psychotherapy.
no, but your assumption seems to be that all parents of kids with ODD are incapable. 4a) Yes. It is too unreasonable. Six billion people all hiding behind legitimate authority?
“unreasonably,” is that a direct quote from the DSM or did you mean so-called unreasonably? I happen to know that it’s not a quote, so you must have meant so-called. And no, it’s not that way at all. The person has to display the criteria more often than is normal for a person of his age. Are you purposely trying to display the fact that you know nothing about this disorder?
Incedentally, I wouldn’t trust a physician to diagnose any mental disorder unless it was a psychiatrist.
Tell me how it works out the next time you react to a cop in that manner, especially if he catches you with drugs in your pocket or in a stolen car. The attitude is one thing, voicing it when you stand to be arrested is quite another. Most of us have the control to keep our mouths shut in such a situation even if the cop is being a jerk.
the sociopaths are the ones who don’t have a moral problem with a kid throwing a chair at someone they care about. I know what a circular argument is, I don’t think I made one.
mind reader again? You know what’s going on inside their moral codes now? Their awareness? Ok, fine, define “right” and “wrong” and we can go from there.
I never said they were crazy. I don’t think they are. Your word, not mine. They are suffering though. I don’t think I even said that they wanted treatment. It’s not surprising that someone who is oppositional to authority doesn’t want to do what a parent wants them to do. Many of them are resistant. The fact remains that they are not capable of making their own decisions legally, their parents are responsible for assuring that they are given the treatment they need; that includes medical, dental, and psychiatric. Go ask your legislators to draw up a bill emancipating all minors if you really have a problem with that.
[nurse ratchett worked on a fictional adult psych ward, no oppositional defiant teens anywhere in that movie]
It might mean something for you to make such a closing statement if you could actually display any knowledge of what psychology is. Your problem seems to be with psychiatry.
Heavens above, TVAA :rolleyes:, your ignorance is astounding. Would you care to explain to us how anyone can have therapy “forced” upon them, or how they can be “forced to be healthy”? I am assuming here you are speaking of psychotherapy.
For your edification:
Q: How many psychologists does it take to change a light bulb?
A: One, but the light bulb has to want to change.
Mean anything to you at all? Its a pretty basic premise of all psychotherapies and counselling. People will only make changes to their behaviour if they want to.
** This is quite possibly the stupidest and most ignorant thing I have ever seen at here at the Straight Dope.
Children and adolescents have no way in the therapies they are forced to undergo. Many mental patients are also compelled to undergo therapies that are far more invasive than psychotherapy.
I’ve seen psychologists and psychiatrists define patients’ behaviors and beliefs as “unhealthy” without anything even approaching a rational reason. I’ve seen them consider any opinion or belief they didn’t understand as symptoms of illness. I’ve watched them judge people as “sick” because they didn’t want to be what the doctors thought they should be.
The most effective therapies for ODD and CD include parent training. An emerging intensive therapy, Multisystemic Treatment, focuses effort at other factors and systems in the child’s world as well. Little support exists for individual therapy focused on the child alone being effective to address these disorders, although there is some benefit to some forms of individual therapy in the context of a broader treatment approach. Only a few randomized clinical trials exist to evaluate the effectiveness of specific medications with these disorders. Good reviews on the topic include Burke, Loeber & Birmaher (2002), J Am Acad Child & Adolesc Psychiatry, and Brestan & Eyeberg (1998) J Clin Child Psychol.
Here a brief discussion of ODD’s definition. Now, how exactly do we define “excessive”? The levels of defiance and disobedience must not be “normal”: how do we define that? Mathematically, or by a set of properties. Either way, how do we determine that this abnormal behavior is due to a disorder instead of merely representing the inevitable extremes of any continuum?
Children and adolescents have as much say in their own therapy as they do in any other facet of their lives (at least in my experience).
If you’re going to ask us to rely on your anecdotes you’ve got to ante up some story about having been forced into therapy yourself as a youth, or something.
“seen psychologists and psychiatrists define…” Where? The movies? Dateline, 20/20? Or did you have some friend who was in a group home tell you all this?
We’ve already established that you’re pretty ignorant of the disorder itself, and psychology in general; so what makes you such an expert?
how do we define “excessive?”
The link you posted didn’t have all the diagnostic criteria (you did read that part at the bottom of the page, right?)
It excluded the most important one (IMO):
“the disturbance in behavior must cause clinically significant impairment in social, academic, or occupational functioning.”
Usually it’s social or academic since most kids don’t have jobs.
So when the kid is flunking school and doesn’t have friends because he’s annoying others, blaming others for stuff he did, etc… (keep in mind that he, by all accounts, does this more than the other kids), if he’s not doing this because he’s got some other mental disorder, a medical disorder, or for some other reason; then we define it as “excessive.”
“the inevitable extremes of any continuum” -hmmm. It depends on how the kid got there.
Two threads with some very repetitious themes, these ODD and ADD ones.
Can one quantify behavioural characteristics like inattention, defiance, provocative, and so on? How does one decide when such behaviour is outside the range of normal variation?
It is inherently subjective and prone to observer and situational biases. Even the best standardized tools still rely on subjective opinions of observers to fill them out. This makes the definitions of these terms unavoidably fuzzier than many other clinical terms in other fields.
From the practical point of view (clinically) an operational definition is that the behaviours are handicapping. Scientifically that won’t wash though because obviously what is handicapping in one environment need not be so in another situation … my relative lack of coordination would have been handicapping to my success in a family devoted to raising a football star but was of little consequence in a family that cared more about academic success, for example.
But the subjectivity is unavoidable in measuring social behaviours because social behaviours only occur relative to other individuals. The best that you can do is to document that it is not situational specific but that the behaviour is severe enough to be considered handicapping by the assessment of multiple observers in multiple venues and that a well trained clinician finds their observations consistent as well.
What qualifies as a disorder?
Are these behaviors distributed along a normal distribution and “disorder” being defined as some arbitrary lowest 5th%ile, or is there a clustering, a lump at the tail end of the curve?
These two are related questions. I do not think that posters on this thread will agree on a defintion of “disorder” … but some would posit that the clustering would be more consistent with a label of disorder than an arbitrary lowest 5th%ile no matter how handicapping membership in that lowest 5th%ile might be.
I think that vast majority of professionals would state that they believe the clustering exists for schizophrenia, bipolar, autism, depression, and so on. A few less would concurr for ADD. And a further few less for ODD. But there is paucity of hard data on this. It would be hard data to collect as it would require both quantification of “defiance” with some consistent measuring device across a spectrum and broad population surveys.
Does the label of “disorder” empower those in authority (parents/the establishment) to “force” treatment upon unwilling individuals?
No.
Parents already have the power to impose interventions whether or not a behaviour is labelled a “disorder” - the label helps guide professionals to guide the parents to more effective interventions - and occassional helps provide access to other support systems.
Society’s ability impose intervention is also independent of the label of “disorder” but instead hinges upon the potential harm to ones self or others. In general the standard is set high … the burden of proof is upon those who say the person is of great potential harm. But abuses do occur. And vigilant defense against those abuses is warranted.
Do all clinicians use these terms carefully, with as much precision as the tool allows, and with full awareness of the limits of the tool?
** Um, no. All we’ve had is your offended assertions that I don’t know what I’m talking about.
You, on the other hand, have made assertions about the nature of ODD that have absolutely nothing to do with the clinical definition of the condition.
** How do we define “clinically significant”? Easy: the psychology/psychiatrist thinks it’s serious. The implicit standards used in such judgments are social constructions, no more valid that traditions of what “good” art is.
If the patient reacts to his or her life in a way the professional feels is “appropriate”, they’re not sick. If not, they are. It’s that simple.
** That is not how we define “excessive”. “Excessive” is defined by our standards of what the world and the things in it should be.
If the kid has friends, but they’re the “wrong kind” of friends, it’s a social impairment. If the kid has a trait which we do not see as bad but drives away others, we tell the kid they weren’t appropriate friends because they didn’t value him for what he is. If the kid has a trait which we see as bad and drives away others, we tell the kid he should change.
Yes, and do we know how the kid “got there”? Can we demonstrate an objective malfunctioning in the kid’s brain? No. We define the disorder by where in the continuum the kid is.
** I agree with all of this, excepting the statement that these terms are “unavoidably” fuzzy. I assert that it is possible to replace current psychology with a genuine science, in the same way that alchemy was replaced by chemistry.
** Everyone is “handicapped” in an infinite number of properties. But since we don’t even consider those properties, much less value them, we don’t realize this. If nothing else, being good at one thing requires being bad at its opposite.
** No. Social behavior can be objectively observed as much as any other property can. That is not the best we can do.
** Even that isn’t enough. There are plenty of traits that are “clustered” with abnormally high IQ and mental ability. Yet those are not considered “disordered”.
** Precisely. It doesn’t matter what any number of professionals believe, any more than the existence of a disease depends on what doctors think.
** I suggest the standard is not as high as you think it is.
Since “disorders” exist only when someone – either the patient or someone else – is “harmed”, being given the label of disordered automatically means that they are considered to be a potential threat to oneself or others. Forced treatment occurs only after a threshold of “perceived threat” has been reached – and that threshold is a subjective and arbitrary one.
I concur. I consider this to be a very serious problem.
cite? you know this how? you have yet to back any of this up, which leads me to:
You’re right, I know one of two things: either A) you’re ignorant or B) you actually have some knowledge and are just jerking everyone’s chain for whatever reason you might do so.
I personally have surmised from your posts that you really know quite little about psychology, or are purposely choosing an ignorant standpoint.
My assertions come with a B.A. in psych, a master’s in social work, I’m a licensed therapist, and I have over 10 years of experience working in mental health; particularly with the client population at hand.
you, again, have just made assertions and haven’t backed anything up.
I know what I’m talking about, and I can tell that you don’t. It’s as simple as that.
2a) If you knew anything about ODD, you would know why my assertions have anything to do with the clinical definition of ODD.
You can choose to read them as illustrative, or ignore them I suppose.
You’re gonna have to prove you know anything about psych. and the profession before this is considered to be anything other than your personal uninformed rambling.
you really want to know? ask, I’ll tell you. Otherwise this is just cheap ignorant mud slinging.
so, if you already knew the definition of “excessive,” why did you ask?
I don’t tell the kid any of that stuff by the way, nor does any therapist I know. Maybe YOU do, but don’t include me or any other mental health professional in that “we” unless you’re prepared to prove it.
We do, in fact. He got there by (insert DSM diagnostic criteria here).
so something only exists if it’s demonstrable in the brain?
It doesn’t work that way no matter how much you want it to. This disorder occurs (arguably) because of interactions between a child’s temprament, his environment, and his socialization. Someday brain research will be so fine-tuned as to demonstrate this, maybe; and even then I doubt there will be a medical/pharmaceutical treatment that is sufficient.
what exactly is your problem? You seem to be on some quest to prove that the mental health profession systematically opressess young people. For what benefit we would do such a thing I have no idea (hint: I ain’t getting rich). It would be cute to hear what your actual motive is.
I suspect that you may have some personal history here that motivates your quite extremist positions. Have you percieved yourself to have been victimized by treatment against your will in the past? Is there something in your own story that would help illustrate why you feel so confident that modern mental health is more commonly “One Flew Over The Cuckoo’s Nest” than it is an attempt to develop a helpful clinical science?
Psychiatry and clinical psychology are neither “Cuckoo’s Nest” nor a helpful science, and I’m quite familiar with the nature of sciences, so I should know.
I strongly dislike medicine for similar reasons, but medicine is a haven of reason and logic compared to psychiatry. Its categories are at least theoretically verifiable… And there’s a lot more accurate patient information available for it.
You do realize how arrogant “so I should know” sounds, don’t you? Especially since you have not evinced any real knowledge of how science works. Maybe you should know, but none of us have any reason to believe that you do.
Other than the fact that you should know, you have offered neither any evidenciary basis for most of your claims nor any reason why your expertise in these matters should held in any regard. Requests for citations are systematically ignored.
Since your expertise does not come from personal experience on the patient side, do have some basis of expertise on the caregiver/researcher side? I refer in particular to your knowledge of the situations under which treatment can be imposed.
My expertise is from the medical side … in training I learned what was required to treat without informed consent or to commit a patient … and from the patient side as a concerned bystander of an ill freind. From both sides I have experienced that the standard is quite high. Which again does not mean that abuses do not occur. Standards and laws get broken. I haven’t seen it myself but I know that it occurs.
Please share your evidence and credentials with us!
We are talking about psychotherapy TVAA. Not “therapies that are far more invasive than psychotherapy”. I am still waiting to see some evidence that anyone can be forced to change through psychotherapy, against their will.
My post may be the most stupid and ignorant thing you have read on the SDMB, but your viewpont is understandable given your evident lack of understanding of how psychological therapy works.
** No, you’re talking about psychotherapy. Psychiatric treatments go way beyond a little therapy.
Traditional psychotherapy doesn’t even work. It’s been almost completely replaced by cognitive behavioral therapy and social interventions.
I don’t know what kind of qualifications you people claim to have, but psychiatry has come to rely heavily on pharmaceuticals, and if you’re not aware of that, then I seriously doubt your clinical experience. An increasing proportion of diagnoses are being made by general physicians with checklists.
** You’re kidding, right? I take it you haven’t read many of my previous posts on these boards.
** Citations for what? That children and adolescents are generally not given a say in the therapies they’re given? That there are still professionals who think that a serious psychiatric diagnosis means a person is incapable of reason or valid opinions? That these labels, no matter how well intentioned, can easily become attributed for all of a person’s actions?
The problem is NOT that professionals create labels to refer to commonly-seen relationships between behaviors, but that these labels are treated as if they were underlying conditions that are responsible for those behaviors.
** The standards don’t always need to be broken for abuses to occur.
AHunter3 had an excellent post a while ago about his experiences with the mental health system. Why don’t you go read it for an example of what can happen when the rules are obeyed?