Neuro-Behavioral Disorders
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psy ...@netcom.com (Ivan K. Goldberg)
For some time, I have been using the phrase "neuro-behavioral disorder" when answering questions from my patients with ADD, depres-
sion, anxiety disorders, schizophrenia and severe personality disorders. At some point in their treatment most patients ask, "Do I have a mental disease?" or "Am I mentally ill?" or "Exactly what is the matter with me, do I have a mental disorder?" I make it a point when answering such questions to introduce the term "neuro-behavioral disorder," and when asked what those words mean, explain that it is an illness in which thoughts, feelings, images, and behavior are the result of a neurochemical disturbance in the brain. The phrase also allows me to point out that the term "mental illness" suggests a dualistic approach to human functioning, and that there is but one self, not a biological self and a psycholo-
gical self.
Many patients write down the words "neuro-behavioral disorder" and at a subsequent session explain to me how for the first time they felt comfortable talking to their family and friends about their psychiatric difficulties. I think the wide-spread substitution of the phrase "neuro-behavioral disorder" for the more commonly used phrase "mental disorder" and "mental illness" would help decrease the stigma attached to psychiatric disorders.
I welcome comments on this proposal.
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-- \\\\ (@ @) ||------------------------------------------------------ooO-( )-Ooo-----|| || Ivan Goldberg, MD ~ || || i...@phantom.com ikg1@columbia,edu psy...@netcom.com || || Voice = +1 212 876 7800 Fax = +1 212 737 0473 || || NY Psychopharmacologic Inst. 1346 Lexington Ave NYC 10128 || ||----------------------------------------------------------------------||
hawle ...@apple.com (Lorin Hawley)
God knows there is a need for new terminology. But you have to consider that the impact and meaning of any particular term or phrase will depend on the audience.
A term or phrase which has success in reducing the popular stigma attached to psychiatric disorders may be interpreted differently by individual patients or by different mental health professionals. It might even be clinically, empirically inaccurate or misleading. I doubt one term would serve in all settings and stay accurate.
It has always seemed to me that the best way to de-stigmatize psychiatric disorders is to seek terminology which emphasizes the biological components outside the control of the individual, and de-emphasizes the volitional or tractable components, if any. For example, calling diabetes an "insulin disorder" would seem, by implication and connotation, to diminish the inexorable biological nature of the disease (allowing for some degree of behavioral control and volition by the diabetic in determining the progress and manageability of the disease). Unfortunately, terms like "depression" and "anxiety" are so ubiquitous they have lost much meaning. "Clinical depression" or "biochemical depression" might connote a more biological and less volitional condition. The term "disorder" might be more accurate but doesn't carry the impact of, say, "biochemical imbalance", though the latter doesn't exactly roll off the tongue. And "behavioral" certainly implies, at least in popular perception, a volitional component which, though perhaps more accurate, may not serve to de-stigmatize. "Neuro" or "neurological" seem to me to carry some of the serious connotations of the feared term "mental illness". "Neuro-behavioral disorder" may be a good compromise. Personally I would opt for something more awkward like "clinical depression" or "biochemical depression" (or anxiety or whatever) while emphasizing the volitional components - the behavioral and psychological work needed - with the patient.
- Lorin M. Hawley hawle...@apple.com
r ...@netcom.com (Robert Orenstein)
I like the idea of a substitute phrase along the lines of the one you propose. But... I've been helped tremendously through my depressions by a therapist who pointed out that the illness did indeed affect my thoughts and feelings, but that my behavior was still controllable by my will. I guess I agree with your statement that the neurochemical disturbance affected my thoughts and feelings, but strongly disagree that it affected my behavior entirely. It's true that there were things that I couldn't do while in a depression (i.e., be charming at a party, keep a conversation going for a long period of time, program my computer), but there were many things that I COULD do that I simply had no motivation to do (i.e., get out of bed, cook, garden). Realizing that I could still do those things, and doing them despite my complete lack of motivation, was part of recovery from depression for me.
The problem I have with the phrase "neuro-behavioral disorder" is that it seems to emphasize a lack of control over behavior instead of a lack of control over thoughts and feelings. I would prefer something like "neuro-cognitive disorder".
Robert Orenstein
r ...@netcom.com (Robert Orenstein)
(stuff cut) (more stuff cut) (I posted this once already, but it didn't show up on my site; if you see this twice, please don't flame me...) I like the shape of the phrase "neuro-behavioral disorder", but I think that the actual words are a bit misleading, at least as far as depression goes. I've been helped greatly through depression by a therapist who pointed out that my feelings and thoughts are influenced by depression to a degree that I can't control, but that I still do have control over most of my actions. It is true that when I am in a clinical depression, there are certain things that I can't do (i.e., be charming at a party, program the computer, sleep as much as I think I need to), but that most of my behaviors are still under my control (i.e., I can still cook, garden, and get out of bed in the morning, even though I have no motivation to do these things, and even though I don't want to).
The problem I have with the phrase "neuro-behavioral disorder" is that it accentuates as uncontrollable the one thing that depressed patients DO have control over; and realizing that this control is there can have a huge benefit on the patients' behaviors, and ultimately on their recovery. I'd prefer a description that accentuates the lack of control over thoughts and feelings, something along the lines of "neuro-cognitive disorder".
Robert Orenstein
fre ...@gibbs.oit.unc.edu (David M. Fresco)
For me, as a student of psychopathology and clinical psychology, Dr.
Goldberg's phrase "neuro-behavioral" captures the best aspects of what one has under her/his control too as you say. Control is somewhat a sticky word for me however. Let me retain the essence of what I get from your post and say: what depressives CAN change to paraphrase you depressed patients DO have control over ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Dr. Goldberg IS tapping into a determinism by mentioning behavior. To me, a committed behaviorist, behavior does not represent a static, unmalleable, fatalistic brand of determinism. Rather, behavior represents a PRESCRIPTIVE approach to understanding the etiology. By viewing the behavior exhibited by an individual, and applying in part, a behavioral interpretation for how s/he arrived at this point, I have a basis for "undoing" some of the behaviors that the individual finds maladaptive. Let me not overstate the importance of behavior and make short-shrift of bio-genetic factors because the neuro side of Dr.
Goldberg's term holds great importance too.
In this post however, I choose to highlight behavior in contrast to the controllability that you desribe above. I don't want to belittle the progress you feel you have made to improve your behaviors while depressed. Indeed, this issue of controllability, for me, lies at the heart of the contention surrounding the term neuro-behavioral disorder and more broadly between me as clinician versus me as theorist of personality/psychopathology.
When seeing clients, I continually want to restore their sense of personal control from which they have been robbed for a variety of reasons. I imagine that I use very humanistic language to cajole individuals into challenging the notion that they have no control over their lives. Because traditional humanistic-Rogerian terms provide for the existence of a "free agent" that is more-or-less immune from biological, environmental and unconscious influences, the whole approach no longer offers a prescription for how to go about returning to self-actualization.
For this reason largely, I prefer a term that I learned from Christopher Peterson of UMich: personal control which is an umbrella term for personality theories/therapies that center around self-efficacy, locus of control, optimism, learned helplessness, etc. None of them take on a strict behavioral orientation. Rather, they all seem to represent the appealing aspects of humanism (e.g., some things are changeable, there's always room for self-improvement) with deterministic prescriptiveness that I find appealing. Through some reflective, uncovering with a client, I would search for past events that were painful and led to the emergence of some response that gave quick relief to the emotional pain, but has had a long-run, negative consequence. That's where I become the behaviorist with a client--helping s/he conduct "insightful" here-and-now work to change aspects that are within reach and reason to change.
Again, I don't wish to downplay the other factors that also play a huge role in shaping an individual (e.g., the neuro of Dr. Goldberg's neuro-behavioral disorders). Also, I don't wish to minimize the strides that clients can make once they feel motivated to improve themselves.
However, I still feel that I can be of most help to an individual by adopting the determistic perspective that I have tried to describe above because it offers some a partial glimpse into how personality emerges and how to get some maldaptive aspects of it back on track given a careful analysis of many inter-related factors contributing to its maintenance.
In summary, I like the term neuro-behavioral disorder. It sheds the medical model, disease model dualism that for so long served as a nearly inpenetrable wall between scientists conducting solid, helpful, important reductionistic research and holistic minded thinkers who eschewed the western approach, in favor of eastern orientations that sound very appealing. There will be no paradigmatic, synergistic revolution because of the term neuro-behavioral disorder replacing disease or mental illness, but it's a nice first-step towards finding heuristic information in the all-too-often-times insular camps of medicine and psychology.
=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= = David M. Fresco = = Department of Psychology = = CB#3270, Davie Hall __o = = Chapel Hill, NC 27599 \<, = = Internet: fre...@unc.edu `,/'(*) = = fre...@med.unc.edu (*) . ./""" = = Voice: (919) 962-5082 """" = = Fax: (919) 962-2537 = =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
dgen ...@CAM.ORG (Daniel Geneau)
Ivan K. Goldberg (psy...@netcom.com) wrote: : I think the wide-spread substitution of the : phrase "neuro-behavioral disorder" for the more commonly used phrase : "mental disorder" and "mental illness" would help decrease the stigma : attached to psychiatric disorders.
: : I welcome comments on this proposal.
It is in the same purpose that Edward Fry (1968) built a "Do-it-Yourself Terminology Generator" for labelling children whit reading problems. Here it is: Select any word from first column, add any word from second and third columns. If you don't like the result, try again. It will mean about the same thing.
Qualifier Area of involvement Problem
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Secondary Nervous Deficit Minimal Brain Dysfunction Mild Cerebral Damage Minor Neurological Disorder Chronic Neurologic Desynchronization Diffuse CNS Handicap Specific Language Disability Primary Reading Retardation Developmental Perceptual Deficiency Disorganized Impulsive Impairment Organic Visual-motor Pathology Clumsy Behavior Syndrome Functional Psychoneurologic Complex
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Voila, now you have plenty of new terms to qualify some of your patients. But, please, if you consult me for one of these patients, specify the exact diagnostic :-) Daniel Geneau
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