Wednesday, February 10, 2010


Today the APA releases a new draft for its latest revision of the Diagnostic and Statistical Manual, or DSM, due out in 2013.  This is a big book of all recognized psychiatric/psychological disorders, their symptoms, and how to treat them.  It's a tome that is pretty fun to just browse through on occasion, to confirm that you're still crazy.  The recommendations include two revisions that are getting a bit of attention in the media, or at least on NPR.  There will no longer be a diagnosis of Asperger's syndrome just a broader spectrum for autism, and childhood bipolar cases are being relabeled as temper dysregulation disorder.  I find both of these moves interesting, and the piece on NPR was especially enlightening. 

As for the temper dysregulation disorder label, personally I feel it's in the vein of just labeling a variation of normal behavior so as to excuse the behavior.  There's a quote by A Gabrielle Carlson in the NPR piece about how the diagnosis of childhood bipolar began with children that had been diagnosed with conduct disorder.  Conduct disorder basically included extremely unruly kids.  What was so great about diagnosing children with bipolar instead?  "We don't have good treatments for [conduct disorder]. We've got parent-training kinds of treatment, very strict behavioral modification kinds of things, but the evidence that therapy makes a big difference is not wonderful."  (my emphasis added)  I know enough people with severe allergies, and wonder how much of this behavior in kids is attributable to undiagnosed allergies or simply not being taught how to control their behaviors. 

The Asperger section in the NPR story was shorter, but also interesting.  Michael Carley, executive director of the Global and Regional Asperger Syndrome Partnership, pointed out that while Asperger's syndrome might be seen as a positive since it is associated with the likes of Einstein and Edison, autism is more often characterized by "somebody who might have to wear adult diapers and maybe a head-restraining device."  This perception of others who now have the same diagnosis as himself is apparently causing some difficulty for Carley.

Running through both of these stories, in my mind, is the question of normalcy.  What is normal, how do we define normal, how do we treat those outside of normal, how does our perception of ourselves as normal or not change our behavior, is normal necessarily better than not normal- these are all big questions that I've fought with on and off for years.  There's a certain pride I take in not being "normal" as defined by our society, and I'm trying to teach that to Ken while instilling in him the importance of some social norms, like not intentionally farting on people in public.  It's a delicate balance.  How far can a person be on one side or another of the spectrum that is "normal" and still be functional?  Can we, as a society, focus more on the functionality of people and their lives, and less on fitting individuals into a the mold of a "normal" human being?  I know it takes more work, but can we embrace a larger view of normal and provide assistance to those outside of normal to make sure they can function, while allowing to be what is comfortable to themselves?


  1. Interesting thoughts. I've often wondered about the effects of labels of behavioral differences. I'm sure they had kids with Asperger's (or that form of autism) when our grandparents were young but they were probably just seen as a different kind of normal since there was no name for it...
    On the other hand a label facilitates drawing parallels between people with similar symptoms, thus making it easier to help not just one but many if you find a cure/treatment.

    Either way, I enjoy the full spectrum of "normal" and wish we could all embrace and accept differences as well as similarities.

  2. the whole social perspective of mental illness has always fascinated me. in countries where there is no recognition of schizophrenia people who fit the diagnostic criteria are functioning members of society. it is not that they do not have the same symptoms as those in other countries, it is that they are expected to function in society and as a result find a place for themselves. institutionalization is easy and therefore the preferred method in countries where it is economically feasible, but it is also the least effective treatment.