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Tuesday, October 15, 2013 - 4:39pmSanction this postReply
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There have been questions of whether the DSM is changed to accurately recognize an existing problem, or whether it creates or expands a disorder artificially. That question isn't anything new with the newest release of the DSM.

Every so many years there are internal battles to define what is a disorder, and what criteria are required. I strongly suspect that the motives behind the different factions are very mixed. I know that many of the participants are doing their best to provide accurate descriptions of those collections of symptoms that characterize harmful disorders so they can be more easily recognized and better treated. But, there is big money involved as well. Give something a diagnosis and it is eligible for treatment, for insurance, perhaps for prescription drugs, and new clinics will rise like mushrooms in the rainy period.

Remember that psychology, unlike medicine, has a wide variety of explanations (theories) for what goes on in our minds and why - theories that conflict with each other (about 400 different theories). The good thing about the DSM is that it takes raw descriptions of behavior and gives them a name - independent of any theory of what causes the disorder. So a Major Depressive Disorder, Single Episode, Mild is the same thing no matter what the theoretical orientation. Apples to Apples. This way Freudians can carry out meaningful discussions with Behaviorists or Gestalt Therapists, or any other orientation.

They can all keep their own theory of how the issue arose, what it represents as a personality dynamics, and how to treat it. Over time, using the DSM, as common ground, should make it much easier to compare the efficacy of treatment techniques, and that can lead to critical comparisons of theoretical orientations. The DSM should make for healthy intellectual competition.

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Tuesday, October 15, 2013 - 6:50pmSanction this postReply
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Luke, regarding your question regarding bragging: It could have been true -- resulting in the mislabeling of Objectivists as autistics -- but that's only 1 of 16 optional criteria and, perhaps even more importantly, I know of at least one living Objectivist right now who really gets a kick out of bragging to others ... if he is confident that he worked hard to earn a certain distinction. He thinks it's cool, though he doesn't necessarily live or die for it, as is evidenced by his virtuous willingness to admit of making mistakes every now and again. I'm not going to name any names here, so you'll just have to guess who it is that I have in mind.

So, in order to qualify for the distinction of Asperger's Disorder, you need to meet 2/3's of 8 criteria ("Asperger's Disorder, which did not enter the DSM until 1994, involves only two thirds of that half") -- which is 5.3 criteria, which can be rounded up to 6 criteria on the basis that I am willing to bet that it would be really very hard for a psychologist/psychiatrist to get him/herself into the epistemological position to be able to distinguish what 0.3 (actually, one-third) of a single criterion "looks like":
Doctor: I can see that you are precisely one-third depressed.

Patient: What is that, Doctor? Is that like being "one-third pregnant?"

Doctor: Ha, ha, ha. Hardy, har, har. Very funny. No. Actually there is this manual that I use in order to diagnose mental dis ... er, uh, forget about it, I'm pretty sure that I could not explain the logic of it to you. I'm just going to have to ask you to trust me that I know what one-third of one symptom would look like.

:-)

Ed

(Edited by Ed Thompson on 10/15, 6:52pm)


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Tuesday, October 15, 2013 - 7:19pmSanction this postReply
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I admit my discomfort at transforming personality traits into medical conditions. Is a homebody who prefers solitude to socializing an "agoraphobe"? Engineers and scientists would likely express several "autistic" traits given their need to obsess with details and numbers. I understand what Steve Wolfer said about the DSM having less than savory influences driven by crony capitalist tendencies. Remove the crony capitalism and the DSM should reach more objectivity accordingly.

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Tuesday, October 15, 2013 - 10:54pmSanction this postReply
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Luke, you mentioned "agoraphobia" and said that people should not be labeled as having a disorder because they are just homebodies or prefer solitude. That isn't the case at all.

I used Wikipedia to gather this DSM info:
Agoraphobia is an anxiety disorder characterized by anxiety in situations where the sufferer perceives certain environments as dangerous or uncomfortable, often due to the environment's vast openness or crowdedness. These situations include, but are not limited to, wide-open spaces, as well as uncontrollable social situations such as the possibility of being met in shopping malls, airports, and on bridges. Agoraphobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments.

Social anxiety disorder (SAD) (DSM-5 300.23), also known as social phobia, is the most common anxiety disorder. It is one of the most common psychiatric disorders, with 12% of Americans having experienced it in their lifetime. It is characterized by intense fear in one or more social situations, causing considerable distress and impaired ability to function in at least some parts of daily life. ... Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating (hyperhidrosis), trembling, palpitations and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort.
I've treated the type of agoraphobia that comes with panic attacks. Its not even close to a preference for hanging out at home. It's like the way you would imagine a person would feel if they suddenly fell into a tank of ravenous 15 foot sharks, but instead they are actually just sitting at home, and realizing they need to go out. People, including doctors, can't tell some panic attacks from heart attacks without tests. One client I had would pass out when the panic attacks peaked.
----------

As to whether or not there are autistic definitions that should be removed because they are harmless personality traits... that I don't know. I haven't looked at that section of the new DSM.
(Edited by Steve Wolfer on 10/16, 9:42am)


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Wednesday, October 16, 2013 - 9:03amSanction this postReply
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"I've treated agoraphobia with panic attacks." Hahahaha...
I know what you meant. We all make these mistakes. In Mortality Christopher Hitchens warns against saying that as a boy your grandmother read you stories, unless, at that stage in her life, your grandmother really was a boy. My favorite is the SNL noire detective skit:"... She came into my office carrying a bottle of whiskey wearing a red dress..." and the camera zooms in on the bottle.

As for the subject here. I take Steve's leveling of the complaints at face value. If you grant that at least some psychologists are making an honest effort at this, then the more they work out the details, the better they know what they are talking about.

That said, Luke's wider claim stands unopposed. A radical collectivist would say that any child who cannot fit in needs to be remediated to the norm. It is a common theory in public education. In my school system (Cleveland), we traditionally had two warring cliques of "progressives". Some wanted to create the leaders of the future. Others wanted everyone to be equal. So, I got some of the radical collectivist application even as I benefited from the application of Plato's Republic.

I mention that because in the old USSR, they said that as they have the perfect society, anyone who opposes it must be mentally ill. And that speaks to Luke's point. Luke has "The Knack". Dilbert YouTube video here.

(Edited by Michael E. Marotta on 10/16, 9:13am)


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Wednesday, October 16, 2013 - 10:44amSanction this postReply
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Meanwhile, from the Objectivist corpus:
Now consider the sphere of recreation. For instance, a party. A rational man enjoys a party as an emotional reward for achievement, and he can enjoy it only if in fact it involves activities that are enjoyable, such as seeing people whom he likes, meeting new people whom he finds interesting, engaging in conversations in which something worth saying and hearing is being said and heard. But a neurotic can “enjoy” a party for reasons unrelated to the real activities taking place; he may hate or despise or fear all the people present, he may act like a noisy fool and feel secretly ashamed of it— but he will feel that he is enjoying it all, because people are emitting the vibrations of approval, or because it is a social distinction to have been invited to this party, or because other people appear to be gay, or because the party has spared him, for the length of an evening, the terror of being alone.

Rand, Ayn (1964-11-01). The Virtue of Selfishness (Signet) (Kindle Locations 1192-1199). Penguin Group US. Kindle Edition.

I think home alone is just fine, thank you very much.

It will give me more time to master "the knack"!

I think collectivist views really have declared war on the introvert. Extroverts just cannot understand why we prefer solitude to their constant vacuous vaporings and intrusive shenanigans. Bah, I say.

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Wednesday, October 16, 2013 - 11:40amSanction this postReply
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I've argued before that part of the source is over-normalization.

An -ability- in excess of the norm to concentrate on minute details is currently classified as a kind of autism.

Anyone who has been around a lot of programmers has seen aspects of 'autism' -- sometimes to extremes. Programmers sometimes 'dream' in code...even while wide awake, but that isn't dreaming.

So instead of classifying someone with such an ability as having 'an ability' outside the norm, they are over-normalized outside 'the norm' and are classified as 'autistic.'

Given current trends, it won't be long before 'anti-social' is expanded and classified to include 'anti-"S"ocial' as well, as the complete '"S"ocialization' of the population proceeds virtually unchecked on all fronts.


The two classifications might someday overlap somewhat; when someone is zoned out, concentrating on complex details, they appear somewhat 'disconnected' from the tribe around them. This 'abnormality' might someday be amplified from 'disorder' to 'misdeameanor' to 'social crime.' Given the army of smarmy louts on MSNBC, and the shrill accusations of 'terrorists!' aimed at the limited government crowd, it isn't hard to see those dark tribal ages coming.

regards,
Fred

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Wednesday, October 16, 2013 - 11:53amSanction this postReply
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Also, I listened to a talk in July 2012 given by a researcher studying over-normalization, who pointed out how important context was for such normalization.

ex: in South Pacific island nations, the ability to navigate is a key skill required not only to survive but to prevail, and so, local tribal leaders tend to be picked from among the best 'spatially adept' individuals. That influences local politics as well as local 'normalization.' The local idiots are those with poor spatial skills.

In DC, the number one required skill is the ability to lie convincingly to large groups of others, and this nation is led by people who can't find their BMW in a parking lot without help.

Yet, it is our tribe of weasels that has so far prevailed...according to our self-kept scoreboards.

He also pointed out 'discovered' afflictions, like dyslexia; virtually unknown until the last few centuries because prior to that, so few folks read the written word as part of their daily lives.

Are we really, as a species, getting more 'diseased' and frail as time goes on?

Or are we only forever over-normalizing in new contexts?

regards,
Fred






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Wednesday, October 16, 2013 - 1:56pmSanction this postReply
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Are we really, as a species, getting more 'diseased' and frail as time goes on?
In some ways, the answer to this is a resounding, "Yes!" Generation by generation we are loosing some character traits that are valuable (while gaining in other areas).
Or are we only forever over-normalizing in new contexts?
Another, "Yes!" There are those among the weasles who make use of any means at all, however dishonest, to achieve even the smallest of ends. If it scares them to be different, they will attempt to define the norms to fit themselves and exclude those different. If they want to nudge us towards giving them control, or what we have that they want... they marginalize us by redefinition and assume that peer pressure ranks higher than the laws of physics.

But going back to the DSM... there is a lot of value in that tool. Like I said, I'm not familiar with the definitions of Autism, or Aspergers, or a few other areas, but that multi-axial, theory-free, treatment-free categorization of disorders is a brilliant conception and most of the content is solid and useful. I'd say that the dishonest special interests and weasels haven't corrupted the bulk of it - not yet.

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Wednesday, October 16, 2013 - 6:08pmSanction this postReply
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Fred,
Given current trends, it won't be long before 'anti-social' is expanded and classified to include 'anti-"S"ocial' as well, as the complete '"S"ocialization' of the population proceeds virtually unchecked on all fronts.


The two classifications might someday overlap somewhat; when someone is zoned out, concentrating on complex details, they appear somewhat 'disconnected' from the tribe around them. This 'abnormality' might someday be amplified from 'disorder' to 'misdeameanor' to 'social crime.' Given the army of smarmy louts on MSNBC, and the shrill accusations of 'terrorists!' aimed at the limited government crowd, it isn't hard to see those dark tribal ages coming.
This is what scares me about Common Core. It is a single, top-down, universalized rubric for all children. When you have something "one size fits all" like that, and you utilize your "top-down" power to change a couple words around in the "common curriculum" then -- Voila! -- instant totalitarianism (under the progressive assumption that you can successfully teach children to grow up as slaves). By taking the individuality away from children -- i.e., by making them common -- Common Core is sort of like re-education.

Of course, I could stand to look over a few more of the details about Common Core before spouting off about it like this, but there is something to be said for process (i.e., principles)-- something which cannot be overturned by an increased attention-to-detail:
Epistemologically, their dogmatic agnosticism holds, as an absolute, that a principle is false because it is a principle—that conceptual integration (i.e., thinking) is impractical or “simplistic”—that an idea which is clear and simple is necessarily “extreme and unworkable.” Along with Kant, their philosophic forefather, the pragmatists claim, in effect: “If you perceive it, it cannot be real,” and: “If you conceive of it, it cannot be true.”

What, then, is left to man? The sensation, the wish, the whim, the range and the concrete of the moment. Since no solution to any problem is possible, anyone’s suggestion, guess or edict is as valid as anyone else’s—provided it is narrow enough.

To give you an example: if a building were threatened with collapse and you declared that the crumbling foundation has to be rebuilt, a pragmatist would answer that your solution is too abstract, extreme, unprovable, and that immediate priority must be given to the need of putting ornaments on the balcony railings, because it would make the tenants feel better.

There was a time when a man would not utter arguments of this sort, for fear of being rightly considered a fool. Today, Pragmatism has not merely given him permission to do it and liberated him from the necessity of thought, but has elevated his mental default into an intellectual virtue, has given him the right to dismiss thinkers (or construction engineers) as naive, and has endowed him with that typically modern quality: the arrogance of the concrete-bound, who takes pride in not seeing the forest fire, or the forest, or the trees, while he is studying one inch of bark on a rotted tree stump.
--http://aynrandlexicon.com/lexicon/pragmatism.html

Ed


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Thursday, October 17, 2013 - 8:57amSanction this postReply
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Steve:

re: In some ways, the answer to this is a resounding, "Yes!" Generation by generation we are loosing some character traits that are valuable (while gaining in other areas).

With some irony, that both is and isn't the answer to the following generational riddle:

1966: MEDICARE = $3B

2013: The above population and inflation adjusts to maybe $45B. Yet we spend over ten times $45B/yr on MEDICARE today.


This generation is over ten times more frail, all right, but in the way you describe above, not necessarily actual afflictions...

regards,
Fred

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