Is Sluggish Cognitive Tempo a Thing?

The DSM remains a source of perpetual controversy, not just within the field of psychiatry, but within the press and public as well. It isn’t hard to see why. With its dogmatic tone and Orwellian self-certitude, this foundational document bears all the hallmarks of a holy text rendered into the scientific milieu. But the DSM is also unfairly maligned at times. As a touchstone for useful analytic therapy and psychiatric care, the manual has undoubtedly helped millions of people discover and name what ails them. The DSM has also been a tool of political progress over time, not least in its evolution over LGBT identity and recognition.

But now a new diagnosis is banging at the gates. A number of doctors are telling the public that we must accept a brand new attention disorder: Sluggish Cognitive Tempo, or SCT. Never mind that the name seems ripe for revision in the very near future (sluggish?), the diagnosis itself remains frustratingly vague. It describes, in the broadest sense, those who “tune out” or daydream, causing them to lose focus without any hyperactivity.

Some people are unhappy with this idea, and many of them have a pretty good argument that this latest malady may be little more than a rearguard effort by pharmaceutical companies to sell us more pills. Attentional deficit disorders as a group are already somewhat controversial, as few prescribing doctors ever bother to discuss subtler behavioral solutions such as improving sleep patterns before they reach for the pad. (We have learned the lesson many times before that prevention is always safer than prescription; consider this example from the world of orthopedic medicine.)

And there is this:

Yet some experts, including Dr. McBurnett and some members of the journal’s editorial board, say that there is no consensus on the new disorder’s specific symptoms, let alone scientific validity. They warn that the concept’s promotion without vastly more scientific rigor could expose children to unwarranted diagnoses and prescription medications — problems that A.D.H.D. already faces.

Daydreaming is simply what we do in childhood, and it’s unclear whether some people do so much of it that it should be pathologized. Until we know, it is probably best to let nature run its course, engage in talk therapy wherever it may help, and medicate only as a last resort.

A Hunger for Analytic Therapy in More Places

The benefits of talk therapy have long been known, but innovation continues to touch the world of psychotherapy. Concepts such as mindfulness and specialties such as LGBT therapy are constantly adding ferment to the field, for instance, and the advent of the Internet has added many new topics worthy of study. Recently much of the “talk” in therapeutic innovation has centered around the possibility of Web-based psychotherapy. The idea involves a version of Skype, where patient and therapist meet somewhere in cyberspace and conduct a conversation over an encrypted video connection. As a recent article in Wired described one website peddling such technology, “Patient and practitioner connect via TalkSession’s video platform—no couch required.”

Is Teletherapy Real?

There are some inherent advantages to this approach, including improved accessibility for remote patients, enhanced convenience for both patients and therapists, and freedom from the sigma of mental health appointments in communities where such prejudices remain.

Yet sites such as TalkSession cannot readily substitute for the real thing -- yet. There is a shared experience that takes place in the room which cannot easily be duplicated. (Witness the confusion that arises when your partner on Skype begin reacting to things you can’t see.) And of course there remains a formidable series of regulatory hurdles to surpass, including a byzantine national licensing system that makes out-of-state therapy a legal minefield.

Still, there is no question that teletherapy will arrive someday. What this news demonstrates most clearly to us is that vital specialties such as depression therapy, anxiety therapy and relationship therapy are still needed throughout the country. If you’d like to find a therapist here in New York City, please contact the Psychoanalytic Psychotherapy Study Center today.