Quick Links – The ‘science’ of psychiatry

by Grace

Up to 20% of American children suffer from mental disorders, but the accuracy of reporting is questionable.

Scientists at the U.S. Centers for Disease Control and Prevention found that 13% to 20% of American children age 3 to 17 experience mental disorders each year, and that rates have been increasing.

A ‘hodgepodge’ of counting methods

The study also showed there are no standard ways of counting afflictions, but a hodgepodge including parental reports or reports directly from children. Some disorders, such as bipolar disease and anxiety disorders, weren’t included in the overall rates for lack of data. The disorders that were included span a wide range, including hyperactivity and severe autism.

Statistical experts are skeptical of the reported numbers.  Data collection is inconsistent, with random phone surveys of parents yielding higher results than other methods.  Families with health insurance report higher rates, and regional differences raise suspicion about different approaches in diagnosis.  Double counting children with multiple disorders leads to inflated rates.

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French children have much lower rates of diagnosed ADHD.

In the United States, at least 9% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?

Different approaches to diagnosis and treatment

 In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological–psycho stimulant medications such as Ritalin and Adderall….

French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children’s focusing and behavioral problems withdrugs, French doctors prefer . . . to treat the underlying social context problem with psychotherapy or family counseling…

Different parenting styles

And then, of course, there are the vastly different philosophies of child-rearing in the United States and France. These divergent philosophies could account for why French children are generally better-behaved than their American counterparts….

From the time their children are born, French parents provide them with a firm cadre—the word means “frame” or “structure.” Children are not allowed, for example, to snack whenever they want. …

… French parents have a different philosophy of discipline. Consistently enforced limits, in the French view, make children feel safe and secure. Clear limits, they believe, actually make a child feel happier and safer … French parents believe that hearing the word “no” rescues children from the “tyranny of their own desires.” And spanking, when used judiciously, is not considered child abuse in France.

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Psychiatry:  diagnosis is not scientific, but political and bureaucratic

In an interview with The Atlantic, Gary Greenberg, a practicing psychotherapist and author of The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatrysays no one can define “mental illness”.

What is the difference between a disorder and distress that is a normal occurrence in our lives?

That distinction is made by a clinician, whether it’s a family doctor or a psychiatrist or whoever. But nobody knows exactly how to make that determination. There are no established thresholds. Even if you could imagine how that would work, it would have to be a subjective analysis of the extent to which the person’s functioning is impaired. How are you going to measure that? Doctors are supposed to measure “clinical significance.” What’s that? For many people, the fact that someone shows up in their office is clinical significance. I’m not going to say that’s wrong, but it’s not scientific. And there’s a conflict of interest — if I don’t determine clinical significance, I don’t get paid.

Is a child autistic or just awkward?  Special education services and insurance coverage are controlled by committee decisions on what is to be included in the DSM.

… You can’t just ask for special services for a student who is awkward. You have to get special services for a student with autism. In court, mental illnesses come from the DSM. If you want insurance to pay for your therapy, you have to be diagnosed with a mental illness….

Arbitrary?
Homosexuality was declassified as a DSM disorder in 1973.  And I’m sure I’m not the only one who has considered that Oppositional Defiant Disorder (ODD), characterized by “negativistic, defiant, disobedient, and hostile behavior toward authority figures that persist for at least six months“, is a particularly arbitrary disorder.

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4 Comments to “Quick Links – The ‘science’ of psychiatry”

  1. French society is different in general. People don’t work as hard, they don’t race around as much, they take enough vacation, meals take longer. We used to get an hour for lunch in my French HS. It is a lot easier to provide structure for kids when there is enough time to do things properly.

    Even the different approach to ADHD treatment is all about time. Family counseling is great when there is enough time to schedule it, and insurance is willing to pay for it. As I am sure you know, French medical insurance is far more comprehensive than American insurance.

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  2. “People don’t work as hard”

    Some articles I Googled attribute this difference to our lower tax rates, higher divorce rates, lower unionization, and other factors. Hmm, maybe raising taxes here could lead to lower ADHD rates? (jk)

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  3. What, ADHD can be blamed on unions and low taxes? Or working harder? Personally, I think it is at least in part cultural. Icelanders work even longer hours than Americans, even though they have high taxes. There is probably something, though, to the lack of a safety net leading to working harder. But is that a good thing or a bad thing? Usually we think that working harder is a good thing, which is why many conservatives are against expanding the safety net. But what if it turns out that our level of working hard is also damaging our children and our family structures? Perhaps it isn’t always better to encourage more work. There is probably some happy middle ground. I personally would rather work hard in the German sense, which I think is healthier for society, than in the sense we have in the U.S. But who knows what is optimal.

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  4. Working harder is attributed to lower taxes and lower unionization rates here in the U.S. So I just riffed off on your correlation between working less and lower ADHD rates.

    I’m sure there’s a happy medium between hard work and sufficient leisure time. And within that context, the right amount and quality of parental attention.

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