24 Dec 2007, 7:37 pm
Well, couple of things here: one is that I have a memory of reading that the schizophrenic gene was located at the same place as one for autistic propensity.
The other thing is that I did read the DSM IV about SPD after my assessment, But I have the classic literalness, the hand flappy thing under stress, huge difficulty in communicating about feelings even though I am very verbal, special interests and oh-so-many other of the usual characteristics.
I think that the SPD confusion is a superficial one - but easy for dork psychs to fall into a trap of their own making. 
25 Dec 2007, 9:49 am
25 Dec 2007, 11:28 am
lupin wrote:
Well, couple of things here: one is that I have a memory of reading that the schizophrenic gene was located at the same place as one for autistic propensity.
There can't be a single "the schizophrenic gene". The condition known as schizophrenia exists only because a few people decided that a lot of traits that have nothing in common with each other at all, are all caused by the same thing. And that same cause was probably discredited a long time ago. It's probably also true that some autistic(Kanner/Asperger) people (not just autistic(Bleuler) people), which means something very different) were part of the many people observed who gave rise to this "condition", from what I've read.
(By autistic(Kanner/Asperger) I mean autistic in the way that Kanner and Asperger used the word, as well as autistic in ways that have been used since then till the modern definitions. By autistic(Bleuler) I mean autistic in the way Bleuler used the word, which had to do with a certain aspect of loss of contact with reality. What I mean is that there were people autistic in the way that Kanner and Asperger used the word who were doubtless included in those observed for the original definition of schizophrenia, and that I don't just mean this because Bleuler used the word differently or anything, I mean it because of reading some of the case studies and for that matter some of the supposed traits of schizophrenia as they were observed, rather than as they were hypothesized about.)
At any rate, there's no possible way that schizophrenia can be all one thing, or even that useful a term, that they could find a single gene to it. With autism there's almost always genuine underlying similarities despite some differences in appearance (and even autism seems to be polygenetic in origin). With schizophrenia there's not even that, to the point where I don't even think that autism was "misdiagnosed" as schizophrenia, I think schizophrenia itself is a catch-all category that already included most autistic people in the criteria, that as soon as autism was identified people started pulling people out of that category (among others) and into the category of autism.
So I'm not surprised that some sorts of schizophrenia and some sorts of autism would have elements along the same gene. Most autistic people could on an outward level seem to meet the criteria for undifferentiated, simple, catatonic, disorganized, or even sometimes paranoid (depending on how certain things were interpreted, anyway) schizophrenia, that just happened to start in childhood, if it weren't for the fact that autistic people aren't allowed to be diagnosed with it. It's not that the supposedly core traits of autism and the supposedly core traits of schizophrenia are supposed to be similar or anything, it's that the outward appearances used to diagnose "schizophrenia" are frequently present in autistic people, even if few people have singled all of them out for the diagnostic criteria in autism.
The criteria for schizophrenia in general are two or more of these traits each present for most of a one-month period, and all in all it has to have lasted at least six months :
* delusions (supposed to be false beliefs that are impervious to logic, but often diagnosed -- even though this is not supposed to happen -- when the person's cultural beliefs clash with the psychiatrist's and the psychiatrist can't talk the person out of them)
My main "delusion" when I was diagnosed was related to folktales that I read and took literally and incorporated into a fantasy world, and I also appeared to have delusions when I tried desperately to substitute dreams for reality and reality for dreams thinking maybe I'd forget the difference someday). This is apparently very common for autistic adolescents to do (according to Tony Attwood), apparently especially female ones.
* hallucinations (particularly auditory hallucinations like hearing voices that aren't there is the most often one diagnosed)
Autistic people often answer "yes" to the question "Do you hear voices?" in taking the question literally, and also some of us have such good hearing that we get considered to be "hearing voices" when we are really hearing people talking a few rooms away or something. Also we might talk to ourselves a lot and get interpreted as hallucinating, or we might respond to things other people don't notice also. If we have OCD, our obsessive thoughts can seem hallucinatory to psychiatrists if they are strong enough.
Also, I have oddly enough seen what normally are called "sensory issues" get reinterpreted as some kind of hallucination, for reasons I don't understand other than that psychiatrists generally see what they expect to see and not what they don't.
* disorganized speech (e.g., frequent derailment or incoherence)
* grossly disorganized or catatonic behavior
* negative symptoms, i.e., affective flattening, alogia, or avolition
I'll get into those three when going through the different subtypes.
They also say, "Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other." What they mean by bizarre delusions is the delusion is impossible somehow (according, again, to the psychiatrist's worldview) instead of just highly improbable.
Now getting into the subtypes.
Catatonic schizophrenia's main traits (and these are supposedly labeled "psychotic" traits even though catatonia was originally a neurological term for a movement disorder and continues to be present in a wide variety of movement disorders) are (and for criteria to be met, there have to be at least two of the following plus the general criteria for schizophrenia have to be met). I'll paste the actual criteria in bold and then descriptions in parentheses that I found on another web page.
* motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor. (People may be completely immobile and appear to be unaware of their surroundings (catatonic stupor). They may exhibit a partial immobility known as "waxy flexibility." For example, if a person's arm is moved into a certain position, it will stay there for some time.)
That one isn't common in autism, although some autistic people appear to show more and more signs of it starting in puberty or early adulthood. (I'm such a person.)
* excessive motor activity (that is apparently purposeless and not influenced by external stimuli) (These motor activities — such as frenzied pacing, turning around in circles, flailing arms or making loud noises — appear to have no purpose or motivating factors. This kind of behavior is called catatonic excitement.)
This is relatively common to happen in short bursts in autistic people, but when autistic people do it it's more often considered a form of hyperactivity or being worked up about something.
* extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism (Without any apparent motivation, people with catatonic schizophrenia may not respond to instruction, may resist any attempt to be moved or may not speak at all. This kind of behavior is called negativism.)
Resistance to instructions without apparent intention to, and mutism, are both often reported in autistic people. Maintaining postures is less often reported but again in a minority of people (that I happen to belong to) it happens.
* peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures) (People may assume inappropriate or unusual postures...)
I'm not sure how they interpret it as "voluntary", but this is somewhat common in autistic people.
* stereotyped movements, prominent mannerisms, or prominent grimacing (...grimace for long periods or adopt unusual mannerisms. They may also exhibit habits known as stereotyped behaviors, such as repeating words, obsessively following a routine or always arranging objects exactly the same way.)
These things are of course very common in autistic people and part of the diagnostic criteria.
* echolalia or echopraxia (A person may repeatedly say a word just spoken by someone else (echolalia) or repeatedly copy a gesture or movement made by someone else (echopraxia).)
Autistic people are well-known for echolalia but are also often echopraxic (and both are common in Tourette's, too, which might be common in autism).
At any rate, most autistic people have at least two of those traits. There have even been some people who believe autism is early-onset catatonia. While I think that's going a little far, they have a point in terms of how we act functionally, and in terms of the fact that people who think so, are talking not just about movement but also thought, emotion, and other things. Someone has summarized some of those ideas in this article (that's a link). I attended a conference in which one of the researchers described admitted that he had a diagnosis of both an autism-related condition and early-onset atypical parkinson's. Also, I talked really late into the night with one of the other researchers and one of the things she said was that in this research one of the things they did was dig back into the earliest descriptions of catatonia from when it was considered a neurological movement disorder, not psychosis. But they call these movement differences because aspects of it might not be bad in the terms they put this all in.
Anyway, in addition to catatonia, all you need is something like flat affect (lack of facial expression) or "inappropriate" affect (having supposedly "wrong" expressions, like laughing while frightened) in order to meet the criteria for schizophrenia, if you exclude the "don't diagnose this in autistic people" criterion. And many autistic people have one or both of those.
The thing I got the extended descriptions of the criteria from noted that people with this form often have trouble (because of their other problems) with:
* Difficulty taking medications as directed
* Risk of injury to self or others during severe catatonic stupor or excitement
* Generally unhealthy lifestyle
* Poor management of other medical conditions
* Risk of dehydration, malnutrition, exhaustion and extremely high fever
* Neglect of personal hygiene
(I would also note, as someone who's had this happen, that in addition to exhaustion, if you have asthma, it's a really bad thing to run around uncontrollably without being able to stop yourself because you start wheezing and having trouble breathing.)
Then there's Disorganized Type.
A type of Schizophrenia in which the following criteria are met:
1. All of the following are prominent:
* disorganized speech (When people experience disorganized thinking, they can't form logical and coherent thoughts. This impairment is also evident in people's speech patterns. They may not be able to stay on track, their speech may "wander aimlessly" through a topic, or they may jump from one unrelated idea to another. These speech patterns are severe enough to render the speech virtually unintelligible. If the thinking is severely disorganized, a person may speak in ungrammatical phrases or use made-up words. These same patterns are evident in written communication.)
I should note at this point that what one calls "disorganized speech", another calls "disorganized thinking". This is a major assumption to make but it's made all the time in psychiatry. Here are some examples of "formal thought disorder" (all of which are based on speech) that are given in the Wikipedia article on it, and which I have actually seen people held to by psychiatrists.
Quote:
- Pressure of speech - An increase in the amount of spontaneous speech compared to what is considered customary.
- Distractible speech - During mid speech, the subject is changed in response to a stimulus. e.g. "Then I left San Francisco and moved to... where did you get that tie?"
- Tangentiality - Replying to questions in an oblique, tangential or irrelevant manner. e.g:
Q: "What city are you from?"
A: "Well, that's a hard question. I'm from Iowa. I really don't know where my relatives came from, so I don't know if I'm Irish or French."
- Derailment/Loose Association (Knight's move thinking) - Ideas slip off the track on to another which is obliquely related or unrelated. e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California."
- Incoherence (word salad) - Speech that is unintelligible due to the fact that, though the individual words are real words, the manner in which they are strung together results in incoherent gibberish, e.g. the question "Why do people believe in God?" elicits a response like "Because he makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons. Hello, beautiful."
- Illogicality - Conclusions are reached that do not follow logically (non sequiturs or faulty inductive inferences). e.g. "Do you think this will fit in that box?" draws a reply like "Well duh; it's brown, isn’t it?"
- Clanging - Sounds rather than meaningful relationships appear to govern words. e.g. "I'm not trying to make noise. I'm trying to make sense. If you can't make sense out of nonsense, well, have fun."
- Neologisms - New word formations. e.g. "I got so angry I picked up a dish and threw it at the geshinker."
- Word approximations - Old words used in a new and unconventional way. e.g. "His boss was a seeover."
- Circumstantiality - Speech that is very delayed at reaching its goal. Excessive long windedness. e.g. "What is your name?" "Well, sometimes when people ask me that I have to think about whether or not I will answer because some people think it's an odd name even though I don’t really because my mom gave it to me and I think my dad helped but it's as good a name as any in my opinion but yeah it's Tom."
- Loss of goal - Failure to show a chain of thought to a natural conclusion. e.g. "Why does my computer keep crashing?", "Well, you live in a stucco house, so the pair of scissors needs to be in another drawer."
- Perseveration - Persistent repetition of words or ideas. e.g. "I'll think I'll put on my hat, my hat, my hat, my hat, my hat..."
- Echolalia - Echoing of one's or other people's speech that may only be commited once, or may be continuous in repetition e.g. "What would you like for dinner?", "That's a good question. That's a good question. That's a good question. That's a good question."
- Blocking - Interruption of train of speech before completion. e.g. "Am I early?", "No, you're just about on-"
- Stilted speech - Speech excessively stilted and formal. e.g. "The attorney comported himself indecorously."
- Self-reference - Patient repeatedly and inappropriately refers back to self. e.g. "What's the time?", "It's 7 o'clock. That's my problem."
- Phonemic paraphasia - Mispronunciation; syllables out of sequence. e.g. "I slipped on the lice broke my arm."
- Semantic paraphasia - Substitution of inappropriate word. e.g. "I slipped on the coat, on the ice I mean, and broke my book."
- Distractible speech - During mid speech, the subject is changed in response to a stimulus. e.g. "Then I left San Francisco and moved to... where did you get that tie?"
- Tangentiality - Replying to questions in an oblique, tangential or irrelevant manner. e.g:
Q: "What city are you from?"
A: "Well, that's a hard question. I'm from Iowa. I really don't know where my relatives came from, so I don't know if I'm Irish or French."
- Derailment/Loose Association (Knight's move thinking) - Ideas slip off the track on to another which is obliquely related or unrelated. e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California."
- Incoherence (word salad) - Speech that is unintelligible due to the fact that, though the individual words are real words, the manner in which they are strung together results in incoherent gibberish, e.g. the question "Why do people believe in God?" elicits a response like "Because he makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons. Hello, beautiful."
- Illogicality - Conclusions are reached that do not follow logically (non sequiturs or faulty inductive inferences). e.g. "Do you think this will fit in that box?" draws a reply like "Well duh; it's brown, isn’t it?"
- Clanging - Sounds rather than meaningful relationships appear to govern words. e.g. "I'm not trying to make noise. I'm trying to make sense. If you can't make sense out of nonsense, well, have fun."
- Neologisms - New word formations. e.g. "I got so angry I picked up a dish and threw it at the geshinker."
- Word approximations - Old words used in a new and unconventional way. e.g. "His boss was a seeover."
- Circumstantiality - Speech that is very delayed at reaching its goal. Excessive long windedness. e.g. "What is your name?" "Well, sometimes when people ask me that I have to think about whether or not I will answer because some people think it's an odd name even though I don’t really because my mom gave it to me and I think my dad helped but it's as good a name as any in my opinion but yeah it's Tom."
- Loss of goal - Failure to show a chain of thought to a natural conclusion. e.g. "Why does my computer keep crashing?", "Well, you live in a stucco house, so the pair of scissors needs to be in another drawer."
- Perseveration - Persistent repetition of words or ideas. e.g. "I'll think I'll put on my hat, my hat, my hat, my hat, my hat..."
- Echolalia - Echoing of one's or other people's speech that may only be commited once, or may be continuous in repetition e.g. "What would you like for dinner?", "That's a good question. That's a good question. That's a good question. That's a good question."
- Blocking - Interruption of train of speech before completion. e.g. "Am I early?", "No, you're just about on-"
- Stilted speech - Speech excessively stilted and formal. e.g. "The attorney comported himself indecorously."
- Self-reference - Patient repeatedly and inappropriately refers back to self. e.g. "What's the time?", "It's 7 o'clock. That's my problem."
- Phonemic paraphasia - Mispronunciation; syllables out of sequence. e.g. "I slipped on the lice broke my arm."
- Semantic paraphasia - Substitution of inappropriate word. e.g. "I slipped on the coat, on the ice I mean, and broke my book."
These are all supposedly showing "psychotic" thinking. Obviously there are major problems with this concept. But at any rate, some autistic people do have apparently highly "disorganized speech". (And that's more likely to get a person considered "low functioning".) The Wikipedia article mentions AS as far as some of the major limitations of thinking of people this way.
* disorganized behavior (As the word "grossly" suggests, the disorganized behavior of schizophrenia is severe and causes significant impairment in a person's ability to function in regular daily activities. Examples of such behaviors include childlike silliness, sudden displays of agitation (swearing or shouting "out of the blue"), wearing many layers of clothes on a warm day, inappropriate sexual behavior in public, urinating in public and neglecting personal hygiene.)
Many of these things, I have seen autistic people do, despite many of them not being described in the diagnostic criteria. For instance, I've known a number of autistic people (mostly labeled "low functioning") who didn't really care where they did sexual things or urinated. Also personal hygiene is something many of us have trouble with, and dressing appropriately for the weather, etc. These are especially true of those of us who have trouble with self-care.
* flat or inappropriate affect (When people show a complete absence of emotional expression (flat affect), their faces seem blank. They don't make eye contact or display observable body language. Although a person with flat affect may occasionally show some emotion, the range of expressions is usually very limited. Sometimes people with disorganized schizophrenia express emotions that are inappropriate to the situation, such as laughing when something bad happens.)
Flat affect is very common in autistic people. "Inappropriate" affect is something that I see discussed less often in the literature, but actually see happen more often in autistic people. Laughing when something bad happens is something that I do and many autistic people I have spoken to do, it's actually a carry-over of a standard primate behavior called the fear-grimace, maybe some of us have fewer cultural add-ons over the top of that (and of course in some cultures you're supposed to smile or laugh when someone talks about something bad in order to reassure them that they are not upsetting you, so this criterion is a bit culturally insensitive as well).
2. The criteria are not met for Catatonic Type.
Which basically means that if an autistic person manages to not fit the criteria for catatonic schizophrenia, there's plenty of traits of "disorganized schizophrenia" for them to end up having (except for that bit about can't have it if you're autistic). (Anyone who meets criteria for disorganized schizophrenia, aside from that sort of thing, automatically meets criteria for schizophrenia, unlike catatonic schizophrenia where simply being catatonic alone doesn't meet the criteria, but being catatonic and then having flat affect or something would.)
Then there's Paranoid Type.
A type of Schizophrenia in which the following criteria are met:
* Preoccupation with one or more delusions or frequent auditory hallucinations.
* None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.
Autistic people can get diagnosed with this without hallucinating, if they either come from a culture the psychiatrist doesn't happen to like, and/or have a fantasy world the psychiatrist mistakes them for believing in (which is relatively common), and if they answer yes to the whole hearing voices thing (and then feel rule-bound to be consistent once they figure out what was meant), and/or if they end up echolalically repeating what they hear other people say in psych wards, etc.
The second criterion (just to get personal for a minute) means that the people who diagnosed it in me were actively lying on the diagnosis sheet, because they noted my catatonic behavior and flat affect constantly in person, as well as what they considered inappropriate affect and disorganized behavior. I even emailed one of them to ask about the catatonia once I read about catatonia in autism, and he told me that yes in fact I froze all the time and stuff like that when I lived at his treatment facility. So they saw it, and they lied about its level of prominence. (And I know they saw flat affect because they were always trying to make me not speak in a monotone and show expressions on my body, and they always called those things "being psychotic".) Of course these are the same people who said I had infantile psychosis and/or childhood schizophrenia, so I can't blame them for being stupid I guess. But even had I actually had the delusions and hallucinations they claimed to believe I had, I would not have fit criteria for this based on the fact that other things (the bit about being autistic and all) were much more prominent.
Then there's Undifferentiated Type, which is:
A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.
Basically, autistic people are most likely to appear to meet any of the three that run:
* disorganized speech (e.g., frequent derailment or incoherence)
* grossly disorganized or catatonic behavior
* negative symptoms, i.e., affective flattening, alogia, or avolition
But it's still possible for an autistic person to meet two of those without meeting the criteria for either catatonic or disorganized schizophrenia. (And I was once diagnosed with this kind at a psych emergency room after being found on one of my walks that got me picked up by the police for so-called "wandering". Presumably because I looked "unkempt" and was not responding to them in a standard way and sometimes freezing. The police oddly enough often assumed I was either "ret*d" or "autistic" but then when I went to psych emergency rooms they went for more standard psych diagnoses.)
There's one more kind of schizophrenia that's not in the DSM but is in the ICD.
Quote:
F20.6 Simple Schizophrenia
An uncommon disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance. Delusions and hallucinations are not evident, and the disorder is less obviously psychotic than the hebephrenic, paranoid, and catatonic subtypes of schizophrenia. The characteristic "negative" features of residual schizophrenia (e.g. blunting of affect, loss of volition) develop without being preceded by any overt psychotic symptoms. With increasing social impoverishment, vagrancy may ensue and the individual may then become self-absorbed, idle, and aimless.
Diagnostic Guidelines
Simple schizophrenia is a difficult diagnosis to make with any confidence because it depends on establishing the slowly progressive development of the characteristic "negative" symptoms of residual schizophrenia without any history of hallucinations, delusions, or other manifestations of an earlier psychotic episode, and with significant changes in personal behaviour, manifest as a marked loss of interest, idleness, and social withdrawal.
An uncommon disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance. Delusions and hallucinations are not evident, and the disorder is less obviously psychotic than the hebephrenic, paranoid, and catatonic subtypes of schizophrenia. The characteristic "negative" features of residual schizophrenia (e.g. blunting of affect, loss of volition) develop without being preceded by any overt psychotic symptoms. With increasing social impoverishment, vagrancy may ensue and the individual may then become self-absorbed, idle, and aimless.
Diagnostic Guidelines
Simple schizophrenia is a difficult diagnosis to make with any confidence because it depends on establishing the slowly progressive development of the characteristic "negative" symptoms of residual schizophrenia without any history of hallucinations, delusions, or other manifestations of an earlier psychotic episode, and with significant changes in personal behaviour, manifest as a marked loss of interest, idleness, and social withdrawal.
This can be really hard to differentiate from an autistic person having more trouble over time, or autistic shutdown, etc., I'd imagine. If it even exists, of course.
Then there's residual schizophrenia, which I'll give the ICD criteria for, which are a bit more involved than the DSM. (This reminds me a bit of "residual autism" though.)
Quote:
F20.5 Residual Schizophrenia
A chronic stage in the development of a schizophrenic disorder in which there has been a clear progression from an early stage (comprising one or more episodes with psychotic symptoms meeting the general criteria for schizophrenia described above) to a later stage characterized by long-term, though not necessarily irreversible, "negative" symptoms.
Diagnostic Guidelines
For a confident diagnosis, the following requirements should be met:
1. prominent "negative" schizophrenic symptoms, i.e. psychomotor slowing, underactivity, blunting of affect, passivity and lack of initiative, poverty of quantity or content of speech, poor nonverbal communication by facial expression, eye contact, voice modulation, and posture, poor self-care and social performance;
2. evidence in the past of at least one clear-cut psychotic episode meeting the diagnostic criteria for schizophrenia;
3. a period of at least 1 year during which the intensity and frequency of florid symptoms such as delusions and hallucinations have been minimal or substantially reduced and the "negative" schizophrenic syndrome has been present;
4. absence of dementia or other organic brain disease or disorder, and of chronic depression or institutionalism sufficient to explain the negative impairments.
A chronic stage in the development of a schizophrenic disorder in which there has been a clear progression from an early stage (comprising one or more episodes with psychotic symptoms meeting the general criteria for schizophrenia described above) to a later stage characterized by long-term, though not necessarily irreversible, "negative" symptoms.
Diagnostic Guidelines
For a confident diagnosis, the following requirements should be met:
1. prominent "negative" schizophrenic symptoms, i.e. psychomotor slowing, underactivity, blunting of affect, passivity and lack of initiative, poverty of quantity or content of speech, poor nonverbal communication by facial expression, eye contact, voice modulation, and posture, poor self-care and social performance;
2. evidence in the past of at least one clear-cut psychotic episode meeting the diagnostic criteria for schizophrenia;
3. a period of at least 1 year during which the intensity and frequency of florid symptoms such as delusions and hallucinations have been minimal or substantially reduced and the "negative" schizophrenic syndrome has been present;
4. absence of dementia or other organic brain disease or disorder, and of chronic depression or institutionalism sufficient to explain the negative impairments.
By the way, positive symptoms means things "added on" to a usual person, such as delusions and hallucinations, and negative symptoms means things "subtracted" from a usual person, such as flat affect, etc. It doesn't mean good and bad.
At any rate, that's the really long answer to why I think the criterion about "not being autistic" was added after autistic people were pulled out of this category. Otherwise most autistic people would meet these criteria. (I've read a good deal about the history of the labels "autism" and "schizophrenia" too, so I'm not saying this out of lack of depth of knowledge of the two, nor saying it lightly.) Seeing the similarities can be difficult if you're used to viewing schizophrenia through a lens of "crazy" that is different than you view autism through. But there are huge similarities, the differentiation of autism from schizophrenia (and the existence of such a broad category as schizophrenia) is largely due to politics, not to one kind of person being crazy and another one being developmentally disabled.
Which is why I have trouble seeing being labeled with schizophrenia as a straight misdiagnosis (although I think I was clearly labeled with a kind that the shrinks labeling me knew full well I didn't meet criteria for, and there's some evidence as well, given what they told my parents beforehand and the fact that the diagnostic process consisted of reading me the DSM criteria and nothing else, that they did not see me as having any of the schizophrenia-related labels but wanted me to get Clozaril really really badly and at that point in time it was only available with a diagnosis of severe treatment-refractory schizophrenia), it's more like seeing an autistic person through one lens rather than another, as used to be routine.
And by the way, it's getting better-known that giving neuroleptics (usually used to "treat psychosis", all of which lower dopamine in some way) to a person with catatonia (which resembles and can be caused by certain disturbances in the dopamine system) is a really, really bad idea. But somehow nobody's grasping why. Grr.
Also, schizoid personality disorder was one of their failed attempts at finding a personality type that seemed to signal the onset of schizophrenia later in life. It didn't work out. They kept the name though. So there's actually no relation despite the name.
And, sorry for the really, really long tangent.
25 Dec 2007, 11:55 am
nominalist wrote:
snuuz wrote:
But it still contains nebulous "disorders" such as narcissicm and borderline personality, which are largely constructs of Freud which continue to be passed down. Calling them diseases instead of personality disorders doesn't make them more definitive and finding a specific genetic or biological basis for such conditions seems unlikely.
Sure, but there has been a massive paradigm shift in psychiatry. Psychiatrists only recently realized that they put their bets on the wrong horse.
As a result of the rapprochement between psychiatry and Emil Kraepelin, there may eventually be a merger (on some level) between psychiatry and neurology. Psychiatrists have now abandoned, for the most part, a silly, and largely discredited, philosophy for a genetic and biological framework. It is taking the nosology a while to catch up. Many disorders which are in the DSM-IV-TR may not survive into the DSM-V.I agree. I'm pleased to see that biology is finally winning, so to speak. It will be interesting to see which disorders are in keeping with biological evidence and which ones are more philosophical in origin. I have my suspicions, but I'm waiting to see what further research reveals.
I've always thought that there should be an official divide between the philosophical branches of psychology and the scientific ones, with a different name for each category. A lot of confusion has been generated through the practice of applying a single name to both sciences and philosophies.
25 Dec 2007, 12:04 pm
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