DSM ?

Recently we needed to move our Morningside Library to make room for two new staff.   On the plus side it was a good move because the material really needed to be gone through and purged of the out- of-date periodicals, books, and other material.  In the end we purged the Library down from three bookcases (16 shelves total) stuffed with obsolete items down to about 6 full shelves.  We decided we really didn’t need Safety Committee minutes and material from 13 years ago!  In the process we ran across old copies of the DSM (Diagnostic and Statistical Manual of Mental Disorders).  The DSM II and III, that were collecting dust on the bookshelf, were first published in 1968 and 1980 respectively.  We also have a couple of the fourth revised edition which came out in 2000.  So obviously this publication, put out by American Psychiatric Association, isn’t revised often.  Every 10-20 years seems like a long time to develop a new manual especially in this changing world of ours.  The next edition is scheduled to be published in May 2013 and, of course, it isn’t without some controversy.  I guess I would be up in arms if I thought they got it wrong and you had to wait a decade to see it corrected!

According to Michelle Diament writing for DisabilityScoop in an article entitled Psychiatrists Approve New DSM, Asperger’s Dropped she writes:

“However, officials did confirm that one of the most controversial proposals calling for autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified to be folded under the label “autism spectrum disorder” did get approved. The organization said the change will “help more accurately and consistently diagnose children with autism.”

Talk of the autism change has sparked concern that some currently diagnosed with the disorder may no longer qualify under the new criteria, but experts on the psychiatric association panel responsible for recommending the updates insist this will not be the case.

There is also concern about dropping the Bereavement Exclusion from Depression from this diagnostic publication.

In Jim Sabin’s Blog Health Care Organizational Ethics - For discussion and debate about the ethics of health care organizations and the wider health system he writes “In January I criticized the American Psychiatric Association (APA) for planning to drop the "bereavement exclusion" from the definition of major depressive disorder in the forthcoming new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Under the exclusion, the diagnosis of depression is not made if:

The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.”

In a recent issue of the New England Journal of Medicine, Richard Friedman, a distinguished psychiatrist at Cornell who writes excellent New York Times columns for general readers, added to the voices criticizing the APA for medicalizing normal grief.  Here's the essence of Friedman's argument:

‘In removing the so-called bereavement exclusion, the DSM-5 would encourage clinicians to diagnose major depression in persons with normal bereavement after only 2 weeks of mild depressive symptoms. Unfortunately, the effect of this proposed change would be to medicalize normal grief and erroneously label healthy people with a psychiatric diagnosis. And it will no doubt be a boon to the pharmaceutical industry, because it will encourage unnecessary treatment with antidepressants and antipsychotics, both of which are increasingly used to treat depression and anxiety...The medical profession should normalize, not medicalize, grief.’

Despite criticism the DSM-V working group has not changed its plan to eliminate the bereavement exclusion, but it has added a footnote that at least acknowledges the challenge of distinguishing normal grief from the illness of depression.”

Well there you have it – two major controversies over the new publication.  They did come up with a new classification though 'Video Game Addiction'.  Hum I wonder what psychotropic drug will be developed to counteract this (I am sure the pharmaceutical manufacturers are wringing their hands in glee over this).   I am not sure how my son will react when I tell him he has a certified mental illness but not to worry because Pfizer will soon have a pill to help!

Is the UN vote a mystery….or a sign of the end of times?

Maybe the Mayans have it correct after all – the end of the world is fast approaching. I don’t think it is some hieroglyphic date on a wheel but truly a world run amok where craziness abounds. A clear example of this apocalyptic sign is that the US Senate rejected the UN Convention on the Rights of Persons with Disabilities! I believe I am sufficiently calmed down now after last week’s monumentally embarrassing decision by the US Senate to reject signing-on to this Convention which promotes the rights of individuals with disabilities worldwide. I guess we in the United States aren’t concerned about the tenets of the Convention to “promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms of persons with disabilities, and to promote respect for their inherent dignity”. I don’t want to get into the politics of certain parties nor do I want to examine the illogical conclusion of those who think signing on to this Convention will affect each home in the United States or diminish us as a sovereign nation.

I would like to talk about how we, as world citizens, support the tenets or Guiding Principles of this Convention.

Here are the eight guiding principles that underlie the Convention and each one of its specific articles:

1. Respect for the inherent dignity, individual autonomy including the freedom to make one's own choices, and independence of persons

2. Non-discrimination

3. Full and effective participation and inclusion in society

4. Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity

5. Equality of opportunity

6. Accessibility

7. Equality between men and women

8. Respect for the evolving capacities of children with disabilities and respect for the right of children with disabilities to preserve their identities

In this Blog I have mentioned that I don’t have a frame of reference personally other than by association to experience the pain of discrimination. I can’t imagine being on the receiving end of being disrespected and not given the option of making choices that effect my life. But unfortunately you don’t need to travel far to see persons with disabilities disrespected and being told what to do and when to do it. It breaks my heart to see an adult with disabilities arrive at our office and a care giver who accompanies the person talk down to, or make a decision for, the person with a disability. I think Bob Dole was disrespected as a person with a disability by the actions of the Senate. I wonder what he was thinking during the vote.

Unfortunately, even in our own great society supposedly the “gold standard” for recognition of the rights of person with disabilities, people with disabilities aren’t afforded full participation and inclusion in our society. Washington State has a great track record of supporting persons with disabilities. After all we were the first state to pass legislation offering free and appropriate education for individuals with disabilities in our public schools with the passage of HB 90 decades ago. We have done a great job of supporting individuals in our schools but have not done a great job of transitioning students with disabilities into adulthood by supporting them through living and vocational services. Apparently the notion that someone might need some support to live and work independently isn’t in our lexicon of inclusion. If we are the “gold standard” then the value isn’t worth much.

Equality and accessibility sound good, very noble ideologies to attain. We may think that the in the United States this is our expectation and the reality that persons with disabilities experience. Sadly this generally isn’t the case. Oh sure strides have been made in the elimination of some architectural barriers but overall we have a long way to go. I still experience “unusual” workarounds when I accompany someone in a wheelchair going out to eat. But attitudinal and artificial barriers exist and those are the hardest to make accessible to ensure everyone is treated equally. Unfortunately I have too many examples to fit in this blog. Often, when I attend a lunch with someone in a wheelchair, the wait staff looks to me for guidance. When I look at the person with a disability to acknowledge them and demonstrate they are present and can make decisions the wait staff looks at me after the person with a disability has spoken as if I am the “adult” and the person with a disability is a child.

I know people have ideologies. Unfortunately they often can only see things their way, as if their way of thinking is the only right way. When I talk to persons with disabilities who heard the Senate testimony they felt devalued plain and simple. People couldn’t even get the correct vocabulary – so it leads one to believe they don’t care.

Ultimately our country can hope for a future it wants to achieve. If those in power don’t want individuals to be successful, included, equal and feel valued then we can create that by doing nothing and not signing on to this Convention. But if we want a society where everyone is valued, included, successful, accepted, respected then we can also do this but it will take all of us wanting this for all people – disabilities or not.

If you want to see the work of the United Nations go to: http://www.un.org/disabilities/index.asp