Thursday, February 16, 2012

New DSM-5...like PAC-MAN...gobbling all experience into illness

Editorial, Globe and Mail, February 13, 2012
A revision of an influential diagnostic manual plans to categorize a wide range of apparently everyday behaviours as mental health disorders, causing considerable controversy in the psychiatric community. This edition, known as the Diagnostic and Statistical Manual-5, makes formal diagnoses for shyness and temper tantrums in children, premenstrual irritability; loneliness; Internet addiction; and neuro-cognitive loss in the elderly.

Giving labels to behaviours and feelings that are simply part of the human condition may do more harm than good. There is a danger in viewing persistent insolence in six-year-olds, or a grandmother’s forgetfulness, in such a light. Not every severe emotion is a sign of mental disturbance.

The manual is not, however, meant to be used in isolation. While diagnostic criteria are an important and influential guide, they are only one component in understanding a patient’s experience. “The manual is not a cookbook to be used mechanically,” notes Dr. Susan Abbey, a past president of the Canadian Psychiatric Association. “You have to look at how impaired people are, and how much they are suffering.” Everyone reacts differently to stressful events such as the loss of a child, spouse or job. A good psychiatrist or psychologist assesses a patient over time to see whether their symptoms interfere with their ability to work and maintain relationships.
The manual, published by the American Psychiatric Association, may have more of a role to play in the U.S., where the private health-care system requires a diagnosis in order for the patient to receive treatment and qualify for reimbursement by their health insurer. It will be officially launched in May, 2013.
"Looking for business in all the wrong places" would be another way to characterize this exercise. Growing the family business, without really learning more about the clients' needs might be another. There used to be a little icon that gobbled up everything in sight when computers were infants. He was called "Pac-Man" and he was literally insatiable. the DSM-5 is the American Psychiatric Association's answer to Pac-Man, prompted by the private insurance industry's insatiable need for a scientific diagnosis before they will pay for care.
And then the political class debates whether the government or the doctors are in charge of health care....when really it is the insurance companies.
And the doctors keep dancing, because they want to be paid for their services.
Soon, there will be no piece of human behaviour or emotions, thought or even figment of the imagination that will not be included in the DSM-#10 and neither the doctors nor the patients will be better off.
Surely, common sense tells us that any specific act, thought, feeling or intuition, in the right circumstances for the appropriate length of time might constitute a "problem" or even an illness. However, suggesting that normal grief, for example, be included as an illness does neither the psychiatric profession nor the grieving person any real service.
Professional psychiatric treatment depends on a core of principles learning, practiced, studied, reflected upon and "ingested" as part of one's being, by the incipient practitioner. It requires a sensibility and a sensitivity that escapes most of us. And it's accomplishment must never be trivialized.
However, it is also a profession that has, for many people, become a crutch enabling them to take time off work, or stay in bed for extended periods, or find the right prescription to "take the edge off my anxiety" or any other number of symptoms whose reality makes their lives a little unpleasant. And rather than confront why they might be experiencing these symptoms, and acknowledging their own participation in the dynamic, conscious or unconscious, they seek "treatment."
Unfortunately, also, those psychiatric practitioners have only the evidence presented in their sessions to deal with. They cannot, they must not, mention other "symptoms" put forward by a partner or a spouse, a parent or a child, of the client in the room. Consequently, there is a client-enforced parameter to the discussion, through which the practitioner can break, only with the client's agreement.
It is James Hillman*, recently deceased, who told us that through the examination of one's whole biography, one's time line, and a complete rendition of its complexities will we reach some reasonable kind of understanding of who we are, and how we might find some clarity about those things, thoughts beliefs, attitudes, feelings and even actions that disturb us. He was convinced, and said so, that the professional practitioners of psychology and psychiatry had moved too far into diagnoses and pharmaceutical interventions, in order to preserve and enhance their professional standing, credibility and endurance. Clearly, he thought and believed that those moves were not necessarily in the best interests of their patients/clients.
Telling our story, in its entirety, is an arduous task that takes courage, persistence (because we do not recall everything in one sitting) and compassion. And it will bring up pieces of memory that have been stored deep in the cavern of our mind/body, as well as brain, because it was too painful to deal with when the incident occurred. And whether there is a specific diagnosis for our specific experience, or not, there is a release, a freeing and a potential "healing" in the simple opportunity to re-tell, to reclaim the truth of who we are, were, were seen by others inappropriately and potentially abused by others.
Many of these stories constitute our literature, and our mythology and eventually our culture and for most people, the retelling does not include a professional psychiatrist, nor a list of prescriptions. And that is as it should be. And the sooner we come to "open up" to our intimate family members, when they are ready and willing to listen to our truth, no matter how painful, the sooner we will be able to depend less on the professional class and more on our own safe and sacred circle.
And then neither the insurance companies, nor the psychiatric profession will have any place in our healthy development to full maturity, save and except those "acting out" moments when we crossed some line of authority or respectability, and need a short-term "ear" (as an arm) to help us across that street.
Perhaps we need to read and listen to some of our great poets, instead of seeking professional treatment:

"Our only health is the disease
If we obey the dying nurse
Whose constant care is not to please
But to remind of our, and Adam's curse,
And that, to be restored, our sickness must grow worse.

The whole earth is our hospital
Endowed by the ruined millionaire
Wherein, if we do well, we shall
Die of the absolute paternal care
That will not leave us, but prevents us everywhere." (127-128)

T.S. Eliot, The Complete Poems and Plays, 1900-1950

*The Acorn Centre and http://www.acorncentreblog.com/ take their name from Hillman's "The Acorn Theory"

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