Tag Archives: Psychiatry

Adaptations and Services I’ve Used to Overcome My Disabilities

Last year, I wrote a post describing my limitations in as much detail as I could then. I got the idea from a disability discussion E-mail list that I was a member of in like 2004. The next discussion topic on the list was to go into adaptations you’ve used to overcome your limitations. Today, I will share about these.

As a toddler, I seem to have gotten by mostly without adaptations. I did have low vision, motor ipairments and was socially a little immature, but nothing too dramatic. I did have many colds until my tonsils and adenoids were removed at age four. I also saw a lot of specialists. For example, when I was about four, I was seen by some kind of rehabilitation physician because I neeed a cast on my left foot. I got lots of physical therapy and other early intervention too. However, I attended a regular preschool and Kindergarten until I fell apart in the spring of my second year of Kindergarten. Kindergarten always takes two years here, but I didn’t finish my second year because of needing to go to a special school that didn’t have a Kindergarten. Instead, I started in first grade early.

At around this age, I mostly got adaptations for my fine and gross motor impairments. For example, I got adapted scissors to be able to cut shapes out without needing to exert too much strength. I also got a large tricycle funded through the local disability services when I was about eight. I’m confused as to where my parents got the necessary doctor’s signature to get this mobility equipment. I mean, I must’ve seen a rehabilitation physician to declare that I had a severe enough mobility impairment, but I wonder whether the ophthalmologist agreed I had enough vision to cycle safely.

Of course, I did have some adaptations for my vision at this point too. I started reading large print in first grade. In fact, I had taught myself to read at around age five with large rub-on letters my Mom would put into little books for me.

By the end of first grade, I had to learn Braille because my vision was deteriorating. I got long keys on my Braille typewriter so that again I didn’t need to exert as much strength. For reading, at first the teachers would provide my Brailled assignments with double line breaks, because I had a hard time with it otherwise. Eventually, I could read Braille just fine, but it didn’t become my preferred reading method until I got a computer.

I still did use the vision I still had. In fact, I stll do, even though I only have light perception and a little light projection left. At age ten or eleven, I got a handheld magnifier. I remember using it to see the large print atlas we had in fifth and sixth grade, even though I really couldn’t make out anything on it.

By the time we moved across the country when I was nine, my parents stopped taking me to medical specialists. There was nothing to be done about my eyesight getting worse and worse and I no longer needed specialist care for my other disabilities. That is, this is my parents’ version of the truth. I think they may be right but there are some things that just don’t add up. Like, from age twelve on, I was accused of deliberately having an odd posture. Guess what? At age fifteen, the school doctor discovoered I had scoliosis. I had to have physcal therapy again.

At age thirteen, I started regular secondary school. I was functionally blind by this time and did my schoolwork on a computer with Braille display. I also got tactile graphics for the STEM subjects and tactile maps for geography. I also got lots of other nifty math tools, most of which I could barely use. I couldn’t even use tactile graphics much at all.

Like I said, I was discharged from all medical specialists at around age nine. At nineteen, when I graduated secondary school, I went back into care at the rehabilitation center for the blind. Besides orientation and mobility, housekeeping and other blindness-related training, I had to get physical therapy again for my scoliosis.

In 2007, I was finally diagnosed with autism and landed in the psychiatric hospital (not at the same time, mind you). My current psychiatrist remarks that I got little in the way of treatment there and she’s right. At first, it was thought I just needed to be moved into a group home and all would be fine, then when I got my last psychologist, it was decided I just needed a good kick in the behind and to move into independent livng as soon as possible.

Now that I’m 31, I don’t really use many adaptive devices other than my Braille display and my white cane, the latter of which I use more for stability than for its intended purpose. My iPhone has a built-in screen reader and I guess it won’t be long until NVDA is almost as good as JAWS for a computer screen reader. NVDA is free and open source, whereas JAWS costs several hundreds of dollars (that thankfully currently health insurance pays for).

I said eye doctors goodbye for good (except when I need a note to say I’m blind) in 2013 when my last chance to get a little sight back failed. I still see a psychiatrist, though my medcation regimen hasn’t changed in years. I have a community psychiatric nurse, whom I see biweekly for dialectical behavior therapy. As for my mobility, I’m due to see my GP on Wednesday to ask about this and about any treatments or adaptations that could help me improve.

Naptime Natter

P – #AtoZChallenge on Mental Health

Welcome to day 16 in the #AtoZChallenge on mental health. Todays’letter is P. There ae many obvious mental health terms starting with P, but also some you may not know.

Privileges

Privileges are what freedom of independence and movement someone has while in the mental hospital. In Believarexic, the book by J.J. Johnson I read a few months ago, the main character rightfully says that what are called privileges in the mental hospital are basic rights in the real world. For example, every adut in the real world is allowed to shower independently, whereas some people in mental hospitals need to do such basic tasks under staff supervision.

Of course, restrictions to someone’s freedom even in the mental hospital need to be motivated. If a person isn’t a danger to themself or others, they should really be allowed to go wherever they want unless this is a hindrance to their treatment. What I mean by this is of course even a person with full privileges should show up for their treatment appointments. Usually, even people with full privileges need to ask for permission from their clinician to leave the hospital overnight.

Psychiatrist

A psychiatrist is a medical doctor specializing in mental illnesses. NOwadays, they’re commonly seen as human pill dispensers, because prescribing medication is their primary task. However, in the Netherlands every psychiatrist is also a qualified psychotherapist. A psychiatrist is usualy a person’s head clinician. Head clinicians are the only ones who can open diagnosis-treatment combinations in the Netherlands. Diagnosis-treatment combination is insurance lingo for the patient’s diagnosis and the treatment that is suited to that diagnosis according to protocols. As such, a head clinician is the only one who can change a patient’s formal diagnosis. By the way, clinical psychologists and psychotherapists can also be head clinicians.

Psychologist

Psychologists do most of the talk therapy part of mental health treatment. There are three levels of psychologists employed by mental health agencies in the Netherlands. Basic psychologists are fresh out of college with a Master’s degree in psychology. We have a basic psychologist employed at my unit but I’m clueless as to what his duties are. Anyone can call themself a psychologist. Then there is the health care psychologist, which is in fact a protected title. Only someone who has completed two years of additional trainign after college and is licensed can call themself a health care psychologist. This is the most common type of psychologists employed by mental health agencies. They can do basic psychotherapy but cannot be head clinicians. Last are cliniical psychologists, who’ve got two more years of specialized training and many also have a Ph.D. These people can be head clinicians and do more specialized psychotherapy too. Clinical psychologists are often assigned to the more complex cases. My unit currently does not employ a clinical psychologist.

Psychotherapy

There are many forms of psychotherapy, both individual and in a group. Psychotherapy usually employs talking to help the patient recover, though some psychotherapies are partly non-verbal too. In many countries, the term psychotherapist can be used by anyone who so desires. Not so in the Netheraldns: psychotherapists are psychologists who’ve had I believe it’s four years of training in psychotherapy techniques. They are bound by the same laws as doctors and health care and clinical psychologists. A psychiatrist is registered separately as a physician and as a psychotherapist. As such, they can lose one license but keep the other. I once read about a psychiatrist who mostly practised psychotherapy and due to abuse of power lost his license, but only his physician license at first.

G – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter G. This was a pretty hard letter for me, so most of the words I chose are not specifically related to mental health.

Gender

There is an increasing interest in gender-specific medicine, ie. medical research and practice that takes into account how medical (including psychiatric) conditions affect women differently from men. For example, autism spectrum disorders and ADHD used to be thought of as typically male conditions whereas borderline personalitty disorder was thought to affect females primarily. It now turns out that many women have been misdiagnosed with for instance BPD when they really have an ASD and/or ADHD. The reverse is also true: eating disorders are stereotypically thought of as female disorders, so men with eating disordes often remain undiagnosed.

Men and women also differ in their treatment-seeking patterns. Women seek counseling more often, whereas men are overrepresented in psychiatric hospitals and are sectioned or taken into forensic treatment more often.

Genetics

When DSM-5, the current edition of the psychiatrist’s manual, was being prepared, initially they wanted to use a dimensional diagnosis with genetics on one axis. However, they finally decided too little is known about the gentics of mental illness yet. Mental illness is not a purely genetic thing and it isn’t purely caused by life events. For example, when I studied psychology in 2007, there was some recent research into the interplay between a particular gene called the lazy MAO A gene and one’s upbringing in causing antisocial behavior. MAO A is an enzyme that breaks down certian neurotransmitters in the brain. When people have the lazy MAO A gene, they produce too little of this enzyme. This is linked to antisocial behavior. However, even if a person had this lazy gene, upbringing played a role in the risk for developing conduct disorder in childhood and antisocial personality disorder in adulthood. The two factors together cause people to become antisocial.

Geriatrics

Geriatrics is the branch of medicine specializing in older people and diseases of the elderly. Geriatrists may work in mental health care, but more often on units for people with neurocognitive disorders (dementia). The city institution I used to reside in had several units for older people, some of whch specialized in neurocognitive disorsers where behavior was particularly dysregulated. On these units, geriatrics and psychiatry are combined.

GP

Everyone in the Netherlands (and other countries with socialized healthcare) is entitled to the care of a general practitioner (G). Most peope in long-term inpatient mental health treatment don’t have a GP where they used to live. I for one have yet to find a GP near the tiny village. Therefore, the hospital employs GPs. GPs in mental hospitals do not generally involve themselves with the patients’ mental health and psychiatrists do not generally take care of the patients’ physical health. In this sense, a GP in a mental hospital has a different role than in the community. In the community, GPs are the gatekeeper to all care whether it’s mental or physical, after all.

Deciding to Go on Psychiatric Medication #Write31Days

31 Days of Mental Health

Welcome to day 5 of the #Write31Days challenge. Today I’m focusing on a difficult decision people with mental illness might face: the decision to ask their doctors to prescribe them psychiatric medication.

Of course, patients do not make the decision to get on medication alone. Neither do doctors. Unless the patient’s mental illness causes them to be a threat to themselves or others, they cannot be forced to take medication. The patient decides whether they’ll swallow the pills prescribed to them, but the doctor ultimately decides what to prescribe. In other words, the decision about psychiatric medication is a cooperative process between doctor and patient.

Each time that I went on psychiatric medication, it was my doctor or another mental health professional who’d taken the initiative. Then again, being an informally-treated patient, I each time had the right to informed consent and chose to take my pills.

The first time I went on medication, in the summer of 2007, I was very seriously distressed. Looking back, the timing of my going on medication was about as wrong as can be. If I have to advise other patients on starting medication, I’ll advise them to change as little about the rest of their treatment or their lives as possible whilst trying the medication. I was pretty stupid in this respect, going on medication a week before I moved into independent living. Consequently, I didn’t have the opportunity to assess whether the medication worked. Maybe it did, but it is quite likely that, if it worked at all, it kept me just millimeters from falling off the edge of sanity.

I was also quite ill-informed about the medication’s side effects. The medication I was prescribed was Risperdal, an antipsychotic known for its metabolic side effects (ie. weight gain, risk of diabetes, etc.). Though I didn’t get any of these side effects as far as I knew, I did develop palpitations. The prescribing psychiatrist brushed this off, saying it was probably stress. Could be, but I’d never had this symptom before and never had it again. Since I know where to find reliable medication information, I quickly found out that heart palpitations are a relatively rare but very possible side effect from this medication.

Like the decision to go on medication, the decision to change a dose or to go off a medication again, requires cooperation between doctor and patient. Because I had moved a week after going on Risperdal and I didn’t have a psychiatrist in my new city, my GP was prescribing my medication. Understandably, she wasn’t sure how I’d do if she allowed me to quit the medication, so she was hesitant about this. I eventually just told her I was going to quit one way or another, and she recommended a taper schedule. In general, doctors have patients taper in relatively large steps, halving the dose one to several times and then stopping. It is however wise to taper more slowly.

I landed in a mental crisis four weeks after going off Risperdal. It is not known whether my going off of Risperdal caused me to fall off the edge, but I didn’t go back on medication right away. In fact, I didn’t go back for another more than two years.

I currently take Abilify, another antipsychotic, and Celexa, an antidepressant. People on antipsychotics are monitored for metabolic syndrome every six months to a year in my institution. When the monitoring project started, we were also given a long list of potential side effects and asked whether we had them or not. I had some, but not enough to warrant lowering my medication dose. The most common side effects of antipsychotics, other than metabolic syndrome, are movement disorders, like parkinsonism (stiffness and tremors similar to those in Parkinson’s Disease) and akathisia (severe restlessness and urge to move). There are medications that can counter thse side effects, particuarly parkinsonism. I don’t take any of these medications. However, it is very important to carefully consider the dosage of the antipsychotic and medications against its side effects. After all, most people want as few medications as possible, so it may not always be wise to counter each side effect with another medication.

Seeking Mental Health Help for the First Time #Write31Days

31 Days of Mental Health

When you feel you may suffer with a mental health conditon, you may want to seek mental health help. This is a very hard step that takes a lot of courage. I mean, there’s still a lot of stigma surrounding mental health problems, so you may feel awkward asking for help for something that’s “all in your head”.

When I took my first steps into the mental health system, it wasn’t by my own initiative. People with more severe mental illness relatively often find themselves being dragged into the system by other people. In my case, it was my staff at the training home for disabled people I resided at who took the initiative to send me to a psychiatrist.

In most countries, you’ll need a referral from your GP or another medical doctor (or sometimes a psychologist) to see a psychiatrist. I went to my GP for the referral, but couldn’t speak at all. I was totally locked up inside. It was my staff member who asked for the referral.

Once you see a mental health professional, the next step is telling them why you are seeing them. This may be hard too. Some people with more severe mental illness do not have insight into their illness. I didn’t when I was first seen by a psychiatrist, and that’s while I studied psychology at the time. Even if you do think you know what’ss wrong with you, it may be hard to articulate. Yu may feel shame, but you also may feel like you have trouble looking at your mental processes. I did. Many mental health professionals, especially those working with the severely mentally ill, will be understanding of this.

The mental health professional may ask you whether you have any idea of what type of help you’d like yourself. Don’t worry if you don’t have an answer to this. Most mental health professionals will understand that you may not have a clear understanding of what help you want, let alone what’s available or most effective with your problems. Particularly when you are severely or acutely mentally ill, the psychiatrist may have to give you limited options or recommend a particular treatment. For example, when I saw a psychiatrist about going on medication in the summer of 2007, she offered me two choices, one I’d come up with myself and another that she felt would be better suited. I chose to go along with her recommendation. Remember, as the patient, you have the right to informed consent, but you aren’t the expert on mental illness and its treatment. You know you best, but the psychiatrist knows what tends to work with your particular type of problems.

Defining Mental Illness #Write31Days

31 Days of Mental Health

For my first post in the 31 Days of Mental Health series, I will discuss how mental health conditions are diagnosed. As you probably know, there is no objective test for mental illness, like a blood or urine test. The diagnosis of mental illness is based on the symtpoms and signs a patient presents with.

The main classification system for mental disorders in use in th United States and elsewhere is the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. In 2013, the fifth edition, DSM-5, was published. However, some countries, like the Netherlands, still use the previous edition, DSM-IV.

DSM-IV uses a multi-axial system of diagnosing mental disorders. There are two axes for mental disorders: Axis I for clinical disorders like depression, schizophrenia and ADHD, and axis II for intellectual disability and personality disorders. The reason for the existence of axis II is that the creators of DSM-IV felt that intellectual disability and personality disorders are particularly hard to treat and relatively stable over time. Later research found this is not necessarily the case for certain personality disorders in particular. In DSM-5, personality disorders and intellectual disabiltiy are listed under the same section as other mental disorders.

In DSM-IV, there are three more axes for diagnostic classificaiton: Axis III for physical disorders, axis IV for psychosocial and environmental factors, and axis V for one’s global assessment of functioning (GAF) score. This score indicates how well or ill a person is in general. A GAF score of 100 indicates excellent mental health, while a GAF score of 50 indicates severe symptoms or severe impairments in one area of functioning (eg. work, school, social life). A GAF socre of 1, the lowest score, indicates persistent danger of seriously harming self or others. My GAF socre is 40, meaning some problems in reality testing or communication or significant impairments in more than one area of functioning.

The GAF score is, as the name suggests, a global scale. As such, it does not determine how severe each disorder a person may be diagnosed with is. Also, if a person has problems in maintaining their personal hygiene, they automatically get a lower GAF score than those who have problems functioning at work or school. It is apparently thought that, if you neglect your personal hygiene, you will be unable to function at school or work. This at least hasn’t been the case with me. In DSM-5, the GAF scale was dropped and severity can be coded for each disorder a person has been diagnosed with. The World Health Organization (WHO) Disability Assessment Schedule is included in the assessment tools section of DSM-5.

You may’ve noticed that I mostly refer to mental disorders, not mental illnesses. The word “mental illness” is not used within the DSM, rather, DSM uses the word “mental disorder” to encompass all conditions listed in their classification system (with some exceptions, eg. medication-induced movement disorder). A mental disorder is defined in DSM-5 as a syndrome characterized by clinically significant disturbance in a person’s cognition, emotion regulation or behavior. It reflects a dysfunction in the psychological, biological or developmental processes underlying mental functions. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expected or culturally approved response to a stressor, such as the loss of a loved one, is not a mental disorder. Religious, political or sexual deviance or conflicts between the individual and society are not mental disorders, unless the conflict originates primarily within the individual.

A mental disorder is not the same as a need for treatment. Need for treatment is determined through a complex process of assessment of symptom severity, presence of certain symptoms (eg. suicidal ideation), the person’s distress or disability related to their symptoms, risks and benefits of available treatment, and possibly other factors (eg. if a person’s mental disorder impacts another illness). Because of this, people who do not meet all criteria for a diagnosable mental disorder but who demonstrate a clear need for care, may be taken into treatment.

Section II of the DSM-5 describes all mental disorders that are currently being recognized by the American Psychiatric Association. Mental disorders, for clarity’s sake, include neurodevelopmental and neurocognitive disorders (eg. autism or dementia), addictions, as well as those disorders more commonly thought of as mental illnesses. Personality disorders are not always seen as mental illnesses. For example, in the UK’s Mental Health Act, they are called “psychopathic disorders”. Nonetheless, I see both personality disorders and disorders such as schizophrenia and depression, as mental illnesses.

Love to Perseverate: Rare Diseases

This week at the spin cycle, we share something we love that everyone else seems to hate or something we hate that everyone seems to love. When it comes to interests and hobbies, my famiy is quite diverse. I, like my mother, am into crafting and reading. Like my father and possibly my husband, I like learning all kinds of new things from Wikipedia or the university library. I, however, am the only one who is interested in psychology and particularly psychiatry. It could be because I’m a nut case myself, though I also love learning about other fields of medicine.

It is not a terribly uncommon interest, but it just sounds weird saying you’re interested in rare diseases. Like, I can’t bring myself to like pages on Facebook on diseases that aren’t at least remotely related to my own conditions, just in case my family believes I’ve decided I have Zellweger Syndrome. For your information: this is a debilitating genetic syndrome from which affected children die early on.

Many people do read inspirational books by people who’ve overcome tragedies, including rare diseases. Brain on Fire by Susannah Cahalan, which I just finished, was a bestseller in the United States and possibly in the Netherlands too. I read the Dutch translation, because my BookShare account has still not been activated (still waiting on my doctor to write the proof of disability thing) and I didn’t want to buy the eBook when the Dutch audio book is available at the library for the blind for free. Anyway, while many people read the book, I’m sure most people didn’t remember every tiny detail on Cahalan’s condition, except for those who think they or their relative might have the same disease. And just so you know, Cahalan does link her condition, anti-NMDA receptor encephalitis, to some diagnoses of regressive autism, but I have no reason to believe I have this condition.

In Brain on Fire, Susannah Cahalan, a reporter at the New York Post, describes the process of her sliding down into madness. For a month during the spring of 2009, for which she herself has no memory, she has seizures and psychotic symptoms and finally becomes catatonic, hardly able to move or talk. Because her parents insist that she be hospitalized on a neurological unit, she is admitted to NYU Medical Center. There, neurologists and psychiatrists are completely baffled as to what is wrong with her. One diagnoses post-ictal psychosis (psychosis after an epileptic seizure), the next diagnoses schizoaffective disorder, and so on. Finally, Dr. Souhel Najjar joins Cahalan’s team after her previous neurologist gives up on her. Najjar thoroughly examines Cahalan and finds, when he asks her to draw a clock, that she places all the digits on the right side of the clock. This causes Najjar to realize that in fact Cahalan’s right brain hemisphere is seriously damaged. It isn’t saidhow he realizes that, in fact, her brain is on fire, being attacked by her own body. It also isn’t too clear what ultimately leads to the diagnosis, because Cahalan gets a brain biopsy but she later writes that only a small portion of people with anti-NMDA receptor encephalitis get brain biopsies.

The NMDA receptor, Wikipedia tells me, is a specific type of receptor for glutamate (a very important neurotransmitter). It is important in learning and memory. When antibodies attack this receptor, the disease Cahalan suffered occurs. Some people experience flu-like symptoms or headaches weeks or months prior to onset of the characteristic symptoms. Usually, the disease starts with behavior changes, which may vary depending on the patient’s age. Children may show violence and increased agitation, while adults may experience psychotic symptoms. As the disease progresses, symptoms may include paralysis of one side of the body, jerky movements (ataxia), autonomic dysfunction (problems with heart rate or blood pressure), or catatonia. These symptoms require urgent medical attention, because the patient may slip into a coma and die.

The book is much more intriguing than my boring summary of Cahalan’s disease. I just love perseverating on rare diseases, like I said, and this is the perfect opportunity.

Terrible Things Mental Health Professionals Say

Heather Clark over at Raising Rebel Souls listed some horrible things “autism professionals” say. This made me think. Professionals can be terribly ignorant about autism. I have only dealt with a few people who claimed to be autism specialists, but I have to agree even they can made insensitive or ignorant comments. Those who don’t know much about autism but claim to know enough to diagnose and support autistics, are actually the worst.

Having an additional diagnosis of borderline personality disorder doesn’t make it any easier. I met a person with BPD when I was admitted to the locked acute ward in the big city in 2007. She was forcibly discharged then readmited or threatened with forced discharge many times because, according to her treatment team, borderlines develop institutionalization behaviors if they’re admitted long-term. Quite truthfully, I am the only person diagnosed with BPD on my unit and I don’t know anyone who hasn’t developed institutionalization behaviors, most worse than mine.

It’s quite common for mental health professionals to clash with “difficult” patients on the right approach to care, and I for one am a “difficult” patient. I don’t care. I may not always make decisions or exhibit behavior that is seen as “normal”, but that doesn’t mean that professionals can look into my head and determine why I do the things I do and what consequence will truly help me. We’ve left the days of pure behaviorism and most people would consider it dehumanizing if it were applied to them. Psychiatric patients are no exception. Here, I will list a few things that professionals say about or to me that are quite frankly terrible.

1. “You have a personality disorder so you need to take responsibility for yourself.” Everyone needs to take responsibility for themself insofar as they can. That’s nothing to do with one’s diagnosis. I am told that people with schizophrenia need to be treated more directively. For instance, if I had had this diagnosis, I would’ve been asked to come back and possibly gotten my privileges taken away if I ran off the ward. Now, I’m “allowed” to wander for hours. I don’t see how my behavior is any less dangerous now that I have a diagnosis of BPD than if I had been diagnosed with schizophrenia.

2. “You are an adult (with BPD), you should be able to remember to take care of your personal hygiene.” Well, the fact that I’m an adult says nothing about my memory – which is often better in children than adults. Forgetting to take care of one’s personal hygiene may not be common in BPD, but it freaking well is common in autism. Besides, whether it is comon in people with my diagnosis, doesn’t change my abilities. My profile of abilities and difficulties should lead to a diagnosis, not vice versa.

3. “You can hold down a conversation, so you aren’t autistic.” They never realize how one-sided the conversations are, because that’s normal for a professional-client conversation. Besides, not being able to hold a conversation is but one criterion of autistic disorder and isn’t even in the criteria for Asperger’s.

4. “You are so verbally capable.” I am, sometimes. Then again, when I am not, this is seen as deliberate manipulation and I’m left without help to “think on it”.

5. “Do you want some PRN medication?” Then when I answer “Okay”, they say: “So you did know what you wanted.” No, I didn’t, or if I did, I couldn’t communicate it. Saying “Okay” to a suggestion is a lot easier than coming up with said suggestion myself.

6. “You have theory of mind. After all, you apologize when you did something wrong.” Correction: I apologize when I think I did something wrong. I apologize way more often than is truly needed and quite often don’t apologize when I don’t realize I did something wrong. That is then seen as deliberate rudeness.

These are generally comments made to me, taking into account my diagnoses. I won’t say that people with schizophrenia or bipolar disorder don’t get nasty comments thrown their way. I just can’t speak for them.

There are also comments that makke it sound as though the staff are generally uncaring. For example, one nurse often says: “Nurses are too expensive to do cleaning.” True, we need to be encouraged to clean up after dinner or coffee, but it has nothing to do with nurses’ salary.

Post Comment Love

Mental Illness and Autism #AtoZChallenge

Welcome to day thirteen in the A to Z Challenge. I am late once again to write my post, because I have still not mastered the skill of planning ahead and I was out of town all day.

Today’s post is on mental illness. Autism, of course, is not a mental illness; it’s a developmental disability. However, many people with autism experience mental health problems or mental illness. In fact, studies show that as many as 65% of people with Asperger’s Syndrome have a co-exisitng psychiatric disorder.

Anxiety and depression are the most common mental health problems experienced by people on the autistic spectrum. It may be hard to diagnose these problems because of autistic people’s different ways of expressing and connecting to emotions. For example, I once read about a boy with Asperger’s Syndrome who suddenly stopped launching into lengthy monologues about his topic of interest. People thought that he was doing better, because, after all, he was displaying fewer autistic symptoms. On closer observation though, the boy was found to be severely depressed.

Autistic people might display a number of symptoms that indicate they are suffering from comorbid depression or anxieyt. For example, they may become completely withdrawn, may experience an increase in obsessional behaviors, or may have suicidal tendencies. Paranoia, aggression or substance abuse are also indicators that the person with autism is experiencing mental illness.

Treatments that are effective for anxiety, depression or obsessive-compulsive disordeer in the general population, often are also effective for higher-functioning individuals with autism experiencing these symptoms. However, it is important that psychiatrists be aware of the person’s autism spectrum disorder. For example, if a person is experiencing depression because of loneliness, they may need to be provided with social skills training in addition to cognitive-behavioral therapy or medication.

In the above paragraphs, I mainly talked about mental health problems in people with Asperger’s Syndrome or high-functioning autism. Of course, autistic people with an intellectual disability or those who are non-verbal, can also experience mental illness. In fact, it is thought that mental illness is more common in people with an intellectual disability than in the general population. In people with an intellectuall disability, it is hard to diagnose depression and anxiety. Depression may often be misdiagnosed as cognitive decline or dementia. People with an intellectual disability may show aggression as a symptom of depression too. This may lead to them being misdiagnosed and not getting adequate treatment.

Kanner and Asperger: Two Autism Pioneers #AtoZChallenge

Hi readers, it’s Monday again! Welcome to another day in the A to Z Challenge, in which I focus on autism. Today, I will discuss the two autism pioneers, Leo Kanner and Hans Asperger.

The term “autism” comes form the Greek word “autos”, meaning “self”, and describes people who are particularly withdrawn. The term has been in use for about 100 years. It was first used by Eugen Bleuler, a Swiss psychiatrist, to describe a subset of symptoms of schizophrenia.

Leo Kanner was born in 1894 in a small village in Austria-Hungary. He came to the United States and became a child psychiatrist at Johns Hopkins University. In 1943, he published a paper called Autistic Disturbances of Affective Contact. In this paper, he described eleven children who had a strong desire for aloneness and obsessive insistence on sameness.

Also from Austria-Hungary, Hans Asperger was born in 1906. In 1944, he published a description of “autistic psychopathy”. Children with “autistic psychopathy” were described as displaying a lack of empathy, little ability to form friendships, one-sided conversations, intense absorption in a special interest, and clumsy movement.

Unlike Kanner’s, Asperger’s work remained largely unknown. In 1981, Lorna Wing did write about Asperger’s Syndrome and thereby challenged Kanner’s original definiton of autism. Asperger’s work was eventually translated into English in 1991.

Despite common belief, Kanner’s and Asperger’s disorders as originally described were quite similar. Kanner’s original children were mostly highly intelligent. One reason that Asperger highlighted this, calling his children “little professors”, while Kanner didn’t, might be that Asperger resided in then occupied Austria. Given that children with disabilities were often killed by the Nazis, Asperger might’ve had a motive to present the children he described in as positive terms as possible.