Whereof one cannot speak, thereof one must be silent

Reviewing a biography of Beaumarchais, David A Bell, dean of the humanities faculty at Johns Hopkins University, has the following to say:

Beaumarchais was a manic character, of the sort who would now be diagnosed at a young age with Attention Deficit Disorder or something similar, and placed on medication designed to ensure a long life of obscure mediocrity.

So there you have it.  ADD is not a disorder, but a mark of non-mediocrity.  Medication prescribed to people diagnosed with ADD does not help them to manage their symptoms.  In fact, it isn’t even intended to do so.  Far from it: this medication is designed to take exceptional, gifted people and drag them down to the level of obscure mediocrity.

This isn’t, you understand, the result of valid research being deliberately manipulated by pharmaceutical companies who have a commercial incentive to identify all forms of childhood behaviour as a disorder that can be treated with a pill they just happen to manufacture.  On the contrary, the medication has been deliberately designed to have this effect.  A cabal of researchers, psychiatrists, psychologists, paediatricians, teachers and parents conspire together in a system of ‘diagnosis’ and ‘treatment’ with the explicit aim of taking the happy faces of exceptional children and bludgeoning them into mediocre submission.

Never mind the rather inconvenient fact that, far from trying to suppress their kids’ abilities, most parents suffer from an unshakeable delusion that their precious little Tabithas and Timothies are geniuses of the first rank, and that every finger-painting of an unrecognisable cat is proof that they have already surpassed Michelangelo.  Never mind that, in the very next sentence, Bell provides evidence that refutes his claim that Beaumarchais’ behaviour would attract a diagnosis of ADD:

When the first performance of The Barber of Seville unexpectedly bombed in 1775, he re-wrote the play in less than 48 hours and audiences hailed the second performance a triumph.

Someone who is capable of a sustained period of directed concentration like that can’t possibly have had the symptoms that these days get labelled as ADD.  The clue is in the name – it’s called Attention Deficit Disorder – and, far from displaying what he hoped would be an urbane, man-of-the-world wit, Bell has demonstrated that he’s prepared to write about things he simply doesn’t understand.  And anyway, just how ignorant do you have to be not to realise that ADD implies an inability to concentrate?

What has particularly annoyed me about Bell’s ‘contribution’ to the ADD debate, I think, is the air of patrician contempt it implies – that it is not necessary for David A Bell to consider that he might be wrong about something, for he is David A Bell, and thus is always right.  The same attitude permeates his whole article, and while it’s irritating when he’s writing about subjects he understands, it becomes maddening when he assumes certainty on subjects that fall way beyond his expertise.  Bell may provide a particularly egregious example of the phenomenon, but the truth is that this kind of misplaced certainty is everywhere, especially when it comes to talking about mental illness, and you know what?  I’ve had enough of it.

I’ve had enough of people blandly asserting that, because some normal-but-naughty or normal-but-excitable children get wrongly diagnosed with ADD, that means all diagnoses are equally false.  I’ve had enough of people on BBC comment-boards who refer to Prozac as Soma, and assume that the reference makes them sound witty and well-read, and not like people who don’t understand the first thing about antidepressants. (Hint: if you’re not depressed and you take antidepressants you don’t end up extra-cheerful; ADs are not ‘happy pills.’)  I’ve had enough of anonymous web commenters who say that all mentally ill people need is a little bit of love in their lives, and maybe the occasional hug.  I’ve had enough of people who have no experience of mental illness, who haven’t read anything about it, who often haven’t even thought about it, deciding that they understand all about it, and that it doesn’t really exist.

I’ve had enough of people who once had some bad experiences in their life and felt sad for a while, and think that this means that anyone who has been diagnosed with depression is experiencing the exact same thing.  I’ve had enough of people who can’t recognise that feeling bad when bad things happen is a sign that your emotions are functioning as they should, and that depression is feeling bad when there is no cause, and is a sign that your emotions are malfunctioning.  I’ve had enough of people who can’t understand that there is a difference between clinical and sub-clinical symptoms.  I’ve had enough of people who sometimes feel a bit down telling me that they ‘know what I’m going through’, and that their experience proves that all I need to do is give up wheat and dairy/ take more exercise/ become a flower-arranger/ accept their preferred flavour of inane supernatural bullshit and I’ll be magically all better.

I’ve had enough, because I know they’re talking bullshit.  I’m not a child, I’m 36 years old, and I’ve had some experience of negative life events.  I’ve watched as dementia took my father away a piece at a time, and seen him cremated when the end finally came.  I’ve watched my mother slowly disintegrate from the effects of a progressive physical illness; I’ve seen her – the strongest person I have ever known – lie down on the floor and weep because she was so scared of the place where her illness would take her, then been forced to stand passively by while she went there, and watched her buried when the end finally came.  I’ve endured the break up of relationships, including one that had lasted for getting on for a decade.  I’ve been fired from my job, and seen my flat repossessed because I couldn’t pay the mortgage.

I’m not trying to pull some miserabler-than-thou stunt – I’ve never buried a child; I’ve never buried a partner; I’ve never fought in a war; etc, etc – all I’m trying to do is make the point that I’ve experienced some negative life events, and I have some idea of the feelings and emotions they conjure up.  But as well as the misery that follows these kinds of events, I’ve also experienced the kind of misery that strikes out of a clear blue sky, and – you know what? – they’re not the same, not remotely.  Not a-bit-similar-but-worse: they’re utterly different.

Ordinary sadness is an active feeling, you feel it intensely, desperately, overwhelmingly, even.  Depression isn’t like that, it’s an utterly passive feeling, a total hopelessness, a depth of despair and stillness and silence it is beyond my ability to articulate.  Just because everyone has experienced an ordinary low mood once-in-a-way, they think they know what depression is, but the truth is they don’t.

I’ve had enough of the kind of people who, because they’ve experienced the slightest whisper of mental distress, think that they understand exactly what’s going on in the mind of someone who’s mentally ill.  I’ve had enough of these people telling me that I’m not really ill, just suffering in the way that we all do.  I’ve had enough of witless commentators who say that antidepressants are ‘the latest remedy for that incurable condition called life’.  I’ve had enough of the people who – commenting on Incapacity Benefit – will say that depression is nothing but a made-up condition to let the work-shy con money out of taxpayers.  I’ve had enough of the self-same people who – when they find out that Gordon Brown might be taking an AD – will say that depression makes him incapable of doing his job.

Wittgenstein put it more elegantly – whereof one cannot speak, thereof one must be silent – but I’m going to be more blunt because, like I say, I’ve had enough:

  • If you think you know what mental illness is, even though you’ve never suffered from it, or talked to anyone who has, or even read a book written by someone who has – then STFU;
  • If you think mental illness is just another name for normal experience – then STFU;
  • If you think you’ve suffered from mental illness, even though you were able to carry on with your life in the ordinary way – then STFU;
  • If you think you know how to cure mental illness, even though you’ve never actually suffered from it, or been involved in treating people who have – then STFU.

Remember: everyone may be entitled to an opinion, but opinions formed in the absence of knowledge aren’t worth jack-shit.

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This entry was posted in About me, Depression, Media commentary, Psychiatry, Psychology, Social commentary, Stuff I've read. Bookmark the permalink.

19 Responses to Whereof one cannot speak, thereof one must be silent

  1. BoB says:

    Thank you for this excellent, excellent post. I completely 100% agree with you about depression, and the way people think that just because they’ve been a bit depressed for a while and then felt better, everyone with depression should be able to “pull themselves together”.

    I really wish it had a different name actually. If only the same word didn’t get used for those temporary periods of the blues, and the kind of depression that disables you for years and years at a time or leads to suicide. Then maybe we wouldn’t have so many ignorant twits spouting off about how they were depressed once but hey, they got better, so why can’t we?

    BTW, this post may interest you, on the stigma of being on benefits for depression:
    http://benefitsculture.wordpress.com/2009/11/13/depression-stigma-benefits/

  2. Kapitano says:

    I put ADD in the same category as Dyslexia, Asperger’s Syndrome and MPD, in that it’s:

    * a vaguely defined disorder
    * massively overdiagnosed for a few years while it’s fashionable
    * used as a catch-all diagnosis by lazy physicians and writers like Bell
    * used by some ordinary people as an excuse for failure
    * used by the same people as a claim to be “special”
    * possibly nonexistant.

    I can’t count the number of people I’ve met online or in life who proudly called themselves aspergic, when all they were was mildly eccentric and somewhat attention seeking. These were people who’d maintain constant eye contact and talk animatedly to people they’d just met about how they couldn’t maintain eye contact and were socially awkward.

    The “Dyslexic Hero” trope is horribly familiar. You know the one: “I’m dyslexic and I suffered terribly at school but because I practiced reading amazingly hard I’m now a better reader than you, so I’m simultainiously a misunderstood victim, better than you, and fascinatingly different“.

    Maybe dyslexia does exist, I don’t know – all I know is that every single person who’s ever told me they had it…obviously didn’t. The same for Aspergia, Hyperactivity, ADHD, ADD and my particular favourite, Social Anxiety Disorder.

    If there’s nothing more to ADD than “constantly being distracted by things” or “school being boring”, then every single child in the world has it, together with every adult who finds the world interesting. It’s just another disorder invented to sell drugs and self-help books to the worried well.

    If there is a real disorder behind the hype and ludicrous overdiagnosis…then it’s quite rare, probably underdiagnosed for those who actually have it, and needs a lot more research – with real subjects who aren’t self-diagnosed.

    —–

    You talk about clinical depression, and absolutely correctly describe it as a passive feeling – a passionlessness, a feeling of having been drained of life force.

    But you don’t seem depressed in that sense. You’ve got passion, anger, a sharp mind and the ability to write clearly in an ordered way – as shown by your post.

    If you wrote it on a “good day” then fair enough and I stand corrected, but judging from what you write and the way you write it, there’s nothing wrong with your neurotransmitters.

    —–

    In parentheses, I think I know what clinical depression’s like, because I had it for six or seven years – as a side effect of paroxetine, prescribed for, yes, depression.

    It’s a nice irony that I was depressed in what I now believe to be the non-clinical sense – because I was stuck in a shit town, failing a course which didn’t interest me in the slightest, looking at a life without prospects, then falling into an abusive relationship – and the treatment turned me in a shambling zombie with no feelings except unhappiness.

    Then one day I threw away the pills, joined a gym and sucked off a stranger in the park at midnight. A liberating day. End of parentheses.

    —–

    Now, just to be clear. I’m not saying mental illness doesn’t exist, or that it just needs love and hugs to be cured, or that all diagnoses are shams and all drugs are ineffective. I’m saying:

    * Most new categories of the past two decades are marketing niches, not existing disorders.

    * Normal bahavior and variation has been pathologised.

    * Most people diagnosed with commonly known mental disorders don’t have any disorders.

    * Most drugs really are ineffective – or make things worse.

    * The science behind the diagnoses and the drugs is highly questionable, most of the time.

    * Far more people get cured from spontainious remission than psychoanalysis or psychiatry. In other words, most recoveries are unexplained.

    —–

  3. cellar_door says:

    Excellent post A.

  4. J.Wibble says:

    Excellent post, and far more eloquent than I could manage. People who talk nonsense about things they know nothing about end up having their ignorance reinforced by only talking to people who also have no idea what they’re talking about. I’ve had people tell me how easy it must be to be disabled and not have to work, and they all seem to retract their former sentiments after having known me for longer than a week. A good part of my social anxiety stems from the fact that avoiding people means not having to partake in slow and painful conversations.

  5. Formerly-known-as-Adair here with a wordpress account now. Wrote a long response and got it deleted, d’oh, so will quickly reconstruct major points.

    @Kapitano

    Rest assured, people with severe dyslexia exist. My boyfriend has it, and watching his error-strewn stop-start process of reading or typing, taking more than twice as long as a normal person, is painful. That’s different from people who once had a teacher who told them in an off-hand comment that they maybe had dyslexia.

    Asperger’s is also real. Watch a grown person disintegrate into a temper-tantrum, be helpless in interacting with people, and get into problems with physical clinginess or physically fighting anyone who touches them, and any variety of other expressions of the disorder. Misdiagnoses, again, are also real–I once got diagnosed on insanely sketchy evidence (read, no evidence) with a pervasive developmental disorder NOS after the people gave me screening tests for Asperger’s and I, being normal, of course fell far, far short of the cut-off line for the disorder.

    And it’s possible to be severely depressed and still display passion and intelligence a good bit of the time. I’ve been there and still am there. It is depression. It’s not a result of medication because I’ve almost never been on medication.

    @Aethelread

    People speaking with authority often claim that “hyperfocus” is actually a symptom of ADHD–so being able to rewrite that play in 48 hours would confirm a diagnosis of ADHD in their minds. I don’t know how mainstream or supported this view is, but I do know it’s prevalent and that people who claim authority speak of it.

    Also, I think it’s dangerous to say that people who can live life in “the ordinary way” aren’t suffering from a serious mental illness. “The ordinary way” varies in different people’s mind–for one person, anything less than passing school full time, working full time, taking care of a family, and dealing with personal physical illness is indicative of “serious depression”, while for another person, sleeping 18 hours a day, spending most of the rest online, but keeping up in college classes is just fine. I’m often debilitated by my illness, but because I make decent grades most of the time and, being 18 and having scholarships and middle class parents, have never been asked to do more than that, people think I’m functioning well. I finally managed to get out of bed at 4:30 this afternoon with an exclamation of, “God, thank you!” and tears in my eyes because I’d been struggling to move for quite some time.

    I think that many of the vehement opponents of mental health care and benefits actually suffer from a disorder themselves–so many of us are in denial. My mother doesn’t work and rarely can get around to household chores like opening her mail–she spends her days sleeping, sitting staring blankly in a chair, or reading novels–but she is derisive of mental health treatment or people who claim to have a mental illness. Similarly, I’ve had life-long depression, and I rarely notice that I’m *currently* depressed, even if most of my conversations in the past few weeks have been about how I think it’s probably a good idea to commit suicide but I’m hesitating because I don’t understand why everyone else isn’t doing the same. I think it’s easy for someone to build up a kind of psychological defense around their own current condition and to take stabs at people who conceptualize the same symptoms as an illness or who try to reduce those symptoms with treatment. To well-defended people with mental illness, anyone else receiving treatment or benefits is an indication that maybe they should look at exactly those problems in their own lives that they have had to blind themselves to in order to survive.

    I agree with and love most of your post, though. I do avoid commenting on “ordinary sadness” and the emotions of normal people, though, because I’ve never experienced that kind of existence and I don’t think I understand or am qualified to speak on it. I’m usually grateful for any degree of empathy someone has to offer, even if they don’t understand what it’s like to have always been in a state where, say, the thought of reading replies to emails or comments online is enough to make you curl up for hours or days and if you actually have to do so, it takes a few attempts and tears to get through it on a good day, even if it’s comments from someone who’s ALWAYS been supportive and so on. However, if someone’s false understanding of a milder state of things leads them to deny you what you need to deal with your symptoms, then that’s a problem.

    Thanks for the great post as always!

  6. Katherine says:

    Well said. I have not told anyone at the new university about my problems for precisely this reason and it has been very nice. I’m not embarrassed for people to know and at my university for undergrad it wouldn’t have been possible to not to talk about it since I had a semi-public nervous breakdown over the course of a month but, as things are more or less on an even keel for me now, I’m enjoying the respite from the fish-oil salesmen.

    Wittgenstein! ‘The world is all the things that are the case’!

  7. aethelreadtheunread says:

    Thanks for the comments. Kapitano & almostsurreptitious – sorry yours took a while to appear, the spam filter had a fit.

    BoB – I agree, the use of the same words to describe different things is unfortunate. I think I can understand why the term was arrived at – to an outside observer, the difference between depression and ordinary sadness isn’t immediately obvious – but it’s certainly had some unfortunate side-effects.

    Thanks for the link to the blog-post – I’ll check it out. :o)

    Kapitano – you have a lot to say, and for that reason I’ve decided to shift my responses into a separate comment of their own, which should follow immediately after this one (it’s just been a case of cut and paste). Speak to you soon. :o)

    cellar_door – thanks. :o)

    J. Wibble – and thanks to you, too! :o) I think there’s perhaps an element of ‘confirmation bias’ in people who arrive at a subject already certain that they know everything about it. Such a person might, for example, pay close attention to all the evidence that supports their claim, and minimise (or even ignore) the evidence that contradicts it. I think it’s one possible explanation for why so much emphasis is placed on misdiagnosis, anyway.

    almostsurreptitious – I haven’t come across ‘hyperfocus’ in any of the sets of diagnostic criteria I’ve looked at for ADD/ADHD. My instinct would be to be a little dubious, or at least to feel that the condition had the wrong name – hyperfocus would seem to me to be an example of ‘Attention Surfeit Disorder’ rather than ADD. Although, thinking about it, perhaps I shouldn’t have mentioned ‘ASD’ as a possibility – it might turn out that Ritalin is an excellent treatment… ;o)

    When I talked about carrying on in the normal way, I didn’t mean to suggest that someone who was depressed might be incapable of doing things that get called ordinary. What I meant was that, in my experience of depression anyway, doing even the simplest of ordinary things can be a struggle. I just meant that people who feel a little wistful from time to time, but are still able to jump up and carry on with everything they normally do without a second thought, have probably not experienced clinical depression. I’m not sure I made that very clear, though! :o)

    Katherine – thanks. :o) I certainly don’t see there’s any need for you to tell your new colleagues about the past – like you say, it’s an opportunity to avoid all the helpfully-meant advice you’d be subjected to. :o)

  8. aethelreadtheunread says:

    Kapitano – Thanks for your comment. To begin, let me say that I associate myself fully with almostsurreptitious’ comments.

    On the issue of whether or not I suffer from clinical depression.

    You will find, I think, that people are more inclined to take what you say seriously if you refrain from doing obviously laughable things like asserting that you can diagnose the presence or absence of depression by remote control, and by the medium of blog.

    People who are depressed are depressed, not stupid. Depressed intellectuals are still capable of intellection, just as depressed flautists are still capable of playing the flute. They may struggle to find the motivation to pursue their normal activities, but having found the wherewithal to act, they are capable of pursuing them.

    I infer that, for you, producing a piece of writing in which the sentences and paragraphs link together and all point in the same direction is something you are only capable of doing when your mental resources are functioning at optimum efficiency. You shouldn’t assume that this is the case for all of us. For what it’s worth, I consider the post pretty imperfect – the humour is clunky, and not particularly funny, there are a number of very obvious and wrenching gear shifts, and so on – and take that as a sign that my mind was not functioning as well as it might have done. As with many of my posts (and this response to you), it was also produced over a long period of time – to the extent that minutes would probably be the appropriate unit of measure for average-time-per-sentence. I take it that, for you, the post is a paragon of logical thought and rhetorical brilliance – thanks for the backhanded compliment, btw – but, for me, it isn’t. I’m capable of a lot better.

    Depressed people are entirely capable of becoming angry when they encounter things that make them angry. In fact, they may become more angry than they would in their non-depressed state, as they are more likely to ruminate on the things they come across.

    You are correct, I identified depression as a passive feeling, but you would be mistaken in inferring that I therefore believe that those experiencing depression always act in a passive manner. We don’t. Half a moment’s thought about the practicalities of committing suicide might have led you to this conclusion yourself.

    Finally, I am amused that you still seem to believe that neurotransmitter imbalances are involved in clinical depression. You should google the subject some time – you’ll find (if you read further than advertorial websites, that is) that there is no clear evidence either that ADs significantly boost neurotransmitter levels, or that there is any correlation between neurotransmitter levels and mood. Curiously enough, double-blind placebo-controlled trials continue to show that ADs are remarkably effective in treating severe depression (they are largely ineffective in mild-to-moderate depression). The working hypothesis among most researchers is that they have some other, as yet unrealised, effect (the effectiveness of ADs has been so widely demonstrated it is implausible that errors in the trials alone can adequately explain the phenomenon).


    Looking across your comment as a whole, Kapitano, I’m struck by how often you draw up your own criteria for various conditions, perhaps as a way of reassuring yourself that your dismissal of things you appear not to understand is logical, or perhaps because you have not taken the time to familiarise yourself with the real criteria. I notice, for example, that you appear to be labouring under the misapprehension that dyslexia means non-specific reading difficulties, and that Asperger’s syndrome means social awkwardness and an inability to make eye contact, and nothing else.

    If you were to look into the diagnostic criteria for these, or any of the other conditions you doubt the existence of, I think you might be surprised to find that: a) they’re not all as vaguely defined as you think they are (in fairness, the criteria for ADD/ ADHD are notoriously vague); and b) the diagnostic criteria are not as narrow as you believe them to be. In Asperger’s, for example, an inability to understand and abide by the ‘rules’ of normal social interaction – to the extent, perhaps, that an ill-informed observer might assume a person was over-eager to discuss themselves, or was ‘attention-seeking’ – forms part of the diagnostic criteria. In dyslexia, a propensity for swapping the order of letters is very commonly observed – a friend I sat next to in school would very often write, for example, ‘tca’ where he meant ‘cat’ or ‘labl’ where he meant ‘ball’. Interestingly, dyslexia is sometimes related to another condition called dyspraxia, where the same thing happens, but with spoken rather than written language. I strongly suspect you would be unlikely to claim that a person with dyspraxia didn’t have a problem speaking, but there is some evidence to suggest that malfunctions of the same neurological pathways are involved in both conditions.

    (As an aside, I am astonished that, if you were to meet a person who explained that they had experienced great difficulty reading in early life but had worked hard and could now read well, you wouldn’t regard that as an achievement to be celebrated, whatever the precise nature of the reading difficulty was. Certainly I would be thrilled for the person telling me about it, and wouldn’t feel the need to sarcastically belittle their accomplishments.)

    I am surprised by the number of people you have encountered who were proud to tell you they had Asperger’s (not to mention intrigued to know how you are able to tell that people you’ve met online are capable of making direct eye contact…). I’ll be honest, this is not something that has ever happened to me. I have known two people in real life who had been diagnosed with Asperger’s – in both cases there was no question that, although I enjoyed their company, they didn’t fall remotely within the parameters of ‘normal’ behaviour – but neither of them were proud to tell me about it. In one case, I heard from his mother (she was keen to explain why he wasn’t the most demonstrative friend I might ever have had), and the other person told me herself, but in a matter-of-fact, now-let’s-move-on way that had nothing to do with pride. I can think of three people I have met online who I know have been diagnosed with Asperger’s, and again, none have ever seemed proud of the fact.

    You might perhaps like to consider the possibility that, by only thinking about people who have self-diagnosed with Asperger’s and the various other conditions you discuss, you might be misleading yourself as to their true nature. If you tried to infer what the concepts ‘fair’ and ‘balanced’ were on the basis of Fox News, you would come away with a rather warped understanding of them, for example.

    Finally, I am sorry to hear about the problems you had with non-clinical depression, and really glad that you have managed to find a way to a pattern of life which is more suited to you. I’m especially glad to hear that you escaped the abusive relationship, as that must have been having a catastrophic effect on your emotional and mental equilibrium. Also, you’re too nice a person to have to put up with that kind of crap. :o)

    I wonder, have you ever thought about the extent to which your experience of being prescribed drugs for a non-medical problem might explain your very obvious hostility to the idea of mental illness? Certainly, if I was in your position, I think I would have a lot of anger for the people who had given me the pills, as well as quite a lot of internally-focussed anger for having allowed myself to be ‘duped’ for such a long period of time. Next to yours, my experience pales into utter insignificance, but after 6 months on a drug (escitalopram) which did nothing for my depression and massively increased my anxiety, I felt quite a lot of both forms of anger when I finally took myself off it and realised what had been going on.

    Sadly, for me, stopping ADs hasn’t lead to the resolution of my depression (though this is perhaps not surprising, since, unlike you, I was clinically depressed when I started taking them). Perhaps I need to investigate outdoor felatio instead… ;o)

  9. *standing ovation*

  10. jessa says:

    A, that was an excellent post. I love it. And the timing is just right, having recently gotten so frustrated with just the same thing on my own blog.

  11. Kapitano says:

    Thanks for the response. I can’t respond to all your points without writing a short book, but I can respond to some briefly as time allows. Here’s two of the points you make:

    you appear to be labouring under the misapprehension that dyslexia means non-specific reading difficulties

    There are two common specific reading – and writing – difficulties associated with dyslexia:
    (1) Difficulty in distinguishing between letters which are horizontally and/or vertically mirrored versions of each other.
    (2) Difficulty in ordering the letters correctly, leading to transposition errors.

    Both these difficulties occur normally in children learning to read and write, and in adults learning an unfamilliar script. If you’ve ever learned some Hebrew or a cyrillic language, you’ll know this is true. The cure for these difficulties when they occur as part of the normal learning process is simply to practice. The treatment for them when they’re “caused by” dyslexia is…exactly the same.

    So, dyslexia is either:
    (1) an undetected hypothetical cause for normal difficulties in script aquisition lasting an unusually long time – a cause which presumably disappears when the symptoms are treated, or
    (2) a term which describes these normal difficulties lasting an unusually long time, with no cause posited.

    As for adults living with severe dyslexia which practice and education fails to improve, I see no reason to distinguish this from the vast majority of people who learn a new language in adult life, but never become proficient, despite living for decades in the country where the language is spoken.

    Most people who fall behind at school never catch up. Most people who learn a new language as an adult never develop fluency beyond that of a native speaker child of about 7. That’s not a syndrome, it’s a fact about aging.

    and that Asperger’s syndrome means social awkwardness and an inability to make eye contact, and nothing else.

    Asperger’s syndrome is diagnosed using a list of 14 (15 in the US) criterea.

    These are not precise – rather they’re such vague notions as “unwillingness to make eye contact”, “lateness of language development”, “tendency to prefer gestures over speech” and “lack of interactive play”. If anyone is judged to have any 7 or more of these, they’re deemed to have Asperger’s.

    Yes, you see I’m not as ignorant as you think. I have researched these issues, and come to the conclusion that dyslexia is nothing more than falling behind at school, and Asperger’s is so ill-defined that everyone in the world could be diagnosed with it.

  12. Daisy says:

    Aethelread – I couldn’t agree with you more.

    I got really sick. My psychiatrist prescribed me some medicine and saw me lots of times to see how I reacted.

    I got better!!!!!

    Now I am able to work, have a social life, am full of energy and I don’t feel like I want to kill myself.

    So I agree. If anyone wants to say that I wasn’t sick or that the medicine doesn’t work – STFU.

  13. aethelreadtheunread says:

    Thanks for the extra comments.

    DeeDee Ramona – thanks. :o)

    jessa – thanks – nice to know i’m not the only person who gets frustrated by these things. :o)

    Kapitano – First of all, sorry that your comment again got flagged for moderation – it’s not a deliberate policy, honest :o)

    Yes, you see I’m not as ignorant as you think.

    Or perhaps have done some hasty research between your first and second comments. I’m struck by the fact that your assertion in your first comment that people who are capable of making eye-contact can’t have Asperger’s must have been made by someone who either didn’t know about the diagnostic criteria, or was deliberately misrepresenting them. I had assumed it was the former, but now it seems you are encouraging me to regard you as a liar instead. I’m happy, of course, to dismiss your comments as the product of dishonesty rather than ignorance. Either way round, they were – and are – clearly and obviously wrong.

    I am intrigued by your interpretation of vaguely defined. For example, i wonder how it would be possible to describe a person who will ocassionally make brief eye-contact, but generally avoids it, other than by indicating that they have a prominent tendency to avoid eye-contact. To me this seems like a very precise description of the behaviour that will be observed in some people with Asperger’s syndrome, and not at all vague.

    You seem also to have overlooked the mandatory criterion in both the DSM and ICD definitions that the other features described have to be present to the extent that they significantly inhibit normal functioning. I’m sure you’d acknowledge that this is the most important of all the criteria – it’s the one that prevents ‘normal but odd’ people from being diagnosed with Asperger’s. (It was, of course, your central claim about Asperger’s in your first comment that it was a label that was applied exclusively (or nearly exclusively – you did allow a small morsel of doubt on the point) to ‘normal but odd’ people.)

    As for your assertion that everyone is dyslexic, they just get over it – well, you seem to be ignoring the fact that it’s absolutely standard to treat ‘normal’ things as ‘abnormal’ when they present in unusual circumstances. If we think about learning difficulties more generally, an 8-year-old with a learning age of 8 is wholly typical; an 18-year-old with a learning age of 8 isn’t. In fact, this was a point i made in my original post when i said:

    I’ve had enough of people who can’t understand that there is a difference between clinical and sub-clinical symptoms.

    The claim that adults who struggle to learn a 2nd language are identical to adults with severe dyslexia is patently nonsense – there’s an obvious difference between struggling to achieve fluency in a second language, and struggling to achieve fluency in language at all. A handy way of labelling the difference might be to say that struggling to learn a second language in adulthood is typical, while struggling to learn a first language throughout infancy, childhood and adulthood, even when intensive assistance is provided, is atypical.

    Daisy – i’m really glad to hear that the drugs worked. :o)

  14. Kapitano says:

    You will find, I think, that people are more inclined to take what you say seriously if you refrain from doing obviously laughable things like asserting that you can diagnose the presence or absence of depression by remote control, and by the medium of blog.

    I made no medical diagnosis. I got an impression of your personality and overall mental state from your writings, and reported it. You did the same with me later in the comment.

    have you ever thought about the extent to which your experience of being prescribed drugs for a non-medical problem might explain your very obvious hostility to the idea of mental illness?

    I’m not hostile to the idea of mental illness. I’m hostile to:

    * The way some doctors treat normal variation in human behavior as mental illness
    * The way drug companies do the same thing to sell drugs
    * The way some doctors use some temporarily fashionable but imprecise condition as a lazy diagnosis for patients who don’t fit easily into the available boxes.
    * The way a lot of ordinary people use a real or fictional mental condition excuse and explain away any personal failures that has nothing to do with the condition
    * The way these same people use such term as “dyslexic” or “asperger’s syndrome” as a lifestyle accessory
    * The way mental illness (real or not) is often used as a way to claim spurious victimhood

    Mentally ill people obviously do exist. Some of them set up webpages announcing the world is a cube or that they’re the second coming. Some walk down the street mutting to themselves – as do plenty of sane people. And then there’s the large nebulous class of people with crippling phobias, anxiety attacks, periods of ephoria, and stretches of grey listless depression.

    if I was in your position, I think I would have a lot of anger

    I’m angry, so I have an irrational agenda and I’m not thinking clearly? That’s the usual implication.

    In fact I’m not especially angry. Frequently irritated yes, but full of rage…no. Actually I could use some more anger – I might be more motivated to do more with my life.

  15. Kapitano says:

    sorry that your comment again got flagged for moderation

    No problem.

    perhaps have done some hasty research between your first and second comments

    I checked the diagnostic criteria for Asperger’s, that’s all.

    your assertion in your first comment that people who are capable of making eye-contact can’t have Asperger’s

    That’s not what I said. I was talking about people who claim to have Asperger’s, who obviously don’t fit the diagnostic criteria. Some are self-diagnosed, some would have been hastily diagnosed by a psychologist who projected Asperger’s onto every patient who even vaguely fitted, and some would have been dumped into the currently fashionable category because it’s easier than doing extensive tests which in any case would probably be inconclusive.

    I am intrigued by your interpretation of vaguely defined. For example, i wonder how it would be possible to describe a person who will ocassionally make brief eye-contact, but generally avoids it, other than by indicating that they have a prominent tendency to avoid eye-contact. To me this seems like a very precise description of the behaviour that will be observed in some people with Asperger’s syndrome, and not at all vague.

    So some normal people are shy, and some people who have Asperger’s are shy. You’re right that “vague” isn’t the right word to use here – how about “inconclusive” or “highly ambigious”.

    You seem also to have overlooked the mandatory criterion in both the DSM and ICD definitions that the other features described have to be present to the extent that they significantly inhibit normal functioning.

    “Significantly inhibit normal functioning”. Here, vague is the right word because all four of these terms have a lot of semantic room to move. Plus, it’s mixing up medical and societal criteria.

    Does a perfectionist at work have OCD? If a person with two jobs also does voluntary work are they a workaholic? Was Cassanova a sex addict? If you can answer all the questions on Who Wants to be a Millionaire? but don’t have any close friends, is there something wrong with you?

    I once knew a successful self-employed builder who was completely illiterate. He always found ways to work around situations that involved written words. It didn’t inhibit normal functioning at all.

    it’s the one that prevents ‘normal but odd’ people from being diagnosed with Asperger’s.

    Except it manifestly doesn’t – that’s the point. I’ve been diagnosed with it twice, even after patiently explaining that having a tidy filing system and a disordered bedroom isn’t enough for a diagnosis.

    But no, apparently being the kind of person who’ll “obsessively” question a diagnosis is…exactly the kind of person who has Asperger’s syndrome. Perhaps being unsatisfied with circular logic is another symptom.

    Drop into an Asperger’s support group. You’ll find a wide selection of people whose only connecting feature is that they’re “a bit odd” in very different ways. And yes, I have done this myself – I had been asked to give a presentation on the psychology of perception by the group leader. 22 misfits in a room, who’d all found that describing their oddness with a medical term made them feel better about not fitting in.

    it’s absolutely standard to treat ‘normal’ things as ‘abnormal’ when they present in unusual circumstances.

    And that is to mix up outliers in a normal distribution with special cases.

    struggling to learn a second language in adulthood is typical, while struggling to learn a first language throughout infancy, childhood and adulthood, even when intensive assistance is provided, is atypical.

    Struggling with the written form of one’s own native language, even with intensive schooling, is too common to be called atypical. The schooling may be incompetent, the student’s home life may be abusive, their culture may disparage reading and writing skills – for whatever reason, most people in the western world have, to coin a phrase, high functioning illiteracy.

    Think back to being 15 and the class taking turns to read aloud in school. How many students were barely able to do so? If your experience was like mine, in a class of 25, ~20 could manage 1 word a second or less, 1-3 could barely read at all, and 1-3 could read faster than they talked. Guess which ones read lots outside school, and guess which ones had severely fucked up home lives.

    By the way, I once spent a year helping out at a “special needs” secondary school class. I was given seven students aged 12-14, five diagnosed dyslexic. After a year they were all up to normal standard or above – not solely through my ministrations, I hasten to add.

  16. aethelreadtheunread says:

    Thanks for the comments, Kapitano. Once again, I have to apologise for your comments being flagged for moderation – I genuinely have no idea why it keeps happening. Thank you for being so understanding. :o)

    While I’m apologising for stuff, I have an uncomfortable feeling that I’ve been rather aggressive and bullying in some of what I’ve said – although I have tried to avoid it, even where you have annoyed and offended me with what you’ve said – so sorry for that, too. :o)

    Oh and one final apology – this comment is absurdly long, and sorry for that. You may have avoided writing a book, but I haven’t been capable of matching you, I’m afraid.

    I’m not hostile to the idea of mental illness.

    All I can say, Kapitano, is that you give the impression of being extraordinarily hostile to the idea. The extent to which you are wound up by this is out of all proportion to what you claim is the cause, and only seems to make sense if the wholly justified feelings you have about being wrongly diagnosed are included as additional motivation. This isn’t a criticism, just an observation. Like all observations of this type, it’s subjective, and I may well be talking out of my arse – but the observation seems true to me, for all that.

    I’m hostile to:

    The way some doctors treat normal variation in human behavior as mental illness

    The way drug companies do the same thing to sell drugs

    I agree entirely that the drugs companies ‘market’ mental illnesses, and that this has an effect on rates of diagnosis. This is actually one of my pet peeves, and something I’ve gone into elsewhere on this blog. I was thinking partly of this when I wrote in this post about the importance of recognising a distinction between clinical and sub-clinical problems.

    My point is not that diagnosis is never wrong, but that this fact shouldn’t be used to dismiss a majority of diagnoses as false. It is a widely held belief that there are no safeguards against false diagnosis, but this isn’t, in fact, the case – this is why I stressed the ‘significant impact on normal functioning’ criterion for Asperger’s. False diagnosis unquestionably occurs – you have, of course, personal experience of this – but that is not to say that all diagnoses are false.

    I’m angry, so I have an irrational agenda and I’m not thinking clearly? That’s the usual implication.

    I’ve kind of covered this already but just to be clear – no, I didn’t mean to suggest that you have an unusually irrational agenda, or that you are thinking any less clearly than most of us do most of the time. All I meant is that the depth of feeling you have on these subjects only seems to make sense if the effect of being wrongly diagnosed is taken into account.

    Onto the second of your most recent comments.

    So some normal people are shy, and some people who have Asperger’s are shy. You’re right that “vague” isn’t the right word to use here – how about “inconclusive” or “highly ambigious”.

    Of course, shy people don’t make eye contact as much as confident people. This is normal variation, and it’s sub-clinical. I’m a fairly shy person. It’s rare, for example, that I would make eye contact with strangers in a crowd, but, if someone speaks to me, or I decide to speak to them, then I do make eye contact. It makes me uncomfortable, but not profoundly so, and the difference is obvious to me from the inside, as it would be equally obvious to an observer on the outside. Avoidance of eye contact only becomes significant in diagnosis of Asperger’s when it is present to a profound extent – to an extent way beyond that of a normally shy person like me – and when it forms part of a suite of other behaviours that are also present to a profound extent.

    A little while ago, in a discussion we were having over on your blog, you used an analogy of a mosaic picture made up of individual tiles, and argued that, no matter how closely you studied an individual tile, you would never find the whole picture present within an individual tile. That analogy applies here, I think. By concentrating so heavily on each individual diagnostic ‘tile’ in turn, you’re missing the point that, when they are combined together, and when the behaviours they describe are present to an extent substantially beyond normal, the resulting ‘picture’ is of a person who is not ‘normal’. Not someone who is a little odd, but someone who’s behaviour is substantially beyond the normal range. When you push normal human behaviour far enough, it ceases to be normal. Of course, drawing the boundary is difficult, just as it might be difficult to tell, looking at a succession of subtly different shades of purple, whether red or blue was predominating – but that doesn’t mean there isn’t a clear and recognisable difference between royal blue and pillar-box red.

    it’s mixing up medical and societal criteria.

    I don’t think there are any medical or social criteria for Asperger’s, are there? Certainly all the criteria I’m aware of are behavioural. Psychiatric diagnosis is qualitatively different to usual medical diagnosis, I think, in that the diagnoses aren’t really anything more than descriptive categories – no one understands why some people swing from extreme emotional highs to extreme emotional lows, but there is a consistent pattern of behaviour, it’s distressing to sufferers, it’s known to run in families (even where sufferers have never met), and it’s been described as Bipolar Disorder. I think Asperger’s is in the same category – it refers to a pattern of behaviour that is sufficiently far beyond the norm to be worthy of a descriptive label.

    Does a perfectionist at work have OCD?

    It depends. If their perfectionism means that they’re very attentive to detail, and occasionally stay late so that they can get a particular piece of work finished just right, then the answer is almost certainly no. If they are obsessed with – let’s say – making sure that every paragraph in a report they’re writing has the same number of letters in it, and they will abandon all their other work in order to achieve this one goal, then the answer is probably yes. As with Asperger’s/ not-Asperger’s, it’s a question of degree.

    If you can answer all the questions on Who Wants to be a Millionaire? but don’t have any close friends, is there something wrong with you?

    Absolutely not, if this is the totality of the person’s unusualness – they’re just a little odd, and very knowledgeable, and, presumably, rich. This doesn’t, of course, exclude the possibility that a person who has these entirely normal traits may have some other abnormal ones.

    On the point I made about the ‘present to the extent that they significantly inhibit normal functioning’, you are entirely correct – the presence of this criterion manifestly does not prevent false diagnoses from occurring. I was an idiot ever to say that it did. What I think I can say is that this is what this criterion is aimed at achieving, however, and that it has some success.

    I’ve been diagnosed with it twice, even after patiently explaining that having a tidy filing system and a disordered bedroom isn’t enough for a diagnosis.

    First of all, sorry to hear about the misdiagnosis – you seem to have been plagued with them. Secondly, if you were diagnosed only on the basis of that – which doesn’t appear anywhere in the criteria – then you really ought to pursue official complaints against both of the people who diagnosed you. They are clearly incompetent, and there’s a good chance they’re actively dangerous to their patients.

    But no, apparently being the kind of person who’ll “obsessively” question a diagnosis is…exactly the kind of person who has Asperger’s syndrome. Perhaps being unsatisfied with circular logic is another symptom.

    Well, I can tell you from personal experience that questioning diagnosis and pointing out faulty logic gets you black marks whatever psychiatric diagnosis is being discussed. I particularly ‘enjoyed’ the psychiatrist who panicked when he heard that I had experienced some mild psychosis. He told me that, on the one hand, I needed to take antipsychotics to treat the psychosis, and on the other, I needed to take them to prove that I wasn’t psychotic, and on a third hand he found somewhere that the antipsychotics would help me even if I wasn’t psychotic. I still said no, and was sent to the naughty-step as a result.

    And that is to mix up outliers in a normal distribution with special cases.

    No. Of course the normal distribution for the human population includes some people with Asperger’s – if it didn’t there would be no cases of Asperger’s. If you look at a graph for speed of blood-clotting, you’ll find some outlying individuals who never clot, or only exceptionally slowly. This does not mean that attempts to treat haemophilia are misguided.

    I once spent a year helping out at a “special needs” secondary school class. I was given seven students aged 12-14, five diagnosed dyslexic. After a year they were all up to normal standard or above – not solely through my ministrations, I hasten to add.

    So, your experience demonstrates that dyslexic people who practice reading and writing get better at it, and that non-dyslexic people who practice reading and writing also get better at it. This shows that practice is an effective strategy in resolving reading and writing difficulties of various types. It has nothing to say on the issue of whether or not dyslexia exists. And I’m sure your ministrations had a lot to do with it – people always react well to an engaged teacher who’s actually interested in them as people, as I’m sure you were. :o)

    One final point – and this will be my final point in this discussion, though I hope you take the chance to reply if you want to – I think we may not be all that far apart in quite a few of our ideas.

    I agree that mental illness is over-diagnosed, though I part company with you on the relative numbers of false and accurate diagnoses. I agree that there is a consistent and shameful pressure from drugs companies to ever-increase the range of supposedly ‘pathological’ behaviours, though I think doctors, in the UK if not the US, are reasonably good at resisting the pressure (though they could, of course, do better). I agree that non-experts are very vague on the differences between mental illness and normal human behaviour, and that this leads to a widespread perception that mental illness is more common than it actually is. I agree that the boundary points of the various psychiatric diagnoses are shady, and that this sometimes results in misdiagnosis in ambiguous cases, though I part company with you in that I think there are many more unambiguous cases than ambiguous ones, and that the difference is obvious, if a little hard to define.

    Thanks for the discussion, Kapitano. As always, it’s helped me to work out what I actually think, as opposed to what I just think I think. And, as I say, please feel free to reply (or not reply!) if you want to. Just because I’m dropping out of the discussion at this point doesn’t mean you have to. :o)

    Take care,
    A.

  17. BoB says:

    I’ve been reading this discussion with interest. I strongly agree with Aethelread’s view that “My point is not that diagnosis is never wrong, but that this fact shouldn’t be used to dismiss a majority of diagnoses as false.”

    I’d also prefer there to be over diagnosis rather than under diagnosis, if the diagnosis reliably got people the help they need. Better to help too many than too few (though the “help” offered isn’t always at all helpful).

    I wonder what you think of the campaigns to tell us that 1 in 4 people in the UK suffers from a mental health problem at some point in their lives? Does this help reduce stigma, or does it just make people think “oh, well, lots of people have mental health problems and end up fine, so it’s no big deal”?

  18. Kapitano says:

    I have an uncomfortable feeling that I’ve been rather aggressive and bullying in some of what I’ve said – although I have tried to avoid it, even where you have annoyed and offended me with what you’ve said – so sorry for that

    So we sometimes annoy each other, but we continue speaking and don’t hold grudges. That’s not a bad definition of a grown-up way of behaving.

    I’m just going to respond to one point – in my view the central issue – and leave my commenting it at that.

    So, your experience demonstrates that dyslexic people who practice reading and writing get better at it, and that non-dyslexic people who practice reading and writing also get better at it. This shows that practice is an effective strategy in resolving reading and writing difficulties of various types. It has nothing to say on the issue of whether or not dyslexia exists

    Oh but it does – the issue is epistemological.

    Two groups of ten students each show broadly comparable difficulties with reading and writing for their age. One group is diagnosed dyslexic, the other isn’t. Both groups recieve comparable extra tutition and practice, and make about the same improvements, including a few individuals who become better at reading and writing than their “normal” peers.

    What exactly is the difference between the two groups? Same symptoms, same treatment, same range of results in about the same proportions – just a different diagnosis. Maybe one group had a single neurological cause for their symptoms, and the other had a range of societal and personal ones, but there’s no way of knowing.

    You can use the word “dyslexia” to refer to the symptoms all 20 students had, or to an unknown cause for 10 of them. If the former, then every student with difficulties is dyslexic, and the word means nothing more than…they have difficulties. If the latter, you’ve got a pointless extra hypothesis with no practical ramifications.

  19. Riley says:

    I find the closing of your post somewhat amusing. What you actually end up saying is this: “If you disagree with my opinion, it means you haven’t experienced “true” depression.”

    You end up being that which you dislike about David A. Bell: Someone that says with certainty “This is the way it is” and expects everyone else to “STFU”.

    You claim that if someone handles their ‘mental illness’ in a different way than how you have experienced mental illness (i.e. they were able to fake it and continue living their life in an apparent normal way), that it means that person didn’t really have a mental illness. You’re basically saying that the way you perceive existence is the only real, true, honest way. For everything else that doesn’t fall into lockstep with your experience, it isn’t real. Or, to state it more simply: you’re a narcissist.

    Your entire thesis is flawed on so many levels.

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