November 20, 2012

Temper Tantrums In The DSM

damien_omen.jpglet me guess




From BoingBoing, only slightly more valid than any of the journals I read:

The American Psychiatric Association is set to add "disruptive mood dysregulation disorder" to the Diagnostic Statistical Manual (DSM), the bible of psychiatric disorders. A kid has "DMDD" if she or he has "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation... at least three times a week."

Easy, everybody, if you're enraged about the wussification of America you can assume you watch too much TV and like Blue Pills.

1.  Diagnosis is not the same as disease.  This just coordinates the language, "from now on we're going to call this this."  "Then why is it called a disorder?"  Ah, you must have no insurance or the best insurance.  Healthcare policy is set by Medicaid/Medicare, you Blue Cross suckers are merely collateral damage.

In Medicaid America, i.e. America, if you come through the door and I ask you all the questions and I determine there is absolutely nothing wrong with you, two things will happen at the exact same time: 1. You will punch me.  2. I won't get paid, can't get paid for no diagnosis, no matter how hard I work.

Can't order any tests without a diagnosis code, either.

Someone stupid will ask me this: "then why doesn't Medicaid just offer a billing code for "need three evaluations, but likely no diagnosis?"  Because if Fox News got wind that Obama was paying for black people to get "no diagnosis" they'd blow up an abortion clinic.  Paying for "temper tantrums" is just the right amount of enraging, TV and internet enraging, no violence will occur.  "Isn't this why we need universal healthcare?"  Well, lieutenant, pronounced like I'm a British naval commander, if we had a system of healthcare in which doctors were paid the exact same regardless of diagnosis or severity, then there'd be little attention paid to "correct" diagnosis, all of our epidemiological data would be totally invalid, and the number one drug in America would be Xanax.  "Wait, isn't that the situation now?"  Huh, nailed it.

2.  "Is this is an attempt at preventing the erroneous diagnosis of "pediatric bipolar disorder?"  No. Come on, stop it.  Not to go full Popper, but how can diagnoses be "wrong" while simultaneously "not exist?"  You guys have to decide whether you're materialists or idealists, then we can cross blades.

In other words, regardless of what you call it, assuming the MD thinks it is "a problem fit for a pill," will the pills offered be any different in either diagnosis?  I'm closing my eyes, don't tell me which diagnosis it is... I'm sensing  something, a presence.... is it Concerta?  Concerta, is that you?  And.... Depakote?  Are you here too?

3.  "DMDD is "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation."  I'd like someone to explain what behavior  is "grossly out of proportion" for a situation characterized by physical/sexual abuse, parental drug abuse, and visibly swarming roaches, every day, while you sleep, while you eat....

"But not all kids are raised in poverty."  True, many are raised by nannies who alive in poverty.  So what kind of temper tantrum is out of proportion for a situation characterized by marital infidelity/swinging, overparenting, spoiling them materially and depriving them emotionally?  "I love my kid, I got him a Wii."  You should get them some weed, they'll get it eventually.

"So then it's not really a disorder, it's just caused a response to the social environment?"  Isn't that what a psychiatric disorder is?  "No, a real disease."  Like diabetes?

4.  It's all very simple, you have it mostly right but the direction of the force vector is wrong.  In order to create a living wage, the system deploys its social services through the least offensive department, healthcare.  e.g. people are furious about Social Security, but not as furious about Medicare.  As long as it can pretend it's about "health" or "compassion" or "disability" it doesn't have to worry about politics or race or "need".

But in order for this to work, the doctor has to get paid.  Not much, but paid.  If he is to get paid, the patient must have insurance, i.e Medicaid.  In order to get Medicaid, the patient must be temporarily disabled, for which he needs to have a diagnosis, so he must see a doctor, who will need to get paid, so the patient needs to have Medicaid.  Ouroboros.  The system has won.






Comments

BoingBoing should be in DSM... (Below threshold)

November 20, 2012 12:08 PM | Posted by Hufty: | Reply

BoingBoing should be in DSM; it causes unbearable smugness and obsession with the most pointless annoying shit ever. And faux-activism.

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Second!... (Below threshold)

November 20, 2012 1:05 PM | Posted by Anonymous: | Reply

Second!

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Aww, what's wrong with swin... (Below threshold)

November 20, 2012 1:14 PM | Posted by Alicia: | Reply

Aww, what's wrong with swinging?

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Someone stupid will ask ... (Below threshold)

November 20, 2012 1:29 PM | Posted by Somebody: | Reply

Someone stupid will ask me this: "then why doesn't Medicaid just offer a billing code for "need three evaluations, but likely no diagnosis?" Because if Fox News got wind that Obama was paying for black people to get "no diagnosis" they'd blow up an abortion clinic.

This seems backwards to me. The fear of Fox News exists to keep the "no diagnosis payments" option off the table, maintaining the system and selling a lot more drugs. But both options are wrong. Doctors should only be paid when they make the correct diagnosis, not when they either find or don't find something.

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104 severe temper outbursts... (Below threshold)

November 20, 2012 1:31 PM | Posted by Gary: | Reply

104 severe temper outbursts per year is not sufficient for the diagnosis. "104 severe temper outbursts per year is normal, doc." 156 per year=brain disease.

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The "correct" psychiatric d... (Below threshold)

November 20, 2012 1:45 PM | Posted, in reply to Somebody's comment, by Anonymous: | Reply

The "correct" psychiatric diagnosis? LOL.

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> "Isn't this why we need u... (Below threshold)

November 20, 2012 2:04 PM | Posted by Agonizingly contrived pun detector: | Reply

> "Isn't this why we need universal healthcare?" Well, lieutenant, pronounced like I'm a British naval commander...

Ba-dum tish!

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... all the readers googled... (Below threshold)

November 20, 2012 8:51 PM | Posted by RJL: | Reply

... all the readers googled 'ouroboros' and wondered what the fuck a dragon has to do with pills.

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The so-called UHC that Medi... (Below threshold)

November 20, 2012 10:49 PM | Posted by Anonymous: | Reply

The so-called UHC that Medicaid (not medicare) provides doesn't really extend past the mental health racket. Prove me wrong.

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Pretty sure it's a fairly o... (Below threshold)

November 20, 2012 11:09 PM | Posted, in reply to RJL's comment, by tornpapernapkin: | Reply

Pretty sure it's a fairly obvious metaphor.

Anyway... this isn't just Medicaid. In general unless you just self-pay everything (which actually I would recommend if you are a middle class salaried worker as you don't want a stigma on you) you'll need a diagnosis.

I had a conversation with my doctor that went like this "If you claim this on your insurance we'll need a diagnostic code. Let's pick something that isn't embarrassing...."

Mind you this is not for any kind of massive drugging, basically for your run of the mill shrink talk. Frankly, I found it kind of useless, but whatever. My decision was just to pay out of pocket. Why get "add" or "generalized anxiety disorder" on your next insurance's "reasons why we can screw this person" list.

Pfft... in the long run it probably is cheaper to pay the doctor out of pocket. I can't help but imagine it is the same way for psychiatrists.

But the few times I've seen those they have been so useless it makes more sense just to tell an MD what drugs I want.

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Oh yeah, and don't forget y... (Below threshold)

November 20, 2012 11:16 PM | Posted by tornpapernapkin: | Reply

Oh yeah, and don't forget you need to show that you are completely healed for your life insurance policy, except of course for any meds that might be found in your corpse in the case of an accident :)

Ah bureaucracy... we have such a sick but loving relationship.

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I get sick of, and Boingboi... (Below threshold)

November 20, 2012 11:32 PM | Posted by tornpapernapkin: | Reply

I get sick of, and Boingboing is a bit guilty of being a part of the hysteria here, this whole "OMG this drug is over-prescribed" hype. Fucking idealists ruin everything.

I got kicked off of benzos because of fear over how people might drink too much and then choke on their vomit while using them. Ok, I've been drinking and taking benzos most of my life now. No, I'm not a bored housewife junkie. Believe it or not if it weren't for my amazing privilege I'd probably (probably? No definitely) be dead.

It's not a perfect solution, but it's something. For a while though, the media feared all who use these drugs would flame out brilliantly in a pool of vomit or beneath the suds in their bathtub.

Then it was gabapentin/neurontin the new drug of choice, which actually was ok so long as you don't actually use it every day because it seems to work a lot like extacy (or not-work that is). To me, it is a nice "jump the deep gap" aid.

You realize you're hitting one of those points... so you take something to alter your state for long enough to keep you from fucking your life up, committing suicide, doing something equally stupid. You have these risks because you really do have something wrong with you, but so long as you jump the gaps you can have this great life with almost none of the "go to prison" or "die" or "lose everyone you love" kind of consequences. Wow... how great!

The hysteria about drugs just leaves you with fewer drug options. So like all my genetic ancestry you can start turning to alcohol or heroin or whatever you can get your hands on. Yay! Great! So glad we got rid of those nasty Big Pharma shills!!!!

Like I said, fucking idealists ruin everything.


Now the pendulum has swung. Benzos are back in, anti-psychotics are out, and neurontin is disgraced.

Really this is all idiocy. Whatever works works until it doesn't work.

Honestly, is there anything more than that? I don't think so.

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"BoingBoing should be in DS... (Below threshold)

November 21, 2012 12:19 AM | Posted, in reply to Hufty's comment, by DataShade: | Reply

"BoingBoing should be in DSM"

Let the hate flow through you

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Alone: When we hear that Am... (Below threshold)

November 21, 2012 3:00 AM | Posted by Or: | Reply

Alone: When we hear that America spends $X billion a year on healthcare with outcomes no better than other countries that spend half as much, how much of that $X billion is the psychiatric-social-policy complex?

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-... (Below threshold)

November 21, 2012 3:26 AM | Posted by -: | Reply

-

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<a href="http://opinionator... (Below threshold)

November 21, 2012 3:33 AM | Posted by john: | Reply

http://opinionator.blogs.nytimes.com/2012/11/17/how-to-live-without-irony/

Can you please comment?

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Shame on you for talking ab... (Below threshold)

November 21, 2012 6:38 AM | Posted by Anonymous: | Reply

Shame on you for talking about boingboing. Shame on you.

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The NYT is just upset that ... (Below threshold)

November 21, 2012 8:18 AM | Posted, in reply to john's comment, by tornpapernapkin: | Reply

The NYT is just upset that every time they declare irony dead the world gets more ironic so now they're being ironic about it.

Add me to the list of people who'd love to see TLP write about it though.

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OK, I gotta take a whack at... (Below threshold)

November 21, 2012 9:02 AM | Posted by Anonymous: | Reply

OK, I gotta take a whack at that article. Quote:

"Where can we find other examples of nonironic living? What does it look like? Nonironic models include very young children, elderly people, deeply religious people, people with severe mental or physical disabilities, people who have suffered, and those from economically or politically challenged places where seriousness is the governing state of mind."

So "being sincere" involves aping children, the demented, the retarded, the religious, and... Africans? Because all those people exist only as cutesy models for your lifestyle choices, of course. Ugh, no wonder people spout Star Wars quotes if this is the alternative.

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I’m a child psychologist in... (Below threshold)

November 21, 2012 10:04 AM | Posted by HumbleShrink: | Reply

I’m a child psychologist in Canada (no medicair/medicare) in private practice and I receive every year at least 50 kids from 3 to 15 from middle class families (no poor, no nannies) that fulfill the criterion of DMDD. I totally believe in the constructivist nature of the DSM (and social influence it has and at the same time structures it).
But: those families are in pain and kids get a terrible picture of themselves because they’re not able to regulate their own emotions. The first advice all those parents will have received his set clear and constant limits. They’ve tried and they got more tantrums, not less.
Strangely, some of those tantrums happened after a positive event. There exists a real problem for real people having real consequences. Saying it doesn’t exist is futile, blaming the parents is counterproductive and labeling it could be useful (to get help) but as long as you remain very humble about the validity of any psychopathology. Distress is the ultimate criterion and DMDD families clearly feel it.
I prefer to say that those kids have a DMDD than a bipolar disorder (I tend to use the ODD tag but I think that DMDD is closer to what I observe).
Indignation (against DMDD, DSM, parents, society,... pick the one you hate the most) is easy, helps define oneself but doesn’t help.

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First, 50 a year would put ... (Below threshold)

November 21, 2012 12:52 PM | Posted, in reply to HumbleShrink's comment, by Brazil Psych: | Reply

First, 50 a year would put your numbers surprisingly low from what I've come to expect from psychiatrists here in Brazil. How many of your patients come out undiagnosed?

Second, distress is the criterion for what? Lack of neuropharma in the system? Are you treating the disease or the symptoms? Any other field of medicine pays attention to this difference, you treat Dengue fever with AAS, your patient's gonna die.

Not getting into it's merits, TLP's theory is clear, we're treating the symptoms because society needs a way to perpetuate the disease. The Matrix [i]is[/i] the disease, pharmacology is just the tool-de-jour for covering it's ass.

Now, you can either agree with him, and with the sad fact that you're being told it's up to you to help these people or they're fucked (which wouldn't be wrong, but not in the way you seem to think), or you can disagree with the whole idea that your treatment of their distress also camouflages the underlying cause, but then you need to explain what you think the cause is. (If you say it's neurochemical, I beg you to explain what kind of sick mutation happened in the last 30 years that 10% of Americans' brains stopped knowing how to balance their shit out).

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Humble, no one can doubt th... (Below threshold)

November 21, 2012 1:15 PM | Posted, in reply to HumbleShrink's comment, by Guy Fox: | Reply

Humble, no one can doubt the frustration and agony of the families you see, but what is the yardstick? Show me 50 adults, and 3 of them will have some kind of addiction about which they're in denial and 5 will be downright abusive routinely. 7 will be really good at math and 6 really artistic, and 39 will consider themselves to be above average cooks.

With kids, parents are going to be a huge influence, but any sample will have kids who are peculiarly quiet and withdrawn, others will be hams (I refuse to call kids attention whores, call me old fashioned), some will walk around implicitly screaming 'Kick me!' and others will have short tempers that they can't (yet) control. Sure, that's gonna be trying for the families, but who ever promised everyone temperate and placid children? Just because media represent children as some kind of fantasy accessory, who are good as gold except when they're not and even then it's cute, doesn't mean anyone should believe that, least of all a child psychologist.

Consider the child. What will do that kid more harm? Setting the limits, gritting your teeth and counting down the months until the kid learns to control himself when s/he learns there are better/more agreeable forms of attention, or telling the kid s/he's sick, that there's probably a problem with his brain, and that the attention it needs is going to come from strangers who are paid to be patient and explain things, because the parents have admitted defeat or are too absorbed with their lives' other problems?

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I love these posts. They re... (Below threshold)

November 21, 2012 2:38 PM | Posted by Lady: | Reply

I love these posts. They read like you're ranting at me. (And no, that wasn't sarcasm)

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You know, your blog just ma... (Below threshold)

November 21, 2012 4:01 PM | Posted by Oelsen: | Reply

You know, your blog just makes the horror produced by a energy supply shock bigger. The last series about those hipsters and the mother complaining about how others should suffer like she does? Well, she may be vindicated when the grid falters. Or this stuff about how the masses are now drugged (in the US at least and some parts of Europe, especially the richer countries) with drugs dependent on a well lubricated (in any sense) machine and supply logistics. Meanwhile, the rest of the world, just has its own problems, but also: weed, shrooms and alcohol.

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This gave me pause for a mo... (Below threshold)

November 21, 2012 5:35 PM | Posted, in reply to Alicia's comment, by Jess H: | Reply

This gave me pause for a moment, since I'm in an open relationship, but then I recalled my mother and stepfather's penchant for running off to Jamaica several times a year and going out of town at least once per month in order to meet strangers for a good time. Where was I, and where were my brothers, while they were enjoying themselves? At home, alone, gradually realizing that workdays extending 10 hours plus were not the main barrier to spending time with our parents and getting resigned to the idea that our extended family knew us better than our mother (who chose to buy extensive plastic surgery for herself instead of putting me through college).

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Do you write your blogs usi... (Below threshold)

November 22, 2012 8:47 AM | Posted by Anonymous: | Reply

Do you write your blogs using an iPad?

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"(If you say it's neurochem... (Below threshold)

November 22, 2012 10:27 PM | Posted by Anonymous: | Reply

"(If you say it's neurochemical, I beg you to explain what kind of sick mutation happened in the last 30 years that 10% of Americans' brains stopped knowing how to balance their shit out)."

How about a vitamin D deficiency? Or a reaction to the huge amount of gluten now in our food that wasn't there 50 or 100 years ago? Or the deficiencies and insufficiencies of nutrients in soil. Or our food choices.

Anyone care to look at nutrition? Its always completely ignored. I can speak from personal experience about the tremendous impact of the right nutrients on mental and physical health, and there are scientists on to this but they just aren't good at marketing their findings. And there's no money to be made like with new drugs.

Please, please, please all you clinicians...get on to it!

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Oh yeah, and don't forget m... (Below threshold)

November 22, 2012 10:33 PM | Posted by Anonymous: | Reply

Oh yeah, and don't forget magnesium....

http://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-cofactors/magnesium/

Deficiencies cause:
irritability or anxiety
nausea
headaches
insomnia
fatigue
muscle cramps/twitching
weakness
constipation

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Tornpaper napkin said: "I h... (Below threshold)

November 23, 2012 11:46 AM | Posted by medsvstherapy: | Reply

Tornpaper napkin said: "I had a conversation with my doctor that went like this "If you claim this on your insurance we'll need a diagnostic code. Let's pick something that isn't embarrassing...."

Mind you this is not for any kind of massive drugging, basically for your run of the mill shrink talk. Frankly, I found it kind of useless, but whatever. My decision was just to pay out of pocket. Why get "add" or "generalized anxiety disorder" on your next insurance's "reasons why we can screw this person" list.

Pfft... in the long run it probably is cheaper to pay the doctor out of pocket. I can't help but imagine it is the same way for psychiatrists."

If you come to me for care, this is exactly what I will do.

One of my interests is identifying what we smart people should really be researching - instead of, as Alone notes, running studies to find out that some patented medication has marginal efficacy versus placebo for yet another syndrome.

Here is what researchers need to be studying: what diagnosis could a person be tagged with that will maximize billability and minimize the unintended consequences, whether they be: getting dropped by insurance; having a higher health ins premium; losing your job because your health ins has become too expensive; or
suffering prejudice (not getting job promotion, etc. - real things, not hurt feelings) because it is known you have some diagnosis.

I would suggest a couple but then I would feel bad if this failed to work as Obamacare gets rolled out.

In my field, psychotherapy and counseling, I don't care about "diagnosis" a whole lot. I do care to know if a few things are going on. I care about intellectual level when a client gets down around IQ = 70. Then, I have to start being more creative than usual.

I do care if someone has bona fide panic attacks, obsessions, or compulsions. The impact of those are significant, and will not get better unless you do direct, specific things. Medication is not one of those things. Curiously, DSM has treated these things in an odd way that do not align with the model of "dignosis indicates treatment." Obsessions require differnt interventions from compulsions, yet the two conditions are lumped together. And trichotillamania is in the same vein, but has its own diagnosis/code. Treating a perrson with trichotillamania is more like treating a peson with a compulsion, versus an obsession, but obsessions are paired with compulsions, and trich is separate. Go figure.

Panic attacks require "agoraphobia" to tag along, either as with or without. Why? If someone has agoraphobia, you treat them one way. If they have fear of enclosed spaces, you treat them another way. Why not Panic attack with or without any of the following features: agoraphobia, fear of a heart attack, fear of social embarrassment, fear of wetting your pants, fear of begin trapped, or fear of suffocating?"

If I think down the list of things I might treat people for, it seems that the DSM rarely lines up with my treatment-based discriminations.

But I am off-topic; I am talking abt actual psychological problems of which people are actually aware they have, and for which peopleactually want treatment. I am not discussing the sciency-sounding social-salve being sold to the otherwise-dissgruntled.

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I think it's a blackberry.<... (Below threshold)

November 23, 2012 4:05 PM | Posted, in reply to Anonymous's comment, by rudieboyjoe: | Reply

I think it's a blackberry.

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Just a correction: "We're t... (Below threshold)

November 24, 2012 12:58 AM | Posted, in reply to Brazil Psych's comment, by br? br? I diagnosis you!: | Reply

Just a correction: "We're treating the symptoms because society needs a way to perpetuate the disease." - and so you guys make money to buy iPad apps. Yeah, don't know why every psychiatrist I've met (I'm Brazilian too), have an iPhone/iPad. Crazy...
Like Morpheus said in that comedy movie: "If you are not one of us, you're one of them". Could be forgettable if you really think that help people being a psychic. Dumbness it's really sublime..

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This is a GREAT blog entry.... (Below threshold)

November 24, 2012 2:22 PM | Posted by Anonymous: | Reply

This is a GREAT blog entry. The comments are mostly stupid: plaintive, preachy, lecturing. Embarrassing, actually.

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"Where can we find other ex... (Below threshold)

November 24, 2012 2:28 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

"Where can we find other examples of nonironic living? What does it look like? Nonironic models include very young children, elderly people, deeply religious people, people with severe mental or physical disabilities, people who have suffered, and those from economically or politically challenged places where seriousness is the governing state of mind."
***
this reminds me of an anne sexton poem "one eye, two eyes, three eyes" except the anne sexton poen is so much better.

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Are you saying you seriousl... (Below threshold)

November 24, 2012 2:41 PM | Posted, in reply to HumbleShrink's comment, by Anonymous: | Reply

Are you saying you seriously believe the problem is primarily the child and not the family or the family system?

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"First, 50 a year would put... (Below threshold)

November 24, 2012 2:43 PM | Posted, in reply to Brazil Psych's comment, by Anonymous: | Reply

"First, 50 a year would put your numbers surprisingly low from what I've come to expect from psychiatrists here in Brazil."

Oh no!

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I'm not disagreeing with th... (Below threshold)

November 24, 2012 2:54 PM | Posted by Dovahkiin: | Reply

I'm not disagreeing with the idea that a kid might have the DmDD issues, but I think it's mostly a culture thing. A kid today is raised with pretty much instant and complete gratification. Consumer electronics (looking at you, XBOX and iPad) mean that a kid never grows up knowing how to deal with things like boredom. Having food pretty much everywhere means much the same -- never having to wait until they get home to get a sandwich. Having Amazon.com on the computer means that they never have to go without anything. Everything is instant, and a kid gets the idea that that's the way everything is. So when it's not, when he has to wait his turn or sand in line at Walmart, he's not happy, and he's never had to deal with something that isn't instantly the way he wants it. So he can't. He melts down because he literally has never learned to wait, to make do, or to do without, so when he's confronted with having to do those kinds of things, he's in meltdown mode. So now not knowing how to deal with things that the child has never actually had to deal with, it's a disorder, and of course, we drug the kids.

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50% of drugs are derived fr... (Below threshold)

November 25, 2012 12:00 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

50% of drugs are derived from natural sources. Look at byetta- that is a fantastic story about discovering a new drugs through incredibly resourcefulness (synthetic Gila monster spit). Look it up- it's pretty cool. Scientists- well, at least all scientists- aren't responsible for what food manufacturers do or what we're willing to buy.

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Kids have tempter tantrums ... (Below threshold)

November 25, 2012 12:20 PM | Posted by Anonymous: | Reply

Kids have tempter tantrums sometimes simply because they are overwhelmed. they don't often have the language to say it, you have to figure it out for them. probably pitching a fit offers some relief and clears things the fuck out, not to mention hopefully stopping activity around them so they can re-group. I shudder at the thought of parents or others interpreting it as more than that because whatever the kid gets told as far as interpretation will probably be believed.

American parents tend to get threatened by every little thing- that may be why they are so prone to need to listen to experts so often, so they don't have to deal with their own uncertainty or nascent guilt. They also tend to think they must have the answer to everything as a Parent and that they are responsible for filling their kid's head with the right 'things' as opposed to facilitating the kid doing that for his or her's own self. So- control freaks. For this reason i think treating a kid with tantrums (threatening to a control freak) without treating the family is kind of silly. But teaching a parent to set limits and give appropriate consequences for behavior, difficult enough on it's own, still can't begin to compare with teaching a parent how to love, have a sense of humor, and relax and enjoy their kids even when this is not quite what they had in mind. At least in theory psychotherapy for the parent should be able to do this- and I think it can- if insurance will pay for it and shrinks are willing.

To be perfectly fair, I struggle with these same issues as a parent of a teenager. Just so i don't sound too smug or judgmental here.

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*Even instilling a sense of... (Below threshold)

November 25, 2012 12:47 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

*Even instilling a sense of the continuity of their own kid's development or family's development would be a good idea.

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Isn't the reason other coun... (Below threshold)

November 25, 2012 2:08 PM | Posted by Anonymous: | Reply

Isn't the reason other countries might get a more positive outcome while spending less money often thought to be because the family participates more in the care of it's members, including the mentally ill and the elderly, and also because society's or the family's attitude towards (those) people is thought to be far kinder and more accepting, and willing to find value in their experience? But i wouldn't be surprised if willingness to try other forms of care than just allopathic medicine had something to do with it- like for example if allopathic medicine is not affordable in their country.

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By your own argument, (trea... (Below threshold)

November 25, 2012 5:35 PM | Posted, in reply to medsvstherapy's comment, by Anonymous: | Reply

By your own argument, (treatment follows diagnosis- although i had no idea the DSM-IV was thought to be organized that way). shouldn't the 'merely' disgruntled be able to seek treatment? nobody's pointing a gun at your face to make you diagnose them any which way. I mean, treatment for the merely disgruntled could easily follow some of the basic guidelines any other form of treatment might follow. And anyway, would that not qualify as Adjustment Disorder?

I thought the reason panic attacks were often followed by agoraphobia is that people get afraid to leave the house because they are (more) afraid of a panic attack in public, making agoraphobia a serious additional impediment to an already-complicated situation, including an impediment to seeking or being consistent with treatment. Why is this so unreasonable?

And why can't impulse disorders be separate from OCD? I thought impulse disorders were significantly easier to treat- resist the impulse and the impulse will diminish. this has certainly been the case with my own impulse disorder (diagnosed, and of significant enough duration and intensity, but still, surprisingly easy to treat once i formulated a plan that would enable me to simply resist the impulse).

I thought the whole reason for OCD grouping obsessions and compulsions together was perhaps that they play off each other and lead to each other so well. Is this wrong? If the obsession leads to a need to have a neutralizing compulsion I don't actually see- although i have never heard of it, but- i certainly don't see why a compulsion can't lead to an equally nutty obsession or explanation, either. But I'd love to hear you elaborate.

I also thought OCD was just much much harder to treat than an impulse disorder.

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Kids do have some language ... (Below threshold)

November 25, 2012 9:30 PM | Posted, in reply to Anonymous's comment, by Dovahkiin: | Reply

Kids do have some language skills, I think the issue that's different from say when I was a kid in the 1980's is that kids are living in a different world. The world around them caters to them to a larger degree than it ever has before.

Trivial example, but remember when you were a kid and you wanted to watch TV? You couldn't watch whatever whenever -- there was no DVR to store the show, so you'd wait for it to come on, and if you weren't home when it was on, you missed it. So you'd learn to deal with that minor disappointment, which means that you know what to do when you don't get your way, or you have to wait for something you want. A lot of kids are only children as well -- which means that you don't learn to negotiate or talk or deal with not being the center of attention all the time.

This is what a lot of modern kids are missing those kinds of experiences. Which has nothing to do with language skills. It's not a language problem, it's a dealing with delayed or denied gratification problem. People aren't learning how to delay or deny themselves or deal with a universe that doesn't cater to them.

Kids are not biologically different than they were 20 years ago when DMDD didn't exist yet. They don't have fewer language skills either. Its not the kids even. I doubt that the parents have really changed styles all that much. The modern world simply does a bad job of preparing kids for a world in which not everything is what they want when they want it. Which makes instances in which the kid isn't in conrol much harder to deal with.

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Not getting into it's me... (Below threshold)

November 25, 2012 10:54 PM | Posted, in reply to Brazil Psych's comment, by James: | Reply

Not getting into it's merits, TLP's theory is clear, we're treating the symptoms because society needs a way to perpetuate the disease. The Matrix is the disease, pharmacology is just the tool-de-jour for covering it's ass.

Since you're not telling us how to cure the disease, let alone how to unplug from the Matrix, I'll settle for the ass-covering.

What does it say about us that, in our fiction, the way to disconnect from the Matrix is to take a pill? And that this metaphor is so good, so appealing, that we sometimes use it even here, on a pharmaco-skeptic blog?

I further suggest that if it were possible to unplug from the Matrix, we would quickly construct another Matrix to replace it.

A famous painting by René Magritte illustrates this point, and narcissism in general.

The painting appears to be "only" surrealistic, until you notice the title: "The Human Condition".

When I saw it for the first time, I laughed out loud, and then stopped to think. Now, 30 years later, I have a different take.

What a healthy person the painting illustrates! Only one easel! Not ten, one in front of another, with who knows how many identical paintings, and what terrors on some of the obscured canvases.

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I disagree. Would you be ha... (Below threshold)

November 26, 2012 12:20 AM | Posted, in reply to Dovahkiin's comment, by Anonymous: | Reply

I disagree. Would you be happy with, as in your example, watching whatever you wanted when you wanted? would that be a significant form of gratification for you? probably not, right?


Kids may be different in some ways these days, because of the times they live in, but the basic needs of a young human soul don't change and it has nothing to do with television or delayed or instant gratification. In fact, if all this "instant gratification" does anything, it probably just takes kids away from the needs of a normal young soul, and some part of them has got to know that. i mean, kids can't even hardly play outside anymore. It's not safe. they're not having anything resembling a normal or healthy upbringing for this reason alone. Sure, they have a ton of digital shit as paltry compensation. Actually, the lack of running around outside being resourceful and learning to trust their impulses and imaginations might go a long way toward reducing the temper tantrums. I can't see how digital media could do anything but make it worse, but it isn't because their worlds are all that gratifying. i will say that all these substitutes for real life and real play probably do a lot for making kids strangers to themselves because of what it places into the child's mind as a substitute for health.

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And also, as far as the ide... (Below threshold)

November 26, 2012 12:38 AM | Posted, in reply to Dovahkiin's comment, by Anonymous: | Reply

And also, as far as the idea that it is instant gratification that is destroying them, a lot of kids these days start out in daycare, sometimes when they're babies, but at least by age 2 or 3. Day care is nothing *but* delayed gratification because the needs of the individual are second always to the needs of the group. and you can't tell me that all this daycare is doing anything good for children except possibly, for some kids, teaching them social skills that they could learn in gentler ways, anyway. But as individuals, no way. And daycare isn't--- i worked in montessori and I would still say that daycare pretty much caters to the greatest numbers of kids in 'the middle'. Every other kid suffers through it. there's plenty of delayed gratification to go around, believe me. Nobody's better off for it.

Personally, i think the only real requirements for the most part as far as learning to tolerate distress are still mostly taken care of by simply expecting your kid to deal with the natural distress of living. It doesn't need to be taught or facilitated because it simply happens.

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There is a lot here, and I ... (Below threshold)

November 27, 2012 12:02 AM | Posted, in reply to Anonymous's comment, by medsvstherapy: | Reply

There is a lot here, and I don't exactly know what the leading concern might be. I'll take a stab at it, though.

The DSM is not organized by treatment-follows-diagnosis. Officially, the DSM is supposed to have little connection with etiology or treatment. It is supposed to be descriptive. The logic is that any diagnostician anywhere, with the modicum of training, would be able to assess for the presence/absence and severity of symptoms, from profound mental impairment or psychoticism, to "disgrntled," and pin the same label on the patient as the next diagnostician.

This was intended to cut theoretically-based disagreements out of the process. If I was biologically-minded, and you were psychodynamically-minded, we would still both have high diagnostic reliability. The big switch was from DSM II to III; if you can locate DSM II (dark hardcover barely paperback size, and pull DSM III green-and-yellow 8x11), you will note the absence of "neuroses," etc. So etiology was removed for the most part (organic brain disorder lingered, etc.).

The original post concerned the manipulative use of a "temper tantrum disorder" to justify psychopharmacological treatment.

The Last Psychiatrist thesis goes like this: develop a diagnosis that hold the concept that an individual has a recognized disease entity; this allows you to bring the "problem" into the domain of individual-level medical model; this individual-based, psychaitrically based model allows the psychaitrist to be deemed as the approriate authority to call the shots; gerat portions of society want to get out of such things as responsibility, and this "psychiatry" route "legitimizes" pawning the problem off on the relatively powerless; the psychiatrist can make a good living as long as he or she plays along - but he or she must match a medical-seeming treatment to fit the medical-seeming "diagnosis."

That is where I get the diagnosis > treatment model.

I hope that helps.

Now, never mind that most of the time, the patient does not get "cured," or "healed," and does not get much better, and may ac tually get worse, once side effects and self-fulfilling prophecy effects are factored in. We have bought into this like cult-members, and we cannot question the prevaling oligarchy.

To question the status quo means that me, a parent, has to face the terrible truth that I have failed to do what I am tasked by God to do: raise an adult, including morals.

Raising a child to be a mral person requires an acknowledgemant of morality and some achnowedgement of myself as a parent being generally moral and endorsing the conect of morals and endorsing some specific moral sentiments, and doing some effort to live accordingly.

This is a lot. An awful lot.

As psychiatry excuses our self-centerdness, "spirituality" excuses our lack of this moral approach to life.

If you have a moral approach to life, it does not bother you to see someone else attempting to follow the same, and so a bracelt with WWJD should not rally bother you.

You have already declared that the WWJD crowd is disreputable; you are on the side of not-moral apporach to life, but on the side of "spirituality." Praying five times a day? Go aheand and try that for 3 days in a row, to the not-God you acknowledge in your "spiritual" approach to THhnksgiving.

This is what the medica lmodel buys us. We are excused from having to be responsible, moral parents. When the eventual happens - when our kids behave baly, like an untended garden gets uverrun by weeds, we don't have ourselves to blame.

We have our morality.

We have our parenting philosophy.

And we have psychiatry to provide an explanation and cure for the unruly, weed-run garden of our child's behavior.

To achieve this, we have to dress up the natural history of feral children as recognized, legitiamte "disorders."

BTW: you will have to look far and wide to find a mental health professional of any stripe that is aware that there actually is an "undersocialized" diagnosis.

No one knows, yet it fits about 20% of the kids wlking around today. Go figure.

Should you be able to seek treatment merely for being "disgruntled?"

Sure.

Health insurance is for the diagnosis and tretment of medical disorders.

Should you be entitled to receive care for "disgruntled" via health insurance?

No.

When my car loses that new-car smell, should auto ins pay for the new-car smell to be repaired?

No.

Pull $60 out of your wallet each week, and go get treatment for "disgruntled." Somewhere in your locale, there is a mental health professional willing to take self-pay $60/session to help you.

Now that you have to put your money where your mouth is, you suddenly care about: how many sessions will this take? What are my alternatives for treatment? What evidence base can you point ot that your plan has a good likelihood of succeeding, and - get this - succeeding relative to other interventions?

(In 20 yrs, the profundity will be obvious. until then, enjoy health care reform.)

This drug has caused me to lose my sex drive, to lose the firmness of my you-know-what, has caused dry mouth and jitters, and super-realistic bad dreams; and when I tried to quit it, I felt like killing myself or someone else. Is tis really the treatment for "disgruntled?"

Things look really different when you have skin in the game.

You will eventually wish for your "disgruntled" to return if you buy the psychaitrist's cure.

Unless they convince you that you are the problem. Which is how many cullts work: hang on, pay the next payment and perform the next round of ritual, and may be just maybe that what seems like pee on your leg will be manna from heaven. But don't doubt us, we are the authorities, and as we predicted, you have lost your family and friends and that just shows how worthless you are - so hand over the dues, and your pubescent cildren.

I do not know, Anonymous, what you men by an impulse disorder.

If someone is hesitant to leve the home because they worry about having a panic attack where others can see them, that is not agroaphobia.

We all have social-judgment reasons for fearing leaving the house because of certian expected negative events.

There are many people with PTSD who stay close to home because they want to stay in familiar territory. Why is there no PTSD-with-or-without-agoraphobia?

"Agoraphobia" must be orted out as a secondary symptom, or a leading symptom.

That idea is the idea of my erlrier post: figure out what is going on. Figure out where to start. Start there.

As "moral" and Christian as I mght be, I had no problem telling a minister and his wife that they had to spend more time with kids and less with congregation. One of two children qualified for a diagnosis - that disappeared once the parents moved their focus - and I predcited that the other would be in the clinic unless they did the same with both; sure enough, I see them in the waiting room one year later.

Based on my knowledge of parenting by those loving, earnest, but under-involved parents, and having little to no info on the other kid, I predicted the other kid's "pathology."

I could have played the game.

I can guarantee that if they went to a psychaitrist rather than a psychological clinic, they would have gotten a tem,per-tantrum dx and a medication Rx. Guarantee.

And the parents would have continued feeling moral, feeling like good parents, with the complicity of modern psychiatry.

Obsessions and compulsions: why not have separate diagnoses? We have two words. If they are joined at the hip, just use one word. Why is trichotillomania separate?

The treatment of an obsessive thought is a great deal trickier than the treatment of a compulsive behavior.

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A general comment for this ... (Below threshold)

November 27, 2012 2:10 AM | Posted by Darwin: | Reply

A general comment for this blog:

People tend to have personalities resistive to change for the same reason life tends to reproduce. If a species fails to reproduce, it dies out. If a personality changes, it dies too.

In practice a child will have a malleable personality that adapts and learns according to reason, experience and everything else. Eventually aspects of that personality will, in part by chance, become those that strongly resist change and by that nature they will survive until the entire personality is built around resistance to change.

Adult personalities' are governed by the law of the Survival of the Most Resistant to Change. I am not sure it can be any other way.

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Thank you for clarifying.</... (Below threshold)

November 27, 2012 7:37 AM | Posted, in reply to medsvstherapy's comment, by Anonymous: | Reply

Thank you for clarifying.

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Huh. It is weird, and kind ... (Below threshold)

November 27, 2012 7:56 AM | Posted, in reply to medsvstherapy's comment, by Anonymous: | Reply

Huh. It is weird, and kind of sad, if an obsessive thought is harder to treat than a compulsion. I mean, the brain is an idiot monkey that likes to play the same tapes over and over. Big whoop. But a compulsion- with no corresponding thought- is, at least to me, at least in theory, a powerful thing. With no language but a boundless compulsion to repeat, it is irrational, yet powerful. How do you even begin to tackle it? Rituls- at least in theory- are always more than the theories and teh language we use to try to support or explain them.

If someone is really attached to their idiot monkey mind, and they have to admit how fallible and fragile and not even self-serving it can be, then i suppose i can see how that could be really painful; it's like admitting you are crazy, that something about you just is not sound, and never will be, perhaps. If you are a pretty typical human being who way overvalues their own brain, considers everything they are to be a reflection of the soundness of their own mind, proof of their sanity, then yeah, i can see how that could be hard. Especially if your family or society or what have you appears to be in judgment.

In theory, it would help to have a few rituals, to find something that made you feel teh soundness of your soul, so you could let go of some little tick that your head just won't stop doing.

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Determining one's disorder ... (Below threshold)

November 28, 2012 3:33 PM | Posted by Kyle: | Reply

Determining one's disorder based on one's environment when the environment may be horrifying is unreasonable. I think this part of the argument(3) alone is a pretty reliable case. Well done on explaining, I especially like to hear these types of examples.

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There was an excellent arti... (Below threshold)

November 28, 2012 4:20 PM | Posted by John: | Reply

There was an excellent article in the the Journal of the World Psychiatric Association (WPA) by Heinz Katschnig that covered internal and external challenges to the profession of psychiatry (2010).

I'm unsure if the author of this blog allows links, but this is one enlightening read. I would highly recommend it.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816922/

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There is a requirement, i b... (Below threshold)

November 29, 2012 9:10 AM | Posted, in reply to Kyle's comment, by Anonymous: | Reply

There is a requirement, i believe, that when diagnosing ADHD n children you want to observe the behaviors at school, at home, and I believe at play (not sure about the third location). the problem is, at least according to my psychology text, they accept accounts from teachers and parents and the like instead of direct observation. It is too easy to see how this could go wrong. In theory, to treat the parents, it would help anyway to at least occasionally observe them at home anyway, so you'd think it could somehow be arranged. But i don't think the money is there. I wish it was. the parents, again in my psychology text, are supposed to get treated-whether it is the parents or the kids fault, the parents still need new skills to deal with it. My book only gives statistics on kids and what kinds of treatment they get for the diagnosis- there is no information about parents and if they are compliant with treatment.
I'm climbing up on my soapbox.... 90% of ADHD-diagnosed kids are boys. the criteria is stuff like "squirms in chair" and "difficulty awaiting turn." I think it is gender bias, against boys, and i think it is the desire to quickly, too quickly, make children fit into society's box, that is behind this diagnosis. Restlessness and independence in boys needs to be dealt with another way than medicating them and stuffing them back into the box. And statistically, this is what happens: medication. Not therapy or innovative school programs. Apparently the only gender bias worth studying (according to my text) is all for women, mostly for BPD. It makes me sick.

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No, when you hear American ... (Below threshold)

November 29, 2012 11:28 PM | Posted, in reply to Or's comment, by Carl Pham: | Reply

No, when you hear American spends $x billion on healthcare without better outcomes than country $y, you should ask yourself why the same people think the obvious reason our public-school graduates rank 105th (or whatever) among Western nations in math is because...we don't spend enough money on education.

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I can't see where the child... (Below threshold)

December 2, 2012 11:17 AM | Posted by Laura: | Reply

I can't see where the children's age is referenced.

A 13-yr-old who has uncontrollable meltdowns 3X per week is at least desperately unhappy, if not actually disordered. A 2-yr-old who doesn't probably has something wrong with her.

Before I ever approached wondering if a tantrum-throwing kid had a disorder I'd ask these question:

Can the kid verbally express her wishes?
Does the kid have any meaningful age-appropriate control over her environment?
Is there any adult in authority over the kid who cares about her happiness?

If the answer to any of those questions is "no" then I would stop there. It's not the kid.

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I smoke weed and I'm a doct... (Below threshold)

December 7, 2012 2:22 AM | Posted by Anonymous: | Reply

I smoke weed and I'm a doctor. Maybe you should substitute that for your rum - your rants will be less caustic.

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If you read that as a caust... (Below threshold)

December 7, 2012 9:18 AM | Posted by Laura: | Reply

If you read that as a caustic rant, you might ought to cut back on the weed.

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Or teaching the rest of soc... (Below threshold)

December 7, 2012 10:28 AM | Posted, in reply to Anonymous's comment, by Dovahkiin: | Reply

Or teaching the rest of society about actual children. 4-year olds are not little grownups. They don't think the same way a 20 year old does, they need to run and play and frankly get into trouble. I feel bad for the parents of small children who have the gall to try to take the kid to a restaurant -- the people around them expect a 3-4 year old to sit still with their hands in their laps for 20 minutes, to not laugh or sing, to basicly act like a 20 year old on a date. It. will. never. happen. So parents are kinda stuck, either they never take the kid to a restaurant or other public places, or they get the steely stare or comments from other people for how "bad" a four year old is because he wanted to sing Old McDonald and maybe run around the table to sit next to daddy. I did that as a kid, heck I think I stuck crayons up my nose for a laugh, but the difference was that in 1980 and on, people had kids, as in more than one, and people genrally knew what a kid was actually like. They knew that a 4-year old would get bored, or sing, or whatever. No one expected indoor voices from an excited preschooler who just found something cool on the wall.

So kids have a double problem. They live in a world where they are expected to act like someone twice their age, while at the same time not being taught how to, or what to do when they don't get their way, or how to learn what they need to do to grow up. We give the kids what they want, when they want, we don't let them actually be kids, and then we drug them when they can't act like 20 year olds from the age of 5. Kids need better, they need places where it's expected that they act like kids.

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Send the little fuckers to ... (Below threshold)

December 7, 2012 10:51 AM | Posted by Anonymous: | Reply

Send the little fuckers to Chuck E Cheese - where a kid can be a kid!!!

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Seems kinda sad that you ca... (Below threshold)

December 8, 2012 6:10 PM | Posted by Dovahkiin: | Reply

Seems kinda sad that you can't take your kid to a normal restaurant just because a lot of grownups don't accept that kids are kids. I'm not talking about going to a really fancy place, I'm talking about family dining. TGIFriday's or places like that. Try to take a kid with you, especially one under 6-7, and you'll experience periah-hood, because a 3-4 year old wants to act like a kid.

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Couldn't put it better - di... (Below threshold)

December 12, 2012 7:05 AM | Posted by Lenny: | Reply

Couldn't put it better - diagnosis is not the same as disease, something doctors and patients alike tend to forget to their disadvantage.

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How can you possibly not ge... (Below threshold)

December 17, 2012 12:49 PM | Posted by Gledwood: | Reply

How can you possibly not get paid for not needing to slap a diagnosis on someone? Surely a patient or their insurer pays for the dr's time and expertise, not the final diagnosis! Well if it really is as you say, America is even more crackers as a country than I thought before. I mean that healthcare system (or lack of it) you have is positively mediaeval :-(

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So, is it true that a psych... (Below threshold)

December 17, 2012 3:24 PM | Posted by Sid: | Reply

So, is it true that a psychiatrist would not be paid by insurancefor the evaluation if he does not find anything wrong with the patient, i.e no diagnosis? I mean, just the initial evaluation session?

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A dragon eating it's own ta... (Below threshold)

December 17, 2012 8:42 PM | Posted, in reply to RJL's comment, by Anonymous: | Reply

A dragon eating it's own tail that's historically used as a symbol of an unending cycle referenced in the middle of a sentence about an endless circle of medical clusterfuckage doesn't make sense to you?

I think the smart people googled it (or knew it already) and then knew exactly why it was used...

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If it's a "diagnosis", one ... (Below threshold)

December 27, 2012 12:56 PM | Posted by Bryan: | Reply

If it's a "diagnosis", one can attach drugs to it. If it's a "diagnosis" parents can absolve themselves of responsibility for yet another aspect of parenting. Everybody is happy (or at least too drugged to remember what it's like to actually be unhappy). I wish it were actually a conspiracy behind this, at least then it would make some kind of sick sense. Instead, we are blundering into yet another expression of collective human stupidity. As a culture, we seek to avoid responsibility. It is better to be a victim than to be in error. Victims are automatically virtuous (unless they partake of the one remaining sin--tobacco use--we must have something left for people to call "Satan", after all).

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i hear what you're saying a... (Below threshold)

January 15, 2013 9:06 AM | Posted by Shamsi Ruhe: | Reply

i hear what you're saying and i think it's valuable because i hadn't looked at it that way.

in terms of my own life, i've watched people turn their children into monsters and then get them diagnosed so they could medicate them into torpor and get special services for them at school and complain about it to everyone for more attention.

that does make me sad.
i also know someone who has a truly autistic son and am mentally ill myself and am grateful services exist because there is the occasional person who actually needs them.

when kids are in horrible situations like you describe, i'm not sure medication helps with roaches or abuse.

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Diagnosis is a means of con... (Below threshold)

January 15, 2013 12:32 PM | Posted by Bryan: | Reply

Diagnosis is a means of control. A "naughty" child still has moral agency and can thus, in theory, be eventually trusted to make its own decisions independently of parental control, employer control, government control, etc. A child with a "disorder" has had some level of moral agency involuntarily removed. It is now to some part forever dependent upon some other entity.

Running around and saying everyone is a "sinner" doesn't work very well for controlling people. It lasts for a while, but the sinners eventually figure out that, if we're all sinners, then none of us have the inherent right to lord it over anyone else.

Classifying people with "disorders", on the other hand, works. Anything can legitimately be done to people with "disorders"--even acts in violation of the Geneva Conventions--so long as those "treatments" are given some kind of rubber stamp by an appropriate medical official.

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Not so bad.<a href="http://... (Below threshold)

January 16, 2013 12:10 PM | Posted by Sam Oneal: | Reply

Not so bad...

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can this behviour be linked... (Below threshold)

February 15, 2013 10:50 AM | Posted by Emetophobia Treatment: | Reply

can this behviour be linked to phobic / obsessive bahaviour

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Thanks for your researched ... (Below threshold)

March 4, 2013 8:09 AM | Posted by glasgow airport taxis: | Reply

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My neighbor was 285 pounds,... (Below threshold)

March 9, 2013 4:31 AM | Posted by markerpeter: | Reply

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Detoxification of the body ... (Below threshold)

March 9, 2013 4:32 AM | Posted by markerpeter: | Reply

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Temper tantrums have underl... (Below threshold)

March 15, 2013 2:18 AM | Posted by Kelly Williams: | Reply

Temper tantrums have underlying causes. It may be brought about by a dormant sickness or something may have happened to the affected person psychologically or emotionally for this to occur.

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The "proper diet" as you ca... (Below threshold)

July 12, 2013 8:32 AM | Posted, in reply to markerpeter's comment, by MAlice: | Reply

The "proper diet" as you call it is a cliche. There is no actual research to prove it. If you want to live healthy for as long as possible, you need to keep try and reduce the levels of oxidative stress, learn to control your appetite and exercise regularly. Regarding nutrition, detox would mean limiting red meat and eliminating processed food form your diet. But, not everyone can afford to do that. Healthy and nutritious food has become so expensive, it is mainly a feast for the upper class. BUT, there is way around it, and it's called intermittent fasting. Having sluggish metabolism (genetics) even though I exercise regularly, and a sweet tooth, I struggled to control my appetite. I've been fasting twice a week since January and not only gone down from 30%-18% body fat, I actually eat when I need to, I have a lot of energy throughout the day and don't get mardy, when due to busy schedule I need to skip a meal. In animal studies this regime prevented them from developing age related diseases such as diabetes, heart disease and alzheimers, compared to control groups - proper diet. If you look at practising buddhists or yoga instructors, you will see exactly the effects of intermittent fasting - they seem lean, full of energy, their skin is glowing and healthy, time impacts them very little. Animal studies confirm that reducing calorie intake by 25% does have a great impact on health. If you want more info,go on fast-diet.co.uk. Please note, this is NOT a diet in a pop-cultural sense, but a long term investment in your health.
I think modern society has a wrong relationship with food, and partially, this is due to companies putting a lot of salt and sugar into products, the portion sizes in fast food restaurants (Americans, you beat any other country lol) leading to increase of appetite for nutritiously poor foods. If you think you have a problem controlling your appetite due to binge eating or simply want to improve your health and live a healthy life, fasting is a way to go.

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A healthy perspective is tr... (Below threshold)

September 22, 2013 10:45 PM | Posted by miriam bronkhorst: | Reply

A healthy perspective is truly important and it improves your life. Thank you for making us rethink this issue.

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dont understand why people ... (Below threshold)

December 6, 2013 7:03 AM | Posted, in reply to RJL's comment, by Anonymous: | Reply

dont understand why people didnt like this. I totally am going to right now.

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This is so funny and the di... (Below threshold)

February 16, 2014 2:13 AM | Posted by Sarah: | Reply

This is so funny and the discussion going on here is even funnier :)

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This is an excerpt from m... (Below threshold)

August 2, 2014 8:40 PM | Posted by Tru Harlow: | Reply

This is an excerpt from my blog
Www.curementalillness.wordpress.com
I am trying to spread awareness of the truth of dissociation.

The most effective methods of causing dissociation are believed to be those that consist of inflicting moderate amounts of pain over extended periods of time. Emotional trauma is also important.
The horrific experiences victims are exposed to result in their mind utilizing a defense mechanism called DISSOCIATION. Dissociation consists of the victims consciousness detaching from their bodies (or so it seems to them). The result is a euphoric floating feeling. DID caused by Beta programming only serves as the most drastic form of abuse which stimulates dissociation.

We can utilize this knowledge to show how any survivor of any level/type of abuse can be considered as having any measure of DID it is my proposal that many trauma survivors have on some level dissociation of self. Therapists must gain awareness of this fact and utilize techniques which can facilitate a unity between all senses of self. Self awareness can surmount once we confront past events which we are scared of. And the personal, familial and social ramifications of this endeavor may be great. But in order to create unity within one self, we must be self aware. We must gain confidence. We must be free.

I will be tracking my findings of my readings of Carl Jung, unconscious memories, dissociation, dissonance and therapeutic accounts on this blog. Please open your mind to new thoughts on treatment and the reality of DID in the majority of patients.

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