Saturday, February 2, 2008

On Disease

There's an article by Bruce Levine up at Alternet about Oppositional Defiant Disorder (ODD).

In 1980, the American Psychiatric Association (APA) created oppositional defiant disorder, defining it as "a pattern of negativistic, hostile and defiant behavior." The official symptoms of ODD include "often actively defies or refuses to comply with adult requests or rules" and "often argues with adults." While ODD-diagnosed young people are obnoxious with adults they don't respect, these kids can be a delight with adults they do respect; yet many of them are medicated with psychotropic drugs.

Apparently the diagnostic criteria listed in the DSM-IV-TR are:

• Deliberately annoying people
• Blaming others for own mistakes
• Easily annoyed
• Angry and resentful
• Spiteful or even vengeful

Meeting four out of five of these criteria gets you a diagnosis of ODD.

ODD seems like a perfect example of the way our society pathologizes behavior, especially behavior that we find discomforting. Levine emphasizes the ways in which these behaviors might be a natural response to a negative environment - controlling parents, a school that doesn't meet one's approval or one's needs, etc. He points out that most children diagnosed as ADHD will show no symptoms when engaged in an activity that they've chosen and they enjoy.

While I enthusiastically agree with much of Levine's article, some of the sentiments expressed in the comments disturbed me. I think there is a tendency in this movement to discount the possibility that some people may really be suffering from a disease.

I was raised by a psychologist who is a passionate advocate for mental health parity. I have always believed that mental illness is as "real" as physical illness - as cancer or arthritis or the common cold. I support the expansion of health care to cover the costs of treating mental illness (whether with medication, therapy, or some other treatment) and I hope, as most people do, for a day when it is no longer stigmatized. And I think there are clearly some examples which back up this point of view - Alzheimer's disease, drug addiction, disorders which involve severe psychosis, just to name a few.

So for me, seeing certain behaviors as a disease is something that can be empowering. And while I believe in challenging our conceptions of mental illness - what causes it, how we should treat it, whether we should treat it - I think we run the risk of denying people the right to understand and categorize their own experiences in whatever manner they see fit.

I think this is a conflict where mental health and radical psychology advocates can draw something from other progressive movements. I've noticed, for instance, a strong focus among supporters of GLBTQ rights on letting individuals define themselves and their experiences. There is a deep respect for people's autonomy, for the diversity and the validity of each of their experiences. Another example is abortion rights - forced abortion is just as unacceptable as not having access to abortion. That's why feminists work against laws and conventions which pressure women in one direction or the other. Because when it comes to people's lives, choice is paramount.

What is so disturbing about ODD is not that we are given a person a certain label - it's just a label after all - but that we are using that label to justify treating them in certain ways, frequently against their will. When it comes to labeling children, this is even more troubling, as children are less likely to understand their situation, more likely to internalize the opinions and judgments of others. However, we have to be careful not to go too far in the other direction. We don't want to tell someone they're sick, when they're not. But it's not necessarily our place to tell someone they aren't, if they are.

Hat tip to Laurie Corzett on the RadPsych list.


The Minstrel Boy said...

goddamned glad they didn't have psychotropics when i was a kid. i was all of that and more. i delighted in offending certain folks. like some of the more tight assed missionaries who came to my rez to teach school. they were fun to scandalize. later, in the service i learned that subtle trick of being so exquisitely polite that it feels rude. i loved that one because there was nothing they could do about it. like complain i was too polite? hahahahaha.

welcome to the world of blogging shauna. melissa and a lot of the folks over at shakesville will give you lots of help. it's yours for the asking, or the taking.

konagod said...

I saw your comment at Shakesville also. And minstrel boy and I go way back (well, in blog years at least).

You have an interesting niche.

Everyone has advice on how to build readers and get linked. My suggestion is purely based on my own experience and not meant to discredit any other suggestions.

I gave up on the big blogs long ago. For starters, their comment threads are not so much a community as they are a concert stadium. You might as well be at a U2 concert at MSG during an encore and yell out, "visit my blog."

Find a blog or two where you develop a relationship with a number of people over the course of time and things will build.

I think it's far more important to stay active in a number of comment threads at different smaller blogs than it is to try and gather a few readers from commenting at the Big Box Blogs.

I would also highly recommend you try and post fresh content at least once every day or couple of days, particularly with a new blog.

And Shakesville is a great place to start. It's not a small blog but definitely has real community you'll unlikely find at very many blogs of equal size.

Aside from the blogwhoring opportunities that Melissa mentioned -- particularly those posts each week which encourage blog links, I also suggest checking out the Friday night Virtual Pub (sometimes not for the squeamish! :lol:) -- it's a great way to kick back and really get to know a few people, most of them bloggers, on a personal basis.

Good luck and hope you stick with it. It may take awhile to notice much difference but if you work hard, it will pay off to some extent.