Neuron Culture

Psychiatry Throws a Tantrum

Over at Slate I have a story, “The New Temper Tantrum Disorder,” about the “Disruptive Mood Dysregulation Disorder” I wrote about more briefly here a couple weeks ago, when DMDD was still a proposed diagnosis. Last week the DMDD diagnosis was approved for inclusion in the American Psychiatric Association’s forthcoming Diagnostic Statistical Manual, Fifth Edition — and some in the field are upset:

[T]he alterations the APA announced for DSM-5 this week sparked unusually ferocious attacks from critics, many of them highly prominent psychiatrists. They say the manual fails to check a clear trend toward over-diagnosis and over-medication — and that a few new or expanded diagnoses defy both common sense and empirical evidence. This medicine is not going down well.

Nothing burns the critics worse than “Disruptive Mood Disregulation Disorder,” a new diagnosis for kids 6 to 18 years old who three or more times a week have “temper outbursts that are grossly out or proportion in intensity or duration to the situation.” It actually started out as “temper dysregulation disorder with dysphoria” (tantrums, plus you feel bad) but got changed so as not to openly malign tantrums. But the diagnosis still focuses on tangrums, and critics say it is so broad and baggy that it’s ridiculous — and dangerous. Duke University psychiatrist Allen Frances, who chaired the revision of DSM-IV in 2001, says the DMDD diagnosis “will turn temper tantrums into a mental disorder.” In a recent blog post at Huffington Post, Frances put DMDD at the top of his list of DSM-5 diagnoses we should “just ignore,” because “a new diagnosis can be more dangerous than a new drug.” Clinical social worker and pharmacist Joe Wegmann called DMDD a diagnosis based on “no credible research” that would help drive a “zealous binge” of over-diagnosis.

Is the outcry legitimate? Or are Frances and Wegmann just having themselves their own conniption fit?

As the story reveals, the outcry is shrill, but likely not out of proportion, and speaks to far deeper problems in psychiatry. Do saunter over and get the whole thing at Slate. The comments thread is growing richer by the second.

Penetrating the Walls of Autism

Autism, famously fuzzy, seems to defy most attempts at definition, treatment, understanding. It’s often easier to spot the ideas and writing about it that don’t make sense than to find and fully embrace those that do. That’s what makes writers such as Emily Willingham and Steve Silberman and Amy Harmon so invaluable: They show us the possibilities within the confounds; that the fuzziness is richly textured.

So too does a new story by Gareth Cook*, a Pulitzer-winning journalist whose article “The Autism Advantage” appeared today in the early-online version of this coming Sunday’s New York Times Magazine. This wonderfully smart, richly reported, finely turned piece explores with unusual skill what may be autism’s central paradox — the difficulty of discerning a person who meets the world through such different perceptual, social, and communicative prisms. Take, for instance, this story from the principal of a school that has embraced the task of teaching children with autism:

The Specialisterne school uses Legos, too. Frank Paulsen, a red-haired man with a thin beard who is the school’s principal, told me about a session he once led in which he handed out small Lego boxes to a group of young men and asked them to build something that showed their lives. When the bricks had been snapped together, Paulsen asked each boy to say a few words. One boy didn’t want to talk, saying his construction was “nothing.” When Paulsen gathered his belongings to leave, however, the boy, his teacher by his side, seemed to want to stay. Paulsen tried to draw him out but failed. So Paulsen excused himself and stood up.

The boy grabbed Paulsen’s arm. “Actually,” he said, “I think I built my own life.”

Paulsen eased back into his seat.

“This is me,” the boy said, pointing to a skeleton penned in by a square structure with high walls. A gray chain hung from the back wall, and a drooping black net formed the roof. To the side, outside the wall, two figures — a man with a red baseball cap and a woman raising a clear goblet to her lips — stood by a translucent blue sphere filled with little gold coins. That, the boy continued, represented “normal life.” In front of the skeleton were low walls between a pair of tan pillars, and a woman with a brown pony tail looked in, brandishing a yellow hairbrush. “That is my mom, and she is the only one who is allowed in the walls.”

The boy’s teacher was listening, astonished: In the years she’d known him, she told Paulsen later, she had never heard him discuss his inner life. Paulsen talked to the boy, now animated, for a quarter of an hour about the walls, and Paulsen suggested that perhaps the barriers could be removed. “I can’t take down the walls,” the boy concluded, “because there is so much danger outside of them.”

Get the whole thing at The Autism Advantage.

*Disclosure: I first came to know Gareth’s work when he was editing the Ideas column at the Boston Globe. Later he took over editing of Mind Matters, a Scientific American online department I founded. And yet later I signed a book contract with an editor who happens to be married to Mr. Cook. I feel confident I’d be highly impressed with this autism feature anyway. The Lego story alone: It’s not every day one comes across something that beautiful.

Should Soldiers Who Survive Suicide Attempts Be Court-Martialed?

Should soldiers who survive suicide attempts be court-martialed — tossed from the military in shame? It’s a sticky question that gets stickier on examination. USA Today looks at it through the prism of a case in which a Marine private was court-martialed after being convicted of ‘self-injury’ after he slit his wrists in a barracks in Okinawa in 2010:

He was convicted under the Uniform Code of Military Justice’s Article 134, known as the General Article, because the judge found his self-injury was prejudicial to good order and discipline and brought discredit upon the service.

At least one judge on the military’s high court agreed with that argument. “You don’t think that the public will think less of the military if people are killing themselves? …There’s literature out there that these things come in waves,” said Judge Margaret Ryan.

Underpinning the case is the question of why the military criminalizes attempted suicide when it does not treat successful suicide as a crime.

“If (Caldwell) had succeeded, like 3,000 service members have in the past decade, he would have been treated like his service was honorable, his family would have received a letter of condolence from the president and his death would have been considered in the line of duty. Because he failed, he was prosecuted,” noted Navy Lt. Michael Hanzel, the military lawyer representing Caldwell.

Suicides among active-duty troops have soared in recent years, from less than 200 in 2005 to 309 in 2009, and a spike this year has put 2012 on track to set a new record high.

The court seems to be weighing, from a particularly military point of view, a two-stage question that is actually quite slippery: Within the military’s serve-the-group culture, will punishing suicide attempts actually reduce suicides by stigmatizing the act of attempting it? Or will stigmatizing the act actually raise the rate because it will also stigmatize the impulse or thought — or depression generally —‚ and thus prevent people from seeking help? In general, stigmatizing any given behavior does tend to reduce it, and one might expect that to be all the more true in rules-based subcultures like the military. This is probably part of why those in the military are generally more law-abiding across the board.

But is it possible, even within the rules-based military culture, to stigmatize suicide without stigmatizing depression and thus discouraging treatment? My guess is No. But if the USA Today story is paraphrasing the trial fairly, the court is struggling with just these questions. I suspect the military may find no way to be truly consistent here, or to come up with any rulings or policies that hold no difficult contradictions or confounds. As it is, however, the military’s stance is already all a-hoo: Soldiers who are successful in committing suicide are put to rest with full military honors, while those who fail to — but succeed, as it were, in living — are subject to courtmartial.

A reminder here to keep comments respectful, svp.

via Military court wrestles with punishing suicide attempts.

The Ruthlessness of Gravity

Years ago, I tried crossing a downhill street plated with glare ice (friction is one of our few weapons against gravity) and could no more walk across that street than I could fly.  And for the first time, I understood what gravity was capable of.  It doesn’t negotiate, it can’t be avoided, it runs this place like an absolute dictatorship.

Anne Finkbeiner, channeling Haldane*, on Falling.

* “You can drop a mouse down a thousand-yard mine shaft; and on arriving at the bottom, it gets a slight shock and walks away.  A rat is killed, a man is broken, a horse splashes.” From On Being the Right Size, by JBS Haldane.

The Neanderthal In (and On) Steve Colbert


The Colbert Report Mon – Thurs 11:30pm / 10:30c
Chris Stringer
www.colbertnation.com
Colbert Report Full Episodes Political Humor & Satire Blog Video Archive

We sapiens weren’t always the only Homos. Not long ago we shared it with Neanderthals, Denisovans, even hobbits, it seems, and perhaps others, most of whom were technically humans, which is to say, Homos.

So how did we end up being solo Homo? Did we outlast, outsmart, or outcompete the others, or just luck out? This question, which happens to be one of the hottest and most vital in anthropology, is the subject of a new book, Lone Survivors, by paleoanthropologist Chris Stringer, who heads the human evolution group at the British Museum of Natural History. Somehow, rather incredibly, he manages to deliver a fairly concise overview of this subject during a typically entertaining but distracting barrage of questions from Steven Colbert. Take it in, and if you want more, go fetch the book.

See also:

Chris Stringer on the Origins and Rise of Modern Humans

Chris Stringer – The Colbert Report