posted
I was reading the thread on Special Education in America and it got me wondering how helpful being labeled with a behovioral disorder is.
I'm currently a second year psych student and I've always been very curious about why people rush to label things. To me, behavioral disorders are a list of personality traits that tend to be maladaptive. Yet, almost everyone has maladaptive qualities. Admittedly some people have more problems than others, but does this mean they have an "illness" or a "disorder"? Or are they just a normal person who has unique characteristics that they need to learn to adapt to the world in a productive manner?
What I'm wondering is how helpful do people find these labels?
There are obvious minuses and pluses of such labels. For example, some people will feel like something is wrong with them (such a suprise when you're calling it an illness) and feel inferior, and thus feel that they have lower standards to meet. I believe that this is incredibly dangerous, because people stop themselves at the limmits of the label and it becomes very difficult for them to pass it.
Yet others might feel that the label allows them to better understand themselves. They feel more able to regulate their behavior and improve themselves with this new knowledge.
How do you personally feel? It's currently very popular in the psychiactric world to hand out labels, so I'm sure that most people here either have had a label or know someone who has. So from your experience, do you believe that a label creates more good than harm or the other way around?
:-) Laura :-)
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posted
Good use of a diagnosis is not as a label, but as a grouping for a set of symptoms to allow for better, more targeted treatment.
Behavioral disorders aren't describing personality traits--they're describing symptoms. Were they personality traits, they'd be personality disorders, which are inherently more pervasive and much harder to treat.
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posted
Mackillian- You say that, "Good use of a diagnosis is not as a label, but as a grouping for a set of symptoms to allow for better, more targeted treatment. " Yet, several studies explain that psychological problems are inevitably treated as labels. D.L. Rosenhan wrote about this in, "On Being Sane in Insane Places". Essentially, he had several sane volunteers get admitted into a mental hospital by saying only that they heard voices and listing no other symptoms. Not only did no one even guess that they might not be insane, but every action (even writing in a journal for the experiment) was interpreted as manifestation of an illness. The paper explained that once they had recieved the label, they were seen in that light and treated accordingly.
While good diagnosis will uncover a label that truly applies to a person's case, it is still a label. If a person is diagnosed with bipolar disorder. Then they are supposed to always be bipolar and will be treated that way even if the situation later changes and makes the title false. (If symptoms change, they are "in remission") Whether intended to or not, these diagnosis become labels.
Furthermore, I was gouping personality disorders and behavioral disorders together because both are treated as illnesses based upon people's maladaptive behaviors and thoughts (things that can potentially afflict all people)
As to the rest of your response, you answer the question in a way that suggests it is helpful to treat psychological problems as distinct illnesses, which I guess is really my question. Why do you feel this way? Why do you feel that this is better than never calling a person ill per se, but instead teaching them that they have difficulty doing certain things (just as everybody has difficulty doing some things), and teaching them how to adapt to these certain things? This method avoids any stigma from a label as well as any sort of crutch. Do you feel that treating it like a specific illness adds something to the treatment process?
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posted
Fallow- "why the rush to label? security?" I don't understand what you're asking? Are you asking why I think that there is a rush to label? What are you asking about security?
:-) Laura :-)
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Security for whom? For the psychologist? Certainly having a patient labeled with a disorder that can never be fully overcome helps to ensure job security. (j/k)
How do you think that it creates security for the patient?
As for why I think that they jump to labels, I think it might be because it makes the person easier to evaluate. If they can fit a person into a cookie-cutter mold of a problem, then they can fix you with cookie-cutter solutions. Dealing with every individual's problems and giving them unique solutions for their life takes a great deal of time and effort. In fact, to a degree you have start grouping things into patterns at some point if you don't want to dedicate all of your effort to the individual's every thought and action. But I think that the desire to group into very generic labels can be very seductive.
Additionally, I think the psychological community has been striving for more credence as being a science. Many still see it as a very spiritual and unscientific endeavor. Specific disorder titles give it a more solid foundation in science. My only problem with this is that when trying to universally treat the subjective (a person's view of life) with objective (scientific) tools, one has remember the importance of the subjective. People with a certain disorder do not all see the world in the same way and thus different tools need to be used. While grouping similar views with similar tools can be useful, I think that labels tend to lead people to cookie cutter methods.
But those two reasons are really my only guesses, I'm sure there are more reasons. What does anyone else think?
posted
The way it was explained to me, diangostic labels are more for insurance purposes than anything else. Those insurance companies need to be able to have some way to tell whether they should pay for services or not and how much.
Most of the mental health care professionals I've seen would diagnose someone differently if they were self-pay vs. insured or on Medicaid. Self-pays get a "disthymia" label, or the least serious diagnosis so as not to permanently stigmatize the client and to keep it off their permanent record. Insureds and Medicaid patients might get closer to the "real" diagnosis, or just enough to ensure a constant flow of money to the service.
I myself have been labeled with disthymia, mild depression, moderate depression, severe depression, generalized anxiety disorder, psychosis, post-traumatic stress disorder, dissociative identity disorder, dissociative disorder not otherwise specified, obsessive complusive disorder, various eating disorders, and maybe more I have forgotten.
To me, the label is nearly meaningless. There is no perfect pigeonhole for me. As long as my shrink and therapist get paid, I don't care.
I can think of two justifications for introducing terms to refer to a group of symptoms. The first which i will ignore, is to get your name attached to something that people will repeat
The second and i think typically utilized reason for associating a term with anything, is for ease of classification. What should be made absolutely clear then is the distinction between whatever is being classified, and the terminology being used to classify it. The world is however the world will be, the words we use to describe the world allow us describe certain features and distinctions we would like to observe and make others aware of. What's also important to realize is that a particular choice of a set of distnictions may obscure other distinctions or other vitally important information about the way things are.
Thus, good nominclature will be informative, and not imply, or assume things that are not true. But again, to reiterate, the names used for something, are simply an empty theoretical stand-in for whatever it's supposed to represent.
The problem in a lot of fields that aspire to being scientific (and this is true of broad swaths of psychology) is that the so-called scientists don't understand how the things that they're talking about represent the world, and the limits of such descriptions. Thus you end up with this discrepency between how the 'scientist' believes the world is, having taking the terminology at face value, with the actual state of the world.
Good contientus theorists of any stripe should be extremely well aware of what jargon and other terminology are supposed to mean, and what they represent.
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posted
On a slightly different note, addictions are actually the object i find most frustrating in terms of their classification.
Alcoholism and addiction to tobacco are treated by people in one of two ways(well theres a third as well, but much more obscure).
The first is that an addiction is the fault of the addicted, and their lack of will power. I think this is flat out wrong. There's alot of evidence that addiction is a perminant neurological change. Once you're addicted to something, you're stuck that way. There's nothing that will-power is going to do for you.
The second is that addiction is a disease. This perhaps is truer, since it appears that likelihood of addiction to certain substances does appear to be hereditary, and once again, it's certainly chronic, given the perminant neurological change. The problem with this is twofold. First, the perception of how diseases are to be handled in modern societies is that one is to take medication and one will get better. That is patently not the case with chronic diseases, such as say lyme disease. But people don't view addiction as a chronic disease, and believe that once they've 'kicked the habit' they're fine. Hence why smokers who've quit for 10-15 years, who end up some place where someone hands them a cigerette, are surprsied to find they're just as addicted as they were before they quit.
The other problem, which i find the most difficult to grapple with conceptually is how can you call a genetic disorder a disease? You are in large part what your genes specify. It's absurd to claim there is some sort of ideal that all humans are supposed to adhere to genetically speaking in light of how evolution works. We are what we are. Thus, it seems strange to call predispositions toward addiction as a disease, because it's simply how a particular individual functions genetically speaking.
This leads to some sort of third view. My own personal one is that predisposition to addiction is simply a parameter within which people have to function. In this way, people certainly aren't created equal (again, axiom of evolution). But it shouuld get the correct results. It's the same as knowing your limitations in any other domain. If you can't do a pull up, it seems like a bad idea to attempt climbing a mountain.
Thus the idiotic claim that it's an issue of will power is side-stepped, but there is a matter of personal responsibility. People should know what they're capable of, and what they're not capable of.
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Before we address labels in psychology, it is helpful to remember how young psychology is as a profession.
At best, we have been around 150 years. True, there has been philosophy, but there has never been a systematic study of human behavior and disorders and how to go about changing behavior.
Think about it, how old is math? how old is law? How old is physiology, biology, and physics? We have had centauries upon centuries to refine, study, explore, change, and develop a precise language for hard science. And yet debates rage on...
Psychology is new. We understand as much about psychology now as the Egyptians understood what a Red Dwarf was in their study of astronomy. Add to that psychology is a liberal science with no "hard rules," we always need to remember how little we know. Our current understanding is subject to change with new social conditions and research.
Take the book Cybil. After it was published, there was a sharp spike in multiple personality disorder diagnoses. Before that damn book, most MPD involved 2-4 personalities, after that book, the average jumped to 12-15. Now we have retracted MPD and replaced it with Disassociative disorders.
My point, labels change, are misunderstood, and are probably not very accurate. HOWEVER....we need a common language to identify patterns of behavior. We need labels to communicate with other professionals, clients, the public, and insurance agencies.
We need labels to identify the debates we need to work through. Without the label of ADD, there would be no debate about over medication of childhood ADD, whether we should medicate, and whether we are over diagnosing and stamping out creativity.
Without the labels, we could not progress psychology as a valid study of human behavior. We could not treat disorders to the extent of our understanding. Labels are inaccurate and may be wrong, but necessary. Just remember, the our understanding of the labels found in the DSMV-4R will change.
As long as you don't think the labels we use are unchangeable, and we remember the person behind the label, and we actively participate in the debates and study that will advance psychology, you and your patients should be fine.
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posted
Both mental health and physical health sciences have components of social construction. The impact is more significant in the mental health arena, though. What is "pathological" is at least partly defined through social norms - homosexuality was once defined as a pathology in an earlier version of the DSM, for example.
Here's an interesting example in the variability of diagnoses over time. It has to deal with the relative waning and waxing of mental retardation and learning disability labels over time. Why? It's all related to the to the renorming of IQ tests every 15-20 years.
quote:Since average scores on particular IQ tests rise a few points every 3 or 4 years, those tests become obsolete after a couple of decades. In order to reset the average score to 100, harder IQ tests are devised every 15 to 20 years.
Trickier tests have no practical impact on people who score within the normal IQ range of 90 to 110. But so-called renormed IQ tests create a yo-yo effect in the number of mental retardation placements in U.S. schools, a new study finds.
Rates of mental retardation among children appear to bottom out near the end of a particular test's run, followed by a sharp rebound with the introduction of a tougher test, say Tomoe Kanaya, a graduate student at Cornell University, and her colleagues. Scores on the new test then increase over time, pulling many children from just below to just above the score of 70, which stands as the rough cutoff for mental retardation. That trend continues until the next test revision comes along.
I mentioned the physical health sciences are also vulnerable to social factors. Last year, the FDA helped the pharmaceutical industry redefine being short as something that can now be "treated" with growth hormone injections. This is something the pharmaceutical industry has wanted since they started being able to make the stuff by the barrelful. Being short wasn't seen as something to be treated before there was a marketable "treatment."
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The former are the labels the world will give, with no attempt at solving them other than, likely, punishment, frustration and anger.
The latter are conditions that have known treatments (be they medicinal or no), that can be more easily understood and overcome.
If someone knows they have a data-processing problems, they can be given ways of adapting. Color coding things, for instance, or being taught methods of organization. More graphic ways of organizing things, rather than textual. These are skills they can use in the real world after school is complete - rather than failing out, or eeking by, after having years of being labeled "dumb" or "slow" by other students.
Identifying trouble spots is increcibly important in young children - moreso than in adults. A child who is given strategies to succeed *despite* their obstacles grows up entirely differently than one who is grouped with everyone else and must fight twice as hard to make it.
By the teenage years, it's harder to change a student's habits (or an adult's), and the social problems that have arisen from their obstacles (be they perceptual, emotional, or cognitive in origin) are more deeply seated and harder to change.
So, with regards to labels, they will happen no matter what. Hopefully we can identify a student early enough so that the labels don't become "idiot" "jerk" or "psycho" through lack of treatment (or simple ignorance of the problem).
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posted
Pod--genetics also cause other diseases that are not The Person, such as PKU, Huntingtons, fragile X, downs...so I'd argue about it being "the person" because we'd get into the argument about formation of personality and the trick question of consciousness and soul.
alexa--DSM-IV-TR
laura--no, I see your point and even concede it about current majority use of labels. My point was that it isn't the GOOD use of diagnoses. However, used properly, they can provide a good treatment methodology. As for that methodology, there are tried and true methods of treating certain diagnoses that work for many people. Cognitive-behavioral therapy for ADHD to change behaviors but medicating at the same time with a stimulant to help control impulsivity, distractability, memory. Desensitization for treating phobias. CBT for major depression. Psychoeducation teaching coping mechanisms and the ability to recognize symptoms of anxiety.
As for your bipolar example. Mine is personal. A little over a year ago I was diagnosed with Bipolar II. I had a bad psychiatrist and therapist at first...the psychiatrist attempted to label me as a person with borderline personality disorder without attempting to treat her first diagnosis. Anyway, a medication was found to treat my depression and was quite successful. However, hypomanic symptoms continued to prevail, even through attempting many medications to control it. My doctors kept their minds open to what my diagnosis could be and said they might be missing something. Nearing last October, they were convinced they were. So we took another look at my family history and my symptoms from childhood onward. Did a screener for ADHD. Finally, did a trial of Ritalin.
It worked. They managed to look outside my "label" despite diagnosis. They changed it to major depression and ADHD and we continue to treat it successfully with medication.
At my place of work, a community mental health agency, we DO change diagnoses in order to treat better. Symptoms are not set in concrete in order to prove a diagnosis. We commonly do rule outs...watching symptoms that could be one diagnosis or another until we can be more sure of what we're seeing. We study differential diagnosis and take it quite seriously. Ethically, changing a diagnosis depending on income is wrong.
Here's the deal about psychological illness. For the most part, people don't WANT to be ill. They're willing to attempt to change using talk therapy and CBT interventions. But it reaches a point where a person is doing everything they can possibly do...but still have pervasive symptoms that significantly interfere with daily functioning. So we continue to research neuropsychology to try and find causes for these symptoms...these illnesses. Schizophrenics have overly large front ventricles. What impact does this have on the forebrain? Are the enlarged ventricles part of maladaptive behavior...can these manifestations of brain dysfunction be changed through willpower?
No. Not really. The same goes with other illnesses, such as ADHD, bipolar disorder, major depression, generalized anxiety, etc. Telling people who have these illnesses that they're merely maladaptive behaviors that can be changed, having them change their cognition and behaviors surrounding them, and STILL not having it work, is detrimental.
Pod has a good point...that at a point, neurologically, the brain does manifest these diagnoses AS an illness. Major depression is often low serotonin levels. ADHD, low dopamine and norepinephrine levels. Dopamine is responsible for alertness and focus in the forebrain. Low levels of dopamine--less alertness and focus. The locus coerleus (the major source of norepinephrine in the brain) releases a burst of norepinephrine when a significant event occurs. This aids in the formation of memory. If you have low norepinephrine to being with, that burst won't be enough to form a solid memory--so you forget things a lot, another symptom of ADHD. Sure, you can use lists, reminders, and such things to behaviorally control this symptoms, but using a medication that increases norepineprhine (amphetamines, strattera) can lead to better memory in the first place. Coupled with the C-B changes this can lead to a better quality of life.
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posted
And Cow is absolutely right about maladaptive behaviors starting in childhood. These behaviors in coping with the illness are as adaptive as these people can do without help. Some are more successful than others.
If a child is abused, they develop hypervigilance in order to avoid being abused. This is often not successful. But these behaviors can lead to changed brain chemistry in order to sustain the ability to be vigilant. How? Vigilance requires activation of the limbic system in order to provide the defensive "fight or flight" response. This means more dopamine, more norepinephrine and so less sleep, more tiredness through acculmulated adenosine (a neurotransmitter that shuts down the alert forebrain by being take up by those neurons and signaling a shutdown in dopamine production for awhile). Constant stimulation of the limbic systems means the brain gets used to these neurotransmitter levels. Because sensitization to sensory stimuli can't occur for risk of a nonresponse, the brain remains unsensitized to stimuli--jumpy, anxious, etc. These behaviors can be changed once the cause is identified--but the brain has already moved to a different chemistry, and since it took awhile to make it how it is in the first place, it'll take awhile to change it back. A significant source of help can be through psychiatric medication.
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quote: Here's the deal about psychological illness. For the most part, people don't WANT to be ill. They're willing to attempt to change using talk therapy and CBT interventions. But it reaches a point where a person is doing everything they can possibly do...but still have pervasive symptoms that significantly interfere with daily functioning. So we continue to research neuropsychology to try and find causes for these symptoms...these illnesses. Schizophrenics have overly large front ventricles. What impact does this have on the forebrain? Are the enlarged ventricles part of maladaptive behavior...can these manifestations of brain dysfunction be changed through willpower?
Hey, Mack, watch what you say about enlarged ventricles!
Seriously, though, there is a lot of guesswork going on here. Take schizophrenia. I was doing some research awhile ago, and contrary to the popular image of the condition, it's not necessarily progressive. In fact, there is kind of a "rule of thirds," derived in terms of progression. That is, about a third stayed at the same level in the condition, a third got worse, and a final third had their symptoms disappear over time. Just how medication impacts the overall outcome is unclear.
The source of the info is not some radical, btw, but E. Fuller Torrey, who is a pretty mainstream psychiatrist who wants more people to get medication, but that it is a complicated picture.
quote:Medications have certainly influenced the course of schizophrenia, but it is too early to say exactly how much. At a minimum the drugs have decreased the number relapses and rehospitalizations; whether this prevents some of the brain damage from occurring is not known It is most likely that the drugs have 'improved' the functioning of the 'improved' middle one-third, allowing more of them to live independently and hold jobs. This is no small accomplishment. It is less clear whether the drugs have altered the course of the recovered one-third, who would probably have recovered with or without drugs although drugs may have well speeded the process. Nor is it yet certain whether drugs decrease the size of the group who are unimproved on follow-up, although it is likely that they do so, at least modestly. And in addition to probably moving some patients from the unimproved to the improved category, the drugs significantly improve functioning in some unimproved patients.
posted
"Good use of a diagnosis is not as a label, but as a grouping for a set of symptoms to allow for better, more targeted treatment."
In public education, and with insurance companies, you need a diagnosis in order to get services. That is one reason labels are important, at least to the person who needs treatment.
To me, it is the same as having a doctor's diagnosis that I have a disease. It gives information to people helping.
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posted
In all this discussion, I hope we don't forget what sndrake said:
quote:What is "pathological" is at least partly defined through social norms - homosexuality was once defined as a pathology in an earlier version of the DSM, for example.
We must remember the definitions of what constitutes mental illness is changing.
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I'd never thought about the importance of labels for insurance. That makes a lot of sense and it sounds like your therapist(s) have used them essentially for that purpose only. very interesting, thanks for the new perspective!
Pod-
"My own personal one is that predisposition to addiction is simply a parameter within which people have to function... It's the same as knowing your limitations in any other domain. If you can't do a pull up, it seems like a bad idea to attempt climbing a mountain.
Thus the idiotic claim that it's an issue of will power is side-stepped, but there is a matter of personal responsibility. People should know what they're capable of, and what they're not capable of."
BRAVO!!! I agree with this completely! But I think that labels tend to lead people to think that they are capable of less. It's one thing to tell a person that they have difficulty socializing and that they are more prone to become sad, upset, and moody than other people. Thus, they need to be aware of this and learn how to adapt their behavior so that they can function well. I think that this does involve a great deal of will power, but that doesn't mean that will power will suddenly change who they are and make it easier for them to function. It simply means that through will power, you CAN function. I don't see how this differs greatly from telling somebody that they are clinically depressed (or most other "disorders") and then treating them with treatments for the depressed, except that the first is more tailored to the individual (and probably more effective) and it also avoids the stigma from a label.
Alexa-
"As long as you don't think the labels we use are unchangeable, and we remember the person behind the label, and we actively participate in the debates and study that will advance psychology, you and your patients should be fine."
I agree that this is the utopian view of using labels, but I still believe that there's a dangerous stigma that comes from being labeled, and that treatment is very possible without labels.
Stalling Cow-
"So, with regards to labels, they will happen no matter what"
Why do the labels have to be "jerk", etc. Why not, "has difficulty concentrating"? Admittedly, it's more of a description then a label, but isn't that exactly what we should strive for? Once we identify the specific problems, we can treat them. A label like ADD lists many problems that will most likely not apply to many people diagnosed with ADD.
Mackillian-
"It worked. They managed to look outside my "label" despite diagnosis. They changed it to major depression and ADHD and we continue to treat it successfully with medication."
I guess all that I'm saying is I see the label as a middle-step that is unneccesary and causes additional problems. If they had looked only at your symptoms and treated those, do you think that they would not have discovered your ADHD symptoms and prescribed medicine to treat those symptoms? I'm not against medication (although I believe that it is used far too much currently and that in most cases, it should be used for the short term only), but other than the insurance reasons already mentioned, why is the label helpful? Ritalin doesn't cure ADD, it helps raise low dopamine levels, which helps alerness and focus. If ritalin was necessary, couldn't it be prescribed to help alerness and focus (which it is) rather than ADD? Since you work in the field, you clearly have a perspective based on experience. I'm wondering, in your experience, how have these labels been helpful with your patients? Do you think that there are any negatives to them? Or do the benefits outweigh the negatives? What are the benefits?
:-) Laura :-)
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quote:"So, with regards to labels, they will happen no matter what"
Why do the labels have to be "jerk", etc. Why not, "has difficulty concentrating"? Admittedly, it's more of a description then a label, but isn't that exactly what we should strive for? Once we identify the specific problems, we can treat them. A label like ADD lists many problems that will most likely not apply to many people diagnosed with ADD.
I think you misunderstood what I was getting at. Lemme try again.
Labels happen. It is human to label. What color is that? It's green. What color is *that*? It's green. Is it a different green? Sure, but we like to label and classify, as a species. It's in our nature.
Now, let's look at behavior.
Take a student who acts out, doesn't listen, talks back to the teacher, and gets frustrated and angry when asked to do simple tasks.
That student will be labeled.
Sure, he'll be labeled differently by different groups. Students who are trying to focus despite this student's outbursts will think of the disruptive student as stupid, or foolish, or rude, or a waste of their time. Parents of other students may label the student as a problem, a distraction, someone who needs to be controlled, someone who needs to be removed, etc. Teachers will likely try to classify the behaviors specifically, trying to see trends and patterns that might be indicative of a greater problem.
Now, say these trends *are* noticed in the early grades. The teacher may make a recommendation like the following: "The student has difficulty concentrating, despite my best efforts to keep him focused. He acts out both physically and verbally when asked to concentrate for extended periods of time. He has difficulty staying in his seat. He has difficulty copying work from the board. The student may have an attention deficit problem."
Now, with that, the CST can test the student, and see if they can further narrow the problem. Specifically, they'll look to see if it resembles problems *other* students have - mainly to see what worked with those other students.
See where this is going?
Each student cannot be handled wholly as an individual. You can't reinvent the wheel every time you approach a problem. "Child X exhibits a, b, and c. Child Y exhibits a, b, and c. Child X's problem was solved with this method, perhaps Child Y's will be too. Let's try."
If you get enough similarities, with recurring symptoms that can be treated similarly, you can make a classification.
This is basic scientific method.
If the first fifteen objects you drop fall to the ground, there's no reason to expect the sixteenth will fly off to the side. You make a hypothesis based on observed data, you test the hypothesis, and you evaluate the results. If the object *does* fly off to the side, you form a new hypothesis.
Granted, every child is different, but not so vastly different as you suppose. Certain methods of accommodating one child will work with another who shows similar symptoms. There is such great symptom overlap that certain methods of treatment can be developed to treat that *type* of problem.
You don't treat a headwound by pumping the patient's stomach, for instance. You know that, regardless of the type of headwound, certain responses are warranted, and others aren't. Though, from the way you seem to be talking, you'd hesitate to even label the head wound.
To be effective, you MUST categorize at some level, then refine your classifications and your focus.
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posted
Stalling, Very good point about being able to treat certain students with the same "prescription." For example, an ADHD child will do well with less transition times. So will a child with a nonverbal learning disablility, etc. However, I still think it is important to give a diagnosis, so you can know what helps. There are specific ways to teach math to someone with a nonverbal learning disability that would not be necessary for a student with ADD. Liz
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quote:However, I still think it is important to give a diagnosis, so you can know what helps. There are specific ways to teach math to someone with a nonverbal learning disability that would not be necessary for a student with ADD.
Elizabeth,
we've touched on this before. Some of what is prescribed for people with nonverbal learning disability is helpful - but also fairly commonsense. For example, realizing that people with that label process language and print with greater ease than mathematics, it's obvious that using as much verbal explanation as possible in teaching math aids learning.
But you don't really need a label for that, do you? Careful observation on the part of a teacher who is aware that different students have varying preferred modes of learning will catch on to that.
And, yeah, I know that most teachers have their hands full with overcrowded classrooms or don't have the skill to do that, so the label serves as a shorthand explanation.
But with the NLD label, it doesn't stop there. There's some pretty speculative stuff about the core difficulty in mastering social skills, about the ability to handle abstraction, and a few other things that may be more hurtful than helpful.
I speak as someone who fits easily within the nonverbal learning disability spectrum. I also have a background in teaching, working with a variety of people with developmental disabilties, and some experience with educational assessment.
There's a whole generation of kids with hydrocephalus that was assaulted by professional literature that warned teachers not to be "fooled" by the high verbal ability of children with the condition. They (we) weren't as smart as we seemed. I was lucky enough to be old enough to get through school before this literature started getting published and taken seriously by psychologists and special ed teachers.
I think we should always be asking ourselves if we're helping as much as we think we are or if there are areas in which we're doing damage, in spite of our best intentions.
History suggests it's a good question to be asking.
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quote:labels tend to lead people to think that they are capable of less
Or they give people a reason for why they aren't performing how they'd like to and find previously established methods to be capable of more than they were.
quote: It's one thing to tell a person that they have difficulty socializing and that they are more prone to become sad, upset, and moody than other people. Thus, they need to be aware of this and learn how to adapt their behavior so that they can function well.
Of course. In most instances of people who are mentally ill, they KNOW this. They are perfectly aware, unless delusional, that they more prone to being sad, upset, irritable, euphoric, etc (mood dysregulation if you want the clinical term) and it is significantly negatively impacting their daily functioning. Diagnosis of any mental illness requires that it DOES have that significant impact. If it doesn't, it would be well within the bounds of normal human emotional/behavioral functioning. Becoming aware of symptoms and behaviors and impact on socialization and capability are an integral part of treatment. Cognitive behavioral therapy is actually just that.
quote:through will power, you CAN function
Of course you can. It doesn't mean you'll necessarily function well. I'm betting that most folks who go for treatment of a major mental illness are functioning, through willpower, to the best of their ability. I'd recommend that you read An Unquiet Mind by Kay Redfield Jamison. This book is a memoir of the author's lifelong struggle with bipolar I disorder, coupled with being a practicing psychologist. This book clearly illustrates the difference between willpower and symptomology.
quote:I don't see how this differs greatly from telling somebody that they are clinically depressed (or most other "disorders") and then treating them with treatments for the depressed, except that the first is more tailored to the individual (and probably more effective) and it also avoids the stigma from a label.
Stigma is a societal problem that needs to be acted upon--NAMI (National Alliance for the Mentally Ill) is doing a great job of it. However, removing diagnostic "labels" isn't going to make stigma go away. Instead, other labels will be applied, ranging from crazy to touched in the head to effing psycho. Treatments actually ARE tailored to the individual--one technique isn't necessarily going to work for another, same with medication. However, diagnosis gives you a place to start. Differential diagnosis is very important here. Symptoms of many conditions overlap--many clinicians are looking more at a spectrum that completely separate categories--and treatment still differs for each one. Take bipolar and ADHD.
ADHD is often comorbid with depression. Figuring out if a person has bipolar disorder or depression with ADHD is difficult at first. ADHD symptoms look much like hypomania--impulsivity, irritability, distractability, starting projects and not completing them, talking quickly, moving quicky--and vice versa. Without taking a good look at pattern of symptoms, pervasiveness of symptoms and severity of symptoms, you could end up treating the wrong disorder and it could have disatrous effects. Giving a bipolar patient exhibiting hypomanic symptoms a stimulant could lend to a trigger of a full blown manic episode--which can be quite dangerous and often results in hospitalization for their own safety. Treating a person with ADHD for hypomanic symptoms using an atypical antipsychotic can have some awful effects as well. Quality of life will certainly go down.
Tagging someone with a diagnosis also allows for treatment by other health professionals. If someone has ADHD with depression and the depression becomes dysregulated and said person becomes suicidal but has no "label" as you say, the doctor this patient presents to will have to look at all the symptoms and treat them accordingly. But as I've mentioned, symptoms can overlap or mimic and have quite different neuropsychological causes. So if this person with depression and ADHD is treated for just the depression and not the ADHD, the recovering suicidal patient will be much more dangerous to himself as they're more impulsive, more distracted, more disorganized, more irritable, and are driven to action as they rise from the low depths of depression (a dangerous time for anyone who is depressed, not just with folks with ADHD).
But if this patient presents in the ER and IS diagnosed with depression and ADHD and is suicidal, it can be treated properly.
Sometimes, it's almost like a diagnosis is shorthand for a collection of symptoms. Actually, it IS shorthand for a collection of symptoms.
Other medical diagnoses act in much the same way. Little insulin or no insulin production leading to glucose in the bloodstream but unable to be transported into cells leading to starving cells, weight loss, concentrated urine and high blood sugar--diabetes.
quote:there's a dangerous stigma that comes from being labeled, and that treatment is very possible without labels.
Yes, there IS a stigma of labels of mental illness. But there's a stigma anyway, as there was before any DSM diagnoses were created. The notion of stigma in society needs to be taken head-on...not just wiping away labels as if that would take care of the problem. And yes, treatment without diagnoses is certainly possible...but it wouldn't be GOOD treatment.
quote:ADD lists many problems that will most likely not apply to many people diagnosed with ADD.
Actually:
quote:Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder
A. Either (1) or (2): (1) inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (b) often has difficulty sustaining attention in tasks or play activities (c) often does not seem to listen when spoken to directly (d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (e) often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities
(2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity (a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situations in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often "on the go" or often acts as if "driven by a motor" (f) often talks excessively
Impulsivity (g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g., butts into conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality Disorder).
Basically, in order to be properly diagnosed, you have have a majority of the symptoms.
quote:If they had looked only at your symptoms and treated those, do you think that they would not have discovered your ADHD symptoms and prescribed medicine to treat those symptoms?
You'd have to ask them. Actually, they WERE looking at only "my" symptoms and attempting to treat them as they presented. It was through continued differing psychopharmacological interventions that they figured out what my real diagnosis is. This is in addition to a few years of cognitive-behavioral therapy, btw, where I picked up a textbook of coping mechanism that I used to their full extent.
quote:I'm not against medication (although I believe that it is used far too much currently and that in most cases, it should be used for the short term only),
I disagree. Short term use in some instances is fully valid--such as a brief depressive episode. However, stopping mood stabilizers for people with bipolar disorder, or stopping antipsychotics for people with schizophrenia is unethical. Medication is not the be-all, end-all. Throwing pills at people isn't going to solve the problem. They aren't a cure-all. However, for a valid illness, they do work. In some cases, they work very well.
quote:Ritalin doesn't cure ADD, it helps raise low dopamine levels, which helps alerness and focus
No, ritalin doesn't cure ADHD. There isn't a "cure". However, it does what you say. Ritalin (methylphenidate) blocks adenosine receptors in the forebrain, allowing more dopamine to remain in the forebrain to keep awake and alert. Methylphenidate also blocks the reuptake of dopamine, allowing more dopamine to attach to postsynaptic receptors.
Methylphenidate will actually increase alertness and focus for those who don't have ADHD, but only to a point. Caffeine works for this as well, most through its blocking of adenosine receptors in the forebrain--making your brain stay awake in that the adenosine can't attach to presynaptic receptors and inhibit the production of dopamine in order to produce sleepiness.
As for labels being helpful in my field...if I'm looking at a case file and read "has difficulty paying attention"...it could be many things.
Depression Anxiety ADHD Hypomania PTSD ...many different things. Each of these can have different causes, different treatments, etc. Working with a child with attentional difficulties due to ADHD is quite different than working with a child with attentional difficulties from depression. When I see the diagnosis, I get a general sense of what symptoms this kid has and where it's impacting his life.
Posts: 14745 | Registered: Dec 1999
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posted
"But you don't really need a label for that, do you? Careful observation on the part of a teacher who is aware that different students have varying preferred modes of learning will catch on to that."
Sndrake, You see, I disagree here. I think I do need to know what helps or hurts a student. If no one tells me that a student is ODD, and I get into a head-on collision with him, shame on me for not approaching him differently.
If a child is sexually reactive, and I walk up on him from the wrong side, I have frightened him or made him uncomfortable unnecessarily.
I am using examples, but the more I know about the students in my class, the better. To be honest, I rarely look at files until I have made my own observations. If I find that a child is particularly obstinate about certain parts of the curriculum, I might take a peek and see if there is something I should know that can help.
It is all about helping, for me, not about making any kind of judgment, and then boxing a student into a category.
Honest. I am here to help, not hurt.
Posts: 10890 | Registered: May 2003
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Elizabeth, that wasn't my point. The professionals prescribing what I feel is misinformed on nonverbal learning disability are well-intentioned. The professionals who would have red-flagged my early speech and reading as "cause for concern" were well-intentioned too.
So I wasn't trying to say that you or other professionals were mean-spirited or anything like that. That wasn't my point all. I'm sorry you took it that way.
I just don't see where the label itself gives you all that information. When you look at the "diagnosis" (note scare quotes) of autism or aspergers, you pick from behavioral checklists that have literally thousands of potential combinations. Some profoundly different individuals are found within the spectrum. And I'm not talking about their individuality, I'm talking about their differences in terms of "maladaptive behaviors." So it still comes down to knowing the student.
posted
With regards to asperger's, I had two such students this year, that displayed remarkably differently.
The first is very meticulous. He is almost obsessive compulsive about cleanliness, would not touch chalk with his bare hands, brushed off his desk and chair before he sat down, and got agitated by invisible particles he felt were on him. He is very erudite, to the point of speaking on a level many of the students don't understand, and generally tries to approach situations with cold, hard logic (and gets confused when that doesn't work).
The second (before he transferred to another school) was almost the total opposite. He never showered, nor combed his hair, nor changed his clothes. He hated change in all its forms, and rebelled constantly against any and all authority. He was obsessive about folding and crumpling paper, or tearing the corners. He was often irritable, snide and rude, and took great pleasure in the misfortune of others.
Two totally opposite cases, but there were similarities. They each had certain routines they had to follow, especially when stressed (cleanliness, paper folding). They both had trouble understanding social motives and fitting into social groups.
On top of this, the first was medicated, while the second was not. While I can't base the efficacy of drug therapy based on these two cases, the night and day difference between the medicated child and the nonmedicated one gave me pause.
If I was not told at the start of the year about these two students, I would have had a lot of trouble - and likely would have stepped on many a landmine with their obsessiveness. Thankfully, they had been diagnosed when they were young and a great deal of data had been collected on each. I was informed by the label and was educated on aspergers by my special ed department.
If such a diagnosis (or label, if you will) had not been made, new teachers would have had to start from scratch with each of these students, or would have had to hunt down their teachers from previous schools.
Posts: 106 | Registered: Apr 2004
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posted
"So it still comes down to knowing the student."
Yes, yes, yes!! It should ALWAYS come down to that. That is why I usually refuse to look at folders for at least a few months. If I see a repeated issue, that is when I will go and look, to see if I am missing a possible strategy.
Also, and this really burns my biscuits, teachers rarely communicate from grade to grade. If I am able to tell Stalling Cow, "Look, don't waste your time teaching times tables, just give him a multiplication chart," I have saved weeks, maybe months, of him having to figure things out. Communication is key, and it happens at an alarmingly pathetic rate.
So, it is a balance between getting to know a student on your own(a fresh start is SO important for some kids), asking other teachers about what works and what doesn't, and then reading about the particular challenge the student faces.
Posts: 10890 | Registered: May 2003
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posted
I think knowing I have OCD and PMDD are helpful for me. I found the discussion of hypervigilance interesting as well. But in general, I try not to use them to excuse my behavior. I don't know if they help professionals- I'm not qualified to say.
Posts: 11017 | Registered: Apr 2003
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posted
laura, You start out with an interesting premise and then almost immediately abandon it. It is important to acknowledge that labeling of psychological disorders has some negative consequences. I'm on board with that. We should examine these consequences and see what can be done about amerliorating them.
However, it seems to me, that while you start out by separating the analysis of possible goods and bads of labeling, you then jump right into "labeling does no good". using the negative consequences as justification. This just isn't accurate or logical.
Almost every intervention has both good and bad effects. In order to evaluate whether or not it should be used, you have to consider the entire post-intervention state as compared to pre-intervention one. For example, anti-psychotic drugs can have some very severe side-effects. On the other hand, without the drugs, most psychotics have no chance at a life even approaching normalcy. The benefit of treating the psychotic symptoms must be weighed against the cost of the side-effects.
This must be the case with using labels in general. I'll be the first (well, ok, more like the fifth) to admit that this labeling leads to some problems. However, as I think other people have done a good job of showing, it also is a necessary part of methodological treatment of disorders across a population. Without some sort of agreement of what things mean and references to past cases, each individual case starts with a more or less blank slate and each symptom must be considered as a separate thing, instead of part of a whole syndrome.
Also, I think that the problems that come with labeling disorders are easier to deal with than those of giving up standardized diagnosis and treatment. A lot of these things are unintentional consequences that spring up because people are misusing or misunderstanding what these labels are supposed to be used for. People have brought up the homosexuality being considered intrinsically a disorder. This was a case of psychologists overstepping their role and has acknowledged as such. The DSM IV has changed to reflect this idea and is structurally very different from the previous versions. It would be very difficult to make that same mistake with this version. As we learn about the bad effects of the way we look at things, we're able to modify our approaches to prevent or at least lessen these effects. I don't think the same is generally true for the effects of abandoning the systematic approach to treating mental disorders.
People seem to easily fall into the polarization trap where something is either all good or all bad. I think that this does a disservice to the realities of the situation. There are very few things that are this black and white.
posted
Well, since the original post referenced Special Education, I will address why I feel labeling is needed in that area.
My middle child has dyslexia. However, we didn't know he had dyslexia until he was in 5th grade. It took extensive testing (outside of school) to figure out why he was struggling so much. He was obviously bright, but had tremendous problems with written assignments, etc.
Up until the time of testing/labeling, many of his teachers just would tell him he needed to "try harder". Some were good teachers that would try different things, (such as oral testing), etc. -- but most teachers would NOT do anything -- just keep trying to make him do it over and over (expecting different results from the same actions is the definition of stupidity, isn't it?)
With the "label" the school takes a whole different look at it -- accomodations are made, different ways of handling assignments are considered. A child's strengths are emphasized.
The trouble was, with years of dyslexia before we discovered the problem, he already had several years of "failures" at school that really shaped how he felt about himself and how others felt about him. I wish the "label" had come earlier, so we could have had him succeeding and recognizing his strengths, instead of his failures, much earlier.
The "label," as stated by others, also is necessary then when you need to do testing or therapy work for a learning disability, because insurance may play a factor in that. That's the first question many places ask if you are taking a child for help/therapy, etc -- "what is the diagnosis?" (or label).
Like Farmgirl's middle child, I had an undiagnosed learning disability. I was in 9th grade when I tested as being learning disbaled in math/spatial areas. I got the one on one help I needed, and graduated with honors. My diagnoses was helpful.
However, I think we are going overboard on childhood labeling. I am a "spirited kids" group, and it seems more than half the parents are searching for a "diagnosis" for their spirited child. Most of them are homeschooling so they are not even taking advantage of scholl district therapies. I think some parents are just easier saying "My child has a disorder" than "Hey, this is my kid's personality, the good and the bad". I DO see diagnoses used to explain and/or medicate away personality traits, and it disturbs me. Yes, depression, schizophrenia, etc are true disorders that need treatment, including medication. But I don't see sensitivity to the seams in one's socks, or being stubborn, as a disorder. (I have been told that my 7 year old son would likely be diagnosed with "Oppositional Defiant Disorder" if he were in school.I have a lot of problems with the whole diagnosis- I can post the definition, if anyone is interested. ) So I think lables can help, if used to gain appropriate therapy, but I also think they can be used by parents and schools to avoid responsibility.
Posts: 2711 | Registered: Mar 2004
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posted
"It took extensive testing (outside of school)"
Eeek, this is the key, in many cases. Schools don't NECESSARILY test very well. So much depends on the tester, and also the test. A good, frugal Special Ed. director can choose tests that will screen out many things. I know the kids in my class have something more specific than "needs adaptive tchnology. I KNOW that if they were tested by an outside agency, some sort of expressive language disorder would come out. Something.
So, for the parents out there, push, push, push.
Posts: 10890 | Registered: May 2003
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Your ADD/ADHD example is exactly what I was referring to when I said that a behavioral disorder will amost always include more symptoms than a person suffers from. You listed 22 symptoms when a patient only needs to meet 10 to have one of the disorders. That's 12 extra symptoms. When a person is diagnosed with the disorder, it becomes easier to interpret their actions to better fit the disorder. Perhaps before the diagnosis, it was never really noticed that that a person "often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace", but afterward the occasional unturned in assignment or delayed chore will be far more likely to be seen throught this light and cause additional problems for the person.
Mr. Squicky-
I realize that I have jumped on to the anti-labeling train in this thread, and that's not what I meant to do. A lot of the responses at the beginning of the thread were very pro-labeling, and so I uberly defended the other position. While I obviously believe that labeling should be utilized less, I also believe that it has a proper place.
Stalling Cow-
You make a very good point that there's no need to reinvent the wheel. I suppose, if people saw these labels as simply being a normal and natural part of a person, like being tall or short or bossy or quiet, than I would have less problems with them. But many people, including some on this thread, espouse treating it like an illness that can not be dealt with except with extreme methods. While more extreme disorders call for more extreme treaments (for example many cases of both schitzaphrenia and bipolar improve only with long term medication), people with lesser disorders, in my opinion, can be seriously harmed by seeing their behavior as a serious illness. For example, I was diagnosed with ADD as a child. While it's certainly true that I'm sometimes restless, I don't believe that this is an illness and it certainly doesn't interfere with my funtioning any more than any other personality trait. I think that my case was quite likely part of the fad and that most responsible psychologists would never have labeled me (seeing as my entire family was diagnosed with ADD within a half hour at the doctor's office). Another example of quick to label doctors: when my cousing was two years old, he was diagnosed with schitzaphrenia after an afternoon in a hospital. I just don't believe that such a diagnosis can be made on a two year old after a couple of hourse. Yet, this sort of over-diagnosis on the part of doctors is incredibly common. I suppose this is my greatest problem with labels, and so long as labels are seen as accurate descriptions of illnesses I don't think this will change.
Farmgirl-
I completely agree that learning disabilities such as dylexia ought to be labeled. However, people don't describe dyslexia as an illness. It's simply an aspect of a person that they need to learn how to cope with. This differs from the way that many see behavioral disorders. I think that labeling these disorders in the way that they currently are, leads to unhealthy results.
Pooka-
Thanks for your input. I think that your response shows that there is a right place for labels. I suppose labels seem most appropriate when they are found helpful and not as an excuse for behavior. But I really don't know how to tell when that would be. :-( any ideas?
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