Leaving aside the DSM: patients deserve better diagnostics

Last Friday, may 3rd, 2013, National Institute of Health Mental (NIMH) of the United States announced that decide to abandon the Diagnostic and statistical Manual of Mental Disorders (DSM),  after decades of being used as the means of diagnosis for excellence not only in the United States but at many other countries for the treatment of the mental diseases that attack humans from infancy to old age.

 

The news comes a few days before that the Fifth version of this Manual comes to light after some changes that can be considered minimum, especially in the subject of neurodevelopmental, among which was the reconsideration of Asperger syndrome as part of the autism spectrum disorders.

This news is announced with a tone of sarcasm by different media and social networks to refer to the DSM as the Bible of Psychiatry, which was of course used as a clinical diagnostic tool for most of the mental health disorders and which was translated into several languages in order to unify internationally, regardless of phenotypic aspects.

However, this does not mean that we  should burn the DSM and much less that new version shouldn't be  received favorably, unlike what many journalistic notes say, separation is not divorce, it is only the gate to allow further diagnostic tools for the treatment of mental illness. 

On the web site of the American Psychiatric Association, it was announced very recently  that at 22de may of 2013 would appear the fifth version DMS after two years of intense reviews involving more than 13 000 thousand comments, more than 12,000 e-mails and the work of at least 13 working groups, thus achieving unified criteria among the scientific community.

Although had been mentioned in various clinical forums that the Manual had a tradition of reductive of sufferings, it seemed impossible that this could change, as the length and breadth of the planet was used as the wand able to choose not only the treatment of patients, but its future development having medical, educational and legal inference.

One of the main problems is that continuous attributing illness to each clinical entity based on principles that do not necessarily occur together in time and space in the symptomatology of the patient and that it did not allow in many cases, to carry out further studies of contrast.

The story began in 1952 when the first version of the Manual was published under various research that emerged after the second world war who sought to evaluate mental health in surviving soldiers in the fields of combat the problem and that returned home confused.

Previously, in 1949, the World Health Organization had published the classification and statistics International of diseases (ICD) which included a special section for the first time for mental disorders.

Over the years the DSM had several reviews, the second published in 1968, the third in 1980, the fourth in 1994 and the fifth waiting be published on May 22, 2013.

The reasons for which the National Institute of Mental Health of the United States decides to put away the Diagnostic Manual may be many, from voices that cry out that it is not possible to classify nosologic entities  from a group of symptoms, such as disorders of autism spectrum disorders or attention deficit, which did not allow to physicians give clear attention to patients to the desperate claim of several researchers who watched as nationwide increased the number of cases of autism and attention Deficit, depression and bipolar disorders.

The truth is that neurocognitive and physiological, genetic research have given breakthroughs and not can continue to be ignored, so that the look will now rest on a project that has already gone way called Research Domain Criteria (RDoC) seeking to be considered irregular psychological component to the understanding of mental illness in cognitive terms, as well as neural and genetic differences.

While the DSM criteria allowed the overlaps in Diagnostics, for example it was possible to recognise a child with Down syndrome and autism, usually granted a single diagnosis of the classification, which would let physicians in a professional helplessness that sometimes you should work in a despite health and conditions of the patient.

On the other hand, in the case of autistic spectrum disorders, usually pediatrician only could treat only observable symptoms, it doesn’t matter were they could begin as perinatal, genetic or environmental difficulties that may occur as roots of  the symptoms leaving the children and their families under cover of drugs that were not always prescribed whereas clinical laboratory studies.

In this sense one of the potential benefits of the removal of the traditional psychiatric model is that it will be possible, on the one hand analyze further disorders, whereas influential factors, from genetic, environmental, and clinical and on the other hand, will force mental health professionals require greater diagnostic tools.

In this context, it may be possible to see people beyond the label which is granted, in addition to any other forms of treatment as well as the magic pill cure it all to which traditional Psychiatry we had used.

Neurocognitive research will finally have application beyond than only basic research, although to all power, it will be a great responsibility, as Spider man says, it is also true that psychological research and neuroscience is under scrutiny because of several works that have been considered lacking in ethics, so will just be waiting for the benefit of patients and their families who deserve, no doubt much more respect, including more and better health care professionals.

Meanwhile, it should not be forgotten that the context of the United States is very different from the rest of the countries, however, as I mentioned elsewhere, there to continue the investigations underway and wait for the response from the international scientific community.

References

American Psychiatry Association (2013) DSM-5 Development. Available at: http://www.dsm5.org/Pages/Default.aspx

Drummond K (2013) Federal Institute for mental health abandons controversial "bible" of psychiatry. Available at: http://www.theverge.com/2013/5/3/4296626/nimh-abandons-controversial-bible-of-psychiatry

Dzib Goodin (2013) The disorder or attention: pay attention!. Available at: http://talkingaboutneurocognitionandlearning.blogspot.com/2013/04/the-attention-deficit-disorders-or-pay.html

  

Dzib Goodin, A (2010) Alteraciones del desarrollo por dificultades perinatales y la confusión con los trastornos del espectro autista. Revista de Neuropsicología. 5 (1) 4-9.

Dzib Goodn, (2012) Austism spectrum disorders: detection of abilities and not dis-abilities. Available at: http://talkingaboutneurocognitionandlearning.blogspot.com/2012/07/autism-spectrum-disorders-detection-of.html

Mind Hacks (2013) National Institute of Mental Health abandoning the DSM. Available at: http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/

Reese, H. (2013) The real problem of psychiatry. The Atlantic. Avaliable at: http://www.theatlantic.com/health/archive/2013/05/the-real-problems-with-psychiatry/275371/

Toor, a. (2013) Controversial update to "bible" of psychiatry fuels debate over foundations of mental health: One book raises big questions. Avaliable at: http://www.theverge.com/2013/4/19/4243060/dsm-5-bible-of-psychiatry-mental-health-revisions-spark-boycott

Chicago: the place of accents

The city of Chicago, in the State of Illinois, is one of the paradises for researchers of language. It is a city with a large migratory flow which allows listening to multiple accents, languages living together and communicating every day.

Chicago is the largest city in the State and the third most populated in the United States. You can hear many languages but you can also hear many accents as these bilingual people speak English.

You will find many people from around the world that speak the English language well, but always with accent of their native language.  Their accent is the result of different variables that influence the degree of their accent when a second language is spoken. For example, the age when the second language is learned, time of stay in the country where they used the second language, gender, formal instruction, motivation, skills for learning the language and quality and quantity of the native language (Thorsten, MacKay & Flege, 2001).

The latest 2010 census shows that the linguistic variety is due in part to the diversity of nationalities of the residents of the city, which are 2,695,598 people, and mean 1,045,560 families. Chicago is also one of the most densely populated cities in the country. The racial makeup of the city is the following: 45.0% white (whites non-Hispanic of 31.7%); 32.9% African-American, 13.4% from some other race, 5.5% Asian (1.6% Chinese, Indian 1.1%, 1.1% Filipino, 0.4% Korean, Pakistani 0.3%, Vietnamese of 0.3%, 0.2% Japanese, Thai of 0.1%); 2.7% from two or more races, 0.5% Native American. 

Hispanics or Latinos make up the third largest race in Chicago at 28.9%.  This group of Chicagonans came from several Latin America countries: 21.4% Mexican, Puerto Rican 3.8%, 0.7% Guatemala, 0.6% Ecuadorian 0.3% Cuban, Colombian 0.3%, 0.2% Honduran, Salvadoran 0.2%, 0.2% Peruvian. 

Eastern Europeans and people from Africa also make up a minor percentage of the people living in Chicago as well. Lastly, those traveling to Chicago for vacation or family should also be considered. 

It is natural that with such a large number of foreign languages, people will mix and match that own language with English, creating interesting mistakes with the English language.

It’s always a fun exercise is to listen to the speakers and try to determine where they come from. When speaking with academics, it’s much easier to guess where the speaker is from. For example, a Spanish speaker can determine the difference not only from one country to another but the regional differences in his native country.

Learning a language in its oral form means to learn the sounds, words and grammatical rules of this as well as particular prosody(Peña-Garay, 2005). This component is also related to the specific region where it is native.

More nearby is the geographical location least different is the intonation, but as away geographically, the prosodic difference becomes more noticeable, along with many other linguistic schemes. It is very easy to distinguish between a Mexican accent and a Spanish one, but it is not so easy even for the Hispanic speakers, distinguish between a Honduran and a Guatemalan speaker.

 

That’s why some researchers seek the identification of the prosodic characteristic features of regions from, for instance intonation structure or parameters of duration and intensity (Ramirez Verdugo, 2005). 

These features are interspersed with learning another language. But the prosody is that allows linguistic clues sometimes save the limitation of the vocabulary within a conversation. Maybe not understanding all the words but intonation does know whether someone is asking something or is denoting a complaint. 

Although the prosody is perceived through the language, this is added a visual component in the form of facial expressions, which denote the communication is socially relevant (Jaywant & Pell, 2012). It is that interaction face to face, persons can  understand the meaning of a sentence even when not understood the verbal message, facial expression will help to decipher the message and ultimately allows the required question: Sorry, what did you say?.

Why is learning the words of a second language not enough? Because the words of the second language is only a component of communication. It is necessary to add the prosody as well as the intonation which gives the emotional content of each phrase. Some might say this is not as important between speakers of the same language (however, it is) but it is vital between bilingual speakers. The prosody and intonation is what allows someone to understand if the person is asking them a question or giving them an order. When the body language is added to the conversation, the words become secondary and understanding is achieved through the prosody and facial expressions.

Mimicking the prosody during the verbal production adds another component to language (Crystal, 2012), although sometimes this is more difficult than learning the words. There are theories that explain a pre-internal articulation, rather than the pronunciation of the word. This means we heard internally every sound before producing the word (Huettig and Hartsuiker, 2010). Even so, the intersections of the native language will always be a constraint. There will be sounds that a bilingual cannot imitate fully, even if during the mental review, the sounds are the right ones.

That's why Chicago is my favorite city to enjoy the accents, and the cultural linguistic combination, where the Spanglish is common and same person speaks a phrase with a full Spanish and the following sentence it said in English and then mixes it, or is common to listen to parusglish, where the Russian and the English get together. There is nothing more melodious than listening to Hindu’s speaking with their multiple variations or attempt to recognize the difference between the Asian languages. 

Nobody cares about your accent when you’re craving a pizza or taco or hamburger, it's the cultural experience that matters the most.

Alma Dzib Goodin

If you would like to know more about my writing you can visit my web site:
http://www.almadzib.com

References:

Crystal, D. (2012) On quotatives (he goes). Available at: http://david-crystal.blogspot.com/2012/03/on-quotatives-he-goes.html

Huettig, f. and Hartsuiker, RJ.(2010) Listening to yourself is like listening to others: External,but not internal, verbal self-monitoring is based on speech perception. Language and Cognitive Processes 25 (3) 347-374.

Jaywant, a. and Pell, MD. (2012) Categorical processing of negative emotions from speech prosody. Speech Communication. 54 (2012) 1-10.

Peña-Garay, M. (2005)Aproximación a la prosodia del habla de Madrid.Rev. Neurol. 41 (5) 291-298.

Ramirez Verdugo. MD. (2005) Approximation to the Prosody of speech in Madrid. Studies of Experimental Phonetics. 14. 311-326.

Thorsten, P, MacKay, ANGER., and Flege, JE. (2001) Factors affecting degree of foreign accent in an L2: a review. Journal of Phonetics. 29 (2) 191-215.

World Population Review (2012) Illinois Population 2012. Available online: http://www2.census.gov/census_2010/01-Redistricting_File--PL_94-171/