{"id":11292,"date":"2011-07-09T08:29:02","date_gmt":"2011-07-09T12:29:02","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=11292"},"modified":"2011-07-09T08:53:26","modified_gmt":"2011-07-09T12:53:26","slug":"idiopathic-behavior-disorder","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/07\/09\/idiopathic-behavior-disorder\/","title":{"rendered":"idiopathic behavior disorder…"},"content":{"rendered":"\n
I have finally tired of writing about Biederman as if he’s a force to reckon with. You know what I think about him and his science. You probably think something similar yourself. But I’m not tired of discussing childhood bipolar illness au Biederman<\/em>. What is<\/u> wrong with the kids that he wants to gather under his umbrella? If they don’t have Manic-Depressive Illness – at least the version we’ve known throughout the 20th century since Kraepelin convincingly argued it was a disease – what is wrong with them? I don’t think we know the answer. In his letter in the NEJM, Biederman says:<\/div>\n
    \n
    They argue that “no existing DSM [Diagnostic and Statistical Manual of Mental Disorders<\/em>] diagnosis conveys the appropriate severity” of the moods and behaviors of children “who can be explosively angry, irritable, frantically active, suicidal, or even homicidal.” An adult with these symptoms would very likely be diagnosed with bipolar disorder<\/font>…<\/sup><\/strong><\/div>\n<\/ul>\n
    The hallmarks of Manic-Depressive Illness are an expansive and grandiose mood, psychomotor agitation, and periodicity<\/font><\/strong> – they are that way<\/em> for a time, then they’re normal<\/em>. Patients with the classic version usually have other periods when they have the opposite – psychomotor retardation and a depressed mood. So we’ve always used the synonyms affective disorder<\/em> or mood disorder<\/em> when talking about the illness, hypothesizing that the mood<\/em> is primary.<\/div>\n

    But there are some other qualities. They take up too much space. When you’re in the room with a Manic person, that’s all there is. When I ran the emergency room at our City\/County hospital, the major source of our Manic patients was the airport. For one thing, Manic people are on the move<\/em>. But once on the plane, they become loud, boisterous, disruptive, walk the aisles. Many times, planes added a stop in Atlanta to off-load such people, or turned around to bring them back.<\/p>\n

    Another example of their space occupying problems has to do with jails and civil commitment. In order to involuntarily confine a mental patient, there are two criteria – mental illness and dangerousness. You can’t deprive a person of their civil rights just for being mentally ill. They have to be imminently dangerous to self <\/em>or others<\/em>. With Manic patients, the first criteria is easy, but the second is much less clear. After a few years it gets easier because you’ve allowed Manic people to leave only to have them returned having been beaten to a pulp because they’ve wandered into a bar and agitated the wrong kind of people. New psychiatry residents don’t have a feel for that, so they send them back to jail where they’ve been incarcerated for causing disturbances. And if you’re in charge of the emergency room, you get a call at home from an experienced jailer who says, "you’ve got a new resident on call tonight, right?" And then you’re in a department store and run into that patient you saw in a full manic splendor last year, and they say, "Hi doc," exchange a few niceties, and go on with their shopping – and you get it about periodicity.<\/p>\n

    With the coming of the DSM-III and its progeny, a whole lot more patients fell into the pot – "rapid cyclers," depressive people, bipolar II. A lot of the new arrivals didn’t have periodicity. They were always disturbed or frequently disturbed. I never totally bought their inclusion. They didn’t seem to fit clinically, didn’t have they same response to treatment, and I never ran into them in the store normal<\/em>. I assumed they had something else, though I wouldn’t know how to describe them as a group. All I know is that they didn’t fit.<\/p>\n

    What I’m getting at is Biederman’s comment, "…who can be explosively angry, irritable, frantically active, suicidal, or even homicidal.<\/font><\/strong>" An adult with these symptoms would very likely be diagnosed with bipolar disorder<\/font><\/strong>…" Not by me. Manic people can be "explosively angry, irritable, frantically active<\/font><\/strong>" if you challenge their grandiosity or try to stop them, but that’s not their nascent state. So I’m wondering if Biederman is following the over-inclusive lead of the adult psychiatrists who came before him that [in my opinion] were way too loose with this diagnosis since being Spitzer-ized <\/em>[Wash-U-ized<\/em>] with the DSM-III. There is a classic Manic Depressive Illness. Then there’s a new extra-crispy bipolar disorder that’s only about thirty years old. I’m not impressed that expanding the diagnostic net for the adults has been much more successful than it has been with the kids. <\/p>\n

    As with the overly inclusive Major Depressive Disorder, the modern Bipolar Disorder diagnoses have given the illusion that we know more than we actually  know – and in the process obliterated the boundary of our understanding. They’ve redefined research as an endless regress of repetitive clinical drug trials that are little more than marketing for symptomatic treatments. Biederman cites "Large-scale pediatric trials documenting safety and efficacy have led to Food and Drug Administration approval of two agents<\/font><\/strong>" as meaningful. The FDA is just doing its job – saying that the drugs are safe and have a statistically demonstrable effect. The FDA is not charged with telling us what’s wrong with our patients or how to treat them. There’s a difference between a statistically demonstrable effect and treatment<\/em>. And the FDA is certainly not certifying Biederman’s idiosyncratic views on diagnosis or treatment. I’m wondering if his real discovery is that the adults that got thrown into the bipolar pot had childhood problems too – at neither time being the problems Kraepelin was talking about. How about Idiopathic Behavior Disorder<\/font><\/strong>? At least we’d be admitting that we don’t know what’s wrong…<\/div>\n
      \n
      id·i·o·path·ic<\/font><\/strong> [id-ee-uh-path-ik]
          –adj
          of unknown cause, as a disease.<\/div>\n<\/ul>\n
      The most important starting place is knowing what we don’t know…<\/div>\n","protected":false},"excerpt":{"rendered":"

      I have finally tired of writing about Biederman as if he’s a force to reckon with. You know what I think about him and his science. You probably think something similar yourself. But I’m not tired of discussing childhood bipolar illness au Biederman. What is wrong with the kids that he wants to gather under […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-11292","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/11292","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=11292"}],"version-history":[{"count":7,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/11292\/revisions"}],"predecessor-version":[{"id":11299,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/11292\/revisions\/11299"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=11292"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=11292"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=11292"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}