Healthy Skepticism Library item: 4533

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Publication type: news

Wasowicz L.
Is childhood a mental problem?
United Press International 2006 Feb 1
http://news.monstersandcritics.com/lifestyle/consumerhealth/printer_1094005.php

Full text:

By Lidia Wasowicz

SAN FRANCISCO, CA, United States (UPI) — For diagnosticians assessing a
child`s state of mental health, the separation of the sick from the well
requires scrupulous care.

Few mental-health issues fire up as much debate as the question of when it
is appropriate to treat a child with mind-altering drugs. Before that
controversy can be extinguished — and, many critics insist, before
adequate safety measures can be melded into treatment plans — another
burning issue must be doused: how to draw the line between appropriate and
aberrant behavior.

‘Defining the nature and concept of mental illness is analogous to defining
art,’ says James Maddux, clinical child psychologist and professor of
psychology at George Mason University in Fairfax, Va. ‘What is good art,
what is bad art changes cross-culturally and over time.’

Part of the human condition, mental illness has been present in America
from the onset, only under a different label. The Colonists associated
‘insanity’ with birth under a full moon, believed ‘lunatics’ were possessed
by the devil and should be locked away from society and treated ‘madness’
with plunges into ice baths, massive shocks to the brain and draining of
‘bad’ blood, among other unseemly practices.

‘Mental illness existed in America 200 or 300 years ago, only under a
different name,’ notes Kathleen Gerson, professor of sociology at New York
University. ‘We`ve developed a wider array of behaviors that we now term
mental illness.’

The modification was certified through the American Psychiatric
Association`s Diagnostic and Statistical Manual of Mental Disorders, which
listed some 60 conditions in its first edition, published in 1952. Since
then, the manual, which defines, describes and classifies all recognized
psychiatric disorders, has undergone five revisions — and expansions.

‘In general, the number of disorders has increased (to the current 256
classification codes), partly because disorder categories have been split
and partly because `new` disorders have appeared,’ explains Jane McLeod,
associate professor of sociology and director of research at the Schuessler
Institute for Social Research at Indiana University in Bloomington.

The shift has complicated efforts to discern trends in children`s mental
health. Attempts to make comparisons between past and present incidence of
illness can be waylaid by any differences in diagnostic criteria,
assessment methods or reporting practices of the periods under study.

For example, in trying to determine whether the rates of new cases of ADHD
have risen since 1970, one would have to consider the confounding fact that
prior to 1980 the condition was not recognized, and thus could not be
evaluated or reported, as a psychiatric disorder.

‘We don`t really know whether the rates of problems have increased or not
because so few studies have comparable data on mental health across the
past 30 years,’ McLeod says. ‘Children`s emotional and behavioral problems
are more likely to be interpreted through a medical lens now than they were
20 years ago.’

Researchers offer multiple explanations — but no hardcore scientific proof — to explain the numbers, from increased recognition by parents and
professionals to a broadened view of what comprises a mental disorder.

‘We`re now able to identify conditions that in the past were not
identified; in the `50s a lot of these children would be sent to
institutions for incorrigible children,’ says Donna Palumbo, head of
pediatric neuropsychology training at the University of Rochester School of
Medicine and Dentistry in Rochester, N.Y. ‘Another theory says the children
are overly diagnosed, that we`re looking for perfect behavior, and we don`t
have a society that can tolerate any imperfections.’

Most mental-health experts are more concerned about cases being
underreported and children being underserved, particularly as mental-health
problems escalate under a barrage of newfound societal and environmental
pressures.

‘We have gotten very good at saving premature babies born early and at low
birth weight who are at a much higher risk of developing these kinds of
problems,’ Palumbo says. ‘There are also other environmental factors like
more lead poisoning, more moms smoking, more substance-abusing moms, older
moms at higher risk for premature babies.

‘There is a whole host of those issues, and our society at large is fast
paced, violent, high pressure,’ she adds. ‘All these can have an impact on
a child`s behavior.’

But at which point does a youngster`s deportment become a disorder?

The revisions in psychiatric diagnostic criteria have led to a
revolutionary readjustment of the way mental illness is perceived, a shift
both celebrated as a defining moment in psychiatry and censured as a
potential plunge into the mongering of mental illness.

‘The publication of the Third Edition of the Diagnostic and Statistical
Manual for Mental Disorders (DSM-III) in 1980 (when conditions such as ADHD
made their debut on its pages) substantially altered the way that we view
many problems,’ McLeod says. ‘The precise diagnostic criteria presented in
the manual allowed for new types of research on the causes and consequences
of mental disorders.’

In the minds of critics, the changes have cut a dangerously wide swath.

‘I`m not totally convinced by the data on a supposed increase in the
incidence of mental health problems in children,’ Maddux says. ‘Over the
last 50 years in the DSM, you`ll find a tremendous increase in the number
of mental disorders, to a point where anything a person does that`s
imperfect, illogical or a little bit unusual or unhealthy can qualify as a
psychological disorder.’

Expressing the views of many colleagues, Gerson sees the refinements as
instigators of a mix of positive and pernicious developments.

‘On the one hand, we need to pay attention to people`s problems and not put
our head in the sand,’ she says. ‘The degree to which we can discover some
form of individual difficulty that can be treated, like schizophrenia, is
extremely useful, but the danger is we extend this to all behavior, the
rich variety of personality, and that we will pathologize behavior … and
overmedicalize our problems.’

Full text of the book Children, Ethics, & The Law by Koocher &
Keith-Spiegel at HYPERLINK

“http://www.kspope.com/ethics/child.php“http://www.kspope.com/ethics/child.php