Archive for the ‘controversies’ Category

I looked up a review of MPD/DID treatment practices, and their effects. I’m skipping the extensive and disturbing description of the lengths practitioners go to in order to elicit alters, but it includes things like spending 4-8 hours in therapy without breaks attempting to elicit personalities (i.e., you don’t get to go home till you show me a personality), and taking momentary silence or a glance around the room to indicate a switch in personalities.

Selections from the article:

This proliferation of alters is typically accompanied by clinical deterioration that is often quite marked. In one investigation, more than 8 of 10 patients “developed florid posttraumatic stress disorder during [DID therapy]”; the authors commented that this result is typical (6, p 361). Hallucinations, increasing discomfort, and severe dysphoria often cause patients to be in states of chronic crisis for long periods of time after DID treatment begins (9,11,52–54).
Moreover, suicide attempts may occur in the weeks following the diagnosis: Fetkewicz and associates showed that, after the diagnosis had been made, MPD-diagnosed patients attempted suicide more frequently than age- and sex-matched patients suffering from major depressive disorder (55). In another study, 4 of 5 MPD patients improved dramatically when they were rediagnosed and treated in more conventional ways (56).

Such deterioration should surprise no one, given the treatment practices that leading DID proponents recommend. These proponents believe that successful treatment requires DID patients to search their memories for each supposed trauma and then to abreact (that is, experience in therapy) the memories and associated emotions (1,11,57). Such searches frequently consume hours of each day, and the abreactions are extremely draining (58,59). Patients thus sink ever more deeply into a swamp of ruminations about past mistreatment, abuse, and trauma.

(emphases mine)

We don’t have a lot of research on this, unfortunately. It would be nice to have more. Part of it is for the reason the article talks about – in practice MPD/DID is often specified in ways that dodge testable definitions, which sets things up so that you can’t ever find out that a diagnosis is wrong, regardless of whether it is. Part is because it’s fringe, which is unfortunate because it’s also important.

This is in agreement with other research I’ve read – eliciting alters is a good way to get someone’s mental health to deteriorate. I’ve heard this cited as a reason that a lot of North American MPD clinics have closed, but I don’t know if that’s really the reason; my guess would actually be that they closed because they weren’t getting new patients, not because they were serving their old patients poorly.

Here is part 1 of the article above (with a historical review of MPD).

The online magazine Spiked has an issue just out on MMR and autism, with a lot of articles which are both detailed and reasonable.

“[T]he approvable letter concerns treatment of schizophrenia in adolescents aged 13-17 and for short-term treatment of the manic phase of bipolar disorder among children and adolescents ages 10-17”.

I wonder what it’s conditional on.

This was going to be a longer post on kids and antipsychotics, but I got some very good news and am going to go celebrate instead.

The hot in-depth dissection of and commentary on the trial transcripts is going on over at Autism Diva‘s blog. I encourage you to check it out, though you may want to start back in the archives when the trial began.

She also links to this New Scientist article that brings to light some of the shadiness going on behind it.

Pediatric bipolar disorder has been coming up more frequently over the last few years, and the current flap is about Joseph Biederman, who is an advocate of the view that bipolar can exist as early as birth. There’s also scandal (from back in December) over a four-year-old who died from being given too much medication by her parents, and that’s being brought up in this as well.

Those are the extreme cases. I’m going to write about the typical stuff.

(But first: At birth? Why at birth? I’m pretty sure our emotional regulation systems neither suddenly turn on nor suddenly break then. I know he’s using it for dramatic effect, but it bugs me.)

The news coverage I’ve seen tends to have one of two themes:

1. “Kids will be kids”: You can’t diagnose bipolar in children because that’s just what children are like – they change by nature. (This is similar to the incorrect argument that AD/HD doesn’t really exist, because to be bored by school is to be a normal child.)
2. We’re overprescribing antipsychotics to children. They should only be prescribed for their intended purpose. (Meaning, to treat psychosis, or, even more restrictedly, to treat schizophrenics.)

I’m going to talk about the “kids will be kids” aspect, and then talk about why it actually is hard to diagnose bipolar disorder in children, and will talk about antipsychotics later in the week. I’m pulling heavily from Goodwin & Jamison’s “Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression”, second edition. The first edition is considered the classic work in the field; the second edition is just out as of a couple months ago and I heart it down to my research-loving bones.

Okay:

Bipolar disorder occurs in young children.

There are debates over how common it is, what it looks like when it happens, and whether we can diagnose it and when, but it’s not at all like being a normal child.

Here are a couple parallel normal and pathological examples from the Goodwin and Jamison book (originally from Geller et al, 2002a and if anyone really wants cite that I’ll get it for you):

Happiness: Child was extremely happy on days family went to Disneyland, on Christmas morning, during grandparents’ visits (joy appropriate to context, not impairing).

Elated mood: 9-year-old continually danced around at home, stating, “I’m high, over the mountain high” after suspension from school.

Sexuality: 7-year-old child played doctor with a friend of the same age.

Hypersexuality: Girl faxed a note to the local police station asking police to ____ her [underlines in the original]

And you can find all kinds of examples on websites for parents of bipolar children – kids trying to spontaneously jump out of cars, that kinds of thing.

It’s hard to diagnose because kids with bipolar frequently meet criteria for other disorders too

Like ADHD, conduct disorder, and oppositional defiant disorder. Some kids have a *lot* of problems, and it’s not clear whether they have one disorder that’s causing other disorders (for example, bipolar disorder can cause anxiety) or whether they have multiple disorders (bipolar disorder can coexist with a separate anxiety disorder). This happens with adults as well, but it’s particularly common for kids with bipolar-ish symptoms.

This leads to a disturbing situation that I would like to see get more press: although the popular controversy is about whether bipolar exists in kids, it should really be about what is going on with these kids who are badly impaired and difficult to diagnose and treat. It’s not about whether they’re bipolar or not, with “not bipolar” meaning “normal”, because they’re not normal. It’s about what should we be doing to help them.

Children with bipolar disorder also tend to look different from adults with bipolar disorder. They are more likely to rapid-cycle (go through many mood shifts throughout the day); to be irritably instead of happily manic; and to not have well periods between mood episodes. So they’re less likely to be recognized by practitioners whose mental picture of bipolar disorder is based on an average adult.

Another interesting question is whether the kids we’re identifying with bipolar disorder are going to grow up to look like most adults with bipolar disorder – do they have an early version of the disorder that changes as they mature? Do they have a more severe version of it that doesn’t? Or do they have something that’s just different?

Check out these two articles together:

Let’s not reject our geniuses: Genetic screening risks losing a future Dickens

Joyce’s ADD and not talent made him a genius

The latter is a spoof, but it satirizes something common that shows up in the first article: We must retain mental disorders because society needs geniuses.

Most people with mental disorders, like most people without mental disorders, aren’t geniuses (duh). Mental disorders impair the ability to function normally (for all people – that’s why they’re disorders), rather than providing talent (for most people). Most aren’t even associated with genius and creativity. Bipolar disorder is, but I haven’t found any plausible research for any other disorders (someone correct me if I’m wrong here).

Maybe at some point we will deliberately keep some mental disorders around because society values so strongly the minority of sufferers who have associated talent. Via genetic screening, or a decision not to fix things in children when we can, whatever. (I really hope we make this choice based on actual associations between a disorder and creativity.)

If so, society and its individual elements are going to owe a debt to all the people they’re causing to suffer in obscurity, because they’ll be sacrificing all those individual peoples’ welfare to get a few people who get to be geniuses. And society better pony up compensatory resources.

People with mental disorders who are not geniuses are valuable to society in many other ways, and I’m not ignoring that. I’m just saying that if society makes a deliberate decision to keep mental disorders to get geniuses, it needs to take responsibility for the other effects of that decision, and to thoroughly recognize the value of the people it’s compensating, above and beyond that of regular human beings with medical disorders (which it sucks at now), as people who contribute to genius.

The LA Times has a good article on the history of autism/vaccine research.

They raise an interesting point at the end, which is that vaccines do not “cause autism” but we can’t prove that they never cause autism in anyone ever (and don’t currently have the knowledge of etiology to say how likely it is or isn’t that they never cause autism in anyone ever). So scientists continue to look to see whether there might be a tiny, highly susceptible population.

I’m sincerely hoping that what happens is that 1) they do find such a population and 2) it is identifiable, so that 1) anti-vaccine believers might focus on a tiny effect that really happens rather than a large effect that does not, and 2) vulnerable people will be identified and prohibited from taking the vaccine and non-vulnerable people will be identified and strongly encouraged to take the vaccine and ideally will. And then all autistic and non-autistic children are that much less likely to get deadly childhood diseases.

Okay, not really. But apparently it’s being asked to decide that thimerosol causes autism.

Who cares about science (and extensive epidemiological studies finding no link)? Let the courts decide…

On a (thematically, but not morally) related link, my dad came home from a chemistry conference with a paper someone presented on a possible biomarker for autism (summary: lower levels of stuff in pee):

Scroll down to “Stercobilin: A Possible Biomarker for Autism?”

Dad says that stercobilin has [mumbo jumbo isomerish chemical-esque] to do with mercury or thimerosol or something. It makes sense to believe the extensive epidemiological studies over a hypothesized connection without further evidence, though.