|Dimensions vs. categories
The clinicians I communicate with most were trained to use the DSM
as a virtual bible, which usually means it is reflexive for them to be categorical not
dimensional. Most have been trained to build compartments, not continuums, and that makes
sense given that classic reductionist science is meant to divide and classify. But my aim
here has been just the opposite -- to connect and unify.
In an elemental way my models
take a leaf from "new edge" sciences, such as systems and complexity theories. I
borrow from systems theory in organizing by patterns and degrees with devices such as
matrices instead of hierarchical lists. And I borrow from chaos theory a bit, in the sense
of shifting states and cycles that can combine and compound to build up to critical mass
New edge sciences often work top down, general to specific, because the specifics of
complex systems such as the weather are too enormous and often too unknown, but the
overall dynamics reveal symmetries of their own. So it is, I contend, with systems of mind
and brain. Divide part too much from whole, and you may lose sight of how the parts can
combine to produce even larger phenomenon.
Learning theorists and cognitive scientists analyze how we learn and perceive;
psychiatrists and psychologists analyze how we feel and believe; while neurosci guys try
to parse it all in terms of bio and chem; each wandering through the forest of the brain
concerned with their own kinds of trees. To an extent, this limits how much of the forest
they can see. What I am trying to do is provide a birdseye view that allows us to look at
them all together to compare and contrast what they tell us about attention differences.
To that end, this paradigm portrays a functional model of internal experience,
the impact of attention difficulties on state of mind, not the content of the thinking
itself. One can get obessive about the theory of relativity or about what kinds of food to
eat; it's the process not the content I am describing.
These models also demonstrate different ways to portray the intersection of interacting
elements, such as arousal and atttention, and their impact on each other. My paradigm may
also serve to help clarify one source of those "yes-buts" -- global vs. local
frames of reference. By layering from specific to general, macro to micro if you will, my
models permit comparisons between things that may be true of ADDers
in general but vary between individuals.
Another important thing I want do with this dimensional modeling is interject time
as an element. The checklists and categories clinicians employ suggest something fixed
instead of states and traits that wax and wane in response to change. To portray the
shifting nature of mind and mood, this spectrum is dynamic, not fixed. It suggests a
"default" mode where one begins and neighboring states where one moves along a
spectrum in time in response to internal and external stimuli.
Before we proceed, let me also give a context for this paradigm as a whole: it is a
schematic, a heuristic sketched in functional equivalents that will hopefully seed a trail
of clues to possible etiologies and how they might combine. Thus it portrays the
"what" and "how" of attention difficulties, but only hints at the
"whys." That part again I leave for clinicians and scientists who are much
better equipped than I to explore what these possible correlations imply.
Viewing any DSM diagnosis dimensionally requires a paradigm
shift, so I am going to ask your indulgence on one score before we begin, to wit -- please
suspend disbelief for a bit.
Pretend this model is already being talked about and that you are here to understand
what it suggests. Please don't pick it apart in your head just yet, or you might miss your
chance to shift your frame of reference. After you see how it seems to me, if you'd like
to critique, I welcome all feedback.