ADHD, Autism, Asperger, LD, ADD - Are they
medical diagnoses? Or behavioral symptoms?
So often we view these terms as labels for illnesses or diseases. We use words like "suffer" or "stricken" in conjunction with these labels, like "He is stricken with severe autism.", or "She suffers from Learning Disability." The underlying assumption is autism and LD belong to the medical model of diagnosis, treatment and prognosis. This rationale is taken as a matter of course when one uses these labels prescribed by the DSM manual (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association, and insurance reimbursements are strictly based on the DSM definitions.
I have long maintained that ADHD, Autism, Asperger, LD, ADD are not medical diagnoses but simply descriptions of abnormal behaviors, symptoms if you will. In a true medical diagnosis, the disease is defined by the cause(s) and not the symptoms. So AIDS is defined by the presence of the virus (the cause), not by how the patient behaves (the symptoms).
The problem with ADHD, autism, etc. as diagnostic labels is that we don’t know the exact biological defects that cause ADHD or autism, even though we can surmise that there must be something different in the autistic or the ADHD brain than the ‘normal’ brain.
How about defining the cause of autism externally, you ask, such as autism is caused by certain environmental adversities like pollution, prenatal birth, or early childhood experience? But we can’t say for sure if any of these is the actual, or even partial, cause of autism or ADHD either.
Treatment, so far, is mainly external rather than internal, that is, we modify the symptom behaviors by changing the environment, rather than treating the deficits in the brain through chemical or surgical means. (Chemical includes drugs, diet, herbal medicine, etc.) Over the years, many have hoped to be able to treat autism, or ADHD, or LD internally, e.g., food coloring-free diet, Adderall, Concerta, gluten-free diet, etc. In this sense, the labels do not qualify as ‘medical’ and we see myriads of treatment procedures with unpredictable outcome and prognoses.
Yet we have used the labels in the DSM as if they are medical deseases, and insurance companies, practitioners and parents alike, for a lack of better alternatives, have used them to justify claims and services. For some, it is the bible of mental ‘illnesses’.
But it is heartening to see that not all psychiatrists see the DSM rationale as sound and the latest DSM-5 as useful. The New York Times published two articles of dissent upon the release of DSM-5. One psychiatrist, Dr. Satel,comments, "the manual medicalizes garden-variety distress, leads doctors to prescribe unnecessary medications,…" She then reveals a secret -- most psychiatrists don’t use the manual to treat. They tend to treat according to symptoms (the behaviors).This is understandable. For the illnesses listed in the manual do not have a consistently identifiable biological or environmental cause(s) and the diagnoses thus cannot offer clear treatment procedures and prognoses. The other article quoted Dr. Thomas Ansel, director of the National Institute of Mental Health, as saying that DSM-5 "does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research. As long as the research community takes the D.S.M. to be a bible, we’ll never make progress." While he was careful in commenting mainly on DSM hinders mental illness research, the principle is the same, that DSM does not offer medical diagnosis and using it to determine treatment leads us into a blind alley, and could be dangerous.
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