Monday, March 5, 2012

Working the system

I just left a comment over at Michael Cornwall's Mad in America blog post. In my comment I linked to an excellent article in the Los Angeles Times about the reasons behind the vast surge in the autism diagnosis.

The LA Times article provides plausible reasons for the jump in autism rates that are not what meets the eye. According to the author of the article, autism has boomed in large part because parents want access to state funded services, and they talk amongst themselves about how to work the system to their advantage.

Three-year-old Benjamin was nothing like the severely impaired children Bailey had seen in clinic waiting rooms. But he didn't speak much, was mesmerized by ceiling fans and liked to be left alone.

On the day of his evaluation by specialists from the L.A. Unified School District, Bailey purposely didn't feed him breakfast. “I wanted him to look as bad as possible,” she recalled. “It's not like he didn't deserve services. I just wanted to stack the odds in our favor.”

It worked. Benjamin threw a tantrum. Over the next three years, the district paid for speech therapy, motor skills training and the attention of a one-on-one aide throughout the school day.

..... Peter Bearman, a sociologist at Columbia University, has demonstrated how such social forces are driving autism rates.

Analyzing state data, he identified a 386-square-mile area centered in West Hollywood that consistently produced three times as many autism cases as would be expected from birth rates.

Affluence helped set the area apart. But delving deeper, Bearman detected a more surprising pattern that existed across the state: Rich or poor, children living near somebody with autism were more likely to have the diagnosis themselves.

Living within 250 meters boosted the chances by 42%, compared to living between 500 and 1,000 meters away.

The reason, his analysis suggested, was simple: People talk.

They talk about how to recognize autism, which doctors to see, how to navigate the bureaucracies to secure services. They talk more if they live next door or visit the same parks, or if their children go to the same preschool.

The influence of neighbors alone accounts for 16% of the growth of autism cases in the state developmental system between 2000 and 2005, Bearman estimated.

In other words, autism is not contagious, but the diagnosis is.

I thought about posting the L.A. Times article when it appeared in December 2011, but decided not to at the time. I try to stick to the knitting on my blog, meaning I stick to schizophrenia as much as possible, and weigh the pros and cons of posting information about other diagnoses, even though, there is much in common between many mental health diagnoses. I decided to post the link today because both the Cornwall article and the L.A. Times article are excellent contributions to our growing understanding of how social factors shape trends in mental health diagnoses diagnoses.

Cornwall writes:
When I-Ward closed I was transferred to an adult clinic as a therapist for about 3 years until the bio-psychiatry, big pharma agenda made possible by NAMI testimony got the statewide Bronzon legislation passed. That law said that so-called severely and persistently mentally ill adults should be given priority for the allocation of adult services that are funded by the state and federal government.

It was supported by bio-psychiatry claims based on their incurable brain disease model that asserted that consumers were best served to be maintained by medication and case management. The law didn’t say therapy had to be eliminated, but the statewide cowardly mental health director’s association saw the handwriting on the wall and decided to announce the wisdom of eliminating therapy ASAP to placate NAMI, and the growing power of Psychiatry in every county system.

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