Monday, March 25, 2013

Three Medical Conditions Commonly Misused in Everyday Speech

Three Medical Conditions Commonly Misused in Everyday Speech

Authors Note:

This article mentions several mental illnesses that readers may not be familiar with, so I’ve provided some links and brief definitions. I also may later add a “further reading” section for readers who share my fascination with this subject matter.

In the interest of clarity, I’d like to start with a quick overview of how these disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders, the epic tome of psychiatry. Diagnoses are currently made using the DSM-IV, but this will change once the much-anticipated DSM-5 is released this May. The DSM’s controversial history warrants a separate article which I’ll write in the near future.

DSM-IV is built on a five component multiaxial system:

Axis I: Clinical and developmental disorders typically associated with mental illness.  Among these are mood disorders, anxiety disorders, eating disorders, schizophrenia, autism spectrum disorders, and ADHD.
Axis II: Personality disorders and mental retardation. The personality disorders are grouped into four subsections: Cluster A - Odd, Cluster B - Dramatic, Cluster C- Anxious, and NOS (not otherwise specified.)
Axis III: Medical conditions and physical disorders
Axis IV: Social and environmental contributors to the Axis I or II mental disorders.
Axis V: Global Assessment of Functioning on a 0-100 scale.

I’ll mostly be discussing I and II, but all the axes are imperative in the formation of a proper differential diagnosis. Not all patients who present with mental dysfunction have a mental illness. Some medical conditions or nutritional deficiencies can produce symptoms that mimic a mental disorder but cannot be treated with standard psychotropics because their root causes lie elsewhere. Hypothyroidism can cause depression and rapid thoughts which could be misdiagnosed as bipolar disorder. In Korsakoff’s syndrome, prolonged alcohol abuse or malnutrition leads to a vitamin B1 deficiency that results in symptoms commonly seen in schizophrenia: memory loss, apathy, lack of insight and diminished conversation skills.

These are just two of many examples that reveal how important it is for doctors to examine all the pieces before trying to construct a puzzle. Jumping to a conclusion of mental illness and prescribing medications with often risky side effects can be a serious mistake with potentially tragic consequences.


Example: “She’s already lost like 10 lbs and still wants to lose more, I think she has anorexia.”
Problem: Anorexia is a symptom or an effect, not a disease.

The medical definition of anorexia is the lack or loss of appetite. It’s derived from the Greek an - without, and orexis - appetite. Often, the term anorexia is erroneously used to describe a person with a possible Axis I eating disorder. The actual name for this disorder is Anorexia nervosa.

Adding to the confusion, an “anorexic” is both the term for a person with this disorder and a term for a drug used for the purpose of appetite suppression. For this reason, I prefer to use the term anorectic when referring to appetite suppressant drugs. (There’s also a semi-related issue that appetite suppressants are often called “stimulants” but that might have to be tabled for a future discussion.)

It’s possible for individuals with anorexia nervosa to experience a self-inflicted loss of appetite as a result of fasting. A fast is simply defined as an 8-12 hour period without food, but not everyone who gets 8-12 hours of sleep wakes up famished and desperate for breakfast (break-fast.) More often however,  sufferers do feel hunger but don’t act on it in an effort to maintain control.


Example: “I’m really OCD about my house, I love cleaning it and keeping it neat and tidy.”
Problem: OCD rituals have nothing to do with enjoyment.

Obsessive-compulsive disorder is one of several Axis I anxiety disorders. People with OCD have intrusive thoughts and engage in repetitive actions to lessen their anxiety. Several OCD subtypes exist, but they’re all predicated on anxiety.  Occasionally, people misuse the term OCD because they don’t know the actual term for the condition they mean to refer to: Obsessive-Compulsive Personality Disorder, an Axis II - Cluster C disorder.

People with OCPD are convinced they’re behaving correctly. By contrast, people with OCD are aware of the irrationality of their rituals or beliefs. They want to stop but can’t, out of fear that something bad will happen to them. The result is a vicious cycle: at first, the rituals seem like a harmless way to alleviate anxiety. Once they stop working, a sufferer might add to the rituals or adopt new ones. The more elaborate and repetitive the rituals get, the more frustrated and embarrassed the sufferers get, and their anxiety hits an all-time high.   

Whether it’s repetitive cleaning, checking, avoiding, or other actions, these compulsive rituals are not enjoyable to people with OCD. People who get a high from keeping an immaculately organized closet or pantry, or from daily vacuuming and constant counter wiping are not suffering from OCD, they may just be neat freaks, not mentally ill.

Example: A popular t-shirt quote: “I’m schizophrenic - and so am I.”
Problem: Schizophrenia has nothing to do with multiple personalities.

It’s quite popular to use the term “schizo” to describe someone who is two-faced, or who flips out for no particular reason. This characterization is false and etymology is partially to blame. Schizophrenia comes from the Greek skhizein (to split) and phren- (mind.) To many, this indicates a splitting of the personality but it actually refers to a splitting of the brain’s thought and emotional processes. This characterization leads people to confuse schizophrenia for the disorder once known as multiple personality disorder, now called dissociative identity disorder, a controversial diagnosis that some professionals feel may not exist.

DID is defined by having at least two distinct personalities which can separately take hold of an individual’s behavior. Occasionally, schizophrenia will appear alongside other disorders like bipolar disorder and borderline personality disorder - comorbidities that feature higher than average rates of suicide and substance abuse.

Symptoms of schizophrenia are typically grouped into two categories: negative and positive. These aren’t evaluative terms, but rather reflect on symptoms that are added to or subtracted from a normally functioning mental state. Positive symptoms include the trademark signs of the disorder, such as delusional thoughts and visual or auditory hallucinations. Negative symptoms include social withdrawal, apathy, flattened emotions, speech difficulty, lack of motivation, and inability to experience pleasure.

Although currently accepted, the DSM-5 may do away with the sub-classifications of schizophrenia. These include paranoid type (grandiose delusions, hallucinations), catatonic type (very slow movements, mental stupor), undifferentiated type (psychotic, but not other, symptoms), residual type (minimal presentation of positive symptoms), post-schizophrenic depression (minimal symptoms still present in post-episode depression), and simple schizophrenia (progressive negative symptoms, no psychotic episodes.)

Cautionary Note:

As a reader, you may find yourself feeling morbidly curious enough to look further at the DSM criteria for the aforementioned disorders or any other disorders. This is normal and probably to be expected, particularly of the fellow hypochondriacs and autodidacts that comprise my niche.

If you find yourself on this path, I highly advise you to proceed with caution. The DSM-IV lists 365 diagnoses - one for each day of the year.  I can guarantee that you’ll find something in there that will resonate with you. It might also worry you. On the other hand, if you’re convinced nothing in there can apply to you, then you automatically meet at least one criterion for narcissistic personality disorder.

Remember - the criteria for mental illness is met only by establishing a certain number or certain combination of symptoms, often for a specified length of time. These symptoms must also negatively impact functioning in one or more life areas such as physical and mental well-being, interpersonal relationships, social interactions, work or school performance, etc. No matter how many symptoms you can match yourself up with, if you think you’re doing a fine job of coping and not letting these presumed issues take over your life, then keep on truckin - whatever disorder you *may* have is subthreshold and requires no treatment. Either way, no treatment is one-size-fits-all.

So, if you decide to seek a professional diagnosis, take it like you should take any other tidbit of information offered up by a so-called authority figure - with a big grain of salt. Even a brain in a vat doesn’t have to accept that it’s sharing that vat with its own cooties.

There’s nothing ill-advised about the individual quest for knowledge and self-understanding, just try and have a clue about where you want to go. You likely won’t want to go to a place that pathologizes your every thought - if you gaze too strongly into that abyss you may launch yourself into oblivion. If oblivion is what you’re after, there are recreational means of arriving there that are far more desirable and pleasurable to fretting over the pedantries of an 886 page manual.

Friday, March 8, 2013

A Fresh Perspective on a Messy Problem: Talking Prison Reform with Economist Daniel D'Amico

Connecticut’s early release program is hotly debated by critics questioning the plan’s impact on public safety. 

For most, imprisonment is the knee jerk reaction to the crime problem, but many argue that the prison system is severely flawed and in need of not just minor nips and tucks, but of massive overhauls. 

Serious conversations about the defects and injustices pervading U.S incarceration policy are long overdue. Learning about alternative solutions proposed by innovative researchers can kick-start these much-needed discussions. 

Daniel D’Amico, the William Barnett professor of free enterprise studies and assistant professor of economics at Loyola University, is one such researcher. D’Amico applies public choice theories and free market economic perspectives on issues of punishment and social change. 

His dissertation, “The Imprisoner’s Dilemma: The Political Economy of Proportionate Punishment,” earned him the Society for the Development of Austrian Economics' Israel M. Kirzner Award for best dissertation in Austrian Economics. He discussed the many facets of the prison problem in an email Q&A.

Do you think Connecticut’s early release program is likely to work and, if so, why? Do you think it goes far enough?
I'm very sympathetic and hopeful to these sorts of release programs. If we are going to limit and alleviate the social problems of prison growth we have to discover good ways to manage release safely and justly. I'm currently looking at historical studies associated with the closures of the Gulag and Concentration camp systems to garner applicable insight for our own challenges.

The main concern with these programs is the political process and what economists call availability bias. It probably took a lot of political effort to get this program or anything like it off the ground, all could be quickly reversed with a few anecdotal stories of recidivism if they happen. Criminal X gets released and re-offends and the public perceives a fear of trying these programs ever again in the future.

What are some less costly alternatives to the modern prison system, or, what changes could be made to the existing system?
As for many complex questions of political economy, the answer is "it depends." It depends first on your operating presumptions behind the purposes and supposed intentions of prisons and incarcerations. If, for example, you believe that there is a legitimate and or necessary public role of government and or politics to impose ex post punishment as a reaction to criminal behavior then incarceration is probably most useful and necessary for extremely violent criminals and or those individuals who pose an active threat to the welfare and safety of innocent citizens. Potential alternatives could be controlled living environments, probation, house arrest even the death penalty.

For other crimes such as drug violation, incarceration is harder to justify. So many more alternatives are on the table rehabilitation, medical treatment fines, or even total decriminalization.
If on the other hand incarceration is thought of more abstractly as a strategy to resolve the social problems associated with crime, then anything which diminishes crime and its associated costs could substitute away from the supposed need of prisons and incarceration such as better education, more vibrant forms of civil association, better technologies and institutions for the private enforcement of property rights etc..

What are the primary concerns regarding the prison problem - the social costs, the economic costs, etc.? Do you think both the social and economic costs go hand in hand? How? 
The economic costs are clearly noted in the Bureau of Justice statistics for anyone to look up and see for themselves. In most states it costs about as much to incarcerate an individual human for a year as many prestigious colleges charge for annual tuition.

The social costs are harder to pin down as the result of removing significant portions of the young black male population have led to very lopsided communities in urban environments. Such has had ripple effects upon the family structure, religious and civic organization forms in those neighborhoods.Together, these costs, along with the democratic tendencies to not gauge criminal justice resources in response to changes in real crime rates suggest that this trend is fiscally and socially unsustainable.

Why do you think there has been so much opposition to prison reform and do you think this tide is turning? If it isn't quite yet, how can it? 
I think most people are very culturally conditioned to rely upon incarceration as the predominant response to crime. It takes a lot of creativity and complex critical thinking to understand the social processes associated with excessive incarceration. So prison reform tends to invoke thoughts that criminals are getting off easy.
Drug war reform is gaining a lot more public attention. People are updating that addiction is more a medical than a criminal issue and we see public opinion polling supporting this more and more year after year.

What would a free market solution to prisons or the prison problem look like? 
Some have argued that insurance companies could be configured to serve as a sort of free market criminal justice system. Such would require a change in the motivation of criminal justice more generally from retribution to restitution. Currently restorative justice proposals seem very compatible with free market principles as far as they can be applied in our imperfect system today.

What are the prison stories no one is talking about? 
Some of my current research is trying to investigate the relationship between incarceration rates and economic performance by investigating how legal systems in different countries were historically organized as a consequence of their nation of colonial origin. In all other measures of correlation, common law nations tend to have small governments and civil law countries large state powers. In the criminal justice realm and terms of prison populations this relationship is reversed. The criminal law was implemented after the common law had already evolved to operate to govern tort procedures where constraints on government developed and worked well, but almost no similar constraints or checks and balances were implemented in the newly developed criminal justice realm.

To read some of D'Amico's published work, visit the following links:

Sunday, March 3, 2013

CT Media Ignores Human Rights Rally

The early afternoon on Saturday, March 3 was cold, gray, windy - a perfect day to stay indoors, worry free. That is precisely what the media in Hartford did. 

All the while, dozens of outraged citizens were gathered at the capitol giving heartfelt testimony on proposed legislation that threatens the rights of a certain group of citizens - the mentally ill. 

The group, Advocacy Unlimited, organized the rally to prove they still have a voice, despite people trying to silence them. Brave, honest people spoke about their experiences falling through the cracks of the mental health system. Some were institutionalized, some were imprisoned, some were drugged, but all made it out alive and well. 

Their stories provide inspiration, not just another derivative public hearing but the kind of inspiration needed by Connecticut residents living in the shadow of recent tragedy.

The state of mental illness has been a hot topic in Connecticut since the Newtown shootings in mid December. Since then not a day seems to go by that the media and politicians don't seize some sort of opportunity to discuss the problem - a problem they suddenly have to pretend to care about. They're trying desperately not to get too close - perhaps out of fear. Looking at the proposals through the eyes of someone with the capacity for empathy and maybe their own horror stories to tell, reveals that legislators don't have the interests of the mentally ill at heart. Outside of a dystopian novel, involuntary commitment is not an appropriate answer to the problem. 

The truth is, mental illness is highly stigmatized - many people are aware of this and yet continue to perpetuate it. This is the kind of harmful cognitive dissonance that groups like Advocacy Unlimited can help to remedy - if only someone would listen. 

Just weeks earlier, at the very same location where AU gathered, another rally was held. This one was full of Rocky Hill residents and angry homeowners. This one was full of media, and MC'd by local politicians. This one featured vitriolic speeches that practically equated mental illness and criminality. And this was the one that got the attention. I was there on assignment, tasked with giving it attention and alongside other reporters. It was another bitterly cold day and I scribbled quotes down in my notebook, wondering if attendees could read the look of shock and indignation on my face. 

I just typed "Advocacy Unlimited rally" on Google and the hits pointed only to their website. Try the same with "Rocky Hill rally" and see if you starve for news links. 

An involuntary commitment bill was defeated weeks before the Newtown shootings. Self-righteous moral crusaders have actually argued that the bill could have stopped the shooting. They frame the situation in what they think are purely rational terms, but in actuality the scenario they point to is more like Minority Report - for "brain cooties." 

Individuals who have struggled with ebbs and flows of depression, anxiety, euphoria and dysphoria are labeled mentally ill. In the eyes of many, they are deficient human beings who need to be drugged, locked away, or at the very least need to stop whining and keep their sadness to themselves. It just isn't possible that someone might actually be a person living in a troubling world and being spoon fed crap on a regular basis. Anything outside constant cheerfulness is deemed dysfunctional and subsequently pathologized.

Try and fight back after this happens and it's just the mental illness talking. This is not to say, however, that mental illness is a myth. Gene and brain imaging research clearly point to the contrary and misdiagnosis can occur in every field of medicine. But mental illness and addiction are the only two sicknesses you can have and still get blamed for. No cancer patient in the history of the world has ever been chastised for being a burden on the family, they have never been told to shape up or ship out.  And no cancer patient in the world will ever be forced into chemo. With hope and the continued efforts of groups like Advocacy Unlimited, one day the same will be said of mentally ill patients. 

Wednesday, February 27, 2013

Pope's Got a Brand New Handbag

Going by CNN I'd guess something like: dress like a 5 year old girl who raided granny's closet.

Saturday, February 2, 2013

New year, new quixotic and sporadic writing efforts

I haven't posted in forever, though I have written tons of ideas down. Some have been written on post-its, some on my mobile notebook, and many across a series of notebooks. I live alongside piles of notebooks and gallon ziplock bags full of index cards, scraps of paper and multi-colored post-its. Poe allegedly had hypergraphia as well, so that fact makes me feel a bit better about this pathology -though I of course recognize that its a problem. My goal, therefore, is to take hold of these primordial ideas and expand on them.