The Global Summit on Diagnostic Alternatives: An Online Platform for Rethinking Mental Health
Critiques of Diagnosis
Diagnosis in Practice
Far from Rotten in the State of Denmark
Dave Traxson November 19, 2013 Cultural Issues, Current Status of Dx, Pressing Issues, Sociopolitical Issues
Psychotropic Drugs and their Use as Agents of Social Control and Alternative Philosophies in some Western Societies
Many international surveys, such as the one done by the World Health Organisation in 2009, show Denmark in a very positivedenmark light in terms of its Welfare State and treatment of vulnerable groups in society. Renowned as a country with a vibrant and progressive society with a graduated tax system that it needs to fund it, Denmark regularly comes out as the happiest country in which to support a child’s development and in which to live and somewhat surprisingly a country whose citizens do not object to such tax rates. It also, interestingly, has one of the lowest rates of usage of psychotropic drugs for children in the Western World, is this a coincidence? Mental health indices are also very strong in Denmark with 89% of people reported as having more positive experiences in an average day (feelings of rest, pride in accomplishment, enjoyment, etc) than negative ones (pain, worry, sadness, boredom, etc). This figure is the highest in the OECD where the average is 80%, which on its own is very significant. Surely we all want to emulate such fundamental findings and learn how to improve our currently ever more divided societies. Denmark has invested heavily in a pioneering approach, called Social Pedagogy, for the most vulnerable group of children in society, what we call ‘Looked After Children.’ This is based on using ‘Social Pedagogues’ who work intensively with around 5 young people each and keep those cases long-term. This intervention gets excellent life outcomes e.g. six out of ten such children in Denmark get into Higher Education compared to six per thousand in the U.K.
Social Pedagogy is an academic discipline concerned with the theory and practice of holistic education and care. The term ‘pedagogy’ originates from the Greek pais (child) and agein (to bring up, or lead), with the prefix ‘social’ emphasising that upbringing is not only the responsibility of parents but a shared responsibility of society. As a result, social pedagogy is a ‘function of society’ it reflects how a given society at a given time thinks about education and upbringing, about the relationship between the individual and society, and about social welfare for its marginalised members. Consequently, social pedagogues work within a range of different settings, from early years through adulthood to working with disadvantaged adult groups as well as older people. To achieve a holistic perspective within each of these settings, social pedagogy draws together theories and concepts from related disciplines such as primarily psychology, then also sociology, education, philosophy, medical sciences and social work.
As social beings we live with our eyes upon our reflection, but have no assurance of the tranquility of the waters in which we see it.
Charles Horton Cooley
Social pedagogy is based on humanistic values stressing human dignity, mutual respect, trust, unconditional appreciation, and equality, to mention but a few. It is underpinned by a fundamental concept of children, young people and adults as equal human beings with rich and extraordinary potential and considers them competent, resourceful and active agents in their own development and life planning.
Overall, social pedagogy aims to achieve the following:
Holistic education - learning of the head (cognitive knowledge), heart (emotional and spiritual learning), and hands (practical and physical skills);
Holistic well-being - strengthening health-sustaining factors and providing support for people to enjoy a long-lasting feeling of happiness;
To enable children, young people as well as adults to empower themselves and be self-responsible persons who take responsibility for their society;
To promote human welfare and prevent or ease social problems.
Petrie et al.(2006) identify nine principles underpinning social pedagogy:
“A focus on the child as a whole person, and support for the child’s overall development;
The practitioner seeing herself/himself as a person, in relationship with the child or young person;
Children and staff are seen as inhabiting the same life space, not as existing in separate hierarchical domains;
As professionals, pedagogues are encouraged constantly to reflect on their practice and to apply both theoretical understandings and self-knowledge to the sometimes challenging demands with which they are confronted;
Pedagogues are also practical, so their training prepares them to share in many aspects of children’s daily lives and activities;
Children s associative life is seen as an important resource: workers should foster and make use of the group;
Pedagogy builds on an understanding of children’s rights that is not limited to procedural matters or legislated requirements;
There is an emphasis on team work and on valuing the contribution of others in ‘bringing up’ children: other professionals, members of the local community and, especially, parents;
The centrality of a therapeutic relationship and, allied to this, the importance of listening and communicating.”
Overall, a highly skilled social pedagogue’s practice is a holistic and human process creating a balance between:
the professional: (theory and concepts, reflective practitioner = THE HEAD)
the personal: (using one’s personality, positive attitude, building personal relationships, but keeping the private out = THE HEART )
the practical: (using certain methods and creative activities = THE HANDS )
All three elements are equal and complement each other, thus generating synergy of shared purpose. Due to this philosophy it is perhaps not surprising that prescription rates of psychotropic drugs are lower than many other countries with a similar economic and cultural profile but that lack this philosophical underpinning of Humanistic values and co-constructed opportunities.
To put these observations into an international context, Constantine Berbatis and associates from Ausralia summarised their findings in a study entitled, ‘Licit psychostimulant consumption in Australia, 1984–2000: international and jurisdictional comparison,’ that, “For the 10 countries from 1994 to 2000, total psychostimulant consumption increased by an average 12% per year, with the highest increase from 1998 to 2000. Australia and New Zealand ranked third in total psychostimulant use after the United States and Canada, where it averages 8% of the school population. Australia where from 1984 to 2000, the rate of consumption of licit psychostimulants increased by 26% per year, with an 8.46-fold increase from 1994 to 2000, consumed significantly more than the United Kingdom, Sweden, Spain, the Netherlands,who in turn were more than France or Denmark, both having rates of less than 0.2% due to specific approaches used. France believes in the use of psychotherapy and sport to reduce anxiety levels and behavioural difficulties.
For the European perspective, ‘The Spirit Level’ (2009) provided excellent evidence of the inequality split in societies and how it affects well-being. The research suggests that the authors Wilkinson and Pickett finding, that there is a strong correlation between the scale of income inequality within a country and the severity of multiple, discrete health, mental well-being and social problems, and is also relevant to cultural activity. The study demonstrated that, among the 22 European countries analysed, there was a strong association between the income gap within a country and the cultural activity of its citizens. Psychological well-being and cultural activity were found to be significantly higher in egalitarian countries, such as Sweden and Denmark, than in highly stratified countries, including Portugal, Poland and Greece.
The recent changes to the most commonly used diagnostic statistical manual were introduced as part of the revision to produce the American Psychiatric Association’s new DSM-5, published in May 2013. This is now the current bible for modern psychiatry. DSM has gone through a number of modifications over the past fifty years and has provided a very large annual income from its sales for the APA, particularly when the revisions, this time produced by ‘closed medic only groups,’ are first released.
Children who are overly sad have been rebranded with ‘social anxiety disorder,’ (SAD) by the diagnostic manual’s revision, those who regularly display tantrums could be diagnosed with ‘temper dysregulation with dysphoria,’ (TDD) – OR ‘intermittent explosive disorder’ (IED) and teenagers who are particularly eccentric might be porescribed drugs for the treatment of ‘psychosis risk syndrome.’ (PRS) As we all intuitively know any of us are ‘at risk’ of a transient episode of mental instability and pain due to many factors such as bereavement, unemployment, bullying, prejudice and exposure to an uncaring society. The most scandalous deliberate alteration is the removal of the ‘bereavement exclusion’ which prevented anti-depressants being prescribed for at least two months. Now that has been removed children and other vulnerable groups can and are being prescribed these untested psychotropic drugs within a fortnight of losing a ‘loved one.’ The widely publicised risks of increased suicidal ideation and self harm in this early adjustment period could easily compound the one tragedy with another.
Large numbers of mental health workers around the globe fear the new diagnoses could unnecessarily stigmatize many children and lead to the unnecessary use of psychotropic medications that can often produce a wide range of serious side effects. These may include neurological tremors or ‘Parkinsonianisms’, Tardive Dyskenesia, significant weight loss, psychotic episodes, self-harming behaviour and ironically major sleep disturbances, when we all know that a ‘good night’s sleep’ is a necessary pre-requisite of wellbeing / good mental health and behaviour in our children, the following day and in the longer term.
By massively pathologizing people under these categories, you tend to put them on an automatic path to medication, even if they are experiencing normal distress,
states Jerome Wakefield 2012, who is a Professor of social work and psychiatry at New York University. We as a progressive society must not remove normal and transient human responses from the repertoire of acceptable human reactions to traumatic and persistent stressors for children and adolescents. Rather than diagnosing dubious disorders many mental health professionals believe it is more important to understand the significant stressful life events that have occurred to an individual and to shape up the coping strategies and support mechanisms that naturalistically occur in a healthy community.
The most important thing is not to diagnose what is wrong with someone but to find out what has happened to them.
Baroness Susan Greenfield, Professor of Pharmacology at Oxford University and ex- Director of the Royal Institution said in a Times Educational Supplement interview in 2007,
There is clearly a growing willingness to offer young people drugs which have profound effects on the way they think and behave,
We should give more thought to changing the shape of our classrooms to fit our children, rather than trying to medicate our children to fit the classroom!
Behavioural and mental health issues, as we now know, have many potential and interacting causal factors involved in their onset, and therefore require a varied repertoire of creative and caring responses to meet the needs of a young person experiencing emotional and physical distress.
-Dave Traxson 2013
Among the gravest concerns of these health workers are the creation of “risk syndromes” in the hopes that early diagnosis of young people and treatment will prevent the full-blown conditions later in life. For example, the new manual creates a “psychosis risk syndrome” for adolescents who have mild symptoms found in psychotic disorders, such as paranoia, delusions, inner voices and disorganized speech or behaviour. “There will be adolescents who are a little odd and have funny ideas, and this will label them as pre-psychotic,” said Robert Spitzer, a professor of psychiatry at Columbia University, who has been one of the most vocal critics of the DSM revision process. This could stigmatise the young people for a significant part of their life harming employment prospects and educational opportunities.
Giving a child a label of a mental illness is stigmatisation NOT diagnosis.
Professor Thomas Szasz – 1968
Many commentators share the concerns expressed by the author of “Shyness: How Normal Behavior Became a Sickness,”(2010), which was nominated for a major writing in medicine prize, who states,
They are close to treating the children like guinea pigs. I think that’s appalling and outrageous,” and also “the APA should be moving to prevent such controversial practices, not encouraging them, as it is doing here.
Professor Christopher Lane 2010
I, personally concur with Lane and feel that this increasing tendency to pathologise and medicate thousands of vulnerable children and adolescents is a form of Psycho-Economic Imperialism, which is the biochemical colonisation of children’s’ developing minds for huge commercial gain and to effect either directly or indirectly a greater form of social control.
The saddest element of this lucrative and sick twenty first century ‘trade triangle’ formed between Big Pharma, psychiatry ; medicine and families is that parents often become seduced by the rationales being offered by professionals. This is especially true if they are socially disadvantaged and are told or discover from websites that they can benefit financially from one of the two levels of Disability Living Allowance payments (£300 or £600 per month), which are then approved by the same professionals who suggested the diagnosis. Slavery was driven by a wealth generating ‘business plan’ and there are very few trade cycles in the modern world where all participants can be so generously rewarded, than the provision of psychopharmaceutical products for children, which in my view is a form of chemical enslavement. We must not forget that the major driver in this process is the improved profitability and market expansion of the drug companies at the expense of some of the weakest members of society. For vulnerable children in particular, enslaving them and creating long-term dependency or ‘customers’ on a plethera of drug treatments in turn boosts the massive profits of the drug producers, and so the profit cycle turns endlessly on.
Why is America so focussed on the disease model of difference? Thomas Szasz went so far as to argue that the prominence of the ‘medical model’ is a major reason for the decline of democracy in American society (2001). Szasz claimed we have become a pharmacracy, a society governed by medicine’s understanding of humanity in which “people perceive all manner of human problems as medical in nature, susceptible to medical remedies.” As medicine became a dominant arbiter of truths about, and solutions for, the human condition, values were also transformed. Szasz proposed that an ethic has emerged that supports accountability for our good deeds while excusing our bad deeds (and less than desirable traits), depicting the latter as the result of diseases and disorders. The outcome, Szasz contended, is a nation of people who evade responsibility for their actions, blaming diseases, genetic inheritance and others for behaviours that at one time would have reflected poor character or irresponsibility. In effect, Szasz argued, medicine undermines citizens taking personal responsibility, and consequently damages the very fabric of society.
I can calculate the motion of the heavenly bodies but not the madness of people.
Many critics and members of the general public feel these retrograde changes in our diagnostic bureaucracy are symptomatic also of a societal drive for increased social control, in some countries, over young people. I have previously mooted a societal model of social control which consists of a graduated response hierarchy by the health and legal systems of some Western countries. It starts with the very increased levels of prescribing psychotropic drugs for children and adolescents that have been outlined so far in this post. It then progresses to adolescents and young adults being placed or sectioned in mental health facilities where they can often be given psychoactive drugs against their wishes or worse still ECT. Some ‘developed countries’ have hugely disproportionate levels of these first two tiers of intervention compared to other more progressive ones and this trend continues to the next tier of the massively differential rates of incarceration which often also involves psychiatric diagnosis and prescribing of psychotropic drugs. The U.S. for example incarcerates 28 times per 100,000 of the population more than Denmark resulting in 2.3 million inmates, of whom, a million are claimed to have psychiatric conditions requiring medication. Sometimes this is compounded by young people being put in solitary confinement which is obviously ot going to help them resolve their social difficulties. This is sometimes occurring in adult jails with vulnerable children younger than sixteen being locked up ‘out of sight and out of mind’ from the community to which they will eventually have to learn to cope within.
To be fair handed some of the modifications in DSM-5, such as removing the bi-polar label as a diagnosis for any child, and its replacement by the mood dysregulation disorder category are possibly preferrable without the ‘disorder’ tag but this outcome still stigmatizes and is likely to medicate a child who isn’t conforming to social norms. Conditions such as Oppositional Defiant Disorder (ODD) seem deliberately designed to pull more and more children into the very profitable ‘business planning’ of the pharmaceutical industry, which sees childhood as a ‘market expansion opportunity.’ When the symptom checklists are read by any lay person they can think of a wide sample of young people in their circle of acquaintances who could be ‘fitted up’ for these newly designed pseudo-scientific disorders. The very process itself is disordered and dysfunctional.
The systematic over-diagnosis and pathologisation of broad swathes of children and developing adults is observed, by many social commentators, to be more risky to the long term psychological wellbeing of individual children and society as a whole than the supposedly abnormal patterns of behaviour these categories are designed to determine.
When the supposed ‘cure’ is potentially more harmful and systematically toxic than the ‘issue’ of concern being explored then we have an ethical duty to raise our heads above the parapets in a society, that is blissfully unaware of the implications of such draconian practices.
-Dave Traxson 2013
Many child cases reported by colleagues have in their opinion clearly very high, if not clinical, levels of anxiety, which according to National Institute of Clinical Excellence (N.I.C.E.) guidelines, is a contra-indicator to treatment with Ritalin. This is because Ritalin in its variety of forms is a psycho-stimulant and could cause overstimulation or in some reported, thankfully limited, number of cases sudden death by heart failure. Severe weight loss has been reported in many cases, which when not addressed as a matter of urgency, has led to further deterioration of the child’s health and can compromise their delicate immune systems in a few tragic cases. Some very worrying reports from parents tell of multiple prescriptions or ‘drug cocktails’ of high levels of Ritalin, SRI anti-depressants and anti-psychotic medication to aid relaxation. When, in one case, the prescription was taken to the pharmacist after consultation he refused to issue the prescription, saying it was a potentially “life-threatening” combination of drugs. The parent was advised to go back to the prescribing child psychiatrist and get it changed which she duly did. Thankfully the toxic mix was significantly modified but not all pharmacists are equally vigilant to the risks involved.
A number of professionals have grave concerns about the principle of informed consent regarding medication, with some parents saying words to the effect that they don’t understand how they work, particularly the purported ‘paradoxical effect’, but they get their child to take it because they trust the prescribing doctor. This resonates with the famous Milgram experiment where subjects said, “I did it because the man in the white coat told me to.” Milgram’s seminal book, ‘Obedience To Authority – An Experimental View’ (1974), endorsed this strong socio-psychological phenomenon.
This situation is not some distorted conspiracy theory, but the current reality as recognised by such august bodies as the USFDA Drug Safety Committee, whose chair Peter Gross of Hackensack University Medical Center stated in 2006, “It has become clear that drugs are being overused with children.”Indeed one eminent American psychiatrist Leon Eisenberg, born in 1922, who was the “scientific father of ADHD” and who at the age of 87, seven months before his death in his last interview expressed regret about the universally growing condition his name was associated with, stating,
ADHD is a prime example of a fictitious disease.
To end as we started with a literary theme, the current dulling of affect of thousands of young people by ‘drug cocktails’ is redolant of the use of daily Soma in Orwell’s poignant ’1984′ and the siligism,
He who controls the past controls the future. He who controls the present controls the past.
The lead character, Winston, went on,
Your worst enemy, he reflected, was your nervous system. At any moment the tension inside you was liable to translate itself into some visible symptom.
-George Orwell from ’1984′
Perhaps society now perceives the manifestation of ‘symptoms’ of high energy and vibrancy as a challenge and thus ADHD was born or assertiveness and challenging adult views in a conformist society was seen as ODD (Oppostional Defiant Disorder) both of which must be suppressed chemically leading to sad and socially anxious individuals who also neeed medicating. If so we have collectively got into one of R.D.Laing’s famous ‘Knots’ and we are doomed to a humdrum future of uniformity and global warming both caused by similar drivers.
I am glad to have lived in an era where assertiveness and energy are highly valued and I still passionately hold to a vision where our wonderful young people are allowed to curiously roam, channelling their creative energies into a shared preferred future that is better not worse to our current reality. Countries like Denmark whose happiness and psychological wellbeing ratings are significantly higher than our own should be seen as models that we can all learn from as an interactive learning community. Happier children are automatically less likely to be given mind altering drugs by any society, hopefully.
If being energetic, individualistic, creative, restless and curious are stigmatised as mental disorders then civilisation and science as we know it is put at risk of collapse as all pioneers possess some of these very characteristics.
-Dave Traxson 2013
So to end where we began in a northern European Democracy – the parents in Denmark state collectively by their actions, ‘We don’t need a prescription for our childrens’ happiness and wellbeing. We have the personal resources to do it ourselves with the help of our excellent paediatric support teams.’ Such collaborative teamwork is a message we need to heed, in the U.K.
It’s up to you (and society I would add) today to start making healthy choices. Not choices that are just healthy for your body, but healthy for your mind.
My appreciation to Todd Krohn’s recent article on the ‘Power Elite’ Website for some of the ideas and quotes contained within this post, and to the article “Inventor of ADHD Deathbed Confession: ADHD is a fictitious disease,”by Moritz Nestor, on the Current Concerns Website. Also to Wikipedia for the definition of Social pedagogy .And of course to my parents ,grandparents, wife and children for making me believe in these timeless essential values.
I also commend the following electronic resource to you – “Working with children in care : European perspectives ,” Pat Petrie et al.(2006) All other cited work can easily be searched.