Psychiatrist Deems Autism “Fashionable”

The DSM-IV is the diagnostic manual that defines all psychiatric disorders. After much controversy, Asperger’s Syndrome is now being included in the DSM-5 (2013 edition) as an autism spectrum disorder, relinquishing its once separate diagnosis. Language delays are no longer among the criteria for the new ASD and questions remain as to how mental challenges such as Fragile-X syndrome will be treated.

Dr. Allen Frances pioneered the diagnostic “bible” and is unhappy about the pending changes, going so far as to claim that the autism epidemic is a by-product of over-diagnosis. According to Frances, autism is now a “fashionable” disorder popularized by movie stars like Jenny McCarthy, Internet advocacy, support groups and media coverage. He went so far as to say:

Autism is no longer seen as an extremely disabling condition, and many creative and normally eccentric people have discovered their inner autistic self.

My hackles went up at that, because he seems to be confusing acceptance of autism with its glorification. If he perused the newspapers and kept pace with the ongoing cases in which individuals with autism are discriminated against and even persecuted, I think he’d lose that tone. It’s not like a diagnosis ushers someone into a magical world in which all their needs are addressed and they are then considered cool. On the contrary, services are scant and schools are ill-equipped to handle the disorder.

One thing that really gets to me as the mother of high functioning twins is the characterization of Asperger’s as "mild" because it makes it sound innocuous and not the heartbreaking ordeal that it actually is. The Catch-22 is that while individuals with Asperger’s are more functional, their competency qualifies them to feel more vulnerable and isolated. Mainstreamed, they still live apart and know it.

Not wanting to believe that this is all there is to his story, I did further research on Dr. Frances and found a piece by him that cast him in a more thoughtful light. For example, he points out that the proliferation of diagnostic labels is a bonanza for the pharmaceutical industry, who get to peddle more drugs for every articulated condition in the manual. It lead me to appreciate the timing of the drug companies now eager to market once off-label anti-psychotic drugs to everyone on the autism spectrum, as I wrote about in a previous article. For instance, Frances indicated that the proliferation of new and unnecessary labels in behavioral problems leads to over-medication that culminates in medically induced, full-blown conduct disorder.

The diagnostic manual was Dr. Allen’s baby and he’s now upset that a new wave of clinicians have taken custody of it. That’s understandable. He also has valid objections. But those objections aren’t going to be heard and appreciated if he doesn’t craft his words more carefully.