Posts Tagged ‘ diagnosis ’

Dissertations – Hans Asperger and the Ward for Therapeutic Pedagogy of the Viennese University’s Children’s Clinic

Ina Friedmann: Hans Asperger and the Ward for Therapeutic Pedagogy (Heilpädagogische Abteilung) of the Viennese University’s Children’s Clinic. Concepts and continuities in the institutional treatment of children categorized as ‘maladjusted’ between 1911 and 1977.

MUW-FO-S-004464-0082

Patients at the Ward for Therapeutic Pedagogy, 1920s (Josephinum, Sammlungen und Geschichte der Medizin, MedUni Wien, Sign. MUW-FO-S-004464-0082)

The Ward for Therapeutic Pedagogy of the Viennese University’s Children’s Clinic was a central institution from its opening in 1911 onwards concerning diagnosis and treatment of children and youth, who were labeled ‘difficult’, ‘maladjusted’ or to be in ‘need of education’. Science and institutional care were converging and interacting with socially widespread opinions. The Ward was founded under participation of pediatrician Erwin Lazar (1877-1932), who headed it until his death. He was succeeded by Valerie Bruck (1894-1963), who had been working at the Ward since 1923 and then led it until 1935. In this year, Hans Asperger (1906-1980), best known for describing the Asperger Syndrome, replaced her and stayed in this position until 1957, when Paul Kuszen (*1920) took over until 1985. It was especially Asperger who influenced not only the treatment of so-called ‘difficult’ children by decades of work in therapeutic pedagogy, but also had an impact on how those children and youth were perceived in the public as well as social and medical institutions. Already shortly after the opening of the Ward a close cooperation with the Youth Welfare Office, Juvenile Court, schools, children’s and correctional education homes and similar institutions was established, but also parents soon made use of the possibility of having children examined there.

The reasons for acceptance to the Ward were manifold and besides school and educational problems of any kind also included petty crimes, enuresis, masturbation, (sexual) violence, ‘vagrancy’ and ‘neglect’, but also epilepsy, speech disorders or the clarification of fits. The personnel of the Ward consisted of doctors, nurses, but also pedagogues and, from the 1920s onwards also of a psychologist. This correlated with Lazar’s conception of therapeutic pedagogy, who postulated the equal concurrence of pediatrics, pedagogy, psychology and psychiatry with the task to liberate children of their alleged ‘behavioral problems’ by the means of individually applied pedagogical-therapeutic methods.

This thesis focuses on the concepts which were used in the diagnosis, or rather judgment, therapy and further treatment of the patients. It tries to establish which scientific opinions on ‘social abnormity’ were dominating in the research period of 1911 to 1977, and if and how they changed. Therefore, the medical records of the Ward of the first half of the 20th century are the foundation of the thesis, allowing insight into the institutional treatment of children who were judged as ‘abnormal’ and ‘deviant’. Thus, it is also possible to contribute to the history of ‘institutionalized childhood’ in Austria.

Ina Friedmann is writing her thesis at the University of Vienna and is currently working at the University of Innsbruck.

 

Diagnostic Ambivalence and Psychiatric “Workarounds”

The Science, Knowledge and Technology section of the American Sociological Association has awarded this year’s Hacker Mullins Student Paper Award to Owen Whooley (NYU) for his paper “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders” (Sociology of Health & Illness, vol. 32, 2010: 452–469).

Abstract

In 1980 the American Psychiatric Association (APA), faced with increased professional competition, revised the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychiatric expertise was redefined along a biomedical model via a standardised nosology. While they were an integral part of capturing professional authority, the revisions demystified psychiatric expertise, leaving psychiatrists vulnerable to infringements upon their autonomy by institutions adopting the DSM literally. This research explores the tensions surrounding standardisation in psychiatry. Drawing on in-depth interviews with psychiatrists, I explore the ‘sociological ambivalence’ psychiatrists feel towards the DSM, which arises from the tension between the desire for autonomy in practice and the professional goal of legitimacy within the system of mental health professions. To carve a space for autonomy for their practice, psychiatrists develop ‘workarounds’ that undermine the DSM in practice. These workarounds include employing alternative diagnostic typologies, fudging the numbers (or codes) on official paperwork and negotiating diagnoses with patients. In creating opportunities for patient input and resistance to fixed diagnoses, the varied use of the DSM raises fundamental questions for psychiatrists about the role of the biomedical model of mental illness, especially its particular manifestation in the DSM.

History of Bipolar Diagnosis in Children

National Public Radio has aired a story that examines the history of the increasing diagnosis of children with bipolar disorder in the United States.  The draft of the DSM-V that was just recently released attempts to mitigate against this trend with its proposal for a new diagnostic category: Temper Dysregulation Disorder.

You can access the NPR story at http://www.npr.org/templates/story/story.php?storyId=123544191

%d bloggers like this: