martes, 8 de enero de 2013

Adam Lanza a paranoid gunman, the tip of the iceberg.


The overpowering global triumph of DSM psychiatry, perhaps the main church of that religion called scientifism, is not based on its success in treating major mental illnesses, rather it is based on diagnosing more and more “disorders” and signing more and more prescriptions,  providing corporate and political complicities, legal addictions, excuses for uninterested or  poorly trained teachers and alibis, relief or hopes for uncommitted  or worn out parents in communities, with weakening bonds and values, which before provided them.

Practically anybody can use the DSM although only its highest priests can define or measure dogmas. Only they can classify, that the most metaphysical task of the discipline, and recycle ordinary adjectives into new diseases.

Critics underestimate grossly the power behind this global development. To start with, at a practical level, why take a critical position however balanced, and risk promotion, earn less money, lose friends or associates, have your stroppy kid excluded from school or your demanding mother from the day centre? 

Ongoing evaluations but with the clinician alert to the need of active intervention, and work outside the office are not efficient. Gone seem the times of hierarchical diagnosis when if a new disturbance appeared, it could be interpreted in terms of the evolution of the main one and the changing circumstances of the patient. Depression or anguish cannot any longer be considered as possible reflections of the gaining of insight by a patient and hence rather tricky propositions. They are just co-morbid disorders like any other.

Information about the possession of assault weapons might not be part of assessments. Excluding clauses are ignored. If you give various diagnostics surely one of them will be right and treatable. Given the contradictory properties of some of the “meds” prescribed, one is left wondering if some patients have more than one head.

World Health Organization studies that found that the long term outcomes of schizophrenia are better in the developing World, seem to be ignored by planners, researchers or trainers. There is no encouragement to observe and describe or to look at contexts and interpret; if one uses the right kit and tics the right box one gets the wanted answer. Egos and records are involved in this too. Some doctor in Florida, I read, prescribed over a million dollars of one neuroleptic alone over just a year. Added value is in numbers.

If tools such as PANSS or BPRS fail to demonstrate significant improvements in a majority of long term treated patients with psychosis, why bother with them?  The translation of psycho-pharmacological, brain imaging and genetic data into DSM categories has been as interesting as flat beer. So what? A bigger, DSM enlightened psycho-industry, that is the answer, an answer not that different from that of Mc Donald, Coca Cola or… mortgages even if they are sub-prime.  

 Am I am getting a bit paranoid myself?

No. I just think that the paranoid one was Adam Lanza, it does not matter which sub-category of the DSM or outside it.  His executive function, something deficient in autistic individuals, was in excellent shape. But, how is a professional to be so foolish as to diagnose a “folie a deux “or “a plusieurs” and get only a reimbursement, when you can diagnose one by one of the “plusieurs” and get many. Except that you cannot get to them, this is why they are paranoiacs.  Hence you end up with media diagnostics of “asperger”, “a little autistic” etc and neglecting the only real and dangerous epidemic in the USA which is that of paranoia.

Autism, that is Kanner’s autism, is not a mental illness but a grave neuropsychological deficiency which in the context of normal environments and without appropriate supports becomes a disability, frequently a very severe one.  And it is my opinion that people with autism and their families do not need more political correctness and surrealist denials or media circuses and stigma but the psychosocial equivalent to the ramps and wheelchairs that paraplegics use, that is: decent medical care, adapted educational and occupational environments, facilitated access and specific supports.
I will leave you with these considerations.


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