On Mental Disorders, Part One

One of the major errors that people make when thinking of DSM mental disorders and the like is to think of them as diseases. While this is undoubtedly true for some diagnoses in the DSM, the fact of the matter is that "mental disorder" and "disease" are really very different concepts.

While disease categories are abstractions based on etiology, mental disorders... well, aren't. That isn't even the ideal anymore.

As I discussed in an earlier post, certain conditions must be met for something to be called a disease:

• It must be an impairment of the normal state of the living animal or plant body or one of its parts.
• It must interrupt or modify the performance of the organism's vital functions.
• It must be typically manifested by distinguishing signs and symptoms.
• It must have a distinguishing etiology (which may be simple or complex).
  

The conditions for something being called a mental disorder, however, are very different. Unlike with the concept of "disease", however, these are anything but straightforward.

Going to MedLine Plus, for instance, yields the following definition: "a mental or bodily condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological functioning of the individual—called also mental illness."

In other words, while a disease is an abstraction based on etiology, a mental disorder is an abstraction based on symptoms. While a disease is a process which causes its symptoms, a mental disorder is a label which describes them or a description of them. Classification of mental disorders makes no reference to the why, only to the what. They have no explanatory value whatsoever; to say that a psychiatric diagnosis has any explanatory value whatsoever is to commit nominal fallacy.

Even this, however, isn't really satisfying. What, for instance, does "disorganization" mean? How do you decide whether or not something "impair[s] the normal psychological functioning of the individual"? Heck, just what does "normal psychological functioning" mean?

These questions are important because of the "wiggle room" built into these terms. In the DSM-I and II, for instance, homosexuality was considered a mental disorder -- homosexuals were considered "broken" heterosexuals whose attraction to members of their own sex represented an impairment to their functioning qua members of their gender. Another infamous example of this problem featured a doctor who pathologized the desire of slaves to flee their masters (he considered whipping to be curative).

My abnormal psychology textbook provides a somewhat more clear answer: it defines one as "a psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected." (p. 2)

This, in turn, breaks down into four parts. To qualify as a mental disorder, a set of symptoms must:

• Constitute a "psychological dysfunction".
• Be within the individual.
• Be associated with distress and/or impairment in functioning.
• Be associated with (at least one) response that is not typical or culturally expected.

Unfortunately, none of these is quite what it seems. I'll write more on this later, but for now... just keep in mind: a mental disorder is not a disease.

Edit: Corrected an embarassing typo.

Alphabet Soup!

Back when I was a kid, I used to like Campbell's Alphabet soup. Part of this was the preschool fascination with letters. Part of it was the taste.

Kids, in general, like alphabet soup. It's a great thing educationally, as well as being... well, better than some things... nutritionally.

To many adults, on the other hand, a different kind of alphabet soup is the bane of their existence. In a real way, this sort of alphabet soup has invaded our lives, thrusting such arcane acronyms as FBI, CIA, NSA, IRS, USSS, DEA, and NCIS... just to name a few of the more commonly mentioned examples within the US government.

Medicine, too, has its own alphabet soup. Ranging from HIPAA to MRI, it bombards us with labels like IRB that seemingly have no relevance to our day-to-day life. Every diagnosis seems to have its own inpenetrable jargon... to most people, anyway.

It should be no surprise that autism, too, has its own fair share of related alphabet soup, words like ABA, IBI, DTT, IEP, PT, and AS, just to name a few examples. Many of these acronyms are often misused.

To someone new to the world of autism, this can be... confusing, to say the least. As such, I've put together a little guide to them.

Do not expect this guide to be complete. If someone mentions an acronym to me that's not on this list, I'll go back and add it in (with a little thank you), but this initial version is just a guide to the ones I could think of offhand.

I've grouped these acronyms into two categories: those which are ABA-based and those which are not. There's some room for debate here, my classification of PBS as not-ABA being a prime example, but that would have been the case regardless of which direction I chose to in that case.

Not ABA

ADOS - The Autism Diagnostic Observation Schedule, a tool used to access the "symptoms" of autism.

AS - Asperger Syndrome, often (debatably) referred to as a "mild form of autism".

ASD - Autism Spectrum Disorder(s), any of the conditions classed as PDDs under the DSM.

NT - Neurotypical. Depending on use, either someone of "normal" neurology or having to do with non-autistic attitudes and/or society.

MMR - Vaccines used to immunize against measels, mumps, and rubella. Often blamed for kids "becoming" autistic despite a lack of evidence to support the view.

IDEA - the Individuals with Disabilities Education Act, a United States law which has considerable impact on the education of autistic individuals.

OT - Occupational Therapy. Also occasionally used to refer to an Occupational Therapist.

SLP - Speech-Language Pathology. Also, occasionally, Speech Language Pathologist.

PBS - Positive Behavioral Support, a breakoff movement from ABA. PBS methods typically differ from ABA methods mostly in marketing and attitudes.

PDD - Pervasive Developmental Disability, one description of what autism is. Other conditions classed as PDDs under the DSM-IV are Childhood Disintegrative Disorder, Rett Syndrome, Asperger Syndrome, and PDD-NOS.

PDD-NOS - Pervasive Developmental Disability - Not Otherwise Specified, the DSM-IV's catch-all diagnosis for anyone on the spectrum who can't be given a diagnosis of CDD, Rett Syndrome, AS, or autism.

CAN - Cure Autism Now, a predecessor group to Autism Speaks.

DAN - Defeat Autism Now!, a network of physicians, researchers, and so on who advocate nonstandard treatment methods for autism. Many accuse them of being quacks.

FEAT - Families for Effective Autism Treatment, a movement consisting primarily of the families of autistic individuals which is dedicated to the advocacy of intensive ABA-based treatment programs.

ASA - the Autism Society of America.

DSM - The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

DSM-IV - The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth (IV) Edition.

CDD - Childhood Disintegrative Disorder.

ASAN - the Austic Self Advocacy Network, an autistic-run group dedicated to championing the rights of autistic individuals.

ABA

ABA - Applied Behavior Analysis, the science of applying behavior analytic principles and theory to real-world situations.

BACB - the Behavior Analysis Certification Board, the group responsible for certifying behavior analysts.

BCBA - Board Certified Behavior Analyst, someone certified to design and oversee a course of ABA-based therapy (among several other things).

BCABA - Board Certified Associate Behavior Analyst, someone certified to implement behavior plans and conduct the day-to-day work of ABA-based therapy.

BIP - Behavior Intervention Plan, a plan (or document detailing a plan) to alter behavior.

NET - Natural Environment Teaching, a blanket term for teaching methods conducted in a natural or nautralistic setting.

IBI - Intensive Behavioral Intervention

EIBI - Early Intensive Behavioral Intervention, IBI starting at a young age.

DTT - Discrete Trial Teaching, a teaching method used as the basis of most early ABA-based autism interventions. In many minds and documents, DTT is equated with ABA.

PRT - Pivotal Response Training, a teaching method designed to target so-called "pivotal responses" such as motivation,

PECS - the Picture Exchange Communication System, a teaching strategy for communication skills.

VBA - Verbal Behavior Analysis, either the application of ABA to human interaction or a specific approach to language intervention.

AVB - Analysis of Verbal Behavior, another name for VBA.

JABA - the Journal of Applied Behavior Analysis, the flagship academic journal of ABA.

JEIBI - The Journal of Early Intensive Behavioral Intervention, a major ABA-based jounal and the flagship journal of the IBI movement.

This, of course, is an incomplete list. If you think of any others, feel free to comment with them and I'll consider adding them... with, of course, appropriate credit.