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Doctors under pressure to label bookish children as mentally ill'

(30 Posts)
Theseus Sun 22-Jun-14 21:20:02

I know it's behind a Paywall, but have you seen this article in the Times?

The new president of the Royal College of Psychiatrists sounds a bit ill-informed: ' “Certain behaviours carry stigma and there’s less stigma if it’s associated with a disorder. Often it’s about the avoidance of guilt. You get obvious pressure from parents: we’ve all been to middle-class dinner parties where so many parents seem to say their kids are mildly autistic and yet they’ve just got into Oxford. And you think, ‘I don’t really buy that one’ . . . It’s interesting that many of these disorders are more common in the private sector of education.”
He added: “When did you last hear a kid called bookish or shy? At what point do those normal traits become social phobia or Asperger’s, or when does a naughty kid become ADHD? Now those are socially defined, and where psychiatry sits on those is often not where the public think.'

Theseus Sun 22-Jun-14 21:47:12

Bump. I'm fuming a bit here. It sounds as though he's been to a couple of irritating dinner parties and based his opinions on that, rather than on any actual research.

He also sounds weirdly chippy: 'Professor Wessely also said other doctors looked down on psychiatry because “we don’t have very big machines that buzz”, but it could teach the rest of medicine about the importance of communication with patients.'

Icimoi Mon 23-Jun-14 13:41:57

He ought to have a look on MN if he thinks you never hear of children being described as shy.

And if he seriously thinks that autism is a middle class phenomenon, he's in the wrong job.

TheBogQueen Mon 23-Jun-14 13:48:47

He is president if the royal college of psychiatrists - so I expect he knows a bit about it.

I guess he's warning against pathologising NT behaviour - fair enough. You see on mumsnet people 'diagnosing' their toddler with aspergers or claiming their husband must have aspergers because he treats them badly. It's kind of slipped into normal discourse like someone who is tidy stating they have OCD.

7Days Mon 23-Jun-14 13:52:23

well it makes a change from denouncing the wc for claiming their dc has adhd when really there's just naughty, which you see a lot of

i agree with bog queen tough, it's fair enough to warn against patholoising normal, if not particularly agreeable behaviour. define agreeable for a start and to whom?

pointythings Tue 24-Jun-14 12:03:01

Simon Wessely is saying this in response to the issue of DSM-V, a diagnostic manual which is very influential in the US but is also in use here. DSM-V has been controversial from the beginning for pathologising behaviour which is 'normal but unusual', and the influence of the pharmaceutical influence is suspected.

I work in the field and I think he's largely right in raising this as an issue. And anyone who doesn't think psychiatry is looked down on needs to do some research on the enormous funding crisis in Mental Health services, which have been hit far, far harder than other parts of the NHS, to the point where it is now not uncommon for someone needing an acute care bed to end up hundreds of miles away from their homes and their support networks.

Theseus Tue 24-Jun-14 12:37:25

That's interesting pointy. In that case it's just a bad piece of journalism.

I'm in the process of having my dd assessed, and because she is highly intelligent some people (mostly my mum) think I'm wrong to do it.

I can imagine her going Oxbridge and some know it all thinking that must mean there is no problem for her. It was that particular comment of his which riled me. I am not excusing any bad behaviour (she has none) nor academic underachievement (again not applicable) nor pathologising shyness (she isn't shy). It's hard enough dealing with the possible implications of diagnosis without comments about 'middle class dinner parties'.

pointythings Tue 24-Jun-14 12:53:13

Bad journalism and mental health go hand in glove... I've heard Simon Wessely speak out against the culture of over-diagnosis and he makes a lot of sense. Essentially what he says is that diagnosis is often no more than a label - you get the label and then you're expected to go away satisfied because you have the label. The focus needs to be on ensuring that everyone has a chance to make the most of themselves.

I think you're probably wise to get your DD assessed, because if she is on the spectrum at the high-functioning end, there are actually a lot of things you and she can do to make her life more comfortable. One of my best friends is on the spectrum, and getting assessed has helped him focus on finding a career that will suit him. He's now in training to be a pastry chef and chocolatier, where all that meticulous attention to process and detail is going to make him shine. However, getting the label won't help with all of the labels DSM-V would like us to use.

LumieresForMe Tue 24-Jun-14 13:03:47

Well it's clear that you can be on the spectrum and go to Oxford.

And yes there is a tendency for ostentation to over diagnosed. But then there is no support at all for children who are 'normal' but are struggling. The shy kid that doesn't have any friend. The one who has massive meltdowns due to anxiety. But none if these children are receiving any support because they don't have the label.

So maybe this tendency of over diagnosing has more to do with the very little help that us available from CAMHS and the like rather than the 'need' to diagnose children who are on the edge if what is considered normal.

Theseus Tue 24-Jun-14 14:39:01

Thanks pointy that's quite reassuring at a wobbly time for me!

pointythings Tue 24-Jun-14 14:43:00

Lumieres that is one of the things that Simon Wessely raises regularly in his talks - that we need to be focusing on providing services, not applying labels. Allocation of support should not be decided by whether someone has a diagnosis or not but by whether they require help or not. It's a massive culture change but it's really important.

squizita Tue 24-Jun-14 14:50:45

So maybe this tendency of over diagnosing has more to do with the very little help that us available from CAMHS and the like rather than the 'need' to diagnose children who are on the edge if what is considered normal

This x1000000!!!

LumieresForMe Tue 24-Jun-14 16:05:23

To be honest, it's not rocket science. Anyone who has had the misfortune to go through CAMHS will have had an idea on how things work and how poorly founded they are.
And dc2 is probably (or I have been told) one of those dcs who need support but don't get a label.

The result though is appalling because then all the issues are put under the 'overreacting mum' syndrome and issues are downplayed and ignored.

almondcakes Thu 26-Jun-14 10:46:04

Yes, OP, this has been my experience with my DCS. Shyness is seen as a mental illness/ disorder/ problem to be solved.

DS is shy - the primary school fought me for two years because they insisted he had autism and I insisted he did not. I moved him in the end.

DD is quiet and shy, but not as much as DS - this was negatively commented on by numerous different teachers in her report. When her form teacher pointed it out again at parents' evening, I pointed out that it is completely and utterly normal to be shy and it is not any kind of problem to be solved. She told me management say they must tackle it with all kids.

Bonsoir Thu 26-Jun-14 10:52:08

"I pointed out that it is completely and utterly normal to be shy and it is not any kind of problem to be solved."

Not everyone is of this opinion. Shyness is not believed to be an inbuilt trait, rather a learned behavior.

forago Thu 26-Jun-14 10:56:06

I was treated by Simon Wessely at Kings back in the 90s for CFS. Even then he impressed me. He recognized that CFS could have a physical cause and recommended CBT - fairly unheard of back then. I think, really, for someone so experienced we should probably take on board what he is saying as parents.

Which doesn't change the fact that it's catch 22 - you need an official label to access the services or get your dc the additional help they might need.

Helpys Thu 26-Jun-14 11:02:52

I wasn't shy but I chose to absent myself from company by reading obsessively 3/4 books a day. TBH for me it's obvious that it was a marker for subsequent MH problems- insomnia, anxiety, the need to change the way I feel and inability to be present in many situations. I don't know how a diagnosis would have helped, although now I think about it, maybe general talking therapy and some vocabulary would have helped a lot!

I agree that people push for diagnosis as a means to getting support for a child because it is practically impossible to get any additional support in a lot of cases; if a diagnosis will help then it makes sense to go for it. There would be less need if support services were more readily available. Everyone I know who works in mental health or social services is at their wits end about not being able to support people who are crying out for help.

Perhaps it is skewed towards the middle classes because they are more likely to be able to pay for private assessments, may have better access to the information needed to navigate the systems etc.

hellsbells99 Thu 26-Jun-14 11:07:14

We are doing University open day visits at the moment with DD1 and I am dragging DD2 along so she can check out what she wants to do etc. In the medical talk at one university last week, the tutor stood chatting to DD2 afterwards. She asked if DD2 had considered going into psychiatry as that is an area where the demand is increasing rapidly.

Thumbwitch Thu 26-Jun-14 11:19:03

He doesn't seem to think that autistic people can get into Oxbridge. That shows a startling lack of sense and knowledge of autism.

forago Thu 26-Jun-14 11:21:51

whoknows you're absolutely right - the MC, educated professionals, whatever you want to call them are also more likely to have private HC through work and can use it to get their dc the diagnosis they need to ensure they get any additional help they need. They are also maybe more likely to be confident enough to push for things, used to corporate tyoe settings where you have to shout to be heard etc (eg taking them back for multiple GP appts, phoning round consultant's secretaries etc).

I am in this category. After waiting on the NHS waiting list for almost a year with my son, I started a new job and was able to use private HC and got him seen by a specialist, diagnosed and referred to GOSH within weeks. (not a MH issue per se but has an element of it and, thankfully, not too serious). I feel guilty about this as all children should be able to access the help they need. Equally, my son was struggling and I was lucky enough to be able to do something about it. I am lucky.

I think over diagnosis and labeling goes on and can't be good - but is an inevitable consequence of the system and resource squeeze.

almondcakes Thu 26-Jun-14 11:49:23

Bonsoir, I never suggested that shyness was an inbuilt trait and couldn't be a learned behaviour.

What I said was that it was normal and not a problem to be solved.

I also think there may be a middle class association because those who perhaps have MH issues or learning difficulties themselves are not only less likely to be able to access diagnosis for their children but are less likely to fall into the middle class demographic because they have faced similar difficulties themselves. So the problem can perpetuate itself through the generations.

LumieresForMe Thu 26-Jun-14 12:44:27

almond I think we should have swapped school between our dcs.
Dc2 comes across as shy and has some social issues but it has always being dismissed as him 'being shy' and not an issue. I round have loved my dc's school to do what they did at yours and I suspect you would have loved our school reaction.

Shyness for me can be linked to lots of reasons. Autism can be one but also anxiety, self esteem issues and self confidence or it can be just being an introvert which is certainly not an issue!
Sometimes listening to the parents can help making the difference between all of those. I wish they were.

TheBogQueen Thu 26-Jun-14 15:16:21

I've a close relative who has social anxiety and depression. He is like he is stuck at age 15. He stays up all night watching films, he interacts as little as possible. He used to use cannabis and alcohol.

He got a diagnosis of aspergers at 27, gave up his job and for the last 5years had made no attempt to get one. He lives off with his elderly parents.

Sometimes I wonder if that diagnosis - given with no information to any of his family, no help at all - has done my relative any favours. He seems convinced he is incapable of anything at all now.

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