Insult, Injury and Calling a Spade a Spade

This week the American Psychiatric Association announced its proposals for revising the most widely consulted guidebook for diagnosing mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). This revamped DSM-V, as it is known, will be used by clinicians and insurers to define the mental diseases of our age and treat the maladies that result from living in a speed-of-light society that can seem on the verge of unraveling at any minute due to economic upheaval, ferocious natural disaster or not getting your Twitter feed in a timely fashion.
Some relatively new disorders did not get the full treatment in DSM-V, for example, internet and gambling addiction (which often seem to go hand in hand, from my observation) did not make the manual. On the other hand, there are categories and full definitions for “binge eating disorder” and “temper dysregulation disorder with dysphoria,” which appear to be age-old problems gussied up for their walk down the red carpet of media attention. If you’re really interested in seeing the full glory of the DSM-V, http://www.dsm5.org/Pages/Default.aspx will provide the text along with the association’s methodology for developing criteria.
The debate over what’s treatable and what’s not, including the more difficult issue of who is sick and who is not, will be solved by revising the DSM, as worthy and effort that may be in and of itself. As someone who has close personal knowledge of autism -- my brother Brian has a pervasive developmental disorder, now to be renamed, “autism spectrum disorder” and will likely live with it the rest of our lives – I can attest to the fact that not having a definition for a condition can lead to disastrous consequences. The large and growing community of people dealing with children diagnosed with autism, Asperger’s syndrome and other such problems knows that when your kid or sibling doesn’t behave normally and that behavior impairs their ability to live a normal life, getting the right diagnosis is key to getting onto the road to recovery, or at least knowing what the hell you’re up against. Many critics of the DSM-V revision point to the explosion in autism and ADD (attention deficit disorder) diagnoses and the inevitable prescription and over-prescription of stimulants like Ritalin as the main reason we need to be careful when creating whole new classes of patients for the pharmaceutical industry. Once we have a name for something, famed t.v. shrink Lucy Van Pelt once said, we can treat it. I paraphrase Ms. Van Pelt, but you get my meaning. More importantly, once we have a name for something, we can give you a drug for it.
The insult and injury I referred to in the title have to do with the number of people who I know have been denied proper treatment or forced by the mental health bureaucracy into pharmacological labyrinths of trial and error, re-trial and more error simply because the doctors can only treat a problem with drugs and they can’t give you a drug until they can see the symptoms laid out in the DSM and match the symptom column with the prescription column.
Looming on the horizon are the millions of people who overate once a week for three months in a row and are now laid up with real diseases brought on by the side effects of the medications prescribed to solve their “binge eating disorder”. Or imagine the hordes of parents packing their pediatricians’ offices to get little Dylan and sweet Eudora fixed up from the anger outbursts that are, “grossly out of proportion in intensity or duration to the situation or provocation,” to quote the proposed DSM-V.
Another point to consider: think of all the college students who now use stimulants (again our old friend Ritalin drops in for a visit) on a regular basis to enhance their academic performance. Many of these kids who might have used good old-fashioned coffee to cram for midterms are getting their Ritalin from their younger siblings back home that have it coming out of their ears due to over-prescription. This has created a secondary black market for the stimulants in case you can’t get them prescribed, which isn’t likely and the new DSM-V will likely make easier. And even the green revolution has reason to worry. Our sewers and ground water are now so contaminated with pharmaceuticals we can’t boil the water long enough to get it clean.
People who love people with behavior disorders are not the only ones that need to be concerned about this creeping over-medicalization (not exactly a word, but again, you get my meaning). What used to be called “fat bastardism” or a simple temper tantrum might very soon be medical conditions worthy of paid time off from work, therapy, support groups and every modern medical/psychiatric intervention known to man. And if they haven’t found a cure for the disease yet, they’ll invent the disease and then cure it.
Americans in particular have only themselves to blame when it comes to the softening of our society, meaning that problems earlier generations dealt with as a matter of course we have to take pills and 12-step programs to get through. Depression-era hard times made a lot of people’s grandma cheap, but she didn’t have “post-recession disorder”. Someone who ate like a pig on Friday night and felt like crap on Saturday in the Seventies was a fat bastard, now they have a “binge-eating disorder”. Ridiculous on top of ridiculousness, but what isn’t funny is that if we stay true to form and the pharmaceutical industry stays true to its form, we’ll have a lot of internet-addicted, temper-dysphoriac binge-eaters at the helm of every bus, train and ship.
Maybe soon we’ll get a Standard Manual of Common Sense, and everyone can take two pages and not call their doctor in the morning.

© David Mark Speer, Brooklyn