August 22, 2001

11:29 PM

Anxiety disorder,attention deficit disorder. While I understand that these disorders exist, the skeptic in me tends to believe that the seemingly increasing diagnoses are more a symptom of our culture's need to blame external causes for behavior versus personal responsibility. Is this a post-60s/80s "Me" thing or am I way off base?
posted by owillis (41 comments total)

In my opinion only, these disorders have always been around, just not discussed until fairly recently. Every family has a story about uncle Fred or cousin Lamar who did starnge things, not really bad but just strange. If they were alive today they would have some deficit or disorder and we could "brag" about it instead of hidding them in the attic or basement.
posted by bjgeiger at 11:43 PM on August 22, 2001

It's probably somewhere in the middle. Many of the symptoms are quite real, but likely result from some environmental or lifestyle trigger. I've always figured I am easily diagnosable as ADD or AADD or whatever. It scares me because I happen to like the way I turned out. I don't know if I would have survived had I been a child in today's pharmaceutical-first public school system.

Many have chosen to accept these problems and blame them instead on Nutrasweet and Food Coloring. It might be bunk or fear of chemicals, but I can't come up with a rational argument for fake food.

Ultimately I just wish we'd stop drugging our toddlers for being curious and having tantrums.
posted by joemaller at 12:05 AM on August 23, 2001

as a bearer of an anxiety disorder i can tell you that the disease is very real. i, too, however find it hard to believe that all those diagnosed with these disorders actually have them. as for blaming them for behavior, ADD is really the only one that falls into that category as the anxiety disorders tend to be used to explain why one can seem so normal but feel so terribly fucked up...which makes a little more sense :-)
posted by tewedle at 12:05 AM on August 23, 2001

...my apologies for the double post...
my anxiety disorder is quite genetic as it can be traced to my great grandfather and the source of his successful suicide. and you say, "well, it's easy to make yourself believe that you're not quite right if someone *tells* you you're genetically predisposed to something." however, i kept my unwarranted fear of "nothing" pretty much under wraps until after i had reached the age of credibility when people finally began to believe that they were, in fact, irrational fears with no source. my point, and i do have one, is that they do *exist* and they fit the descriptions of those who exploit them. i am as wary as any cynic of the huge numbers of people who claim to have them...as i am wary of using any sort of drug to try and counterbalance what genetics has handed me.
posted by tewedle at 12:13 AM on August 23, 2001

i'm sure that there are a number of cases of misdiagnoses of anxiety disorder or ADD -- indeed of nearly any medical state of body or mind. suppose, owillis, that the larger numbers of diagnosed cases has more to do with the willingness of people to seek out treatment for the problems that gnaw at them in the far corners of their mind, or the willingness of people to accept that the fidgityness or learning disability of their children is not a phase or simply "just the way it is."

that is, i hope that you will agree, a good thing.
posted by moz at 12:29 AM on August 23, 2001

Medical treatment for mental health is a very new thing. And while there might seem to be an increase in the number of people suffering from [insert your favourite psychiatric type illness here], there is no way to know for sure, except by hindsight whether or not there has been overdiagnosis in the general population.

There are some great studies out there that link ADD to a child's father's marijuana use, preconception - and with pot use booming in the 60's, it makes sense to see staggering numbers of children born after 1970 with ADD.
posted by kristin at 1:13 AM on August 23, 2001

While I'm sure these disorders are very real and for some people can be debilitating, I am saddened to see every form of behaviour becoming Oprah-ised. This victim culture is leading to a total lack of responsibility for one's actions, leading to lawsuits, false accusations and libel.
posted by jackiemcghee at 1:57 AM on August 23, 2001

Why wouldn't they be real? Every so often some smarmy pedant crawls out from under a rock to "debunk" some psychological illness or the entire field.

It takes a lot of failure, pain, and courage to admit that yes you may have a problem and its time to see a doctor. You don't just waltz into therapy with the attached social stigma like its nothing.

our culture's need to blame external causes for behavior versus personal responsibility

Yeah owillis, I can really see how the lack of "personal responsibility" causes people freak out in crowds or in the supermarket. Or how a panic attack is just really a hissy fit.

I seriously suggest its time you stopped making generalizations about "our culture" and talk to those who suffer from mental illness. You are completely off base and yes I'm talking from experience.
posted by skallas at 2:16 AM on August 23, 2001

Given that I've written about 90,000 words on this, or something similar, for my doctoral thesis, any answer will be a vast oversimplification. But anyway. Mental illnesses are different in kind, not degree, from physical ailments, because the mechanics of diagnosis are by definition cultural: as skallas suggests, it's a very different process to admit that you have a broken mind, as opposed to, say, a broken ankle. (When Thomas Szasz talks about the "myth of mental illness", he doesn't mean that it doesn't exist, but that its existence is akin to that of a myth.) There's a reason why schizophrenia came into the public consciousness in the 50s, or hysteria in the late 1800s, and it's to do with the way that medicine is, at best, an inexact science, and itself a cultural phenomenon.

Anyway, I'll just dump this quotation from Sir Richard Blackmore's Treatise of the Spleen (1725):

It is certain, that Hypochondriacal Men, as well as Hysterick Women, are often afflicted with various Pains and and great Disorders; and could it be supposed that this was nothing but the Effect of Fancy, and a delusive Imagination, yet it must be allowed, that let the Cause of such Symptoms be never so chimerical and fantastick, the consequent Sufferings are without doubt real and unfeigned. Terrible Ideas, formed only in the Imagination, will affect the Brain and Body with painful Sensations.

For Blackmore to say this illustrates the way that the discovery of the nervous system revolutionised the treatment of mental illness: a century earlier, and instead of internalised disorders they'd have been talking about possession by evil spirits.
posted by holgate at 2:28 AM on August 23, 2001

I don't think you can understand this without an historical perspective, and the insights of thinkers as diverse as Susan Sontag (Illness as Metaphor [9/01 pbk reissue!]) or Michel Foucault (Madness and Civilization). Both make the point that illness is a cultural construct in addition to whatever physical cause or effect it may have.

In looking at the "hard cases" such as anxiety disorders, we can gain insight into the more obvious diagnoses such as schizophrenia. When we say someone is mentally ill we are saying that they behave in a manner outside the norm. When we recognize that the patient wants the behavior to change, and we have a choice of difficult therapy involving changing longstanding habits or reactions, or a pill, the question arises: should we choose the easier path because it is easy, or the hard oen because it is hard? If behavior can be changed with a pill, is it really a choice, or is it representative that we are not the beings of free will we would like to believe we are?

The Foucaultian view (of mental illness, prisons, even sexuality) is that the path taken by the growth of the scientific approach in our culture is to separate and observe. Prisons, for example, changed over time not so much because we found better ways to handle crime but because we had different cultural needs to express in their construction and operation. I can't imagine what Foucault would have thought of the supermax prison, but even before they existed he saw that what we most wanted out of prisons, throughout history, was a way of setting a sharp boundary between ourselves and others (in this case, criminals). The same has held true, in its own way, for mental illness. Sometimes the definitions are there to comfort the normal as much as the abnormal. You're like this because is reflected in You're not like this because.
posted by dhartung at 2:57 AM on August 23, 2001

kristin: > There are some great studies out there that link ADD to a child's father's marijuana use, preconception

Sounds amazingly Lamarckian. Five minutes of Googling turned up nothing -- do you have a link?

- -

holgate: > Mental illnesses are different in kind, not degree, from physical ailments, because the mechanics of diagnosis are by definition cultural

What sort of job is "because" playing in that sentence? Are the two sorts of illnesses intrinsically different on account of some extrinsic matter of fact?

- -

Generally: (A) Interesting that discussions of mental illness usually ends up revealing what lousy monists most people are. It is absolutely normal for someone to say, e.g., "depression is caused by a chemical imbalance" but never that "depression causes a chemical imbalance". (B) Trying rigoursly to answer questions like "is that really a disease?", "what is a 'disease'" is, like, super hard.
posted by sylloge at 3:55 AM on August 23, 2001

What sort of job is "because" playing in that sentence? Are the two sorts of illnesses intrinsically different on account of some extrinsic matter of fact?

That's very arguable, as your question makes clear. In eighteenth-century diagnostic texts, there's the intriguing contention that mental illnesses are a morbus morborum, a disease of "disease", disrupting the normal stimulus/response dynamic of diagnosis. Whether there's a good logical distinction there is hard to say, and depends upon how you regard "disease" to be constituted; it also ties in with Wittgenstein's discussion of pain in Philosophical Investigations, which actually inverts the polarities of the conventional disctinction between "physical" and "mental" illnesses as observable phenomena.

It's worth arguing, at least, that the meaning of "illness" to a physician is quite different to that of "disease" to a pathologist.
posted by holgate at 5:06 AM on August 23, 2001

tewedle - "I am as wary as any cynic of the huge numbers of people who claim to have them"

One important lesson my brother taught me: it is human nature to make our own suffering legitimate and to minimize the import (or "realness") of other people's suffering. Tewedle, while I'm glad you acknowledge that anxiety disorders are real, I think your assumption that "huge numbers of people" are faking it is exaggerated. Where are all these people exploiting anxiety disorders for their own ends?

I speak about anxiety disorders in particular because, in my opinion, generally those suffering from them aren't eager to show off how much they worry, or their fearfulness. Knowing I suffer from anxiety is not an excuse I give other people for irresponsible behavior. It is more an internal explanation for that irrational sense of fear that otherwise would stop me from living normally.
posted by tlong at 5:32 AM on August 23, 2001

One important lesson my brother taught me: it is human nature to make our own suffering legitimate and to minimize the import (or "realness") of other people's suffering.

Good point. I can believe in anxiety disorder because of a few out-of-the-blue attacks I experienced. Not knowing any better, I thought the first one was a heart attack and ended up in the emergency room.

However, with a lot of other stuff I tend to dismiss it as the product of an overemotive society that fixates on victimhood -- like the flaky Emotional Rape Syndrome. Which probably makes me guilty of empathy disorder.
posted by rcade at 5:49 AM on August 23, 2001

"Anyway, I'll just dump this quotation from Sir Richard Blackmore's Treatise of the Spleen (1725"
is this akin to the cultural history of the Lemon? "a century earlier, and instead of internalised disorders they'd have been talking about possession by evil spirits." maybe in England. Alot of people (in america)where listening to Dr. Kellogg and other Health nuts of the era" and when i sift through the big sentence on wittgenstien, you say little if nothing that one could not deduce without ludwig. (i think Dhart is general Zod)
posted by clavdivs at 6:07 AM on August 23, 2001

Yeah owillis, I can really see how the lack of "personal responsibility" causes people freak out in crowds or in the supermarket. Or how a panic attack is just really a hissy fit.

Look, as I said, I don't believe that these ailments are fake. What I am leaning towards is the seemingly high amount of kids who are diagnosed with "ADD" and doped up on drugs, when in reality they may just be spoiled kids who are subject to temper tantrums.

It seems easy for parents and physicians to say "Johnny's poor behavior is this medical disorder" when it actuality Johnny is just acting up. So then the care of kids who may truly have ADD is impacted negatively...
posted by owillis at 6:58 AM on August 23, 2001

If your problem is with ADD, you should have listed ADD only. By adding Anxiety Disorder, you are letting one of the disorders piggyback on your argument, when the two of them don't belong together at all.

It's kind of like saying "Don't people in SUVs and kittens irritate you?"
posted by websavvy at 7:31 AM on August 23, 2001

An interesting Dialog on ADD.
posted by mw at 7:37 AM on August 23, 2001

The flip side of this is those with physical problems being diagnosed as having mental problems.

I've personally met people who've spent years in mental "hospitals" because they have had a neurological disease. Now that this disease has been recognized it is interesting to see the number of people with mild forms of this disease go up.
posted by DBAPaul at 7:39 AM on August 23, 2001

If your problem is with ADD, you should have listed ADD only

I added anxiety disorder because I saw this story last night, and the girl involved seemed more like she had standard "kid fears" about the world around her but everyone was quick to label it anxiety disorder. Then she goes into therapy and a couple weeks later - "all good"! It just felt a little too "movie of the week".
posted by owillis at 7:47 AM on August 23, 2001

Wittgenstein on pain, for clavdivs and anyone else who's interested. "The philosopher treats a question; like an illness." -- there lies the difference between the early W. and the late.
posted by holgate at 7:55 AM on August 23, 2001

Holgate:

> It is certain, that Hypochondriacal Men

'Tis proper to all Melancholy men, saith Mercurialis... Did y'all find room for R. Burton in your 90,000 words?
posted by jfuller at 8:14 AM on August 23, 2001

304(LW) language=convey thoughts is a paradox in the image/picture. The insidious nature of anxiety is physiological(neural) which i belive you tried to raise with (sir) Blackmore. thus the paradox is maintained through the patients conveyance to doctor of said malady.
posted by clavdivs at 8:39 AM on August 23, 2001

Having been married for the last fifteen years to a woman who suffers from panic disorder, I can testify to its very real nature as a biological (neurochemical) disorder. But I do understand the question owillis is asking: once a disorder becomes more widely appreciated, is it overdiagnosed? I think the answer is yes, but I don't agree that it's a manifestation of the culture of victimhood or a lack or personal responsibility.

Panic or anxiety disorders may indeed now be somewhat overdiagnosed after a very long time of being totally written off as a valid disorder -- the story of my wife's problems is a primer on how not to successfully treat anxiety or panic. Only in recent years has she found successful treatment as the disorder has been better understood and the advances in psychopharmacology have improved.

I see the situation with diagnoses of ADD in schoolchildren somewhat differently. I disagree with owillis' statement that many ADD kids are "spoiled kids who are subject to temper tantrums", but I do think that school systems are guilty of using the diagnosis and the subsequent prescription of Ritalin as a method of behavior control. It's an easy way to settle a situation without investing the time/money/effort into a better assessment of the issue. Again, though, this just doesn't seem like a "personal responsibility" issue so much as the poor process of a bureaucratic system.
posted by briank at 8:42 AM on August 23, 2001

Ultimately I just wish we'd stop drugging our toddlers for being curious and having tantrums.

I agree. But the old school treatment of just beating them for both was probably not a whole lot better.
posted by rushmc at 8:57 AM on August 23, 2001

9 out of 10 times these disorders serve as a rational excuse to parents that can't discipline their kids.
posted by Witold at 9:22 AM on August 23, 2001

Burton makes it to the introduction, jfuller: he really belongs to the early seventeenth-century history of melancholy, although the Anatomy remained popular throughout the 1700s. But Descartes, Locke, Newton et al changed the intellectual landscape humungously, and the nervous system revolutionised medicine.

clavdivs: ka-ching. Articulation is the means of diagnosis. If the ailment affects the ability to articulate it, then you're working with a badly calibrated meter.

The ADD/Ritalin situation is different, as others have said, from the overdiagnosis or overmedication of certain conditions among adults, because you're dealing with different dynamics of articulation. There's a long history of self-medication as an assertion of bourgeois liberty -- Bourdieu's Distinction suggests that consumer choice begins with the ability of the middle-classes to choose how they treat their bodies, so that the rest cures of Bath in the 1750s were like the drying-out clinics of the 2000s -- and when you're medicating children, that isn't an element.
posted by holgate at 9:48 AM on August 23, 2001

I like holgate because he sounds so smart.
posted by briank at 10:09 AM on August 23, 2001

"If the ailment affects the ability to articulate it, then you're working with a badly calibrated meter." This would be apparent, hence no paradox. The paradox is asserting the afflictions validly. THUS negating the picture paradox-but you knew this.
posted by clavdivs at 10:19 AM on August 23, 2001

In reference to children diagnosed with ADHD...

I taught Tae Kwon Do for a few years, and many of the children in our classes, especially in the oh, 6-11 age groups were there because doctors suggested to their parents that they try a structured activity like martial arts instead of Ritalin.

There were two kinds of "ADHD" kids.

1) Sweet, classically hyperactive kids who were very eager to learn or participate, but when asked to do something, managed to stay on track for about 15 seconds before they'd notice their reflection in the mirror, or hear someone talking and would get off track. These kids often benefit from activities like martial arts, competitive swimming, or music, because they have goals to work towards, and the activity forces them to concentrate on one thing at a time, and given enough time, they can improve their concentration skills, and also feel good about themselves for being able to set goals and achieve them, instead of being told there's something wrong with them, and being given a pill to make them be seen and not heard.

2) Bratty kids, who when asked to participate, would refuse and cause discipline problems. We would remove them from class, and tell them they were not allowed to participate until they could do sow without impairing the other kids ability to learn. This, unfailingly got their parents all riled up. They would declare that Little Johnny or Susie was having a "bad day" and that we shouldn't be so hard on him or her, etc. These children were obviously undisciplined, but it was easier for their parents to call them hyperactive. Ultimately, the kids whose parents let the child continue to go to class, and be put in time-out etc, improved as well. The disciplined nature of the class gave them some structure, and they became less combatative, and again, more goal driven. The kids whose parents pulled them out... well, I doubt they fared as well.

Ultimately, I believe there really is such a thing as ADHD in children, and that pills are often not the answer. Given a supportive and helpful environment, most of these kids will grow out of it, or learn to cope, and will be stronger for it. Of course, some percentage may be impaired to a level where drug therapy is necessary to get them to a point where they can function enough to start working on the underlying problem, but I'd hesitate to make pharmaceutical treatment a long-term thing, Ritalin is an awfully powerful drug to be given so carelessly to small children.

As for the kids labeled ADHD because adults don't want to deal with their disruptive behavior, a pill isn't going to fix the fact that they are undisciplined, and do not have the skills to function to the level of their peers. They also need help, but of a different kind.

Unfortunately, children aren't capable of helping themselves. The "personal responsibility" aspect falls not on them, but on their caretakers. They're success is dependent on the ability of their parents/teachers to recognize what is really going on, and take the necessary steps.
posted by antimony at 10:48 AM on August 23, 2001

In terms of overdiagnosis, that happens whenever a disease gets a great deal of attention. Recently the doctor who first identified Lyme disease was interviewed for NPR. He stated that he was upset by how often doctors misdiagnose Lyme. (He felt the cause was that doctors were being pressured by their patients to give them a "good prognosis." Apparently many doctors were diagnosing Lyme instead of some other nastier disorders with similar symptoms.) So once a disease, even a physical disease, becomes well known, it is likely to be overly diagnosed for a variety of reasons.

On the other hand, there are the people who are still not getting the help they need. So there is a balance. yes, some people are being misdiagnosed (for a variety of reasons including pressure exerted upon the doctor by the patient, the doctor's personal bias about the disease, and the length and scope of the diagnostic interview) and some people remain undiagnosed. There are also the patients who have been correctly diagnosed and are now being properly treated.
posted by miss-lapin at 12:37 PM on August 23, 2001

"parents that they try a structured activity like martial arts"
yes,yes,yes.excellant contribution to the problem (really, this is a wonderful idea)
posted by clavdivs at 12:45 PM on August 23, 2001

I haven't seen anyone else say this yet:

I HAVE ADD.

Yep. I've been diagnosed with it since middle school (I'm a college sophomore.) Yes, there are lots of misdiagnosis -- the sheer number of my peers who have been diagnosed can attest to that. (I'm right on the tip of the "Ritalin generation.") This is why I'm glad that laws are being passed to stop schoolteachers from saying "Your child has ADD" -- no one is qualified to make that decision other than a child psychologist.

There's a problem with the therapy/behavioral/non-pill approaches though: there's a component of ADD that just makes it impossible for me to concentrate. Sure, ADD has changed my behavior in certain ways that I could change with a conscious effort, but there's no way I could will myself into being able to read for more than thirty seconds at a time without my mind wandering for another ten minutes. And I love to read. I'm currently exploring various medications because I'm desperate for something that will allow me to keep focused on the things that I really want to do. I'm not just some kid who can't concentrate in school -- ADD hinders me from achieving my rational, adult goals in a way that I can consciously perceive. Yes, ADD is fuzzily defined (my belief, based on research, is that there are multiple forms of the disorder which should be treated differently), and it's an extremely easy condition to psycho-somaticize your way into, but it does exist. Thank god actual diagnosed kids are starting to grow up, so we'll be able to start hearing actual first-hand testimonials, instead of the damaging misinformation that's spread by the various parents, educators, researchers and pundits whose opinions are based on little to no actual experience of our disorder.
posted by tweebiscuit at 1:24 PM on August 23, 2001

I agree with the martial arts thing. Another thing that parents may try getting their kids into is rock climbing. There's a subset of rock climbing called bouldering where you climb up a short wall and drop onto a mat. The routes are challenging though - they require a lot of concentration and you have to be able to drop into 'the zone' easily - and you build some serious problem solving skills while you're building strength.

Another parenting skill that my parents made me do was LEARN to solve my own problems. When I came to them with/for something that I could've done myself, they look at me blankly and just say, "Solve the problem!" Even if I threw a tantrum, they'd just keep repeating that over and over again.

I was originally misdiagnosed as Auditory Processing Disorder, which is a learning disability that means your brain doesn't process information you hear. ADD was a slight part of what they thought I had, but they admitted that they couldn't tell because my scores in some areas were so high. Recently, though, I ran across a reference to Aspberger's Syndrome on the internet, and read a bit into it... Turns out, after a little testing, that I'm a textbook case. Aspberger's is a form of mild autism - that's where the processing problems I have come in. Anyway, when I was in high school they wanted to medicate me in school, and my parents and I wouldn't let them. Currently, I use caffeine, which as a stimulant is chemically similar to Ritalin, to manage any attention shortfalls I have.

I suppose my point is that there are other mental disorders besides ADD/ADHD that affect children and are often misdiagnosed. What's even worse are the kids who started out mentally perfect, and are only diseased because of the way their parents treated them - these are the brats that Antimony was talking about above.

I'm curious, though... with all of the historical stuff that we've been bouncing around here, how did they think they cured the stuff back then?
posted by SpecialK at 1:35 PM on August 23, 2001

One important lesson my brother taught me: it is human nature to make our own suffering legitimate and to minimize the import (or "realness") of other people's suffering.

you're absolutely right. it was half poor wording and half "wanting to agree that some are faking it" on my part. thanks :-)
posted by tewedle at 2:34 PM on August 23, 2001

I have ADD. I have always fallen into antimony's 1st group and perhaps that's why I'm so enthralled with Martial Arts. It allows and forces my brain to focus.

SpecialK, that problem solving thing always plagued me as a child as well... Weird...
posted by fooljay at 4:32 PM on August 23, 2001

What is attention defi.... brb
posted by Kino at 5:35 AM on August 24, 2001

My ADD "Success Story" (though I doubt it will ever show up here). I have a feeling that many ADHD individuals would asses this disorder and define their relationship with mental health in similar terms.
posted by hipstertrash at 5:55 PM on August 24, 2001

kinky.

last time i chanced a relationship with mental health it two timed me.
posted by Kino at 6:32 PM on August 24, 2001

Like so many outsiders you have know clue to what the hell you are talking about. Yes, there have been some false cases and yes, outside environments definitely do have a big impact on a child.
Did you know that dispite what you have heard about ADD, a large portion of user's of medications for ADD are adults. The things you have heard about growing out of it only happens to some of the lucky ones. The rest of us continue to be medicated on through college. and sometimes our lives.
The last thing a child that is struggling needs, is their parental support not trying to understand the utter madness that is raging through there minds. What the hell, you can start spanking him or her when thy fail to learn, like my teachers did. These children have a battle ahead of them that most of us fail to even imagine. Dont make it any harder than it is.
A child that is suffering from this illness will not be miss diagnosed by a good doctor. But at the same level he or she should not be pushed away from treatment becouse you have a hunch about ADD. read , read, read, read, read, read, read, and than make comments on the web like these. BEFORE YOU do something dumb.
posted by Jesus Christ at 2:28 PM on August 29, 2001

Hey Jesus.. not sure who your talking to there but that all looked pretty emotional, dramatic and damned important.

I've just popped my head in here to leave a link to bytecodes thread dealing with a similar things to this one. I know it can be helpful for people with various disorders to share their experiences and i know you'd all be made welcome.
posted by Kino at 12:38 PM on September 2, 2001