DSM wars: the battle to define mental illness

Originally published at: https://boingboing.net/2011/01/26/dsm-wars-the-battle.html

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I remain irked that the DSM-5 invalidated Asperger syndrome as a diagnosis. Although, since there is still an ICD-10 code for Asperger, F84.5, I can simply play dumb and use it anyway. So :stuck_out_tongue: thhhhhrrrrrbbbbtttt!!


Out of curiosity; do you dislike it because “autism spectrum disorder”(at least without further subcoding) is vastly more vague to no obvious benefit; because preferred treatments differ significantly between the two so lumping them together is actively unhelpful; or for some other reason?

I ask because, as a layman(albeit a layman with a pressing personal stake in the matter) my (perhaps jaundiced) impression of the controversy was that it included a lot of faff and people drawing distinctions-without-differences about conditions they were equally unmatched to deal with regardless of what classification scheme they chose; which I suspect is, if not necessarily unfair across the board; at least missing some illuminating background information from the medical side.

My objection lies in lumping highly functional individuals with much much less functional ones is often counterproductive. When I tell a parent that their child has autism, they often shut down and I cannot get any further with them. Asperger syndrome is far less threatening and is widely understood in the lay population. Considering that DSM systems are, at their heart, checklists that are designed for researchers categorizing people for their studies, and not really so much intended for clinical use, it is understandable that clinicians struggle in making it work for our patients. I know that I am tilting at windmills here, so in my practice I will continue to do what I feel is in the best interest of my patients and let the checklist makers and bean counters do their thing without me as much as possible.


I feel almost exactly the opposite. I feel like there was a rash of people self-diagnosing Asperger’s to the point that there was a kind of nerd-chic to it. ASD doesn’t have any of that attractiveness and that means that merely awkward people aren’t crowding out people who need and deserve additional help from society. Saying this as the parent of a spectrum kid, it was much harder to get taken seriously by the schools when he was identified as Asperger’s rather than ASD.

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True enough, and there still are. Schools are a PITA when it comes to getting help for kids on the spectrum. My youngest is an Aspie, along with some other non-conforming characteristics, and when we were trying to get him into school, our choices were an autistic classroom, where he would spend all day with kids who were a terrible mish-mash of extremely low functioning kids wearing helmets and rocking with kids who could almost make it in a regular classroom, needing only a little help, or no help at all. Luckily, there was a private school where the kindergarten teacher had training in dealing with kids like ours, and they did very well. Currently in college and doing quite well, all things considered. Psychological diagnoses being what they are, there will always be self-diagnosing people, and a fair number of them are not wrong. My experience, both as a parent and as a pediatrician, is that being able to give a more accurate picture of what they are up against is helpful. It really makes no therapeutic difference, just an easier, less frightening conversation with already stressed out parents.


@orenwolf… time is leaking again!

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