Interesting article about the fuzziness of diagnoses (DSM)

[marc_101]

Related to some recent discussions:

https://www.newyorker.com/magazine/2024/05/13/why-were-turning-psychiatric-labels-into-identities

 

[Neonatal RRT]

The fuzziness of some mental health diagnosis is certainly present in some of the "less effected" individuals. As we've discussed before in other threads, it can be pretty clear that an individual with an ASD-3 autism variant has autism, but often less so with an ASD-1 autism variant. I suspect that this would be similar with other mental conditions due to the highly variable presentation. Welcome to genetics 101.

On one level, I do agree with the author that the current DSM leaves some room for the psychologist and their cognitive biases to diagnose, or not diagnose individuals with specific mental health conditions. The difficulty with psychology is that one must often diagnose a condition via signs and symptoms. It's not like many medical conditions where you can run blood tests and do imaging, etc., at least not today, perhaps in the future. I would also add that society, in general, has begun to place an emphasis on labels, whether you are of a specific ethnicity, religion, sexual preference, gender identity, and of course, any psychological diagnosis. Neither situation is good.

As a person who has worked for nearly 40 years in neonatal medicine, I know that even with rather specific genetic diseases or organ diseases, such as congenital heart diseases, even when conclusively diagnosed, the presentations between patients can be highly variable to the point where student textbooks are often not representative of what you're going to be presented with in the real world. For our pediatric cardiac surgeons, every case of say, Tetralogy of Fallot, A-V canal, or Hypoplastic Left Heart Syndrome, is one of one. They are all unique. The same for neurologists, pulmonologists, urologists, dealing with their respective diseases in patients. Nothing is straight forward. So, to me, it's a forgone conclusion that no two autistic individuals are going to present the same. I can see why many struggle with the current DSM, because at this stage of the game, we only have a basic understanding of the genetic, epigenetic, anatomy, and physiology that contribute to the core behavioral traits of autism and/or any other mental health condition. Of course, this gets further muddled when tertiary psychiatric behaviors present. It's not easy. It couldn't be. We don't know enough yet. We will keep at it, I am sure. The more questions we answer, the more questions we will have. This is the nature of science. Given the current data that is out there, I am pretty well convinced that autism is a medical condition, given its metabolic, neurochemical, neuromotor, and immunological components. It goes well-beyond an isolated psychological and psychiatric condition.

 

[Masaniello]

It looks interesting but the New Yorker told me to subscribe - so I can't reading it without paying.

 

[Rodafina]

It looks interesting but the New Yorker told me to subscribe - so I can't reading it without paying.

PDF version attached.

 

[Masaniello]

PDF version attached.

Thank you. I'll ask the New Yorker for forgiveness later on after reading their free article.

 

[marc_101]

The fuzziness of some mental health diagnosis is certainly present in some of the "less effected" individuals. As we've discussed before in other threads, it can be pretty clear that an individual with an ASD-3 autism variant has autism, but often less so with an ASD-1 autism variant. I suspect that this would be similar with other mental conditions due to the highly variable presentation. Welcome to genetics 101.

I think that's actually the point of the article. Whether a diagnosis identifies a real thing when we're so far off from relating a diagnosis to a gene or a set of genes -- let alone their interaction with environment and gene expression (epigenetics). We do know there is a genetic component in the sense of clustering in families, but not always.

There is also fuzziness with the most severe cases in the sense that nothing tell us the cause or whether the most severe cases originate from the same cause(s). We only have a collection of traits.

Two examples: my step niece is 10 and is non-verbal. She has ASD-3 according to about 5 doctors and she has brain damage according to another 5 doctors. Since some of her traits/behaviors fit ASD, that's one label she gets. My girlfriend's brother would be diagnosed with ASD by any doctor now because of his behavior but he is not because the cause is lack of oxygen to the brain at birth. Had he been adopted, he would be labeled autistic.

I'm not saying all diagnoses are bad or wrong. I'm saying there is a lot of uncertainty and lot that we do not know. There is a lot of fuzziness.

For me, personally, that translates into not getting too attached to my own labels. Others should decide for themselves.

 

[vergil96]

Unrelated to the identity thing, medicine isn't black and white. There is a saying in the medical community "we don't treat symptoms, we treat people", it means that something is a problem to treat only if it causes loss of function, there are lots of abnormalities people have that don't cause loss of function, therefore don't have to be treated.

 

[vergil96]

Three new books—Paige Layle’s “But Everyone Feels This Way:
How an Autism Diagnosis Saved My Life,” Patric Gagne’s
“Sociopath: A Memoir,” and Alexander Kriss’s “Borderline: The
Biography of a Personality Disorder”—illustrate how psychiatric
classification shapes the people it describes. It models social
identities. It offers scripts for how to behave and explanations for
one’s interior life. By promising to tell people who they really are,
diagnosis produces personal stakes in the diagnostic system,
fortifying it against upheaval.
Just as personality tests (see, I’m an introvert!), astrological signs
(I’m a Libra!), and generational monikers (I’m Gen Z!) are used to
aid self-understanding, so are psychiatric diagnoses. When Paige
Layle was fifteen, a psychiatrist told her that she had autism
spectrum disorder. She describes the rush of clarity she
experienced when hearing the DSM-5 criteria: “I’m not crazy. I’m
not making it up. I’m not manipulative or trying to fake anything. . . .
There’s a reason why I’m the way that I am.”
Layle’s diagnosis—and her discovery that “so many of my
questions have one clear answer”—comes halfway through her
book. The chapters leading up to it recount the frustration and
confusion of being inexplicably different. She lists her “traits” early
on: picking at her skin, pulling out her hair, cutting tags from her
clothes, dissociating at the sound of fireworks. By the first grade,
she says, she could read almost as well as a sixth grader, and in
later years, she consistently earned high marks, yet she failed to
decipher implicit meanings of texts in English class. She also
struggled with anxiety; she was, in her words, “the weird kid who
cried all the time and was so stressed that she wanted to die every
single day.”

I hate this phenomenon. It's very invalidating and pushes people with legitimate issues aside to make diagnoses into labels. It is a thing, lots of people do it recently. They behave as if they own the diagnosis and nobody else can have it, if they don't make it their whole identity, don't constantly talk about it, don't make it a core of who they are. Who have a resilient mentality and want to beat problems and persist. There is a fair point in the article about enabling a mindset to give up and specifically Reddit is mentioned... it already came up on the forum not long ago.

 

[jsilver256]

I hate this phenomenon. It's very invalidating and pushes people with legitimate issues aside to make diagnoses into labels. It is a thing, lots of people do it recently. They behave as if they own the diagnosis and nobody else can have it, if they don't make it their whole identity, don't constantly talk about it, don't make it a core of who they are. Who have a resilient mentality and want to beat problems and persist. There is a fair point in the article about enabling a mindset to give up and specifically Reddit is mentioned... it already came up on the forum not long ago.

I saw a parent on Reddit ask for advice regarding her adult ASD1 son playing video games all day and helping him get motivated to do something else. All the Redditors piled on her for daring to imply this wasn't a healthy lifestyle. They claimed her son needed to play these games all day to "regulate" etc. A lot of it seemed like projection honestly.

 

[Au Naturel]

Everything gets sucked into the singularity that is identity politics.

A label is something others put on you in order to simplify their life. It also simplifies your life if you accept it. You get put in a drawer with others with the same label and are expected to conform to how a plurality of the others in the same drawer think and behave.

 

[Masaniello]

I saw a parent on Reddit ask for advice regarding her adult ASD1 son playing video games all day and helping him get motivated to do something else. All the Redditors piled on her for daring to imply this wasn't a healthy lifestyle. They claimed her son needed to play these games all day to "regulate" etc. A lot of it seemed like projection honestly.

As soon as I read “I saw a parent on Reddit ask for advice” I knew it was going to end badly.

 

[Au Naturel]

As soon as I read “I saw a parent on Reddit ask for advice” I knew it was going to end badly.

Yeah. Asking for advice on Reddit is a bad idea for most problems. She's got two strikes against her already, just for asking.