Well, wow. The psychic landscape around here resembles the setting of Waiting for Godot – raw.
Or it’s like Mad Max – a Hobbesian war of all against all, played out on America’s busiest media highways, with desperate gangs (TheraPeuts, PsychíaCrips, DataDevils) truncheoning each other for the biggest piece of the pathology pie.
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Our depressed nation has long taken its orders from the Diagnostic and Statistical Manual of Mental Disorders; but the DSM has – like much of its clientele – grown mulish, morbidly obese… Even as each edition trumpets new and improved deficits, the high-tech, data-gathering world is passing it by.
So the DSM is in denial. Facing obsolescence and repudiation, its editors brightly inform us that it remains America’s go-to book for the blues.
But, you know, the bottom line isn’t about this approach or that approach to psychic disturbance. The bottom line is that more and more observers are simply disgusted at the massive numbers of people in this country who have been persuaded – by television commercials, by the DSM, by doctors – to think there’s something clinically wrong with them for which they have to take pills for years. (‘[S]ome pharmaceutical companies that have enriched themselves by selling psychiatric drugs are now cutting back on further research on mental illness. The ‘withdrawal’ of drug companies from psychiatry, Steven Hyman, a psychiatrist and neuroscientist at Harvard and former NIMH director, wrote last month, “reflects a widely shared view that the underlying science remains immature and that therapeutic development in psychiatry is simply too difficult and too risky.” Funny how this view isn’t incorporated into ads for antidepressants and antipsychotics.’) The DSM has helped to make a lucrative fetish of pseudo-debility in the American population, and as long as there’s money in it and a total absence of biomarkers, it will, it seems, keep doing that.
Even when we get somewhere with biomarkers it won’t make any difference. Do you think an absence of any discernible ground for mental illness will stop a person who has been taught by this culture to think of herself in that way? To think of all of life’s difficult passages as illnesses rather than difficult passages? “The struggle of psychiatry since 1980 has not been to fashion more and more illnesses, but rather to convince us that when we are unhappy, anxious, compulsive, etc., we have a mental illness. In this they have been successful, at least to judge from the vast increase in numbers of people seeking treatment. It’s a predictable outcome of the DSM approach to mental suffering.” The science can tell us what it likes; until we stop liking the image of ourselves as debilitatingly neurotic it won’t make any difference.
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Remember what Nietzsche said about the DSM.
“The DSM is a mobile army of metaphors, metonyms, anthropomorphisms, in short a sum of human relations which have been subjected to poetic and rhetorical intensification, translation and decoration … The DSM is an illusion of which we have forgotten that it is illusion, a set of metaphors which have become worn by frequent use and have lost all sensuous vigor… Yet we still do not know where the drive to produce DSMs comes from, for so far we have only heard about the obligation to have DSMs…”
May 8th, 2013 at 10:13PM
also couldn’t hurt to decouple health insurance from employment and well-being from fitness for employment.
May 9th, 2013 at 9:00AM
Old American saying: “Never ask a barber if you need a haircut.”
The current way in which the DSM is used seems basically to be giving a guild a high degree of control over the criteria to be used in determining if that guild’s services are required.
Imagine if we had government-subsidized haircuts and the government used a book of indicators developed by the barbers’ association to determine when the subsidies would be paid…
SYNDROME #43243: The patient smiled at an attractive person, and he/she did not smile back. This is an indicator that a haircut is required on an emergency basis, with regular follow-up.
May 9th, 2013 at 10:31AM
When will insurers stand up and call BS on this and simply refuse to pay? Does law require them to pay?
May 9th, 2013 at 11:34AM
Once upon a time, DSM diagnoses were also used to justify payment for talk therapy (says someone who was once given a diagnosis of “adjustment disorder” for exactly that reason. I was having trouble “adjusting” to a grad department experiencing internal chaos and a high rate of faculty departures, a job market that looked nothing like the one the Mellon folks had pictured when they gave me a fellowship a few years before, and a family of origin in turmoil. Calling my difficulty in coping with those issues a mental illness made about much sense as confusing normal grief with depression, but it got me the talk therapy, which was useful, at a price I could afford. It also made it very hard for me to get individual insurance a few years later, when I was an adjunct, and the COBRA option from my grad institution timed out. The result of that was that I didn’t seek medical help for actual, chemical depression — also situational, but I suspect that antidepressants and some more talk therapy would have made for a quicker recovery — a few years later).
Of course, it’s now hard to get talk therapy reimbursed even *with* a diagnosis, so scratch that justification for using the DSM.
May 9th, 2013 at 1:37PM
Hello Margaret!
How odd it is to be reading your blog at work, in a ward with 32 seriously ill psychiatric patients.
May 9th, 2013 at 2:49PM
“To think of all of life’s difficult passages as illnesses rather than difficult passages?”
Yes, the medicalization of normal human emotions is very dangerous. Short-circuiting a legitimate feeling of grief or anger will, I suspect, often turn out to have very bad consequences down the road.
Here’s an analogy. If an airplane gets too slow, the airflow over the wing will break down (“stall”) and the nose will drop sharply and alarmingly. Normal untutored human reaction is to pull the nose up, which is exactly the wrong thing to do. You must let it come down and recover airspeed, even if that means losing some altitude, or very bad things will happen.
Interestingly, in the wake of some recent disasters the FAA has determined that airline training has focused too exclusively on *preventing* stalls at the expense of focus on recovering from them if they do happen.
The person whose emotions have been overly medicalized is going to be somewhat like the pilot who has never experienced a stall, is unduly afraid of them, and will be totally disconcerted when one does happen.