DSM, ADHD, and Sybil; Education and obligation.

View 697 Monday, October 17, 2011

I suppose there are more important matters, but the interesting news to me is:

“Sybil Exposed”: Memory, lies and therapy

How three women fabricated the most famous case of multiple personality disorder and damaged thousands of lives

http://www.salon.com/2011/10/16/sybil_exposed_memory_lies_and_therapy/singleton/

It’s hardly a surprise. I never believed in the “Sibyl” story to begin with. Even so, “Multiple Personality Disorder” made its way into the Diagnostic and Statistical Manual, and it’s still there although it has undergone a slight name change. Which means that insurance companies have to pay for treatments for this “disorder” and do. It’s not the only instance of fraud. The DSM defines a lot of “disorders” (and thus makes it legal to bill for their ‘treatment’). Some of them are indistinguishable from what others would say is a case of teenage rebellion. Then there is ADHD and ADD and Autism, none of which occupied much time in graduate classes in abnormal psychology during the 1950’s. Somewhere along the line that changed. A lot.

ADHD in Children Is on the Rise

CDC Report Looks at Racial, Ethnic, and Economic Factors in ADHD Trends

http://www.webmd.com/add-adhd/news/20110818/adhd-in-children-is-on-the-rise

Aug. 18, 2011 — The percentage of children diagnosed with attention deficit hyperactivity disorder (ADHD) has risen from 6.9% to 9% in the past decade, a CDC study shows.

The study suggests the increase may be influenced by racial, ethnic, and economic factors.

The report is published in the National Center for Health Statistics Data Brief for August 2011.

ADHD is one of the most common mental health disorders of childhood, but its frequency varies by race and ethnicity, the CDC says.

Symptoms of ADHD include inattention, impulsive behavior, and hyperactivity.

Not just in the news. Twenty years ago we acquired neighbors: a pair of young lawyers. Nice people. They had two children, well behaved, polite, credit to the community. Both parents had law practices. A few years ago, about the time the children reached their teens, the husband told us he had found himself: it turns out that his lack of success as a lawyer was due to ADHD, and he had secretly been in misery for more than a decade. He had found a psychiatrist who could treat this, and now he felt wonderful. I don’t know what the treatment was, but the result was that he moved out of the house and for a while lived in his mother’s basement with a girlfriend. He didn’t work much. Under California law he was entitled to a share of the income from his wife’s successful law practice, and to force her to sell the house so he could have half. Fortunately the house didn’t sell and soon came the real estate collapse, and she was able to negotiate so the kids didn’t have to lose their home as well as their father. I gather she still has to pay alimony.

Anecdotal, of course, but alas not unique, not even uncommon. But it’s all in the DSM, and if it’s in the DSM it’s a genuine disorder, a disability not anything voluntary. It needs treatment. And that sure sells drugs. Not just to adults who need to find themselves. At one time, I am told, nearly 10% of American schoolchildren were diagnosed as having some form of Attention Deficit Disorder, and the number of them put on drugs was high and rising. That slacked off for a while, but the story above tells us it’s on the rise again.

Having said that, I have anecdotes from trusted and reliable sources that Ritalin was a God-send for them or one of their children. Others had more disappointing stories.

I have studied the ADD and ADHD symptoms given in the DSM and it’s pretty clear I would have been diagnosed as having one (or both; while everyone insists ADD and ADHD are different, the differences aren’t so carefully defined as you might think; lots of highly technical terminology that turns out not to have such precise definitions as you would hope for). I would very likely have been drugged (actually probably not since I doubt my parents would have approved). Anyway, I am glad I had to learn to control myself, rather than be controlled by pharmaceuticals. I learned self control from sheer fear: although the Sisters (and later the normal school graduate women teachers at Capleville) didn’t in fact whack me more than once – I learned fast – it was easier to daydream and be quiet than to invite physical pain…

Anyway, while Multiple Personality Disorder has been removed from the DSM it is still in there under another name; while the number of actual cases of genuine multiple personalities is somewhere near – and possibly at – zero. Sibyl was by far the best known. That was a fraud. So it goes.

It is that time of the year: KUSC is having its pledge drive. I time mine to coincide with theirs, so be prepared to be bombarded for a week with exhortations. I operate this place on the Public Radio Model – it is free, but if not enough donate, it will go away. So far it is healthy. It needs subscriptions and renewals to keep it that way. SUBSCRIBE NOW! RENEW NOW! Thanks!

One problem of public education is rights vs. obligations. It’s easy to say that everyone has a right to an education, and that we are all equal, so therefore everyone has an equal right to an education. What’s harder to come up with is the obligation to pay for it. To pay that union teacher (or retired teacher) one needs to send an armed tax collector to a retired childless couple and threaten to turn them off their property and sell their house at public auction if they don’t pay. Where did they get the obligation to pay that retired teacher?

The usual justification of tax paid education is that it is an investment; but that is not an entitlement. Investment implies fiduciary obligation to make prudent investments. Investment allocation of resources requires some intelligence in expected returns: you get the most from resources allocated to bright kids who want to learn, then to bright kids who need to learn self discipline, then to – well, you get the idea. It’s pretty hard to justify paying to keep a kid in class who doesn’t want to be there and who disrupts the class so no one else can learn — or one who is severely handicapped and thus requires a large part of the education resources and who insists on being mainstreamed and thus deprives the others in the class of everything except the diversity experience — or for special education classes that consume 500% more per pupil than normal education. Those may be rights but it’s hard to see who is obliged to pay for them.

Where did the retired couple get the obligation to pay for the special education classes for crippled dull normal children? I understand that’s a callous question, but if the justification is investment it has to be asked. It’s not a good investment at all.

For everyone entitled to receive there must be those required to pay, and a tax collector who has the right to collect, by force if necessary. That doesn’t get debated much in discussions of rights and entitlements.

But that debate almost never takes place.