SONOMA MEDICINE, the Magazine of the Sonoma County Medical Association, Winter 2009

Autism: "Let's wait and see" is not an option!  By Cathryn Ross, MD

Autistic spectrum disorders are common (1:150), chronic, biologically based neurodevelopmental disorders that are highly heritable. Recognition of early behavioral signs of autistic spectrum disorders (ASD) by physicians, followed by immediate referral to early intervention programs, benefits autistic children, their families, their future schools and society. The old "wait and see" approach is no longer an option!

The cause of autism is being actively researched but remains elusive because so many factors are involved. Several genes have been identified that probably have to occur in multiples in the same person. Researchers also believe that some environmental stressors may enhance the penetrance of mutations conferring susceptibility to autism. The immune system may be involved as well, because many cases of autism involve other organ systems and not just the brain; reduced levels of immunoglobulin in children with autism correlates with behavioral symptoms. There is also often increased prevalence of maternal autoantibodies against the fetal brain in autism.

The American Academy of Pediatrics recommends surveillance for ASD at all well-child visits and formal screening of all children with a standardized test at 18- and 24-month visits, and whenever concern is raised. An ASD toolkit from the pediatric academy contains screening tools and fact sheets (for both physicians and parents) that address major issues associated with ASDs.

Diagnosing ASD is challenging because there are no objective laboratory tests or pathognomonic clinical signs. The physician must rely on subjective guidelines provided by the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) and use informed clinical judgment, which requires training, supervision and feedback from experts, as well as experience with many children of different functioning levels and ages. Compounding the challenge is the variability in the expression of the three core features of ASD:

• Impaired social reciprocity

• Communication deficits

• Restricted, repetitive and stereotypic behaviors

ASDs include three subtypes: autistic disorder (AD), Asperger syndrome, and pervasive developmental disorder—not otherwise specified (PDD-NOS), a threshold term used when a child meets some but not all criteria necessary for a diagnosis of either AD or Asperger syndrome. Since this article focuses on ASDs before 2 years old and the average age for diagnosing Asperger syndrome is 8-11 years old, Asperger will not be discussed. When the word autism or ASD is used in this article, it represents both AD and its milder form, PDD-NOS . . .

The earlier the ASD diagnosis is made, the better the outcome; and yet many of the criteria address developmental skills that are not applicable to children younger than 2 years developmental age. Therefore, many severely autistic children may not meet full criteria. For example, the criteria "failure to form age-appropriate peer relationships," "stereotypic or repetitive use of language" or "impairment in initiating or sustaining a conversation with others" is not relevant to a 2-year-old who may be preverbal. Also many children who are later diagnosed with ASD don't develop ritualistic behaviors or a need for routines until after 3 years of age. Taking these issues under consideration, some researchers have suggested applying only four of the possible twelve DSM-IV-TR criteria for children under 3 years of age:

• Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., lack of showing, bringing, or pointing out objects of interest)

• Lack of social and emotional reciprocity

• Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

• Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

The researchers propose that if all four of the above criteria are met, then a provisional diagnosis of autism should be made. After the third birthday, the child should be reevaluated using the full DSM IV-TR criteria. . .

Read the entire article: http://scma.org/magazine/articles/?articleid=314.

Dr. Ross is a developmental-behavioral pediatrician in private practice in Santa Rosa.

VOM Is Where Doctors' Thinking is Crystallized into Writing.

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Psychiatry: The Shame of Medicine: The Case of Alan Turing

Posted By Thomas Szasz, Prof of Psychiatry, SUNY - The FREEMAN, May 2009,  Vol. 59/Issue 4

Alan Mathison Turing (1912-1954) was one of the legendary geniuses of the twentieth century. The only child of a middle-class English family, the Cambridge-educated Turing played a crucial role in breaking the German Enigma code during World War II, an achievement often credited with saving Britain from defeat in the dark days of 1941. Because of the secrecy surrounding the British code-breaking effort, for a long time only a few colleagues and high-ranking politicians were aware of Turing's towering contribution to science and the war effort.

Turing was a mathematician, cryptographer, and pioneering computer scientist. He was good-looking, athletic, eccentric, and openly homosexual. In 1935, backed by John Maynard Keynes, Turing was elected a Fellow of King's College, a remarkable achievement for so young a man. In 1936 he published a paper that immediately became a classic in mathematics and earned him an invitation from John von Neumann to continue his studies at Princeton University. In 1938, having been awarded a Ph.D. in mathematics, Turing returned to Cambridge and was soon working at Bletchley Park, the famous British code-breaking "factory." When the war ended, Turing moved to Manchester where the university created a special readership in the theory of computing for him . . .

Fatal Treatment for a Fictitious Disease

On June 8, 1954, Turing was found dead by his housekeeper, a partly eaten apple laced with cyanide next to his bed. At the inquest, the coroner ruled his death a suicide. Neither his homosexuality nor his psychiatric treatment was mentioned. The coroner said, "I am forced to the conclusion that this was a deliberate act. In a man of this type, one never knows what his mental processes are going to do next." The verdict was "suicide while the balance of his mind was disturbed." Even in death, psychiatry and the state stigmatized Turing as mad. The posthumous diagnosis of suicide as mental illness is the ritual degradation ceremony of our therapeutic age, much as the posthumous burning of the heretic's corpse was the ritual degradation ceremony of an earlier theological age.

No one in Turing's circle, himself included, was able or willing to transcend the psychiatric zeitgeist: Homoerotic behavior and self-determined death are self-evident symptoms of mental illness, it argues, requiring and justifying coercive medical-psychiatric treatment. Turing's psychiatrist, Dr. Frank M. Greenbaum, vehemently rejected the coroner's diagnosis, though not by contesting the claims that engaging in homosexual conduct and self-killing are evidence of diseases curable by doctors. "There is not the slightest doubt to me that Alan died by an accident," declared Greenbaum.

In 1967 the UK decriminalized homosexuality. Overnight it ceased to be a disease in England but not the United States, where for six more years it remained both a crime and a "treatable disease."

Turing's biographer, Andrew Hodges, notes that Turing did not consider his homosexuality a disease, a crime, or a shameful condition. He suggests that Turing opted for medical treatment rather than a brief period of imprisonment because he feared that a criminal conviction would be fatal for his career. Countless of Turing's gay contemporaries at Cambridge and in London - Wittgenstein, Keynes, Lytton Strachey, many of the Apostles and Bloomsburys - sensibly stayed away from psychiatrists. Many famous people - Gandhi, Russell, and Nehru - spent time in prison, though, and went on to do memorable work. This is not true for people imprisoned in mental hospitals. After the psychiatric degraders finish their job, the "patient" is dead - if not biologically then socially. . .

The original function of psychiatry - which is approximately 300 years old - was penological: The psychiatrist stigmatized persons as "mad," deprived them of liberty, and assaulted them with chemical and physical interventions. A little more than 100 years ago individuals began to seek psychiatric help for their own problems. As a result, many people who entrusted themselves to the care of psychiatrists became entrapped in the machinery of punitive mad-doctoring, dramatically portrayed in Ken Kesey's best-selling novel, One Flew Over the Cuckoo's Nest, and the film based on it. The recent film Changeling presents a real-life example.

So does Alan Turing's psychiatric undoing.

Psychiatry: Trap, Not Treatment

The identification of psychiatry with medical healing and humane helpfulness is factually false and morally deceptive, concealing an existential trap with untold-of potentialities for injury and death for the entrapped. More successfully than ever, the modern "biological" psychiatrist misrepresents his profession as based on biological science and medical discovery, while more than ever it is based on pseudoscience and therapeutic deception. . .

. . . organized psychiatry intensifies the celebration of its founding quack, Benjamin Rush (1746–1813). Declared Rush, "I have selected those two symptoms [murder and theft] of this disease [crime] (for they are not vices) from its other morbid effects, in order to rescue persons affected with them from the arm of the law, and render them the subjects of the kind and lenient hand of medicine." What did Rush mean when he spoke of medical kindness and lenience? Lamenting the "excess of the passion for liberty inflamed by the successful issue of the [Revolutionary] war," he explained, "Were we to live our lives over again and engage in the same benevolent enterprise, our means should not be reasoning but bleeding, purging, low diet, and the tranquilizing chair." Psychiatry - glorifying the use of coercion as cure - is the shame of medicine.

Article printed from The Freeman | Ideas On Liberty: www.thefreemanonline.org/

URL to article: www.thefreemanonline.org/columns/the-therapeutic-state/the-shame-of-medicine-the-case-of-alan-turing/

VOM Is Where Doctors' Thinking is Crystallized into Writing.