Tuesday, September 30, 2008

Bipolar Kids in the Times Magazine

So after the New York Times Magazine covered bipolar kids in the last issue, Barbara Probst of Croton, NY had this to say:

"We need to be cautious about giving psychiatric labels to children who are intense, erratic, provocative and extreme but are not necessarily disordered... "Diagnostic creep" has spread alarmingly in recent decades, with psychiatric categories consuming turf that used to be part of the variety of human life."

Well, first a note about everyday accusations of "diagnostic creep." It seems to be a generally accepted truth that

"Americans turn to pills when good old fresh air and conversation would do the trick just fine!"
"nowadays, if a kid is rambunctious they just slap a label on him and dose him to the gills!"

It's obvious that as a new disorder is diagnosed and knowledge of it becomes widespread, the number of reported cases should rise. But the term "diagnostic creep" describes something else, an insidious process whereby not only are more cases reported, but the diagnosis itself is broadened to blanket more and more cases.

And that's a difficult assessment to make, for most diagnosed disorders. There's the rise in reported cases of cancer, which no one suggests is diagnostically creepy. There's the Victorian concept of "female hysteria," a gynophobic cultural construction used to cover everything from hot flashes and anxiety to legitimate grievances with an unfair political system. But almost everything else falls in between, and I would certainly look at lots and lots of charts, and chart the evolving diagnostic criteria for lots of disorders, before deciding that "diagnostic creep has spread alarmingly in recent decades."

It just sounds folksy to me. Like saying the English language has become impoverished "in recent decades," because people sometimes shorten words in text messages.

But the really telling comment is here:
"psychiatric categories consuming turf that used to be part of the variety of human life."
Any barely competent mental health professional knows that her patients are all varied, all human, and all alive, no matter what "psychiatric category" they fall in. She may have mildly bipolar patients who decline pharmaceutical intervention and severely bipolar patients whose conditions resist medication. And every single one of them will need a different plan of treatment, even if they share a diagnosis.

We should of course "be cautious about giving psychiatric labels to children." "We" should be cautious about giving psychiatric labels to anyone, especially if "we" are not psychiatrists. It takes care and acumen to provide a diagnosis that will help lead the way to an effective treatment. Done well, there's nothing dehumanizing about it.


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