A (head) space of my own

14 Nov

Four days ago the New York Times published a fascinating piece on the hypotheses of two scientists who are positing that mental disorders of an unknown variety and number are all actually one disorder. Specifically mentioned are autism (of course), schizophrenia, manic depression (aka Bipolar), depression:

In short: autism and schizophrenia represent opposite ends of a spectrum that includes most, if not all, psychiatric and developmental brain disorders. The theory has no use for psychiatry’s many separate categories for disorders, and it would give genetic findings an entirely new dimension.

Two fascinating aspects of this appeal to me. Firstly is the idea of this proposition as ‘hypothesis generation’:

The reality, and I think both of the authors would agree, is that many of the details of their theory are going to be wrong; and it is, at this point, just a theory,” said Dr. Matthew Belmonte, a neuroscientist at Cornell University. “But the idea is plausible. And it gives researchers a great opportunity for hypothesis generation, which I think can shake up the field in good ways.”

Can you sense where I’m going to go with this yet? Shaking up the field in _good_ ways…..as oppose to _bad_ ways….I’m getting predictable right?

Well, you’d be right. This is definitely a good sort of hypothesis generation – it leans on sound scientific theory and provides a possible next step for a wide variety of mental differences (my word, ‘disorder’ is not right for me) which other scientists can break down into testable ideas. Some will be right. Lots will be wrong. And science will carry on getting closer and closer to an accurate reflection of reality.

And the bad sort of hypothesis generation? It relies on science that is either unsound, improbable or fabricated from whole cloth. It represents a bad financial investment as the return from this sort of hypothesis in terms of solutions is pretty much zilch. And as the recent letter to the IACC sent by groups pursuing such hypothesis shows what it does produce is an overblown sense of entitlement and the lack of recognition that science cannot be served up like a drive thru burger meal.

Anyway, moving on from that, the second thing that appeals to me about this proposition is the fact that it links my autistic child and I in non just the bonds of blood and familial genetics but the genetics of difference too. She is autistic I am manic depressive – we have a head space all of our own.

Back in July, I wrote an entry that referred to an ever-shifting Aurora of autism’. I would love to have underestimated and would like to be able to refer to ‘an ever-shifting Aurora of neurodiversity’ where I share genetics differences with my autistic child but in slightly different shifting shades. All my online and offline friends with OCD, depression, dyslexia, schizophrenia and a wild mix of others are really my genetic family.

12 Responses to “A (head) space of my own”

  1. hj November 14, 2008 at 21:16 #

    Here, hear Kev!

  2. kristina November 15, 2008 at 06:11 #

    and a big family it is.

  3. Paulene Angela November 15, 2008 at 13:05 #

    Nutritionists see them as one family. Am I missing something here. Do you only believe scientists? Apologies if I seem ignorant.

  4. Paulene Angela November 15, 2008 at 13:05 #

    Nutritionists see them as one family. Am I missing something here. Do you only believe scientists? Apologies if I seem ignorant.

  5. Epi Wonk November 15, 2008 at 14:05 #

    I think this is a very worthy hypothesis. As kristina says,”and a big family it is.” Do you realize that about 60% of chronic migraineurs will suffer from depression at some time during their lives.

  6. alyric November 15, 2008 at 20:18 #

    Well ,the ‘two scientists’ is pushing it a bit. One is a sociologist (lowest form of academic life in the humanities) allied to an evolutionary biologist (not the most highly regarded among scientists).

    Look here for the original brain behavior article and a whole lot of others:

    http://www.sfu.ca/biology/faculty/crespi/publicationsr.html

    I find it interesting if reserving judgement. I feel the authors know very well that throwing brick bats at that remaining edifice to behavioral psychology, the DSM is always a winner. It’s just too easy. Next I want to see how wrong they get the interpretations of autism and swchizophrenia, finding it difficult to think of these spectra travelling in opposite directions. That they are related also seems in the too easy basket, so these guys aren’t coming up with anything too new, though I suppose the variant on the selfish gene model is new enough if the least compelling part of it.

    I’ll wander off and read the brain behaviour article.

    Anything, I think that undermines the DSM is a good thing and long overdue. Seriously I can’t think of any idea in any age in any realm of endeavour that has done more damage to all varieties of humans than the idiotic notion that what you see is what you get.

  7. Joseph November 15, 2008 at 23:12 #

    Nutritionists see them as one family. Am I missing something here. Do you only believe scientists?

    That’s true. It’s not just nutritionists. Generation Rescue at one point was saying that essentially all mental disorders are misdiagnoses for mercury poisoning. Basically, all of the disorders are the same thing.

    So what’s the difference? Well, the Generation Rescue type of hypothesis is (forgive the expression) pulled out of someone’s butt. This new hypothesis Kev is writing about presumably had more thought put into it and it sounds like there’s plausibility behind it.

  8. Paulene Angela November 15, 2008 at 23:20 #

    Quote:Anything, I think that undermines the DSM is a good thing and long overdue.Unquote

    I understand how you feel, it’s so booooooooooring …. so inside the box, so primitive, can we please evolve.

  9. Epi Wonk November 15, 2008 at 23:45 #

    Schwartz,

    What really matters in a Cochrane Review is the Main results and Author’s conclusions. Cochrane’s Reviews originally started out as meta-analyses of Randomized Controlled Trials. They still use the RCT as the gold standard methodology. The authors are supposed to be super-critical. Thus, almost every observational epidemiological study ever done will be “exposed as clearly overblown and ultimately poor in bias, design, or conclusions.” There’s a joke among epidemiologists that if the 1964 Surgeon General’s Report had been contracted out as a Cochrane Review, we’d still be arguing about whether smoking causes lung cancer.

    So why not quote the actual Main results and conclusions relevant to this discussion?: “(1) Exposure to MMR was unlikely to be associated with…autism.(2) [The authors] could not identify studies assessing the effectiveness of MMR that fulfilled [their] inclusion criteria even though the impact of mass immunisation on the elimination of the disease has been largely demonstrated.(3) The design and reporting of safety outcomes in MMR vaccine studies, both pre– and post-marketing, are largely inadequate.”

    I actually disagree with both the Cochrane Collaboration’s conclusions about MMR safety and with your statements about MMR safety. Much of the problem comes from the fact that people in vaccinology debates rarely explicitly define vaccine “safety.” The FDA definition of safety is “the relative freedom from harmful effect to persons affected, directly or indirectly, by a product when prudently administered, taking into consideration the character of the product in relation to the condition of the recipient at the time,” but this doesn’t help us much. However, if if we extend this to a simple quantitative definition, such as Adverse Events Following Immunization (AEFI)/Adverse Events Following Disease (AEFD), we actually get somewhere. For example, based on a meta-analysis of a whole lot of follow-up studies, it looks like 2 percent of all recent measles cases in recent outbreaks in industrialized countries are hospitalized. On the other hand, 0.1% of MMR vaccinations lead to hospitalizations because of AEFI, usually because of high fever or febrile convulsions. So for measles, the AEFI/AEFD = 0.1/2 = 0.05, meaning the risk of hospitalization after MMR vaccination is about one two hundredth of the risk of hospitalization after having measles. I could go into more detail on these and other data on MMR vaccine safety, but I don’t want steal my own thunder, since I plan to do one or more blog posts on this issue in the near future.

    Incidentally, the Hornig et al. study is not a classic vaccine safety study, but it does contribute further towards our understanding that the MMR vaccine is probably safe. One more solid study reporting no evidence of causal association between the MMR vaccine and autism.

  10. Epi Wonk November 15, 2008 at 23:53 #

    WHOOPS! Put my comment in the wrong post! It’s in the right place now, also. But Kev: Is there a way you can erase it from here. (Gosh, this is embarrassing.)

  11. RAJ November 16, 2008 at 01:07 #

    Of course, there are also children who have been clinically diagnosed with childhood schizophrenia, but also meet diagnostic criteria for ASD using universally accepted gold standard diagnostic tools such ADOS (as do Romanian orphans who were institutionalized at birth and who experienced severe emotional distress).

    http://ccp.sagepub.com/cgi/content/abstract/13/1/81

    If autism and schizophrenia are on opposite ends of the spectrum where do these children fit?

  12. alyric November 16, 2008 at 17:42 #

    Am wading my way through the 80 page main article. From what I know, which is not all that much, they have glossed or cherry picked data to increase the plausability of their arguments. One case is the unequivocal statement that autism equals bottom up processing with emphasis on local processing and that schizophrenia equals top down processing with an emphasis on global processing. Now, that’s not really so according to research from Mottron’s lab, Isabelle Soulieres, I believe. Her work supported the position that autistics get a choice and use both top down and bottom up processing as required. Social brains don’t get the choice at all. Now if they’ve done this once, undoubtedly they’ve done it elsewhere and it would take an expert of encyclopaedic knowledge of the calibre of Michelle Dawson to see how much data has perhaps not been honestly dealt with.

    At the same time, I think this has been a mammoth undertaking given the mass of variables involved and the mass of variability in phenotypic expression among both the autistic population and the schizophrenic population. Cynical me also thinks that the main purpose of this paper may be reputation building, in which case it’s more a case of hitching their research wagon to the rising autism funding star. After all, they’ve carved out several lifetimes of research initiatives with this one paper. But the diversion of funding yet again away from anything of benefit to the autistic community is a worry.

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