December 31st, 2010

dsm-5 coverage

Apparently, a few days ago there was some coverage on NPR of Allen Francis' unhappiness with the next revision of the DSM. I looked at the article online; I was tremendously underwhelmed.

There are a lot of issues associated with the idea of "mental illness". A lot. But let's ignore those for the moment.

First, there's way better coverage of what Francis' (and other psychiatrists) are complaining about here:

http://www.wired.com/magazine/2010/12/ff_dsmv/all/1

Second: If we ignore the ridiculous dream of coming up with a definitive dividing line between normal and "ill", and focus instead on what purpose is served by expanding the number of people who can go to a professional, collect a diagnosis and then access resources as a result, it's possible to get some clarity on whether DSM-5 is going to make things better or worse. Every time we collectively decide that more people have a mental illness, the debates surrounding the efficacy of drug and other treatments increases in visibility. The result is generally better treatment that costs less per person, and maybe costs slightly more collectively while being used by a much larger number of people. A diagnosis of mental illness is essentially a measurement of not-fitting-societal-norms. When you get enough people who don't fit in a particular way and stop being willing to lie and say they do, and it's no longer possible to flog the general population into enforcing the norm, the category of illness goes away, and that particular mode of being is treated as being within the range of normal. Those are two mechanisms we've seen in action repeatedly already that mitigate any possible negative effects of diagnosing more and more people.

However loopy #5 is when it comes out, it is actually quite unlikely to be worse than what we have now. The progession, nicely depicted in the table in the wired article, illustrates just how much improvement we've seen. When (over in the NPR coverage) Francis complains about kids who never would have been diagnosed before getting $50K worth of educational services -- as if that's a bad thing -- I can't help but notice that the man is old and his value system reflects it. If we get too many kids who need expensive services for autism disorders, we will figure out a more effective way to provide services that costs less. It's what we do. For that matter, it's what my _town_ does. And we like the results.

Finally, it's always a little sad to see the mental health crowd treating the physical health crowd as somehow "more real". I spend a lot of time making fun of the physical health crowd for defining disease in numerical and statistical ways and then prescribing treatments that will only show beneficial effects over populations, while the risks associated with treatment are born by each individual. The mental health crowd has a long ways to go before they can get nearly as wacky as the physical health crowd.

about those hearing tests

T. finally had his last week. A. had hers earlier and got a normal, within the limits of what they are able to test at this developmental level. T. got through the full battery (I was not there) and I gather there was one part of one test he wasn't paying enough attention to, but when they redid it, he did as well on it as everything else. His hearing is utterly normal.

Hopefully this will put a stop to all those helpful suggestions we kept receiving, along the lines of, hey, maybe his speech problems are because of hearing problems.

The night before the test, I had wanted to charge one of the iPads. I waited until T. was out of the room to plug it in, because for some reason he doesn't like them being charged (I'm sure This Too Shall Pass and be replaced with something else mysterious and somewhat aggravating). Unfortunately, he heard the really very quiet sound the iPad makes to indicate that it has started charging. He came running back into the room and proceeded to unplug both iPads from their chargers.

Yeah. I _knew_ there wasn't a hearing problem. You can stand with your head above and behind him and spell out teletubbies toast and he'll type it into youtube. This would not work if there was a hearing problem. It just wouldn't.

fantastic article about alzheimer's treatment at Beatitudes

http://www.nytimes.com/2011/01/01/health/01care.html

There was a point when I was reading a bunch about nursing homes and reading The New Old Age blog over at the NYT, but there wasn't anything going on in my life connected to it. It was just another random research project: gee, I don't know anything about this and I should. That blog had the most amazing comments threads (probably still does) that were completely wonderful to read.

Anyway. Nothing I read in the course of that project was even half as cool as what is described here. I am _so_ hoping this becomes the standard of care. This is _exactly_ the right way to think about caregiving, at any age, but especially when there is such an impact on cognition. What makes the person happy? Because that is what it is all about.