Wednesday, February 10, 2010

Revising the book on Disorders of the Mind

Benedict Carey's article on DSMV makes particular note of the problems associated with the diagnosis of bipolar disorder in children. I found it a wonderful example of how psychiatric diagnoses are negotiated socially. What is a psychiatric diagnosis if its boundaries can be changed because of concerns about the side effects of the medications used to treat it? Here is an excerpt from the article.

One significant change would be adding a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it.

The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes.

“The treatment of bipolar disorder is meds first, meds second and meds third,” said Dr. Jack McClellan, a psychiatrist at the University of Washington who is not working on the manual. “Whereas if these kids have a behavior disorder, then behavioral treatment should be considered the primary treatment.”

Some diagnoses of bipolar disorder have been in children as young as 2, and there have been widespread reports that doctors promoting the diagnosis received consulting and speaking fees from the makers of the drugs.

In a conference call on Tuesday, Dr. David Shaffer, a child psychiatrist at Columbia, said he and his colleagues on the panel working on the manual “wanted to come up with a diagnosis that captures the behavioral disturbance and mood upset, and hope the people contemplating a diagnosis of bipolar for these patients would think again.

Tuesday, February 09, 2010

Post Traumatic Symptoms in the Civil War

I recently came across this in Louisa May Alcott's Civil War Sketches [Dover, 2006, 34-5]. She worked as a volunteer nurse at a hospital in Washington shortly after the battle of Fredricksburg. This is a layperson's description. The role of psychological trauma was not established medically in the production of symptoms such as these until after the Civil War. I'm not sure how a Civil War doctor would have diagnosed this "… New Jersey boy, crazed by the horrors of that dreadful Saturday. A slight wound to the knee brought him there; but his mind had suffered more than his body; some string of that delicate machine was over strained, and, for days, he had been reliving in imagination, the scenes he could not forget, till his distress broke out in incoherent ravings, pitiful to hear. As i sat by him endeavoring to sooth his poor distracted brain by the constant touch of wet hands over his hot forehead, he lay cheering his comrades on, hurrying them back, then counting them as they fell around him, often clutching my arm, to Drag me from the vicinity of a bursting shell, or covering up his head to screen himself from a shower of shot his face brilliant with fever; his eyes restless; his head never still; every muscle strained and rigid; while an incessant stream of defiant shouts, whispered warnings, and broken laments, poured from his lips with that forceful bewilderment which makes such wanderings so hard to overhear." Perhaps a febrile delirium.

Monday, February 08, 2010

Wittgenstien's Nephew by Thomas Bernhard

This is a book about madness and friendship. Written as a memoir, which in part it is, it describes Bernhard's friendship with the great philosopher's mad nephew Paul Wittgenstein. What is most moving about this book is that the author, while vividly describing his friend's madness, also conveys how terribly important his friendship with this madman is to him. In the end it is not a book so much about Paul's madness as about Thomas' frailty and his sadness at the loss of a dear friend.

Wednesday, February 03, 2010

Lenz by Georg Büchner

Thanks to Praymont I have read Lenz [for more about this book see his comment on my Yellow Wallpaper post]. Büchner's descriptions of Lenz's madness were convincing and if I had the time I would love to compare them with, say, the descriptions of Lowboy's madness [see my Lowboy post] to get a better idea of how contemporary ideas about madness color our representations of the inner lives of the mad. I don't think it is possible to provide a culture free description of madness and I think all such descriptions say more about the culture and the author than about madness itself. What impressed me more than the description of Lenz was the description of Oberlin and his wife as they struggled to care for Lenz. Without a medical model to channel their feelings towards Lenz their mix of kindness and exasperation reminded of the kinds of feelings that families today have when one of their loved ones begins losing his or her mind.

The Age of Anxiety by Andrea Tone

Almost a companion piece to Hirsbein's book The Age of Anxiety traces the creation of the diagnosis of Anxiety Disorder and the production of treatments for it in the United States during the last half of the twentieth century. This book is less self-consciously constructionist and feminist than Hirsbein's, which is not to say that it does not make clear how the diagnosis of anxiety was constructed and how gender has played a role in marketing the diagnosis and its treatments. Tone is, however, more interested in changes in American culture and how this affected attitudes towards anxiety and its treatments. She does a wonderful job capturing the mood of the country during the Miltown years as well as during the ups and downs in our feelings about benzos. A particular pleasure in this book is that Tone interviewed two of the men responsible for particular medications--Frank Berger (Miltown) and Leo Sternbach (Librium)-- and puts their personal stories in counterpoint with the larger cultural story.