Posts Tagged posttraumatic stress disorder
DSM and Disability
Posted by Phil in A Behavioral Approach to Mental Disorders on December 12, 2010
Every society in every generation makes errors. Some of the errors are minor. Some are major. One of the great errors of the 20th century was this: we accepted the spurious notion that a wide range of life’s problems were in fact illnesses. This spurious notion was initiated with good intentions – to provide shelter and humanitarian care for a relatively small number of individuals whose plight was truly dreadful. But then the concept of mental illness took off, fuelled largely by the efforts of psychiatrists to legitimize their status as “real” doctors.
And then came the drug companies, who formed an alliance with the psychiatrists. These mutually enchanted partners have been dancing heel-to-toe ever since, accumulating wealth and power to the great detriment of individuals and society.
Once it was firmly established that a wide range of ordinary problems of living were “really” diseases, it was a relatively easy step to conclude that individuals manifesting these problems might qualify for disability benefits under programs established by various governments. In the United States the government entity involved is the Social Security Administration, and at the present time the following “diagnostic” categories are grounds for a disability determination.
Organic mental disorders
Schizophrenic, paranoid, and other psychotic disorders
Affective disorders
Mental retardation and autism
Anxiety related disorders
Somatoform disorders
Personality disorders
Substance addiction disorders
Now it needs to be acknowledged that some of the problems embraced in the above list are genuine medical problems and are definitely disabling. These include: serious brain damage and mental retardation. But the vast majority of the so-called diagnoses listed are not genuine illnesses in any meaningful sense of the word. They are problems of living. They are problems of living that have been artificially medicalized for the benefit of psychiatrists and their allies the pharmaceutical companies. These spurious “diagnoses” include: schizophrenia, depression, bipolar disorder, anxiety disorders (including post-traumatic stress disorder), substance addiction, etc.. All of these problems are remediable, but under the bio-psychiatric system of pseudo-care, the individuals concerned receive little or nothing in the way of genuine help – in fact, they receive little more than a steady supply of mood-altering drugs.
Paying disability benefits to these individuals is an insult to the genuinely disabled people who have real medical problems which restrict so severely their ability to function.
In addition, the payment of disability benefits to the so-called mentally ill is a great disincentive for these individuals to try to resolve their problems and learn functional ways of living.
All of the “symptoms” of the so-called mental illnesses can be fabricated. A diagnosis of schizophrenia, for instance, is based entirely on what the individual says and does during an examination interview. There is no lab or clinical test for schizophrenia. Occasionally an examiner may question family members, but the “diagnosis” decision rests on the individual’s self-report. That’s how the system works. If you don’t mind the stigma of being considered “crazy,” you too can acquire a diagnosis, and with a little help from the mental health services, you can be awarded disability status and a modest monthly income.
And it doesn’t end there. If you go to college, you may qualify for a variety of academic accommodations. Michael Rose, PhD, writing in the July/August 2010 issue of the National Psychologist says:
“With the proper documentation, students may qualify for a wide range of learning aids, such as extra time to take tests, use of a private room for tests, word banks, use of a word processor with spell check and help from a proofreader. A specific documented disability, typically made within the past three years, has been the basis for approved accommodations at most institutions of higher learning.
Besides qualifying for extra help that will likely improve grades, students may qualify for a range of vocational rehabilitation services (paid tuition, books, dormitory costs, computers) that are not dependent on family or individual income.” (pg 18)
I cannot think of a better way of trapping people in a dysfunctional state than providing them with multiple rewards and benefits contingent on their continued dysfunctionality. As I have noted elsewhere: Is this a great country or what?
Back in the 1990’s there was a great push to get people off the welfare rolls. It is an open secret that Social Services departments in many areas were encouraging their welfare clients to enroll at the mental health center and establish a “diagnosis” so that they could then apply for a disability determination from Social Security.
I could never prove this, but I know of a number of parents who were actively coaching their children in attention-deficit and other kinds of dysfunctional behavior so that the child would qualify for a Social Security income. It’s a simple fact in America today that if you teach your child to misbehave seriously from an early age, and take him regularly to the mental health center for “help,” you stand an excellent chance of having him qualify for a Social Security income. I have known families with more than one child receiving Social Security “disability” payments for no other reason than chronic misbehavior and lack of discipline.
I discussed the spurious nature of Attention Deficit Hyperactivity disorder in an earlier post, but I’m repeating the diagnosis “symptoms” below for convenience.
The APA’s eighteen criteria for this fictitious illness are:
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)
I have only one question for my readers. How hard would it be to train a child to function in this way?
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Posttraumatic Stress Disorder
Posted by Phil in A Behavioral Approach to Mental Disorders on June 23, 2009
One of the anxiety disorders listed in DSM is posttraumatic stress disorder. The criteria for this condition are listed below:
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person’s response involved intense fear, helplessness, or horror. Note: in children, this may be expressed instead by disorganized or agitated behavior
B. The traumatic event is persistently reexperiencd in one (or more) of the following:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) , as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g. unable to have loving feelings)
(7) sense of a foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Posttraumatic stress disorder consists essentially of painful memories. Even the most organized and insulated lives are touched by tragedy and misfortune. Painful memories are an integral part of the human condition. Occasionally individuals are involved in incidents that are truly horrific, and the memories associated with these events are commensurately painful. The paradigm example of this is warfare, but traffic accidents, criminal attacks, and natural disasters are all potential sources of painful memories. The APA’s use of the term “…a threat to the physical integrity of self or others” (in A: above) is sufficiently vague to embrace almost any kind of traumatic event.
Everyone is familiar with painful memories and everyone is also familiar with the fact that these memories can and do intrude in our present lives. People who have lived through severe flooding, for instance, tend to react negatively to even light rainfall for years afterwards. People returned from combat sometimes react strongly to loud noises. What has happened in these cases is that the bad memory has in itself become a source of fear or anxiety, even though it poses no actual threat. The fear response, which initially was triggered by the traumatic incident, is now triggered by the memory of the incident. In other words, the person is literally afraid of his own thoughts.
Painful memories are not trivial. They can be extremely difficult to deal with and can interfere with present functioning. But they are not illnesses. Memory is an adaptive device – it helps us to survive and to cope with our surroundings. But memory doesn’t screen out unpleasant material. In fact, memories of particularly unpleasant incidents tend to stay with us longer, because of the emotional significance we attach to them at the time.
It is an obvious fact that our experiencing of the world around us modifies structures within the brain. If we hear a catchy tune a few times on the radio, we find that we can sing the melody without difficulty. Clearly there is some “trace” of the tune inside the brain that wasn’t there before. Similarly it has been shown in several animal studies that repeated exposure to stressful situations can produce long-lasting structural and functional changes in the brain. These studies are often cited as proof that PTSD really exists and that it is a brain disease. The reasoning, however, is muddled. Even if we concede that repeated exposure to stressful events can damage the brain and cause the individual to behave in erratic and destructive ways, this does not prove that all of the people who behave in erratic and destructive ways have damaged brains. The critical point is this: If indeed there is a neurological condition which is brought on by repeated exposure to stress and which in turn causes the individual to behave in an erratic and destructive manner, then this condition needs to be identified as a neurological illness, given an appropriate neurological name (e.g. hypersensitive dopamine receptors), and should be treated by neurologists. Some of the people currently diagnosed with PTSD would likely meet the criteria for the neurological illness, but just as likely, many would not. In particular, the diagnosis of this neurological illness would not rest on criteria that are purely behavioral.
Posttraumatic stress disorder as it is defined in the DSM is not an illness. There is nothing going wrong in the individual’s body; no diseased organs; no dysfunctional processes; no confirmed neural pathology – nothing that a normal intelligent person would consider necessary for a condition to be called an illness.
A particularly interesting feature of this matter is that people have been dealing with painful memories (and helping others deal with them) since the beginning of time. The “secret” to desensitizing this kind of material is to talk about it. In our culture women are better in this regard than men. If a woman is involved in a traumatic incident, she usually recounts the matter many times – to her mother, her sister, her husband, her best friend, her hairdresser, etc. With each telling, the memory loses some of its potential to hurt. A man, on the other hand, in the same situation, will often feel that talking about the incident constitutes childish whining, and he keeps it to himself – shuts the memory away – where it remains strong and potent.
An individual who goes to a mental health center for help with painful memories is routinely assigned a diagnosis of posttraumatic stress disorder. He will be prescribed an anti-anxiety drug to keep him becalmed and he will talk to a counselor. He will tell the counselor about the traumatic incident and might be assigned to a PTSD “survivors’ group”. At subsequent group meetings he will be encouraged to tell how he is doing in his day-to-day matters, and he will listen to each newcomer recount his/her precipitating trauma.
The talking and the listening, of course, are helpful, though the benefits are mitigated somewhat by the fact that he is under the influence of the prescription drug. But what’s really needed – repetitive recounting of the incident – doesn’t occur.
In addition, PTSD is a major gateway diagnosis, and diagnoses of depression and bipolar disorder are often tacked on for good measure – or to extract more money from insurance companies.
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