For those not in the know, the DSM or Diagnostic and Statistical Manual of Mental Disorders contains the diagnostic criteria for all things psychiatric. The DSM also contains criteria for conditions that affect cognition. It has been revised many times over the years, but in 2013, the American Psychiatric Association will finally be putting out DSM-V.
The DSM has undergone many changes over the years and has re-written and discarded various nuances of humanity to reflect the times. It wasn't until 1973 that homosexuality was removed, for example.
The term "Mental Retardation" was used extensively in the DSM and listed a variety of diagnosing criteria. Included was a range, from mild to severe and the language very judgemental (this is taken right from DSM-IV-TR):
"A. Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test (for infants, a clinical judgment of significantly subaverage intellectual functioning).
B. Concurrent deficits or impairments in present adaptive functioning (i.e., the person's effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following areas: communication, selfcare, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.
C. The onset is before age 18 years.
Code based on degree of severity reflecting level of intellectual impairment:
317 Mild Mental Retardation: IQ level 50–55 to approximately 70
318.0 Moderate Mental Retardation: IQ level 35–40 to 50–55
318.1 Severe Mental Retardation: IQ level 20–25 to 35–40
318.2 Profound Mental Retardation: IQ level below 20 or 25"
As of May 2013, the term "Mental Retardation" will no longer be used; instead "Intellecutal Development Disorder" will be substituted. The rationale for this, is as follows:
"The term mental retardation was used in DSM-IV and in earlier DSM definitions. Mental Retardation is no longer used internationally or in U.S. federal legislation, so a name change is required in DSM-5. The term Intellectual Disability (ID) is widely used..."
Instead of the old definition, the following is what is proposed:
"Intellectual Developmental Disorder (IDD) is a disorder that includes both a current intellectual deficit and a deficit in adaptive functioning with onset during the developmental period. The following 3 criteria must be met:
A. Intellectual Developmental Disorder is characterized by deficits in general mental abilities such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning and learning from experience.
B. Impairment in adaptive functioning for the individual’s age and sociocultural background. Adaptive functioning refers to how well a person meets the standards of personal independence and social responsibility in one or more aspects of daily life activities, such as communication, social participation, functioning at school or at work, or personal independence at home or in community settings. The limitations result in the need for ongoing support at school, work, or independent life.
C. All symptoms must have an onset during the developmental period."
On a more personal note, one of the largest arguments that I have heard regarding usage of the R word is "it is medical term". As of this publication, it is no longer an accepted description or diagnosis and is therefore not acceptable in ANY context.
...And that's the facts, Jack. Happy Friday.
"American Psychiatric Association DSM-5 Development." Proposed Revision. American Psychiatric Association, n.d. Web. <http://www.dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=384>.
"As of this publication, it is no longer an accepted description or diagnosis" - not true. It's in every textbook and medical curriculum and it's not going anywhere, in part b/c this terminology isn't an issue within medicine. I'm a physician and I routinely use the term (usually abbreviated to 'MR') as do the consultants who see my patients. The DSM-IV doesn't dictate what language physicians use.
ReplyDeleteIt's too bad you felt that you had to post anonymously...
DeleteHowever, you are right. It is out there. But, this is a start. As every medical textbook is updated every few years, this will slowly change for all of you as well.
Hopefully, the physicians that come after you will be a little more compassionate.
Sure, the DSM-IV doesn't dictate what language a physician will use. But I am sure that many patients and their advocates will be looking for a doctor that is sensitive to their specific needs and goals for health will want a doctor who keeps up with current and future publications from noteworthy sources such as the APA. A doctor, on the other hand, who is still using their texts that date back from their first years of medical school will soon find that they will limit their clientele... and possibly not be able to practise the medicine that they would like since they refuse to acknowledge that we are constantly revamping and reviewing and refocusing. After all, it's not so long ago that we were treating most illnesses by bleeding, or the way simple hand washing can help arrest the spread of disease.
DeleteAnonymous - Thanks. I hope you never come across my kid, or me for that matter. The DSM-IV might not dictate what language physicians use, but one would hope that manners, common decency, and constructive feedback from national organizations would. I'm guessing you didn't go into medicine for the patients' sake then?
ReplyDeleteAnonymous, as a physician, you are expected to be on top of your game. Perhaps you should stop reading those outdated textbooks.
ReplyDelete"Updated May 18, 2012
Name change. The term mental retardation was used in DSM-IV and in earlier DSM definitions. Mental Retardation is no longer used internationally or in U.S. federal legislation, so a name change is required in DSM-5.
The term Intellectual Disability (ID) is widely used. This term is used by the AAIDD and criteria have been developed to define ID as a functional disorder, explicitly in keeping with the WHO International Classification of Functioning (ICF).
The ICF is a classification of disability, unlike DSM. Rather, DSM is a classification of diseases and disorders. The DSM-5 criteria are harmonized with the International Classification of Diseases (ICD), not with the ICF. Thus, the DSM-5 Intellectual Developmental Disorder is classified as a neurodevelopmental disorder of brain development.
Its inclusion in the manual is analogous to the DSM-5 category Neurocognitive Disorder (in DSM-IV, dementia) where onset is typically later in life, there is loss of prior cognitive capacity, and degeneration is often a feature. In Intellectual Developmental Disorder (IDD), there are deficits in cognitive capacity beginning in the developmental period. The term IDD was chosen to be consistent with DSM-5 as a classification of disorders and to harmonize this diagnosis with the proposed ICD-11."
The DSM may not dictate what language physicians use. The words you choose are a personal choice. However, the world of medicine is changing to respect the rights of the disabled. Something you might consider doing yourself in a profession that prides itself on compassionate care.
Wow. If me stating that medically, mental retardation IS an accepted diagnosis - and not 'no longer accepted as of this publication' as Jen states - makes me uncompassionate (a very heavy charge for someone devoted to her patients), this is not a conversation worth having.
ReplyDeleteIf you're going to shoot the messenger, I'm sorry I engaged.
I didn't "shoot the messenger", I just pointed out that in time, even medical terminology changes. "Mongolian Idiocy" used to be in every textbook and used by every physician as well. How would you, "Anonymous", refer to someone who used that outdated term in a consultation report?
DeletePerhaps it's a regional thing, "Anonymous". I read a lot of reports in a week from general practitioners, psychiatrists and various specialists. Here, "MR" is almost a thing of the past. "Developmental delay" is usually used, or perhaps a description of the actual condition. We do see a lot of patients with developmental delays in Mental Health as we are referred quite a variety of people from severe autism to acquired brain injuries to chromosomal deletion syndromes.
I have no doubt in my mind "Anonymous" that you feel that you are dedicated to your patients. However, I am going to suggest that perhaps you could rethink your position on this term a bit and reflect on whether or not you are giving them the respectful service that they deserve.
You are correct on one other point as well. This conversation is not worth having. If it were, you would have signed your name to it. You could be anybody, including someone posing as a physician.
Anonymous - You did not state that "medically mental retardation IS an accepted diagnosis", you stated that you're a physician and you routinely use it. If you are as devoted to your patients as you say perhaps you should consider what such organizations, comprised of your patients if your patients have intellectual disabilities, as NDSS, the ARC, and NDSC say about language.
DeleteYou are not the messenger, you are part of the problem.
I enter ICD-9 codes for all of my patients' diagnoses, and that's what the World Health Organization has coded (even in the most recent ICD-10): mental retardation. http://apps.who.int/classifications/icd10/browse/2010/en#/F70-F79.
ReplyDeleteAgain, this statement is false: "As of this publication, it is no longer an accepted description or diagnosis and is therefore not acceptable in ANY context." Like it or not, it is still routinely used factually in the medical world, and this kind of bitter, personal response (from commenters) is not the way to change that.
Homosexuality is no longer in the DSM-IV b/c it's no longer considered a disorder. Mental retardation hasn't gone away; the DSM simply reflects the euphemism treadmill.
I thought this discussion wasn't worth having?
Delete"Please note that the terms "retardation" and "retarded" are under consideration for a change in ICD-11" - http://www.who.int/mental_health/media/en/69.pdf due out 2015.
DeleteJust FYI.
Anonymous - "Euphemism treadmill"? Yes, now I truly sense your humanity, your compassion toward those under your care, and your 'first do no harm' creed.
DeleteThis discussion is an important one, just not worth having with you.
You know, Anonymous, I was thinking about this some more and I think that the response you are getting to your little 'tidbit' there in the beginning would be much less bitter, if it seemed like you at least understood why the intellectually disabled population does not wish to be referred to as the 'retarded population'. As it reads now, the 'nyah nyah' seems barely suppressed. It seems like you're happy about being able to call someone mentally retarded because it's 'the current code' or some such excuse.
DeleteWe understand that sometimes still doctors have to tick the box by mental retardation because there isn't a box that says intellectual disability or intellectual developmental disorder, but we hope that those doctors aren't happy about it and maybe even want to change with the times and leave in the past all those expressions that are no longer appropriate because their use has gone through such a change.
I really wish I understood why you wouldn't want to show compassion.
Anonymous - Jen is correctly stating that as of this post (October 26), "mental retardation" is no longer a medically accepted term. The APA agrees with her, and has supported the removal of this term from the DSM-V since the 18th of May, 2012.
ReplyDeleteIn fact, the APA also acknowledges that "retardation" is no longer a medically accepted term internationally.
Yes, it used to be acceptable medical and common language. It also used to be acceptable to chain the mentally ill to concrete walls and put them on public display. Just because something or some word USED to be acceptable, does not mean it continues to be so.
As a parent, I am asking you, as a physician and representative of all physicians who continue to use mental retardation in medical language and/or in common-speak to reconsider your defense of the term and to advance with the rest of the international medical community.
If you claim to be "the messenger", why wouldn't you choose to deliver a positive one?
Jen...Skye...don't feed the trolls. I don't believe Anonymous is a physician, I believe Anonymous is a troll looking for attention. The worst thing you can do to a troll is ignore it.
ReplyDelete