Comments on: ADHD, Pamela Stephenson Connolly and what are psychiatrists for?

By: Joanne

Joanne — Sat, 26 Feb 2011 06:56:18 +0000

She only suggested that the fellow be TESTED for ADHD. She didn’t say he necessarily had it. Yeah, she could have mentioned other possibilities, but I think it’s a perfectly fair suggestion to consider testing.

By: Dr. Stephen pamolly

Dr. Stephen pamolly — Sun, 23 Nov 2008 00:09:30 +0000

Might even not be “HER” whom has written it in the first place. A team of writers trained in giving a “General” over-all diagnosis. Either way a very, very niieve piece of advise. It’s like saying “Pam I don’t like pineapple on pizza…” A response just as silly would be; “You must have taste-bud deficiancy syndrome. Try making it dark in the kitchen the next time you and the pineapple are trying….Other than that I’m fucked if I know anything else about the subject”

By: Calochilus

Calochilus — Wed, 16 Jul 2008 07:03:44 +0000

“Why do you think we are prepared to go to such lengths?”
I was tempted to give you the opportunity to explain but your prior statement would preclude such.
Do you want an explanation at the level of the individual?
Some are luddites such as the venerated Fred Baughman
“In 1948, ‘neuropsychiatry’ was divided into ‘neurology,’ dealing with organic/physical diseases of the brain, and ‘psychiatry,’ dealing with emotional/behavioral conditions in normal human beings [1]. There was no such thing as a psychiatric ‘disease’ then, and there is no such thing today!”
Of course there are various flavours of luddites but I won’t digress.
Others are clearly psychopaths such as Harry Bailey who suicided rather than face a commission of enquiry into his activities (triggered by the Church of Scientology)
Others are what I would term “functionally illiterate” such as a recent President of the local branch of the national Medical Association who proclaimed that as it wasn’t taught at medical school it was a figment.
Others are just bone lazy and yet others are well intentioned but totally incompetent
Doubtless there are a great many good practitioners out there also.Finding them by orthodox means is difficult.
You may wish to look at institutional difficulties.
“Bridget Grant, Ph.D., Chief of NIAAA’s Laboratory of Biometry and Epidemiology, and her colleagues found that 1-year incidence rates were highest for DSM-IV alcohol dependence (1.70%), alcohol abuse (1.02%), major depressive disorder (1.51%) and generalized anxiety disorder (1.12%), followed by panic disorder (0.62%), bipolar I disorder (0.53%) and specific phobia (0.44%). One-year incidence rates of DSM-IV social phobia (0.32%), bipolar II (0.21%) and drug abuse (0.28%) and drug dependence (0.32%) were lower but not insignificant. These rates are comparable to or exceed corresponding incidence rates for other common medical diseases such as lung cancer (0.06%), stroke (0.45%) and cardiovascular disease (1.5%”
Interestingly, not a mention of ADHD, yet any astute researcher or practitioner would be aware of the significance of many of these problems as highly significant comorbidities of (especially untreated) ADHD
I could go on ad infinitum but one last question. The esitmated incidence of lifetime ADHD has reliably been suggested to be in the order of as much as 4% of the population. If it is so high, why is it that this incidence is not reflected in diagnostic rates given the frequency of diagnoses of derived comorbidities?

By: Nutty

Nutty — Tue, 15 Jul 2008 22:17:21 +0000

What worries me about PSC’s diagnosis is not whether it is correct (for she may have a longer letter to go on than is published) but the impression it gives that such a diagnosis can be made on the basis of so little information.

Further, I don’t think it matters whether the letter was genuine or made up: what matters is that the advice is offered as genuine. Whilst some people read advice columns purely for entertainment, I believe that many people read them for information and guidance.

Thus, I think that it is entirely probable that there are now a number of people that think that wandering concentration during sexual activity plus being the life of the party and a bit of a joker is enough to diagnose a mental disorder.

No wonder so many people appear to think that many of us with mental disorders are putting it on when the impression is given so often in the media that such little information is sufficient to diagnose a mental disorder.

By: Frontier Psychiatrist

Frontier Psychiatrist — Tue, 15 Jul 2008 15:55:34 +0000

Why do you think we are prepared to go to such lengths?

By: Calochilus

Calochilus — Tue, 15 Jul 2008 11:43:06 +0000

“I think your experience of it is that as a psychiatric diagnosis ADHD is settled upon when other ones don’t seem to fit – that’s a bit different.”
On the contrary. Psychiatrists will go to inhuman lengths to avoid a diagnosis of ADHD in adults.

By: Frontier Psychiatrist

Frontier Psychiatrist — Tue, 15 Jul 2008 10:17:05 +0000

Thanks for your long comment.

I’m aware that newspapers print made up questions for their advice columns. My point is that this is presented to us as a realistic, albeit oversimplified, scenario, and by asking a qualified person to address it then the paper is providing advice by which people may be influenced. I make two points about what she writes:

1. On the information presented, a diagnosis of ADHD is not the most appropriate first stab at a diagnosis. There are other possible scenarios that should be highlighted first, before reaching for ICD-10 or DSM-IV.

2. By jumping straight in with a diagnosis of a mental health problem she is medicalizing a problem that may not be medical problem at all and by this being printed in a national newspaper this will encourage other people to do likewise.

That’s it. I’m not saying anything else. I’m not talking about real world diagnosing of ADHD and the problems with this. I believe that we’re both interpreting the definition ‘diagnosis of exclusion’ differently; I’m using it in the sense of physical medicine, where something relatively benign like irritable bowel syndrome is diagnosed when all other reasonable possibilities have been excluded. I think your experience of it is that as a psychiatric diagnosis ADHD is settled upon when other ones don’t seem to fit – that’s a bit different.

I don’t doubt that it’s difficult to have ADHD and the experiences you relate regarding this run from the unpleasant to the criminal. The things about which you write should not be tolerated. But by saying that you shouldn’t suggest a diagnosis of ADHD on flimsy evidence I’m not saying anything about this. You’re right to say that taken as a group people with mental health problems get a raw deal, but again in saying that talking about diagnosing of them should be approached carefully I do not set out to diminish this in anyway.

By: Calochilus

Calochilus — Tue, 15 Jul 2008 00:34:17 +0000

You set out by making a provocative statement. I am provoked !!
I reiterate , under the laws of defamation, no self-respecting newspaper will print a factual story which could identify ordinary individuals in a light which may be construed as defamatory(Public interest or should that be prurience). There may be a kernel of truth. If, as you infer, you are a competent and practicing psychiatrist, you will admit that this couple of paragraphs may have been distilled from several hours of agonising history taking , which , hopefully, would have run into many pages of cryptic notes. If it is just a random letter to PSC as an “agony aunt” then there are no reasons to assume it is not fiction(ask Pamela). You also appear to have little appreciation of newspaper practice in editing and sub-editing where the copy is cut to the bone, frequently omitting not only salient points but also critical points.Thus, the answer, superficial and brief, is also a fiction.( You appear to fall into the trap that newspapers and television are meant to inform rather than to entertain)
As for a diagnosis of exclusion, you need to listen to what is actually happening in the wide world of Adult ADHD, where a formal diagnosis and effective treatment often take many years to achieve by reason of comorbidity diagnosis excluding the truth and red herring interventions with useless and counter-productive drugs inhibiting meaningful progress. The insistence tht SSRI’s are a first line of treatment is one of the more notable observations. The correlation between erectile dysfunction and distress in ADHD male patients should not be overlooked as a catastrophic consequence of inappropriate intervention( particularly in those with comorbid Asperger traits).See the PLoS articles on SSRI’s.
If you cannot accept the mutual incompatibility of a categorical diagnosis of dimensional traits then you seem to have missed the bus. The reality of this problem is in the interpretation by individual psychiatrists, of levels of impairment, where severe impairment in one setting only is not seen as sufficient to allow prescription of appropriate intervention if the level of impairment in other settings is of a minor nature. This may and does have catastrophic consequences for in reality, the expression of ADHD behavioural traits is significantly setting dependent.
If you have a genuine interest in understanding the dilemmas facing adults with ADHD then may I respectfully suggest that you approach a local ADHD Support Group and offer to sit on their Board of Management as a listener rather than as a pontificator and I suspect you will be horrified at the nature and scale of the problems that pass across their table. As examples, a psychiatrist who will not see ADHD patients and has called police to remove adult patients who enquired about ADHD, a psychiatrist who will not see patients with beards and suggests to female patients that if their spouses are bearded then separation is the road to recovery, a psychiatrist who will not diagnose adult ADHD but remarks how well they do on Ritalin, a psychiatrist who insists that female patients completely disrobe before he will assess their ADHD status and these are some of the more competent ones.
I happen to live in a jurisdiction where , in order to obtain stimulant medication, one needs two independent diagnoses, from a neurologist and a psychiatrist or two psychiatrists. It is little wonder that, in order to facilitate effective treatment , patients travel up to 1000 kilometres to seek professional help in a jurisdiction that requires only a single opinion.
You will also have to acknowledge that, as a group, psychiatric patients are the least likely to stand up for their rights, file official complaints (especially ADHD patients) and to take civil action against offending practitioners. The game is not worth the candle.

By: Paul

Paul — Mon, 14 Jul 2008 23:06:14 +0000

Oh, and she deserves even stronger condemnation for the awful mess she’s made of Billy Connelly. Have you read her biography of him? Cringe….

By: Paul

Paul — Mon, 14 Jul 2008 23:03:59 +0000

Many professionals have reason to criticise Pamela Connelly for this rather idiotic attempt at diagnosis / formulation.

It’s people like her that give clinical psychology a bad name, but psychiatrists are far from immune from equivalent ignorance (Stuttaford anyone?).

So rather than “what psychiatrists are for” perhaps “what competent, intelligent, ethical practitioners are for”, no?