Inside the Battle to Define Mental Illness | Magazine

The insurgency against the DSM-5 (the APA has decided to shed the Roman numerals) has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it. Dissidents complain that the revision process is in disarray and that the preliminary results, made public for the first time in February 2010, are filled with potential clinical and public relations nightmares. Although most of the dissenters are squeamish about making their concerns public—especially because of a surprisingly restrictive nondisclosure agreement that all insiders were required to sign—they are becoming increasingly restive, and some are beginning to agree with Frances that public pressure may be the only way to derail a train that he fears will “take psychiatry off a cliff.”

At stake in the fight between Frances and the APA is more than professional turf, more than careers and reputations, more than the $6.5 million in sales that the DSM averages each year. The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians. Outside the profession, too, the DSM rules, serving as the authoritative text for psychologists, social workers, and other mental health workers; it is invoked by lawyers in arguing over the culpability of criminal defendants and by parents seeking school services for their children. If, as Frances warns, the new volume is an “absolute disaster,” it could cause a seismic shift in the way mental health care is practiced in this country. It could cause the APA to lose its franchise on our psychic suffering, the naming rights to our pain.

The money, the prestige, the pettiness....

Quad Uses Swype to Set Fastest Hands-Free Typing World Record | Android Phone Fans

We’ve already seen Swype lay claim to aiding in the setting of a new speed-texting world record, but would you believe the virtual keyboard also played a role in taking the record for fastest hands-free typing into new territory? In just 83.09 seconds, Hank Torres, a quadriplegic paralyzed from the shoulders down, was able to swipe out the following:

"The razor-toothed piranhas of the genera Serrasalmus and Pygocentrus are the most ferocious freshwater fish in the world. In reality they seldom attack a human."

This was accomplished through a combination of Swype and a head-tracking device. You can see the accomplishment for yourself in the below video.

Convergence at its finest.

PatientsLikeMe : About Us

About PatientsLikeMe

Founded in 2004 by three MIT engineers whose collective experience spans from running the world's only non-profit biotechnology laboratory to large-scale online commerce applications, PatientsLikeMe is a privately funded company dedicated to making a difference in the lives of patients diagnosed with life-changing diseases. Our personal experiences with ALS (Lou Gehrig's disease) inspired us to create a community of patients, doctors, and organizations that inspires, informs, and empowers individuals. We're committed to providing patients with access to the tools, information, and experiences that they need to take control of their disease.

In 1998, a young carpenter named Stephen Heywood was diagnosed with ALS. The Heywood family began taking charge of Stephen's care, searching the world over for ideas that would extend his life and improve the way he lived. This set in motion a series of events that have led to PatientsLikeMe, a new system of medicine by patients for patients. We're here to give patients the power to control their disease and to share what they learn with others. We're here to help you.

They sell your comments without your name or personally identifiable info. So, if you complain about a drug, the drug company will receive the substance of your complaint.

Diary of a Goldfish: An Entirely Biased Who's Who of the Disability Blogosphere, January 2011

An Entirely Biased Who's Who of the Disability Blogosphere, January 2011

@_louhicky who draws Crip Strips recently asked me about the movers and shakers within the disability movement on-line. The part of the disability movement I know most about is in the blogosphere, and when I began to think of important bloggers to tell Lou about, I thought it might make something of a celebratory post. As it turned out, I've had a few poorly weeks and during such times it is other bloggers who help me feel connected to things.

However, I am no particular authority on this, not all important disability blogger will have appeared on my radar and I'm bound to have forgotten some of those that have. I've also struggled to categorise these in any meaningful way. So it occurs to me, maybe other folk can blog their own lists of important disability bloggers. Hmm... I have vague amorphous thoughts about compiling a gigantic map of the disability blogosphere, but as I say, poorly weeks. Please at least comment with links to important bloggers I've forgotten. Right...

What is Disruptive Innovation?

If struggling with a target has limitations as a change strategy, what else can we do?

We can replace the whole darn system!

Disruptive Innovation is a way to replace an entire system.

The framework was originally developed by Clay Christensen to explain how newcomers in an industry could successfully replace mature and very successful corporations.

These successful corporations develop themselves by creating "sustaining" innovations, ones that support their previous successes, using their money and expertise to grow. Eventually, sustaining innovations create a product that has many features of no or even negative importance to their customers. The customers are tied in to the product line by their past choices, and learn to live with what they don't want for what they want. Additionally, the cost and complexity of the product tends to rise over time as a direct result of these sustaining innovations, and a market grows that would like the some parts of the product, but not the cost and complexity. The corporation doesn't address these concerns because of the money they are making and the relationships they have with their best customers.

A "disruptive" innovation partially breaks down the stability of the mature industry. Typically, the product created through this kind of innovation is far cheaper, and does not have the complexity of the mature product. It also tends to target a market ignored by the mature industry. If the disruptive innovation succeeds in tapping a market, it establishes a financial and technical base for improvements. It becomes good at the product it is making.

This process takes away part of the market for the mature industry. This first market is often one the mature industry doesn't consider a profitable market, or one that the mature industry considers a weak market compared with their mature industry customers.

The newcomer, now having a stable financial and customer base, chooses a new market to target for its disruptive strategy. Again, this will be a market that the mature industry has little or no interest in, but that is "upmarket" from the original target for disruption.

And so on. Until the entire industry is replaced by the disruptive newcomers.

Next: A Disruptive Example

The Problem with a Coevolutionary Change Strategy

There are a lot of problems with using Coevolution as our central method of changing a system:

  • While we may have energy, flexibility, and rapidness of response in the early phases of a coevolutionary competition, the other system typically has far more money and an inherently deep inertia. In the long run, we are likely to run out of juice before the other side does. Thus, we settle for what we can get, and go on to another coevolutionary change strategy or phase in the game.
  • Since our targets for change typically want certainty in their future, they will settle with us in ways that reduce uncertainty-typically a clearer (more rigid) definition of some part of the game's defining characteristics. When we settle for less than what we would like, and they settle for something that is more predictable, the system we are trying to change becomes more and more rigid. Look at how special education law has solidified over the decades in ways that have not met the possibilities we all envisioned "back in the day".
  • Once a target system is rigid, "our" side becomes a fractured set of seperate communities who will be unwilling to give up progress in their interests in order to achieve progress in some other set of interests. This fracturing is most obvious when the target system attempts to implement cutbacks. We can only stand against all cuts, even though some cuts will eventually be made, because we would have no "push" otherwise.
  • We do not have the resources to directly push for the kind of ultimate full system change we want. Even if we push hard in one part of our change agenda, we are likely to run out of resources before the other system does. So we settle in some way or another in order to get a decent outcome now, and preserve our ability to continue the fight, operating on the assumption that we have created a new plateau for the struggle.
  • As can be seen over the last half-century, the political basis of change shifts. We now live in a time when much of our success (and our methods of change) will be undercut by reduced funding over the long term. Any change in overall resources for the two parties to the game changes the basic dynamic of coevolution.

While coevolutionary change strategies have allowed up to create change in the legal infrastructure of our rights and possibilities, I believe that the effectiveness of those strategies is fading. We are getting less and less for more and more effort. We need to think about systems change using a new framework.

 

Next: What is Disruptive Innovation as a Change Strategy?

Coevolution or Disruptive Innovation: What's the Best Change Strategy?

What Is Coevolution?

When the disability community tries to change a system, we almost always use some kind of Coevolutionary Strategy. Think of the relationship between the United States and the Soviet Union during the Cold War. One side would make a move, the other would respond. Back and forth the two governments would go. Advocacy change strategies and political change strategies are largely coevolutionary. 

Coevolution is also described as the "Red Queen" effect, from Alice in Wonderland. In Coevolution, as sometimes in Wonderland, you have to run faster and faster just to keep up.

Generally, systems engaged in coevolution become better and better at their "side" of the competition, and they tend to become more complex over time. Eventually, Coevolution slows and stops when one party reaches some resource limit. The Soviet Union ran out of money for the fight, and collapsed.

Predator-Prey relationships have a coevolutionary element. So do ongoing competitions of all types. You can think of Coevolution as a game. Each side tries through its responses to win the current phase of the game. Note, importantly, that it is not enough to win one phase of the game. Both the side that wins and the side that loses a phase must be able to play another "game" or Coevolution ends.

Next: Problems with Using a Coevolutionary Strategy

Interstitiality

Anyone who has written a Federal or State grant of any size has had to deal with the not well defined geographic realities of explaining where your marvelous project will have impact. A favorite ambiguity of mine has been how to define counties in Michigan as either urban or rural. After all, every Michigan county has cities. At the same time there are some sort of clear differences between Detroit and Houghton. (For example, Houghton doesn't have a cop show named after it.)

Well, I ran across a solution from the Office of Management and Budget a few days ago, and thought I would pass on this illumination to all of you.

They have divided Michigan counties into three categories:

  • Rural: Anything not defined under the other two categories. Rural is the throw-away category.
  • Micropolitan: Contains at least one urbanized cluster of a least 10,000, but not more than 50,000, population, and an adjacent territory that has a high degree of economic integration with the core, as measured by commuting ties.
  • Metropolitan: At least one urbanized area with at least 50,000 population, and an adjacent territory that has a high degree of economic integration with the core, as measured by commuting ties.

All clear, now?

In a recession like ours, I think economic integration is more of a hope than a reality.

Commuting is becoming a thing of the past.

Does this expansion of geographic reality also lead us to the cultural concept of microsexual?

Go Direct: Direct Deposit for Social Security & Federal Benefits

The U.S. Department of the Treasury will pay all federal benefit and non-tax payments electronically. Benefit recipients can choose to receive their payments by direct deposit to a bank or credit union account or to a Direct Express®Debit MasterCard® card account.

Act now to get your money safely and quickly – on time, every time!

  • Retiring or applying for federal benefits soon? Be ready.
    If you will apply for federal benefits on or after May 1, 2011, you will need to choose your preferred electronic payment option when you enroll to receive benefits from the Social Security Administration, Veterans Affairs, Railroad Retirement Board, Office of Personnel Management or Department of Labor (Black Lung). Find out what you'll need on hand.
     
  • Already getting federal benefits payments by paper check? Switch today!
    You will need to make the switch from paper benefit checks to electronic payments by March 1, 2013. Learn more or sign up now.

If you do not choose an electronic payment option by March 1, 2013, or at the time you apply for federal benefits, you will receive your payments via the Direct Express® card so you will not experience any interruption in payment.

If you are already receiving your federal benefit payments electronically, this change will not affect you.

Receiving SSI or SSDI? This applies to you, too.

A Gesture Based Web Browser: Ideal Web Reader » Mobile Apps Showdown

School children, the elderly, college students, returning veterans, are among the 600 million consumers worldwide who have print disabilities With the Ideal Web Reader (IWR) they get the opportunity to enjoy full access to Android-based devices–no reading required. IWR is an advanced, high-quality, free, open source, gesture-based, self-voicing Android web browsers whose content can be highlighted and read by text to speech translation. Sight impaired can change page content color , text size, letter spacing, and line spacing. The screen can be on or off when the app is running. Most important, users can define the gestures for all the actions allowing them to change voices, speed, and language.

The gestures include: Next, Previous, Reading Granularity (word, sentence, paragraph), Accessing Links, Completing Forms, Read All, Set Bookmark, and Dictionary Lookup. Talk about an enabling app!

Cost: Free