Wednesday, December 26, 2007

Autism Is Not a “Mental Illness”

Remember that the term "mental illness" is not a diagnosis.

It is jargon -- a term society uses to refer to some, usually severe and persistent biologically-based, disorders of the brain such as schizophrenia or bipolar disorder which are in the psychiatric manual of symptoms and labels for sets of symptoms arising from some malfunction of the brain, regardless of cause. This psychiatric manual is called the DSM (Diagnostic and Statistical Manual of Mental Disorders). In the DSM, there are hundreds of labels for sets of symptoms we do not consider "mental illness" including symptoms arising from traumatic brain injury, hyperthyroidism, vitamin deficiency, enteritis (intestinal inflammation), and more.  Some people include psychopathology under the umbrella term "mental" illness.  Some think of personality disorders and emotional issues as "mental illness" but others do not. So it is a social term.

The parents of children with autism worked very hard to change public and medical perception of the diagnosis of "autism." It is listed in the DSM-IV, but that does not make it a “mental illness,” at least not in the socially used jargon. It is considered a developmental disorder, but then, some doctors advocate that is what "schizophrenia" is as well.[1]

Some dictionaries may define autism, and anything else in the DSM, as "mental illness" (here), which would include head trauma, mitochondrial disease, Parkinson's, mental retardation, brain effects from Celiac, etc., but enlightened society generally does not refer to these as "mental" illnesses anymore, knowing they are medical issues.  

Psychologists may love to study autism, but it is not a “psychological” problem. Psychological and other approaches can help the child grow and develop, and adjust to their biology, but that does not mean that something psychological caused the autism.

Autism used to be thought of as being the result of poor parenting. Psychologists would point to the fact that the mothers did not interact with the toddler the same way as in "normal"mother-child relationships as “proof”, not yet understanding that the mother was reacting to a neurobiological difference in her baby. The baby/toddler was different from other babies.

Autism is no longer viewed as a psychological problem. It is no longer blamed on parenting. It is no longer considered a “mental illness”. Young children can have autism even though the parents provided a loving, nurturing environment.

Here is an important video series on Autism as a whole body illness: 
Autism Now: Meet Nick, Robert MacNeil's Grandson, PBS NewsHour, PBS Video

Autism is now considered to be a biological, genetic, or neurodevelopmental difference--a complex interaction between genes and perinatal influences. It may even be a problem with the immune system or even a lack of certain nutrients such as omega-3 fatty acids (see research below).

Parents of children with autism prefer to keep that hard-won distance from the label “mental illness”.

However, other pediatric-onset “mental illnesses” are just as biological as autism is. Other parents would also love to be distanced from the stigma of that “mental illness” label. When a child is being raised in a loving, nurturing environment and has no psychological trauma, yet manifest symptoms from his brain – it is no more “mental” then autism. What is worse -- many other associated physical symptoms may be overlooked and remain untreated, because the "mental" diagnosis seems to be what doctors find most "riveting".

It is interesting to me that after a decade on discussion boards pertaining to psychotic mood disorders in children, there seems to be many commonly associated characteristics of our children that overlap with autistic children. Note that I am not referring to diagnostic criteria. I am referring to just associated characteristics, such as intestinal problems, gluten intolerance/Celiac, brain reaction to casein (dairy), food allergies, fatigue, spaciness, environmental sensitivities, hypersensitivities to sound and touch, etc. unfortunately our children and our families do not get the same support as the autistic children & their families get. Instead, our children get the label –along with the associated stigma – of "mental illness".

There is so much research showing overlaps between schizophrenia spectrum disorders, autistic spectrum disorders, and even bipolar disorders that it is too numerous to list them all here. Something I find fascinating is that there is numerous research findings connecting schizophrenia and bipolar with other non-“mental” illnesses.

Just as women had to fight for their symptoms of fibromyalgia and chronic fatigue to be taken seriously – be removed from the garbage bucket of "mental" illnesses – so did the parents of children with autistic spectrum disorders. There are so few children with psychotic mood disorders that it is more difficult for parents of these children to band together to have these children’s diagnoses also removed from that garbage bucket. One problem we encounter is the entrenchment of these diagnoses in the adult community as “mental illnesses”.

Here are some examples of interesting overlaps among these illnesses. If one is not “mental”, these others are not either.

I’ll start with an excerpt from “Glutathione Depletion – Methylation Cycle Block: A hypothesis for the pathogenesis of chronic fatigue syndrome” by Richard A Van Konynenburg, Ph.D. 8th International IACFS Conference on Chronic Fatigue Syndrome, Fibromyalgia and other Related Illnesses Ft. Lauderdale, Florida, U.S.A. January 10-14, 2007

This eloquently pulls together information which other studies have found applicable to our children with “mental illnesses”.
Mitochondrial dysfunction and the onset of physical fatigue: As hypothesized by Bounous and Molson, competition between the oxidative skeletal muscle cells and the immune system for the decreased supply of glutathione and cysteine causes depletion of reduced glutathione in the skeletal muscles.

Fatigue is not recognized to be a major feature of autism. However, it should be noted that the evaluation of fatigue is usually based on self-report, which is not possible in children who are unable to speak. Also, it seems possible that fatigue may be manifested differently in very young children as compared with adults. Features such as hyperactivity and irritability may reflect fatigue in these patients.

Chronic pain may also be difficult to identify and characterize in children who do not have speech. A recent paper suggests that chronic pain may be the initial presenting symptom in cases of undiagnosed autism.

Many of the other phenomena found in CFS [Chronic Fatigue Syndrome] are also found in autism, but historically they have not received as much attention in autism as the brain-related symptoms, perhaps because the latter are so striking and profound.

Some of the other phenomena that autism has in common with CFS in addition to those already mentioned are elevated proinflammatory cytokines, Th2 shift in the immune response, low natural killer cell activity, mitochondrial dysfunction, carnitine deficiency, hypothalamus-pituitary-adrenal (HPA) axis dysfunction, gut problems, and sleep problems."
More associated research:

Maternal immune activation alters fetal brain development through interleukin-6 (Confirms role of mother’s immune response to the influenza virus in pregnancy to increased chances of baby developing autism or schizophrenia).

Human diseases have extensive genetic overlap (“autism wound up linked to a huge variety of neural diseases with symptoms that appear far later in life, such as attention deficit, epilepsy, cerebral palsy, depression, schizophrenia, bipolar disorder, neurofibromatosis, Parkinson's disease, and migraine. But those extensive linkages don't mean that all mental disorders form a single large cluster; neurofibromatosis showed a correlation with bipolar disorder, but not schizophrenia, even though all are linked to autism.”)

Autism and Familial Major Mood Disorder: Are They Related?

Schizophrenia Linked to Celiac Disease and Other Autoimmune Diseases

The DISC locus in psychiatric illness. (A gene called “Disrupted in Schizophrenia (DISC) is implicated in some cases of schizophrenia, schizoaffective disorder, bipolar disorder and major depression as well as various cognitive traits).

Expression of phosphodiesterase 4 is altered in the brains of subjects with autism. (Another gene family found altered in cases of schizophrenia is found to also be altered in cases of autism).

Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study.- Amminger GP - Biol Psychiatry - 15-FEB-2007; 61(4): 551-3 (MEDLINE® is the source for the citation and abstract of this record ) - "There is increasing evidence that fatty acid deficiencies or imbalances may contribute to childhood neurodevelopmental disorders. RESULTS: We observed an advantage of omega-3 fatty acids compared with placebo for hyperactivity and stereotypy, each with a large effect size. ... CONCLUSIONS: The results of this study provide preliminary evidence that omega-3 fatty acids may be an effective treatment for children with autism.

Related Links:
Related Books:
[1]   Is schizophrenia a psychotic illness? current psychiatry - nasrallah 
“Glutathione Depletion – Methylation Cycle Block: A hypothesis for the pathogenesis of chronic fatigue syndrome” by Richard A Van Konynenburg, Ph.D. 8th International IACFS Conference on Chronic Fatigue Syndrome, Fibromyalgia and other Related Illnesses Ft. Lauderdale, Florida, U.S.A. January 10-14, 2007 

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Last Updated: 17 September 2012


Anonymous said...

I find this very offensive. Having a mental illness is not a garbage dump diagnosis. Mental illness is caused by both environmental and genetic factors just as autism is believed to be caused by. I have borderline personality disorder and conversion disorder. I think we should try and change the stigma surrounding the term "mental illness" instead of fighting to change the label.

Jeanie said...

The article did not say that. It says, "... fibromyalgia and chronic fatigue to be taken seriously – be removed from the garbage bucket of "mental" illnesses". The "garbage bucket" being referred to is that whenever a medical problem is encountered which they think is "in the head" they seem to throw it into the garbage, and call it "mental".
"Mental Illness" is NOT a diagnosis. Schizophrenia is a medical problem and is a "diagnosis" based on a list of symptoms. There is no diagnosis, either medical nor in the DSM which is "mental illness". It is a term we use and when doctors use it to throw a medical diagnosis not based on what is actually wrong, is is like they are throwing it into a garbage bucket.

Does the doctor actually know WHAT is CAUSING those symptoms of pain, fatigue, intestinal problems. etc? They can throw all these medical issues away, saying it is "mental" - in the person's head.

Anonymous said...

I also found this article really missing the point. All illnesses should be taken seriously and treated appropriately. 'Mental' illnesses are illnesses like any other. Removing certain illnesses from that category doesn't do anything aside from making other mental disorders look less severe. Last time i checked your mind is a part of your body and all illnesses are a combination of environment and genetics. Even affective disorders are not simply 'in your head'; that is a very stigmatising sentiment. Illnesses are categorised based on evidence for treatments rather than cause or severity. A mental illness is usually categorised as such because it should be treated with psychotherapy either on it's own or in conjunction with medication.

Anonymous said...

Actually, the term ‘mental illness ’ is not ‘jargonistic’, it is a term created by psychiatrists to describe illnesses arising from the psyche rather than the body. I say this as an autistic language savant (not a polyglot!) who googled the etymology of the phrase.