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[F_minor] RE: F_minor Digest, Vol 42, Issue 4
Seeing that this is sent to this list, I have to ask, has GG been
posthumously diagnosed with Asperger Syndrome?
Mark
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Today's Topics:
1. Asperger syndrome vanishes as distinct disorder from APA's
Statistical Manual of Mental Disorders (Robert Merkin)
----------------------------------------------------------------------
Message: 1
Date: Tue, 10 Nov 2009 23:31:32 -0500
From: "Robert Merkin" <bobmerk@earthlink.net>
Subject: [F_minor] Asperger syndrome vanishes as distinct disorder
from APA's Statistical Manual of Mental Disorders
To: <f_minor@email.rutgers.edu>
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The New York Times
Tuesday 10 November 2009
Op-Ed Contributor
The Short Life of a Diagnosis
By Simon Baron-Cohen
Cambridge, England -- THE Diagnostic and Statistical Manual of Mental
Disorders, published by the American Psychiatric Association, is the
bible of diagnosis in psychiatry, and is used not just by doctors around
the world but also by health insurers.
Changing any such central document is complicated. It should therefore
come as no surprise that a committee of experts charged with revising
the manual has caused consternation by considering removing Asperger
syndrome from the next edition, scheduled to appear in 2012. The
committee argues that the syndrome should be deleted because there is no
clear separation between it and its close neighbor, autism.
The experts propose that both conditions should be subsumed under the
term "autism spectrum disorder," with individuals differentiated by
levels of severity. It may be true that there is no hard and fast
separation between Asperger syndrome and classic autism, since they are
currently differentiated only by intelligence and onset of language.
Both classic autism and Asperger syndrome involve difficulties with
social interaction and communication, alongside unusually narrow
interests and a strong desire for repetition, but in Asperger syndrome,
the person has good intelligence and language acquisition.
The question of whether Asperger syndrome should be included or excluded
is the latest example of dramatic changes in history of the diagnostic
manual. The first manual, published in 1952, listed 106 "mental
disorders." The second (1968), listed 182, and famously removed
homosexuality as a disorder in a later printing. The third (1980) listed
265 disorders, taking out "neurosis." The revised third version (1987)
listed 292 disorders, while the current fourth version cut the list of
disorders back to 283.
This history reminds us that psychiatric diagnoses are not set in stone.
They are "manmade," and different generations of doctors sit around the
committee table and change how we think about "mental disorders."
This in turn reminds us to set aside any assumption that the diagnostic
manual is a taxonomic system. Maybe one day it will achieve this
scientific value, but a classification system that can be changed so
freely and so frequently can't be close to following Plato's
recommendation of "carving nature at its joints."
Part of the reason the diagnostic manual can move the boundaries and add
or remove "mental disorders" so easily is that it focuses on surface
appearances or behavior (symptoms) and is silent about causes. Symptoms
can be arranged into groups in many ways, and there is no single right
way to cluster them. Psychiatry is not at the stage of other branches of
medicine, where a diagnostic category depends on a known biological
mechanism. An example of where this does occur is Down syndrome, where
surface appearances are irrelevant. Instead the cause - an extra copy of
Chromosome 21 - is the sole determinant to obtain a diagnosis.
Psychiatry, in contrast, does not yet have any diagnostic blood tests
with which to reveal a biological mechanism.
So what should we do about Asperger syndrome? Although originally
described in German in 1944, the first article about it in English was
published in 1981, and Asperger syndrome made it only into the fourth
version of the manual, in 1994. That is, the international medical
community took 50 years to acknowledge it. In the last decade thousands
of people have been given the diagnosis. Seen through this historical
lens, it seems a very short time frame to be considering removing
Asperger syndrome from the manual.
We also need to be aware of the consequences of removing it. First, what
happens to those people and their families who waited so long for a
diagnostic label that does a good job of describing their profile? Will
they have to go back to the clinics to get their diagnoses changed? The
likelihood of causing them confusion and upset seems high.
Second, science hasn't had a proper chance to test if there is a
biological difference between Asperger syndrome and classic autism. My
colleagues and I recently published the first candidate gene study of
Asperger syndrome, which identified 14 genes associated with the
condition.
We don't yet know if Asperger syndrome is genetically identical or
distinct from classic autism, but surely it makes scientific sense to
wait until these two subgroups have been thoroughly tested before
lumping them together in the diagnostic manual. I am the first to agree
with the concept of an autistic spectrum, but there may be important
differences between subgroups that the psychiatric association should
not blur too hastily.
Simon Baron-Cohen, the director of the Autism Research Center at
Cambridge University, is the author of "The Essential Difference."
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