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Thread: Childhood Catatonia, Autism and Psychosis Past and Present: is There an Iron Triangle?

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    Childhood Catatonia, Autism and Psychosis Past and Present: is There an Iron Triangle?

    Someone reminded me this paper exists. Consider this sentence: " Even though mainstream scholarship tends to see all three diagnoses as separate entities, this may make no more sense that keeping depression and anxiety separate as disorders, given that the mixed form is the most common presentation." As regards the analogy, anxiety and depression commonly overlap but they are clearly not the same as they are often not comorbid.

    The definitions of schizophrenia and autism are not as concrete as the public imagine: genetic studies demonstrate that both are heterogeneous and the diagnoses are overused due to poor definition. The authors are concerned with something they call "childhood schizophrenia", that the French called "heboïdophrenie" and they distanced it from schizophrenia. Indeed a case study was notably unresponsive to the antipsychotics that are customarily prescribed for schizophrenia.

    Objective

    To explore the possibility that autism, catatonia and psychoses in children are different manifestations of a single underlying form of brain pathology – a kind of ‘Iron Triangle’ of symptomatology – rather than three separate illnesses.

    Method

    Systematic evaluation of historical case literature on autism to determine if catatonic and psychotic symptoms accompanied the diagnosis, as is found in some challenging present-day cases.

    Results

    It is clear from the historical literature that by the 1920s all three diagnoses in the Iron Triangle – catatonia, autism and childhood schizophrenia – were being routinely applied to children and adolescents. Furthermore, it is apparent that children diagnosed with one of these conditions often qualified for the other two as well. Although conventional thinking today regards these diagnoses as separate entities, the presence of catatonia in a variety of conditions is being increasingly recognized, and there is also growing evidence of connections between childhood-onset psychoses and autism.

    Conclusion

    Recognition of a mixed form of catatonia, autism and psychosis has important implications for both diagnosis and treatment. None of the separate diagnoses provides an accurate picture in these complex cases, and when given single diagnoses such as ‘schizophrenia’, the standard treatment options may prove markedly ineffective.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714300/

    It has long been noted that autistic and schizophrenic/schizotypal people share personality traits however these relate to affective deficit. Otherwise the answer to the first question below answers the second. Autism and schizophrenia are phantoms. However as long as the problem of the discontinuous mind persists the overlap of diagnoses will be a conceptual difficulty, so this is a valid philosophical and clinical point.

    First, what is the role of clinical subjectivity in our knowledge of autism, catatonia and schizophrenia? Catatonia has objective verifications and validations; but schizophrenia and autism seem not to be well-circumscribed disease entities, but rather disease pictures that are fluid at the edges, flowing together easily with other diagnoses. The clinical features that various observers singled out in schizophrenia and autism were not the entire picture. Max Fink writes: ‘The overlap of autism, schizophrenia and catatonia criteria results from the lack of defining characteristics for each ‘measure,’ ‘symptom,’ or ‘sign.’ How are these terms defined? Each observer had his private image. In essence, the patients were Rorschach images and the observers picked at the signs that they thought they saw as ‘objective’ criteria. Since the ink-blots had many curves and pieces, some in black-and-white, and some in colour, the observers’ answers, as with the Rorschach test, tended to vary’ (Fink M, personal communication, 18 June 2012).

    Second question: Is the mixed form of catatonia, autism and psychosis the natural form of the disease? If we wish to cut nature at the joints, is the true joint at this intersection? There is in paediatric psychiatry a long tradition of seeing these as separate, discrete disorders. Yet Watkins et al. wrote in 1988, ‘The symptoms of schizophrenia and autism each appear to serve as final common pathways for a variety of causal factors and pathophysiologic processes’. Thus, at the centre of this Iron Triangle may well lie some deeper font of neuropathology responsible for all three. Consideration and further investigation of this hybrid presentation may offer improved future treatment options for those afflicted.

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    Anti-psychiatry is more mainstream than people think: criticism of psychiatry is common among skeptics despite what people think. In the past whenever there was an online debate about psychiatry among skeptics, the side of the critics always won. In total, most skeptics would regard psychiatry as a mix of scientific facts and unscientific value judgments though conceding that progress has been made in both the ethical and scientific basis. Many of the critics are dissident psychiatrists.

    Ultimately, anti-psychs contributed to the demediclisation of homosexuality and the abandonment of psychoanalysis (a very toxic pseudoscience). For extending their critique to Big Pharma, this got whitewashed from history and shills regularly associate all critics of Scientology.

    One of the ironies is that psychiatry is at times like Scientology itself: arbitrarily and (often) moralizingly deciding what they consider normal or pathological, and sometimes resorting to coercive treatment.

    Moving away from the science to the ethics and the politics, psychiatry still pathologicises healthy responses to a toxic society. There is a problem with psychiatic labelling/diagnosis when the labels tend to reinforce cultural bias and can be abused to oppress dissidence. Resistance to questionable medicalization was a common theme of the gay liberation, anti-psychiatry, and feminist movements but now there is actually no resistance to the advance of government intrusion in lifestyle if it is thought to be justified in terms of public health. ("Muh Scientology...") Indeeed the movements that formerly opposed psychiatry now advocate the pathologicisation of homophobia, for example. The use of psychiatry as a tool of social control is becoming obvious in preventive programmes for various mental diseases. These programmes are intended to identify children and young people with divergent behavioral patterns and thinking before their supposed mental diseases develop. There would be a good rationale for this, except the common predicted diagnoses do not fit proper medical constructs. (See above how childhood schizophrenia does not respond to schizophrenic medications.) There is solid precedent for separating psychiatry and state along the lines of the way America seperates church and state.

    Neurologists are advising psychiatrists just to replace the term "mental illness" by "brain illness". Thank God.

    A few things should not be confused:

    • critique of the mental illness idea, and related constructs
    • the critique of social control through psychiatry
    • concern for patient rights, ie. involuntary commitment and effects of treatments
    • criticism of biopsychiatry


    Of the list I ony fid the last disagreeable. Even so the role of society should not be neglected, this is both on scientific grounds and to avoid blaming the sufferer (which leads dangerously into labelling as social control).

    The involuntary commitment cannot be a medical approach to suffering, because it is based on violence against the patient's will. In order to criticize institutions it is necessary to bring into question also the ideals that created them. There is something inherently wrong with any supposedly benign movement or pratice that leaves "survivors".

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