Friday, February 12, 2010

Is "Normal" Overrated?

I've been following the news around the draft proposal of the Diagnostic and Statistical Manual of Mental Disorders  revision (the DSM-V), the psychiatric "Bible" used to diagnose, classify, and (often) justify medicating mental health disorders. The draft of the fifth revision is open for public comment until April 2010; the final version will be released in 2013.

The Association of Health Care Journalists' Covering Health blog has a quick overview of the topic, with links to an in-depth article on the changes by Benedict Carey in the New York Times. Two big changes in the DSM-V include:
  • Describing Asperger's syndrome as a type of autism, instead of a separate diagnosis, under the umbrella term of autism spectrum disorder. Unlike people with severe autism, who have trouble with behavior, communication, and socialization, people with Asperger's syndrome, considered a high-functioning type of autism, have a much easier time functioning in society. People with Asperger's syndrome generally want to make social connections, but they have difficulty understanding social interactions.
  • Providing a different definition for bipolar-like behavior in children. Carey points out that children with a bipolar diagnosis are treated with sometimes-dangerous antipsychotic drugs. An alternative diagnosis, "temper dysregulation disorder with dysphoria," would be treated primarily with behavioral therapy.

Carey describes the DSM as "the guidebook that largely determines where society draws the line between normal and not normal." A person whose psychiatric problem creates a danger to himself or others certainly needs treatment. But the debate about how to classify Asperger's syndrome in particular brings up the larger question of how tolerant, or intolerant, we are of behavior that is simply different from the norm.

The blog, run by the mother of a teenager with an autism spectrum disorder, argues that diverse neurological conditions should be better understood and tolerated. Some people with autism spectrum disorders, irritated by how their conditions are misunderstood by the general public, call the rest of us "neurotypicals", bound by social conformity and a lack of creativity.

In an age that prizes - and benefits from - cultural diversity, shouldn't we allow for some neuro-diversity as well? A number of well-known people might have or have had Asperger's syndrome, including Albert Einstein, Bill Gates, and Isaac Newton. Certainly you can argue that they thought differently than the average person, but we have all benefited from their achievements.