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When Doctors Decide Your Disease Doesn’t Actually Exist

People come to like their diagnoses, or at least to feel that they have explanatory power for the dissatisfactions in their lives.

by
Theodore Dalrymple

Bio

October 9, 2013 - 4:00 pm
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Diseases that have no objective tests to distinguish them from normality have a tendency to spread like fungus: for example, it is years since I heard anyone say that he was unhappy rather than depressed, and it cannot be a coincidence that 10 percent of the populations of most western countries are now taking antidepressants. Yet the state of melancholia undoubtedly exists, as anyone who has seen a case will attest.

Likewise with autism. I remember an isolated, friendless and uncommunicative patient who tried to kill himself when his landlord could no longer tolerate the collection of light bulbs that he had collected since childhood, was constantly enlarging, and that now threatened to fill the whole house. For the patient light bulbs were the meaning of life. It was difficult to believe in such a case that there was not something biologically wrong with the patient, even if one could find it.

An editorial in the New England Journal of Medicine traces the convoluted history of the diagnosis of autism and Asperger’s syndrome. The pediatricians Leo Kanner and Hans Asperger described the conditions in 1943 and 1944, respectively.

Kanner thought that two features were essential to autism, a psychological separation from the world manifest very early in a child’s life and an obsessive desire to prevent change in the person’s immediate surroundings. Kanner thought that such children had similar parents, often of high intelligence but who were better and happier with ideas than with human relationships. This gave rise later to the concept of the “refrigerator mother,” that is to say a cold and uncommunicative woman who did not cuddle her child or provide it with any emotional warmth, and whose conduct caused the child, by a mechanism of defense, to withdraw into its own world. This was also the era of the “schizophrenogenic” mother, the mother who communicated two messages in one verbal utterance, leaving the child uncertain as to what was meant.

These theories have now been abandoned; they were not only wrong but cruel, for they blamed the mother for the child’s devastating condition. Biology is back in fashion.

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Top Rated Comments   
It is a horror to think one's diagnosis could (or would) become a cause of social or political action. Especially among those diseases or symdromes that are difficult to diagnose and to treat, like Asperger's or autism.

No condition (unless it is contagious) should be placed on the front burner because it is often redefined. We now have a nation of school children who are on medication because they were deemed overactive, or non-cooperative, and teachers (as well as parents) are more than willing to medicate than to step up and do their jobs as parents and teachers to identify and enrich the promises and talents of these kids.

The worst thing you can to is label your child as being less than normal. I have tried to hire people who tell (warn) me they are ADHD, as if that is an excuse for poor performance. And, frankly, they fall back on that excuse every time they can't show up on time. Or follow a simple request to empty trash cans. They have learned to exploit a lifetime of, "It's OK. You just can't do it." It's crazy.


44 weeks ago
44 weeks ago Link To Comment
My son was diagnosed with Asperger's, a mild condition of it, by the psychiatrist who saw him initially for devastating (near-suicidal) depression. He does share some of the social characteristics with Asperger's, and he is a freaky math genius, but I wonder. My son says having a diagnosis is a relief, and since he obtained the label, he has launched himself into dealing with his issues. I guess the label let him feel it wasn't just something in his imagination, giving him a better grip on the need to work on it. Since that time, he is doing much better. If that's what a label does for him, I'm good with that. Just our experience. Disclaimer: no tax-funded goods or services are involved in our family's medical dealings.
45 weeks ago
45 weeks ago Link To Comment
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All Comments   (51)
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Dr. Dalrymple, one of the 10 pillars of the 2010 ACA law is mandatory coverage for mental issues requiring the services of a psychologist, psychiatrist, treatment center, etc.. Is this what you might label "payback" for these often liberal-thinking individuals for their campaign contributions to the (D)s?

As the psychologists and psychiatrists themselves can add to the DSM bible of what is dysfunctional but treatable, how different is this from scam artistry?
42 weeks ago
42 weeks ago Link To Comment
The DSM antics are part of a much wider problem, the fashionable need to avoid personal responsibility and the urge to blame someone else. One test is to turn-off the money: you'll find out where the middle ground lies.

Example: "refrigerator mother" is certainly overstated, but anecdotally nearly everyone has encountered an ice princess or two; often there's no pat explanation. Some people are just plain rotten?
44 weeks ago
44 weeks ago Link To Comment


I am sure why you think the need to avoid responsibility for the consequences of one's actions has ever been out of fashion.  Before the advent of care in the community it was relatively easy to have one's 'crazy' relative admitted to some institution. And there they remained out of sight and mind for the rest of their natural lives.  At the expense of the taxpayer.

This is what the good doctor means when he uses the term 'refrigerator mother':

"The term refrigerator mother and refrigerator parents were coined around 1950 as a label for mothers and parents of children diagnosed with autism or schizophrenia. Parents, particularly mothers, were often blamed for their children's atypical behavior, which included rigid rituals, speech difficulty, and self-isolation."

There was also the concept of the  schizophrenogenic mother.

Basically, these theories privileged nurture over nature.

So I'm not sure how the Good Doctor arrives at the conclusion: 'Biology is back in fashion.'

Perhaps you are.
44 weeks ago
44 weeks ago Link To Comment
You're all over the lot. Who is defending wrongful institutionalization of any kind, let alone for life? Also, as you surely know, 'care in the community', as applied, has very often turned out to be a disaster. Throwing more money at a failed idea 'basically' on the assertion of 'privileging' anything is itself fashionable -- the familiar campus cant of deconstructed, post-modern drivel. It also has nothing to do with what this article is about.

Refrigerator mother is an emotive phrase. Dalrymple's definition is clear, as it his condemnation of its original use. The phrase can also be used in other contexts by anyone, including me, and your approval isn't needed. Your red-herrings are flapping.

I'm not willing to put words into D's mouth, and have not.
Since you're willing to put them into mine, "perhaps you are."
44 weeks ago
44 weeks ago Link To Comment
Usually quotation marks denote...

Oh, never mind. I'd suggest you re-sit your Frank McCourt evening class but as he is no longer with us...
43 weeks ago
43 weeks ago Link To Comment
Even if people today diagnosed with Asperger's would not have been given a diagnosis fifty years ago, there something going on there that is real. There is a reason most of these people find it tremendously difficult to get dates even though many of them want very much to do so. It is not for something imaginary that women reject their expressions of interest.
44 weeks ago
44 weeks ago Link To Comment
In part, yes. But there is massive overdiagnosis going on.
Every few years there's a new "hype disease" and suddenly everyone has it.

10 years ago it was ADHD, now it's Aspergers and Autism. When I was a kid it was Pfeifer's disease.
And in a few years time it'll be something else again.

All have in common that they're covered by a very wide range of seemingly unrelated symptoms, each of which on their own doesn't indicate the disease but is pushed by special interest groups as "if you have X you could have it, go see your doctor" in media campaigns, people visit doctors with mild symptoms that in extreme cases can be an indicator, then make the diagnosis the person wanted to hear and prescribe them some meds (often even placebos) to keep them happy.
Patient happy, doctor that much richer.

Now, with the ADHD thing we see a new factor, the medical industry actually spreading the hype in order to sell more drugs, real drugs, which are effectively strong narcotics that, were you to buy them on a street corner from a pusher, would land you in prison.

And that's where we are now, industry, special interest groups, and government agencies desperate for sales, subsidies, and "making numbers" pushing for ever more diagnoses for ever more vague conditions, to the point where the actual sufferers of the conditions involved get left out and disbelieved when they mention their disease because of all the (usually unknowing) imposters.
44 weeks ago
44 weeks ago Link To Comment
Diseases that have no objective tests to distinguish them from normality have a tendency to spread like fungus

Like all psychiatric disorders?

This is like a witchfinder general suddenly announcing that there is no such thing as witches.

Where is the mea culpa?
44 weeks ago
44 weeks ago Link To Comment
Ritalin (methylphenidate) has been described as "cocaine for kids". About 90% of Ritalin prescriptions written IN THE WORLD are written in North America. (The rest of the world is ok ?)

So you've got an antsy kid, and you slap him on a drug when there is no physiological evidence of an underlying neurological disorder, although "they" have been trying for decades to find one.

But YOU feel better because antsiness has been named and your kid now has a label.

Criminal.
44 weeks ago
44 weeks ago Link To Comment
More often it's the teachers that slap on the diagnosis. Drugging is much easier than discipline, and in today's climate, much less likely to land you in jail.

44 weeks ago
44 weeks ago Link To Comment
"Yet the state of melancholia undoubtedly exists, as anyone who has seen a case will attest."

Wouldn't that be *malignant* melancholia?
44 weeks ago
44 weeks ago Link To Comment
I noticed over the last decade or so, especially at work, that everyone (mostly if not exclusively women) who doesn't want to put in an 8 hour day suddenly has fibromyalgia. I'm not saying it doesn't exist but why the sudden epidemic?
44 weeks ago
44 weeks ago Link To Comment
One pharmacist who blogs calls the disease "fatsomyalgia" because its purported victims happen to be predominantly very heavy women. He also notes that the "inventor" of the disease has backtracked on whether it really exists.

It appears that many of those seeking a "fibromyalgia" diagnosis are looking for narcotic painkillers or for excuses not to work and receive disability. I found it revealing that my doctor, whom I regard as pretty savvy, says she does not treat it because she doubts it exists. And she noted with horror the example of an 18–year-old woman, the daughter of someone she knew, who was on meds for it! At 18!
44 weeks ago
44 weeks ago Link To Comment
Ask their doctors. I suspect that it is a symbiotic process.
44 weeks ago
44 weeks ago Link To Comment
"If much of your life you have been told that you have a condition which has become the focus of your existence, only to be told years later that no such condition exists, you are bound to feel a sense of loss or even of bereavement."

If much of your life you were a committed left winger only to see that your political beliefs were a sham, you are bound to resist acknowledging your mistake because you whole sense of identity would be at stake and you are "bound to feel a sense of loss or bereavement". And left wingers have a mental disorder.

It all fits.
44 weeks ago
44 weeks ago Link To Comment
Like the Air Force NCO in a TV commercial who said he had post traumatic stress disorder [used to be post traumatic stress disease and/or post traumatic stress syndrome--they had to drop syndrome because a syndrome is a collection of certain specific irregularities of a limited number, whereas a disorder is a collection of any number of dissimilar irregularities]. Yes I said Air Force. What his combat trauma was is not specified. Maybe he was just nervous. Excuse me, maybe he just experienced neurological manifestations disorder.
In any case I feel bad for him. He has been provided with an excuse to be disabled for life, the poor guy.
44 weeks ago
44 weeks ago Link To Comment
Would you apply this to all mental illness or just PTSD?

You're on shaky ground when you criticise members of the armed forces.
44 weeks ago
44 weeks ago Link To Comment
As far as I know, some "mental illnesses" are clearly syndromes.
44 weeks ago
44 weeks ago Link To Comment
"You're on shaky ground when you criticise members of the armed forces."

Hogwash. They are not saints, beyond criticism. That attitude is dangerous.
44 weeks ago
44 weeks ago Link To Comment
I suggest you read what I actually wrote, rather than what you think/believe/wish I had written.
44 weeks ago
44 weeks ago Link To Comment
I did.
44 weeks ago
44 weeks ago Link To Comment
Thanks, Mark. Soldiers are just representative of the population in most respects. If you offered them an Obamaphone, some of them would take it. If you offered them full disability without unshakable evidence, some of them would take it. Just like the population.

Because I served myself, I'm standing with one leg on solid ground anyway. Don't feel shaky at all. I don't hate that Air Force NCO. I feel bad for him.
44 weeks ago
44 weeks ago Link To Comment
But before PTSD there were other ways of dealing with former members of the armed forces who claimed that they were unable to deal with civilian life: they put them on psych wards and left them there for the remainder of their lives.
44 weeks ago
44 weeks ago Link To Comment
Or you might become an agent provocateur for "the left".

Or you might over-compensate.
44 weeks ago
44 weeks ago Link To Comment
"In some cases a diagnosis even give meaning to those lives: they devote themselves to associations that care for or (more usually) campaign politically for other people with the diagnosis."

It also 'gives meaning" and often provides an income for the doctors who specialise in treating them.
44 weeks ago
44 weeks ago Link To Comment
"it is years since I heard anyone say that he was unhappy rather than depressed,"

There is a simple explanation for this: the good doctor's specialism is psychiatry. A psychiatrist whining about his patients claiming that they are depressed rather than unhappy is akin to an oncologist complaining about his patients believing that they have cancer rather than the common cold.

The gatekeeper is the GP and would not refer his patients to a psychiatrist if he believed him to be 'unhappy' rather than clinically depressed. At the basest economic level it is a waste of resources.
44 weeks ago
44 weeks ago Link To Comment
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