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Scientists are starting to understand how autism and ADHD can overlap (www.nationalgeographic.com)
submitted 4 months ago by to c/longreads@sh.itjust.works
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an overview of "AuDHD"

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[–] 1 point 4 months ago* (last edited 4 months ago) (8 children)

there are lots of differential diagnosis problems across mental healthcare

And there always will be, because people are complex and there are multiple ways to look at them; why is the medical model [edit: in this area, in psychiatry] so highly valued when it's just a series of failed and incomplete models propped up by drug company research? Medicine got its prestige by being able to diagnose definite problems with definite tests and offer definite treatments with definite results. Mental health medicine is largely absent those traits.

The landmark theory of depression, serotonin deficit, has been thoroughly disproven, and the drugs that theoretically addressed that deficit turn out to be very slightly better than an active placebo.

My conclusion is that society never stopped needing priests and witch doctors.

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  • [–] [S] 1 point 4 months ago (4 children)

    Medicine got its prestige by being able to diagnose definite problems with definite tests and offer definite treatments with definite results

    "definite" tests are extraordinarily the rarity across all medicine. the rest of the body combined is more complex than the brain, and you often need to look at how the rest of the body interacts when you're solving a problem, and sometimes you even need to factor in the brain because stress can cause physical symptoms, everything interacts and you can't just separate one aspect and disproportionately scream at it.

    it's simply that we've been studying the rest of the body for a bit of a longer time than we have mental stuff. in the '60s, aspirin was in a similar place as SSRIs are right now.

    my conclusion is that science is never a clear thing because it is science. we document what we get in and then what we get out of it. we can experiment to show there's a result, and that doesn't mean we have anywhere close to a complete model of it. there's always pretty uncertain areas to explore, and it's often just better than nothing.

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  • [–] 1 point 4 months ago (3 children)

    Yes, I may be being too generous to body medicine, but there sure seem to be a raft of objective tests to interpret; such a thing does not exist in psychiatry, except maybe for some recent genetic testing which is even less conclusive than a cholesterol test. And then you give a treatment and run more objective tests to see if anything's budged. Psychiatry has nothing siimilar.

    I'm willing to give psychiatry a chance, but my problem is that it hasn't really done anything to deserve its current status. Just about every psychiatric drug started for another use and people noticed its psychological effects. Then they tried to come up with a reason the drug worked, then they marketed it. SSRIs are the classic example. "These drugs make you happier. What do they do? They manipulate serotonin. Therefore: depression is caused by a serotonin imbalance." Completely and absolutely wrong.

    There is a long list of similar failures in psychiatry; schizophrenia used to be a passing thing in the past, now people are dx and treated for schizophrenia for life.

    The entire approach of looking at the brain in isolation is problematic. Because, really, the brain is just a reflection of everything we experience. If you're monitoring someone's brain activity, you might notice a spike in chemicals associated with joy. "Hm. Looks like there's been a spike in the brain chemistry associated with pleasure," you'd say, and make a note of it somewhere. Whereas if you talked to the person, you'd realize that what (also) happened is that they got the good news that their wife survived the surgery. Which of those two approach, followed more assiduously, will get you closer to the human truth of existence?

    Another factor against psychiatry is that we are highly suggestible. There's a reason that so much woo works with pain. Because pain is a subjective experience, as long as someone thinks they're getting an effective treatment, they'll have a placebo effect. The problem with medicalizing something like anixety is it suggests that the person has a problem with anxiety, and they must fix it; this causes an obsessive loop. Same for depression--people learn they have a BRAIN DISORDER making them depressed and they both lose hope and dedicate their effort to "fighting the depression."

    One thing that seems very healing across the board across almost any illness is investing in your life, learning about your dreams, and going for what you want in life and relationships.. My problem is that medicalization and (to a large extent) therapy foregrounds an abstract diagnosis that disempowers people, violating the very first line of the Hippocratic Oath: do no harm..

    I came to most of this largely through long and painful personal experience, but I've done plenty of reading and research and met quite a few people who've had the same struggles with the system and only got better once they got out..

    But, anyway, to bring it back to the article.... I do think there's been good work on understanding and appreciating autism and ADD, but I'm wondering why we have to draw lines around THESE problems and not others. For instance, why does a student with ADD automatically get extra time for a test but a student who is going through a personal crises does not?

    And as far ASD, I did just see a comic say she failed two tests for autism, and the second doctor said, "You were really close, but the tag on your shirt doesn't bother; you don't have the sensory issues, therefore you don't have ASD." The joke she had was that being annoyed by a tag on a shirt is the difference between someone being rude and someone having autism.

    But the joke just points back to what I'm saying, If someone doesn't like making eye contact, why do they need a diagnosis so they don't get fired for being "anti-social"? The reason, of course, is the ADA and only people in protected classes have ADA protection. I'm asking why can't we just treat people the way they like to be treated in an environment that's best for them, regardless of anything?

    I failed Autism Video: https://youtu.be/4JnlN6exqhI

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  • [–] [S] 1 point 4 months ago* (2 children)

    my point is that psychiatry is not special but just the thing we've only started working on more recently, and that the rest of medicine was in a similar state just five or six decades ago. the brain connects all those endocrining into the rest of your body so anywhere within your body is a reflection of all you experience. i have a lot of hope that like the rest of medicine, this will get better with time and be more objective as you also hope for.

    why can't we just treat people the way they like to be treated in an environment that's best for them, regardless of anything

    again, i'm saying that is a very valid and popular option that does exist and treatment is only for those who want to be "normal". and more people need to know all the pain associated with attempting to become "normal", and then make the best decision for themselves on which paradigm to choose. i don't think we disagree on this.

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  • [–] 1 point 4 months ago (1 child)

    In addition to being a young field, though, psychiatry is fundamentally wrong-headed. It puts the brain at the center of phenomenon and not the person and their context.

    For instance, let's say that instead of treating depression, you wanted low communication. Let's say you live in a very talkative society and people who don't talk a lot are suspect and considered ill.

    Reasonable approaches to this social problem might be to investigate the context people are raised in, and the context in which they live. Maybe they had a father who actively discouraged them from talking, or they're in a minority that was bullied and staying silent was a survival strategy, or maybe they're embarassed by an accent.

    But what would the "psychiatric" approach be?

    Psychiatry's approach would be to examine the brains of people who do talk a lot and people who talk less. Then they would prescribe a medication that theoretically gets the brains of people who talk less to be more like the brains of people who talk more.

    That's really missing the most important parts of the picture--the social and personal contexts. It's treating people like they are just the results of their brains, and not their brains being a result of their environment.

    Now there is value in looking at the brain in isolation. In this hypothetical, it would be hugely helpful to know about autism! The problem is that psychiatry has an outsized authority that it really doesn't deserve, an authority society is happy to give it in exchange for not having to address what are much more likely to be social problems.

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  • [–] [S] 1 point 4 months ago*

    Looking at the DSM I don't see any item that's analogous to your talkativity example. I agree that would be wrong but I disagree that we see it in current psychiatry.

    their brains being a result of their environment

    I don't think anyone denies that. That neuroplasticity exists is very well known.

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  • [–] 1 point 4 months ago (2 children)

    why is the medical model so highly valued when it’s just a series of failed and incomplete models

    I've seen people with a stroke lose complete loss of their arm & leg. Get thrombolysed then the next day their main symptom being pins and needles. Seems a pretty good reason to value it..

    My conclusion is that society never stopped needing priests and witch doctors.

    Hmm priests around my area aren't exactly know for healing people.

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  • [–] 1 point 4 months ago* (1 child)

    I took the trouble to re-read my comment to give you the bad news with a high confidence interval that you fundamentally misunderstood it. Feel free to read it again and replay again if you'd like.

    Edit: Editted the original comment for clarity.

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