Tag Archives: parenting

Postpartum Depression Not an Illness

BACKGROUND

The primary purpose of the bio-psychiatric-pharma faction is to expand turf and sell more drugs.  This is a multi-faceted endeavor, one component of which is disease mongering.  This consists of using marketing techniques to persuade large numbers of people that they have an illness which needs to be treated with drugs.

With regards to postpartum depression, it is an obvious fact that some mothers do indeed experience a measure of depression in the period after giving birth.  The term postpartum depression has in the past been generally understood to mean that the problem had something to do with hormones.  Today brain chemicals are blamed.

HISTORY

In the old days (pre-1950) postpartum depression was rare.  But perhaps back then things weren’t so difficult.  Most women were in stable relationships and did not work outside the home.  Extended families were usually close by, and for the most part, babies were born at home.

Today it’s very different.  Many women react negatively to the loss of autonomy they experience in a hospital setting.  And when they come home, they are often overwhelmed by the extra work, the sense of isolation, and by the lack of sleep.  In this context, it’s very easy to start doubting oneself, and young women in particular can become very susceptible to the psychiatric-pharma pitch.

Over the years, I’ve worked with a good number of postpartum women who were depressed.  In my view their major needs were: someone supportive to talk to (not necessarily a mental health worker), some practical help with childcare and chores, and sympathetic, non-judgmental encouragement.

DISEASE MONGERING

The disease mongering for postpartum depression is a truly well-organized psychiatry/pharma marketing machine.  Take a look at Postpartum Support International and Postpartum Progress.

UNIVERSAL SCREENING

For years psychiatry/pharma has been promoting the idea of universal screening for postpartum depression, i.e. that all postpartum women should be screened for depression.  They’ve made a great deal of progress in this area, and in the US we may be fairly close to universal screening already.

Screening, however, is a very insidious concept.  It sounds so benign.  “We just want to check to see if you’re sick.”  Who can argue with that?  But the reality is that the thresholds are set ridiculously low, and the “screen” is simply a “patient” recruiting tool.

The new mother is vulnerable and perhaps lacking in confidence, and is an easy sell.  Any resistance on her part is countered by the assurance that getting “treatment” is the best thing she can do “for the baby.”

The marketing pitch doesn’t stop with depression.  Postpartum Progress lists the other “illnesses” that the postpartum mother needs to be aware of (link here):

  • Antenatal Depression
  • Postpartum Anxiety
  • Postpartum OCD
  • Postpartum Panic Disorder
  • Postpartum Post-Traumatic Stress Disorder
  • Postpartum Psychosis

Nor does it stop with the mother.  Check out Postpartum Men!  And why not?  An untapped market is like money going down the drain.  Perhaps next we should have postpartum screening for the baby’s siblings, so we can get big brother and big sister on drugs too.  It makes sense.  The arrival of a new baby inevitably precipitates some negative feelings.  Left untreated, who knows where this could lead?  And what about the baby him/herself?  Enough.

CONTRARY VOICES

Fortunately there are some sane voices out there also.  Evelyn Pringle has written some great critiques of the postpartum marketing.  Dyan Neary (here) addresses the issue of pregnant women being prescribed psychotropic drugs.  Paula Caplan weighs in energetically here.  All good reading.

QUESTIONABLE RESEARCH

Last month (March 2013) an article by Katherine Wisner MD et al appeared in JAMA.  It was titled Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings.  You can see the abstract here.

In the study, 10,000 women who had recently given birth were screened for depression using a 10 item questionnaire.  Fourteen percent screened positive for depression, and of those, 98% were found on interview to have a DSM “diagnosis.”

The study is methodologically flawed.  James Coyne PhD has written an excellent critique titled Time to screen postpartum women for depression and suicidality to save lives?  (From the title you might get the impression that Dr. Coyne is advocating screening – but note the question mark.  It’s a critique.)

By the way, Dr. Wisner has ties to Eli Lilly.  Stephen Wisniewski PhD, one of the other authors of the JAMA article, consults for a number of pharmaceutical companies.

This is another example of spurious research being used as a marketing tool.

Postpartum depression is not an illness.  Nor is it a function of hormones or brain chemicals.  It stems from the fact that some new mothers feel isolated, vulnerable, unsure of themselves, and overwhelmed.  In some cases, they have had a difficult or unpleasant birthing experience.  These problems can only be addressed through human contact, reliable support, sympathetic encouragement, and practical help.

 

Internet Addiction: A Bad Habit, Not An Illness

The DSM-5 drafting committee considered including Internet addiction in the upcoming revision, but eventually backed off, at least for now.  Apparently they decided to put it in the category “requiring further study.”  So it’ll be in DSM-6.

Meanwhile, people are being given the “diagnosis” anyway – and of course, the “treatment.”

AN ILLUSTRATIVE CASE

I’m grateful to Tallaght Trialogue for sending me a link to a recent article in the UK’s MailOnline.  It was written by Rebecca Seales and Eleanor Harding.  You can see it here.

The article is about a four-year-old girl who “…is having psychiatric treatment after becoming Britain’s youngest known iPad addict.”

“Doctors say she is so addicted to games on her parents’ iPad that she experiences withdrawal symptoms when it is taken away.”

The treating psychiatrist is Dr. Richard Graham, who runs the Capio Nightingale Clinic in London.  The Capio, which describes itself as London’s leading private mental hospital, reportedly charges £16,000 ($24,320 US) a month for a digital detox program, which is designed to wean “patients” off their electronic devices.

In the Mail article, it is reported that Dr. Graham commended the 4-year-old girl’s parents for seeking help quickly, adding that “…by age 11, the problem might have become so severe that she would have required in-patient care.”

Apparently the problem is common, and a great many children throw temper tantrums if the devices are taken from them.

LET’S GET REAL

What’s involved here is parent-child conflict, which has probably been going on since we were hunting and gathering in the Rift Valley.  The only “treatment” needed is perhaps a boot camp for parents to help them regain some of the sense they were born with and have apparently lost.

There will always be a certain amount of conflict in parenting, and as a general rule, if the child wins in the short term, he loses in the long term.

One of the “side effects” of modern child psychiatry is the widespread disempowerment of parents.  The unspoken message is:  You can’t deal with this; it’s much too abstruse and technical; send your children to us; we understand; we have pills; you can trust us – we’re doctors.

Internet addiction is not an illness.  It’s a habit.  It can become severe and can be significantly counter-productive.  In the case of children, parents simply need to step up to the bat and curtail the activity, and take positive steps to involve the child in more wholesome and fulfilling activities.  If they can’t manage this, they need to get help – not from psychiatrists, but from their parents, grandparents, neighbors, friends, etc…, and perhaps helping professionals who are not aligned with bio-psychiatric pharma.  Help is there, but people won’t offer unless they’re asked.

Dr. Graham was correct about one thing, though.  The longer you leave it, the worse it gets.

If you’re not already doing so, please speak out against the madness.

In DSM-5, A-D-H-D Still Spells Misbehavior

It is a central theme of this website that there are no mental illnesses/disorders, and that the psychiatric medicalization of ordinary human problems is arbitrary, spurious, and destructive.

The widespread acceptance of ADHD as a mental illness/chemical imbalance has no scientific underpinning, but rather is based on marketing and promotion.  The ADHD “diagnosis” is particularly destructive, in that it targets children, and serves as the justification for “treating” these children with dangerous drugs.

“DIAGNOSTIC” CRITERIA

The APA’s criteria for this so-called illness are set out below:

Inattention
a)  often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
b)  often has difficulty sustaining attention in tasks or play activities
c)  often does not seem to listen when spoken to directly
d)  often does not follow through on instructions, and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
e)  often has difficulty organizing tasks and activities
f)  often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
g)  often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
h)  is often easily distracted by extraneous stimuli
i)  is often forgetful in daily activities

Hyperactivity/Impulsivity
a)  often fidgets with hands or feet, or squirms in seat
b)  often leaves seat in classroom or in other situations in which remaining seated is expected
c)  often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults may be limited to subjective feelings of restlessness)
d)  often has difficulty playing or engaging in leisure activities quietly
e)  is often “on the go” or often acts as if “driven by a motor”
f)  often talks excessively
g)  often blurts out answers before questions have been completed
h)  often has difficulty awaiting turn
i)  often interrupts or intrudes on others (e.g., butts into conversations or games)

A positive “diagnosis” requires six hits from either the inattention list or the hyperactivity/impulsivity list.  What’s very clear, however, from even a cursory reading, is that all the items are matters of discipline/misbehavior.

MISBEHAVIOR AND DISCIPLINE

Fifty years ago every one of these items would have been seen as a disciplinary problem.  The schools would have been taking appropriate action, and in extreme cases, talking to parents, etc…

Indeed, fifty years ago parents would not have been sending children to school with these kinds of misbehaviors.  The only reason that these misbehaviors are considered to constitute an “illness” is because the APA says so. There is no actual evidence of any kind to support this claim.  The APA simply decided that these children are sick and need drugs.  There are no objective tests for ADHD, and no established organic pathology.  The “diagnosis” is based entirely on subjective reports from parents and teachers.

The psychiatry-pharmaceutical alliance is nothing if not entrepreneurial.  The APA created the “illness,” and pharma created the drugs.  The drugs used to “treat” this misbehavior are stimulants, pharmacologically similar to nicotine and cocaine, and have many dangerous side effects.

In my 2009 post on ADHD I cited a nationwide prevalence rate of 7.5% for school-age children, and drew attention to the fact that this had almost doubled since 2000.  A recent NY Times article is quoting a prevalence of 11%!  Psychiatry continues to claim that this kind of diagnostic expansion is the result of more cases being recognized!  In reality, the criteria are so vague and so ubiquitous that they can be stretched to embrace almost any child.  Pharma marketing is encouraging parents to bring their children in for evaluation, and the ever-cooperative psychiatrists are making the “diagnoses” and pushing the drugs.  It’s a well-oiled machine, and it’s working perfectly – for the psychiatrists and the pharmaceutical companies.

DSM-5

And now – DSM-5 is extending the net even further.  In DSM-IV, there was a requirement that the symptoms were present before age 7 and caused significant impairment in activities.  DSM-5 will raise this threshold to 12, and require only that the “symptoms” impact daily activities.  DSM-5 will also make it easier for adults to receive this “diagnosis” by reducing the adult threshold from 6 to 5 items.  And remember, the more people who receive a “diagnosis,” the more drugs get sold.  And also remember, 69% of the DSM-5 task force have ties to the pharmaceutical industry.  But we can be sure that this didn’t affect their decision-making in any way, and that their only motivation is to help alleviate human suffering.

PARENTAL TRAINING

Meanwhile, an interesting study has just been published in Pediatrics.  Interventions for Preschool Children at High Risk for ADHD:  A Comparative Effectiveness Review, by Alice Charach, MD, et al.  The research examined 55 earlier efficacy studies and concluded that parent behavior training (PBT) showed “…greater evidence of effectiveness than methylphenidate…” (Methylphenidate is one of the stimulant drugs used to “treat” the behaviors labeled ADHD.  It is marketed under the brand name Ritalin.)  In other words, grandma was right:  children need discipline and correction, a simple fact that every generation has understood and taken on board until the pharma marketing juggernaut and its psychiatric accomplices decided to sacrifice children on the altar of corporate profits.

Or, in fairness, there could be another explanation.  Perhaps ADHD is an illness that responds to improved parental discipline?  I wonder if that might work for pneumonia!

 

Psychiatric “Diagnoses” for Children

Today, courtesy of Monica, I came across an article by Marilyn Wedge, PhD.  It’s called Six Problems with Psychiatric Diagnosis for Children.   You can read it here.

Here are some quotes:

“Psychiatric diagnoses contained in the Diagnostic and Statistical Manual of Mental Disorders are not classified by causes like genuine medical diseases.”

“Perhaps worst of all, a child who has been labeled with a psychiatric diagnosis grows up believing that there is something wrong with her, that she is somehow “abnormal.”

“Psychiatric labeling and medicating have tragically become the mainstream way of dealing with difficult, mischievous and overly imaginative children in our pill-popping culture.”

The article is succinct, accurate, and to-the-point.  Please read it and pass or tweet it on.

 

Mental Health and the Schools

When I was about eleven or twelve, I had reasonably good social skills with my peers, but I was shy and awkward with adults. Our neighbor, Mrs. F., was a very pleasant lady who loved to spend time in her front yard with her flowers.  Often, as I came up the walk to our door, I would pass her.  She always gave me a nice greeting, to which I would respond by gazing at my toes and grunting.

One day my mother, who had witnessed these interactions many times, took me aside and suggested that I straighten my neck, look Mrs. F. in the eye, and give her a greeting bold.

“Like what?” I asked.

“Like: “Good morning, Mrs. F..  Beautiful day.”

“I couldn’t do that,” I replied

“Sure you could,” she said.

So we went around with this for a while, she coaxing and nudging, I resisting.  Finally she said: “Look, you have to be able to do this sort of thing when you grow up.  If you don’t practice now, you’ll never be able to.”

Well that convinced me.  Next time I encountered Mrs. F. in her yard, I looked her in the eye, and in my best imitation of a manly voice, I said: “Good morning, Mrs. F.  How are you today?”

If Mrs. F. was surprised, she gave no indication.  I made two discoveries.  Firstly, acquiring social skills is not rocket science; and secondly, the best way to learn is to do.

Another incident I recall from about the same time was an occasion when my mother and I had been shopping and were walking home.  We met a classmate of mine, and we chatted briefly, but I didn’t introduce him to my mother.  Finally my mother introduced herself, but afterwards she told me that I should have made the introductions, and coached me in how to do it in future.

Another incident.  When I was about ten or so, plastic footballs became available.  I saved up my pennies and went into town and bought one.  When I got home, I organized a game on a small grassy area in front of the houses on our street.

My father was passing, and afterwards he asked me if I thought I would have gotten quite so many free kicks if I hadn’t owned the ball.

“But they were fouling me!” I protested.

“But would you have gotten so many free kicks?”

“No,” I conceded grudgingly.

Nothing more was said, but the lesson – be a good sport – remained with me.

The point I’m making is that babies are born with no social skills whatsoever, and whatever advances we have made in this area by the time we reach adulthood are due, in considerable part, to the thousands of parental interventions like the ones described above.

I would guess that parents have been doing this since the beginning of history, and will likely continue to do it in the future.  I doubt that parents today are any less concerned about their children than parents of the past, nor are they any less motivated.  But there has been an enormous societal change, the impact of which on this area needs to be acknowledged.  And that is that 60 years ago most mothers were stay-at-home moms; today most mothers go out to work.

Now I’m not saying that mothers shouldn’t go out to work!  That’s an individual decision.

What I am saying is this.  Children have to acquire certain social skills if they are to succeed in the adult world.  In the old days the primary teachers of these skills were the stay-at-home moms, if for no other reason than they were the ones who spent most time with the children.  Today most mothers are available for eight or nine hours a day less than their counterparts of 60 years ago.

In addition to which a great many mothers today, after they get home from work, have to spend another 6, 7, or 8 hours on household chores!

There just isn’t as much time for social skills training as there used to be.  Fathers, of course, could pick up the slack, and undoubtedly some do.  But the fact is that the training in question is not receiving the kind of attention that it used to.

So we have a number of young people in every high school who don’t interact well with other people.  Because of their poor skills, the ordinary social interactions that most people take for granted just don’t work well for them.  Essentially, they don’t find the company of their peers or adults to be pleasant or rewarding.  Instead, when in company, they experience discomfort and distress.

What they need is training:  training in what to say after hello; in how to shake hands; in making eye contact; in listening; in speaking clearly; in paying compliments; in accepting compliments; in being sensitive; in not being walked over; in coping with disappointment; in not being a wimp; in resisting peer pressure; in walking confidently; in good posture; in setting boundaries; in respecting other people’s boundaries; etc., etc..

In the wake of recent mass murders, there is a growing cry for mandatory mental health screening and services in our schools.  What this will mean is more “diagnoses,” more pills, and more confinements in mental hospital. But the individuals will receive nothing in the way of real help.  The critical question is this:  will the schools step up to the plate and start providing this kind of social skills training?  It’s desperately needed, and it’s not rocket science.  Bumping the ball to mental health gets the school off the hook.  But these children are not sick.  They don’t need pills – they need someone to recognize their plight and help them find their way.  It is as necessary as the three R’s, and it is a reasonable extension of the school counselor’s role.

 

Play Therapy

I came across an interesting article Psychiatric Medication or Play Therapy? by Bob Fiddaman, a New Zealand writer.

The article compares the efficacy and dangers of play therapy vs. pharmaceutical products for children with various problems.

Here are some quotes:

 “…play therapy outcome studies support the efficacy of this intervention with children suffering from various emotional and behavioral difficulties.”

 “Pharmaceutical companies spend billions on marketing psychiatric medication.”

 “Front groups that purport to fly the mental health flag are, in fact, nothing more than agents, pimps for the pharmaceutical industry.”

 “Psychiatrists…are…often paid huge sums of money to promote the use of antidepressants in children and adolescents.”

 “If you, as a parent, do your own research on the drug your child has been prescribed and you bring your concerns to the prescribing doctor’s table you will, more often than not, be dismissed as either not knowing what you are talking about or be accused of reading too many Internet conspiracies.”

 “Psychiatric medication as first-line treatment is absurd when the option of play therapy exists.”

The point of the article is that play therapy is an effective way of helping children communicate and become more contented and successful.  And it entails no nasty side-effects.  So why are the drugs the front line “treatment” of choice?

Definitely worth a read.

 

Mandatory Mental Health Screenings for Schoolchildren

A regular commenter to this website has drawn my attention to a bill that has been proposed in the Connecticut state legislature.  The bill would require public school and homeschooled children to be assessed by mental health practitioners at grades 6, 8, 10, and 12.

The bill, sponsored by Senator Toni Harp and Representative Toni Walker, is in response to the recent Sandy Hook murders.

And so it starts.  Given the built-in vagueness of the DSM, and the inclusiveness bias of the mental health business, the outcome of these screenings (should the bill become law) is predictable: more and more parents disempowered with regards to their parenting responsibilities; more drugged children, and, tragically, more mass murders.

In my last post I expressed the belief that powerful forces in America are pushing for “mental heath reform” to distract us from the real issues, to promote the pharmaceutical industry, and to initiate a massive mental hospital building program.

Bills like the one now before the Connecticut legislature are the first step, and it is my prediction that you will see a great many more of these before this nonsense is over.

The great tragedy, of course, is that mental health screenings sound so benign – like we’re finally doing something good for these poor suffering children.  But follow the money.  Neither the psychiatrists nor Big Pharma are much into genuine altruism.  Their objective is to have virtually everybody on some kind of drug.  Perhaps there should be a diagnosis for people who are not enrolled in the mental health system: hyper-independence disorder!

I’m not saying that there aren’t difficult, out-of-control children.  And I’m not saying that there aren’t parents with deficient parenting skills.  But these are not illnesses, and these problems will not be solved by drugs.

Parenting and Psychiatry

About a week ago an article appeared on the ‘net concerning an attempt by parents to ban ice cream vendors from a playground in Brooklyn, New York.  The piece was reprinted in the New York Post.  Apparently some of the parents are upset because the arrival of the vendors stimulates requests for ice cream from the children, which results in confrontation and bitterness.

Responsible parents everywhere will recognize the dilemma.  Ice cream has little or no nutritional value, but children like it.  So do we stand our ground or do we give in?

When I was young an ice cream van (Mr. Whippy) would come round our street every afternoon.  We would run in and ask our mother if we could have money for ice cream.  She would say no. (“I’ll give you ice cream!”) And we would go back to playing tag or handball, or whatever we were doing.

Back then (the old days) it was generally understood that small children are, by nature, willful, self-centered, and bad-tempered, and that eradicating these traits and instilling something more sociable was an intrinsic part of parenting.  It was also understood that this socializing process required the routine delivery of unpleasant consequences when children misbehaved.  Now in the old days, this usually meant beating the tar out of them, and I’m not advocating a return to that sort of thing.  But you can’t raise children properly without confrontation and negative consequences.

So how did we get to this stage, where parents are trying to ban ice cream vendors rather than take charge of their children?  And what has this got to do with psychiatry?

For the past fifty or sixty years, the APA has been engaged in turf expansion.  Their position is that every human problem is a mental illness, and they have been remarkably successful in promoting this notion to other medical practitioners and to the general public.

According to the APA, there is no such thing as a misbehaved child.  If a child is defiant, he has oppositional defiance disorder; if he’s an out and out delinquent, he has conduct disorder; if he won’t pay attention to the teacher, and runs around the classroom, he has attention deficit hyperactivity disorder; and so on.  These are all mental illnesses.  So according to the APA, these children don’t need discipline and correction, they need “treatment” – which invariably means pharmaceutical products.  Parents can’t take care of these problems – they need to take these children to experts.

The result of all this is that children are consuming more pills each year, and parents are being disempowered.  They can’t even say no to their children’s requests for ice cream!  And, of course, we’re building more and more prisons.

And all for the sake of psychiatric turf and pharmaceutical dollars!

Sexual Disorders are Not Illnesses (Part 2)

In my last post I described frotteurism, which the APA lists as one of their mental disorders/illnesses. The central theme of this blog is that there are no mental illnesses – that mental illnesses are essentially psychiatrists’ ways of conceptualizing ordinary human problems for the purposes of consolidating turf and legitimizing the use of drugs to alter people’s behavior and mood.

This is not to say that the behaviors in question are not problems. They certainly are. Frotteurism is a case in point. A man who uses the crowd cover of trains and buses to press his genitals against non-consenting females clearly has a problem. The question is: how can we explain this behavior? Why does he do it?

Socialization is the process by which we acquire the skills necessary to function in society. The newborn has no sense of the needs/rights of others. He is a bundle of pure and utter selfishness. During childhood his parents and other significant adult figures instill in him an appropriate measure of regard for other people’s rights and needs. They also help him acquire an appropriate level of personal control. During his formative years he acquires the ability to control his immediate needs, to respect the rights of others, and to pursue the attainment of long-term goals. This is a complex process, but it is generally achieved through the long-established practices of consistently applying appropriate rewards and punishments and through the process of good example (role modeling).

Now it’s a fairly obvious fact of life that this socialization process isn’t always entirely successful. We have all encountered adults who are “spoilt brats” or who routinely afford more priority to short-term than to long-term goals, or who blatantly disregard the rights of others.

The reasons for these failures in socialization are as varied as the population. Sometimes the parents simply didn’t know what they should have been doing. Other times they were drinking and drugging and just didn’t care. Other times there was conflict and tension between the parents, and the child “slipped through the cracks.” Other times the parents themselves weren’t adequately socialized and so the role modeling was inadequate. And so on.

In order to understand why an individual is deficient in these areas, one needs to examine the individual case closely. So in the case of frotteurism, we have an individual who routinely disregards the rights of females (i.e. the right to be free from molestation) and who probably lacks the social skills necessary for normal heterosexual interactions.

The explanation of his behavior is:

1. Like almost all men he has an internal drive to make genital contact with women.

2. He has not acquired the skill/habit of controlling and channeling this drive in socially appropriate ways.

Note that this is not a complete explanation of the behavior in question. If we wish to understand why an individual behaves in a certain way, we must devote a good deal of time and energy to studying and examining the individual case. There are no shortcuts in behavioral analysis.

This is in marked contrast to the APA’s implied position, i.e., that he engages in this behavior because he has a mental illness called frotteurism. The facile nature of this explanation is seldom articulated, but this kind of simplistic thinking underlies the response of the mental health system (and frequently of the judicial authorities) to these individuals.

Next Post: More on sexual disorders.

Conduct Disorder and Oppositional Defiant Disorder

CONDUCT DISORDER

The essential feature of Conduct Disorder, according to the APA, is a “repetitive and persistent pattern” of rule breaking or activity which violates other people’s basic rights. The manual identifies four broad categories of behavior under this heading: aggression; destruction of property; theft or deceitfulness; and serious violation of rules.

DSM goes on to state that individuals with this disorder display little concern for the feelings or welfare of others, are frequently callous and indifferent to other people’s pain and loss, and show little in the way of feelings of guilt or remorse. Poor frustration tolerance, irritability, temper tantrums, and recklessness are cited as frequently associated features.

Diagnostic Criteria for Conduct Disorder
The notion that the kinds of serious misbehaviors described above are caused by a mental disorder represents an enormous departure from common sense and conventional wisdom. For this reason, the complete list of DSM criteria are set out below, to enable the reader to clearly assess the APA’s position on this matter. The manual lists the following fifteen items, three of which must have been present in the previous twelve months:

Aggression to people and animals:
(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
(7) has forced someone into sexual activity

Destruction of property
(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else’s house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules
(13) often stays out at night despite parental prohibitions, beginning before age 13 years
(14) has run away from home at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
(15) is often truant from school, beginning before age 13 years
(DSM-IV, 90)

It is clear from these criteria that what is being described here is plain old-fashioned criminality. A serial rapist, for instance, who threatens his victims with a weapon meets criteria 1, 3, and 7, and is therefore suffering from a mental illness. A person who smashes car windows to steal from the glove compartment, who steals from stores, and who bullies and intimidates his family meets criteria 1, 11, and 12, and is also suffering from a mental illness. Just about any kind of criminality you care to imagine is covered by these criteria. In other words, a “diagnosis” of Conduct Disorder means habitual criminality. The APA is not saying that some habitual criminals have a mental illness. Rather, they are saying that habitual criminality in and of itself constitutes a mental illness.

Prevalence
APA’s estimates of prevalence rates are high: 6 to 16% for males, and 2 to 9% for females. DSM goes on to state that Conduct Disorder is “one of the most frequently diagnosed conditions in outpatient and inpatient mental health facilities for children.” The so-called disorder is not confined to children, however, and the manual makes it clear that the diagnosis can be assigned to adults if they meet the criteria.

Former Times

As with most mental health diagnoses, the critical issue is not whether the misbehaviors in question represent serious problems. Clearly they do. Rather, the issue is whether or not they should be conceptualized as mental disorders. Former generations would have used more conventional terms, such as delinquency, villainy, vandalism, crime, brutality, etc., to describe these kinds of activities, and as with ADHD, would for the most part have identified lax or inconsistent parental discipline as the proximate cause. By calling these misbehaviors a mental disorder, the APA is promoting an entirely different way of conceptualizing these problems, and in particular is promoting the notion that these kinds of problems need to be treated by psychiatrists and other mental health workers. The assignment of the diagnosis also implies that the problem is something inherent to the child, and downplays the role of the parents, or indeed of other factors.

The high prevalence rates cited earlier make it clear that the individuals diagnosed with Conduct Disorder represent a sizable proportion of the government statistics mentioned in an earlier post. It is tempting to wonder if politicians and other interested parties who endorse these statistics realize that many of the “afflicted” individuals whose cause they champion are included purely on the basis of a persistent pattern of serious misbehavior and delinquency.

One noteworthy feature of Conduct Disorder is that it has not garnered as much public acceptance as ADHD, even though conceptually there are multiple parallels. The likely reason for this is a recognition on the part of the APA that ascribing such serious misbehavior to a mental disorder would not be palatable to the general public, and that a more lengthy “softening-up” period may be necessary before such a concept would be widely accepted.


OPPOSITIONAL DEFIANT DISORDER

DSM-IV-TR defines Oppositional Defiant Disorder as a “recurrent pattern of negativistic, defiant, disobedient and hostile behavior towards authority figures…” (100), characterized by temper tantrums, arguing with parents and other adults, defiance, refusal to comply with requests and directives, deliberately annoying other people, blaming others for his/her own errors, and being spiteful and vindictive.

The manual lists eight specific criteria, four of which must be present for the diagnosis to be assigned. The eight criteria items are listed below:
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults’ requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful and vindictive.

There is little to be said about this so-called mental disorder that has not already been addressed with regards to ADHD and Conduct Disorder. The fundamental question is why this kind of misbehavior, which former generations would have characterized as “being a spoiled brat” should now be considered a mental disorder.

And as with the other so-called mental disorders, the answer is because the APA say so. This is in marked contrast with general medicine, where the identification of a disease usually represents an enormous breakthrough in terms of understanding and treatment. The idea of conventional medical researchers sitting in committees and inventing illnesses by voting and consensus would be considered laughable. Yet that is exactly what the APA has been doing for the past half century with successive revisions of the DSM.

As with other so-called disorders discussed earlier, the diagnosis clearly implies that the problem is something inherent in the child. This effectively lets the parents off the hook, reduces expectations, and in practice encourages a kind of self-centered egotism on the part of the child which usually persists into adulthood. The “disorder” also serves as a portal diagnosis, and typically other mental disorders (e.g., depression, ADHD) are “uncovered” as the child receives “treatment”.

In this context it is worth noting a major weakness of the entire DSM system i.e. the “all or nothing” nature of the so-called diagnoses. In conventional medicine, the all or nothing framework is generally valid. You’ve either got meningitis or you haven’t. There are, of course, degrees to which the infection may have developed, but even a mild case of meningitis is a serious condition, and a dichotomous approach is warranted – not only for treatment/administrative reasons, but also because it accurately reflects the objective reality.

The behaviors outlined above, however, as diagnostic of Oppositional Defiant Disorder are emphatically not dichotomous. Each item very clearly admits of degrees. Consider the first item on the list: “often loses temper”. This could mean anything from a few irate foot-stampings, to wholesale mayhem. Additionally, the word “often” is subject to quantification. Does often mean daily? weekly? monthly? Similar considerations apply to the other items on the list, and to the APA’s requirement of four or more items to make a diagnosis. Why not three, or five?

The fact is that childhood defiance is not a simple unified construct, and is emphatically not dichotomous. It contains multiple components, each of which admits of degrees and could be quantified. In their drive to “medicalize” all human problems, the APA shoehorned this phenomenon into a simplistic yes or no format to facilitate the process of “diagnosis.” The result is not a genuine understanding of the child’s/family’s problem, but a travesty that serves only the interests of the psychiatrists and the pharmaceutical companies. The same criticism can be leveled at almost all the so-called diagnoses in DSM.

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