The Latest DSM

The latest DSM manual will now assert that grieving the death of a loved one is a dysfunctional condition that calls for treatment.

As in, paid for by your benefit plan.

Your therapist will almost certainly prescribe a drug. In my opinion, what the drug does is not all that different from what marijuana or cocaine or methamphetamine does. The difference is all in the packaging, including the “therapist” and the doctor and the pharmacist, the rigid doses and schedule, and everyone soberly declaring that this substance can correct some kind of deficiency in your brain cells which is the cause of your unhappiness. Except that death is not a chemical deficiency, so we have an unusually naked moment here: hell, let’s just call a spade a spade: people who are sad should do drugs.

If you packaged marijuana in the same way, you could convince just as many people that this is some kind of impressive therapy that addresses a real medical condition. Exact dosages, on a schedule, with monitoring. The difference is, marijuana would not have as many side effects and would not be nearly as expensive. The difference is that marijuana is not patented.

There, done. While we’re at it, children who have discovered that school work is “work” should do drugs. Every teenage girl in the country who worries about how she looks should do drugs. Every mother who wishes she could put her feet up and watch tv all day while strange men fall over themselves to buy her gifts should do drugs. Every businessman who thinks the competition is competition should do drugs. Every liar should do drugs.

As you read the previous paragraph did you think of the fact that, for all practical purpose, they are all doing drugs, with nice names and prescriptions.

I have my own suggestion: every executive at every pharmaceutical company should do drugs, just as every congressman should go through the long lineups at the airports and every congressman’s firstborn child, male or female, straight or gay, should enlist.

And every Ayatollah who believes in the Intifada should be the first to strap on that explosive belt. Lead the way!

You are Insane

According to two studies, the National Institute of Mental Health Epidemiologic Catchment Area Program (1980-85), and the National Co-morbidity Survey (1990-92), about 30% of all Americans will experience mental or addictive disorders in a given year and 50% will need mental health services in their lifetimes.

According to the February issue of The Archives of General Psychiatry, those numbers are too high. What a relief to find that out! The “correct” number of people who experience mental or addictive disorders in a given year should be about 18.5%. I didn’t see a corrected number for the second piece of data.

So if you ever thought that most people are nuts, you’re not too far off. The professionals agree with you.

Makes me wonder what would happen if the plumbers did a study showing that 50% of all homes need some plumbing. Would you rush out and hire a plumber to come in to check your house to see if it was one of the 50%? How likely do you think it would be that your house, indeed, was one of the needy homes, if you asked a plumber to check it?

Some car repair shops urge you to come in for free brake inspections. You bite. You bring your car in and wait twenty minutes while a repairman inspects your car. The repairman should probably be working on someone else’s vehicle up there on another lift, but he stops his work to look at your car. The impatient owner of the other car is reading three-month-old newsmagazines and drinking stale coffee in the waiting room. But they already have his car on the lift, so you get priority. Now imagine, if you can, that the mechanic comes back into the office and walks up to you and says, “everything looks hunky-dory down there.” Right.

Now you may believe that unlike car repair shops, psychologists and social workers aren’t after your money. They work in those professions because they want to help people. Right. And pop stars are in it for the love of music. And politicians because people begged them to lead. And lawyers because they love justice. I’m not saying they’re not. Necessarily. Just that their perspectives on the necessity of their professions might be influenced every so slightly by their pecuniary interests.

But psychologists, psychiatrists, and social workers are not plumbers. They do not work with fixed physical properties of objects. They work with your mind. They would like to believe that theirs is a “science”, beyond argument, and demonstrable with evidence and proofs. The assumption is that personal spiritual or philosophical values are secondary to the eternal and scientifically grounded principles of psychology and sociology. You can be manipulated. Fixed.

If about 20% of the population really does have a disorder, you would think that someone would realize that there is a serious problem in our society that needs to be fixed. There are too many casualties. If 20% of all airplane trips crashed or 20% of all ships sank, you can bet that all travel would be suspended until the problem was found out and solved.

The other possibility, of course, is that 80% of our society is nuts and 20% fully comprehend our predicament. Our predicament is that we have built a society that, in order to gratify the voracious appetites of the rich and powerful, has driven itself into a pathological system of destructive obsessive behaviors. The 20% understand that and have opted out and carry their belongings in shopping bags and fervently wish for a happy meal tomorrow. Beyond that, who knows?

The rest of us can just keep taking our medications.

Selling the New Drug

How do the drug companies persuade doctors to prescribe their drugs? Well one company, Purdue, held over 7,000 seminars last year to “inform” doctors about “pain management”, which, of course, consists of prescribing its particularly powerful drug called “Oxycontin”. Why do the doctors go to these seminars? How about free weekend travel and hotel accommodations, to Florida and other lovely locales? (In December, United States attorneys in Maine, persuaded Purdue to stop paying for the doctor’s travel expenses to these seminars and it agreed do so.)

A spokesperson for Eli Lilly said that the company asked women and physicians about a treatment for PMDD and they told Eli Lilly that they wanted a drug with it’s own identity for this special problem. I’ll bet the same focus group told them they wanted to squander $100 a month on medicines that treat imaginary illnesses.

David Rubinow, Clinical Director of the National Institute of Mental Health, says “there is a very high degree of false positive self-assessments– women assume they are suffering from PMS or PMDD when, in fact, they are not.” If you were an investor, would you bet on that dynamic? I would.

Interesting side-effect: if Eli Lilly prevails– you can bet they are using all their influence to get “studies” that show that PMDD really exists– we will soon see court cases in which a woman claims that she shop-lifted or drove too fast or neglected a child, because of PMDD. The court will then hear that Americans spend more than $1 billion a year on treatment for this “disease”, even if it isn’t listed as one in the DSM, and will be duly impressed and find the woman not-guilty, or award somebody a hundred million dollars in damages or whatever. Then Eli Lilly will point to the court cases and say, “see– even our courts recognize that PMDD exists!” Thus you have self-fulfilling prophecy.

The Diagnosis

It is so important to give it a label.

You feel tired. You are bored. You are frustrated. Maybe you’re also not very bright or ambitious. You don’t want to tell people you are tired and bored and frustrated and not very ambitious, because that would make it sound like it’s your own fault. So, instead, you have chronic fatigue syndrome.

Maybe your two-year-old is really active. He climbs up everything. He’s loud and noisy and eager and excitable. You find this annoying. But you can’t tell anyone that you find your own kid annoying or that you are too impatient to be a good parent, so, instead, you say that he has attention deficit disorder and pop some drugs into him to slow him down.  Sure, it takes away some of his energy and curiosity, but, hey, you have to get your sleep.

The diagnosis, in our society, is essential. We need that label. We need an identifier. We have to generate public belief in and enthusiasm for conditions that might be nebulous, vague, or invisible.

Why?

Well, almost every time you hear the diagnostic label being propounded, it’s by someone who makes his or her living treating it. This is why the bible of psychotherapy, the DSM III or IV or V or whatever it’s at now, always gets bigger and bigger. It never shrinks. They almost never remove “syndromes” from it. (It caused a bit of nudging and winking when they did finally remove homosexuality from their list of morbidities not all that long ago.)

And that’s why pharmaceutical companies are determined to get your kid into their slimy clutches. They are promoting the idea that a four-year-old who wont go to bed nicely when asked has some kind of mental disorder and needs to be drugged. Once your kid is used to those colorful little pills twelve times a day, they know he’ll never, ever again feel that he can handle life without some kind of narcotic assistance.  His “baseline” is obliterated.  Whatever he feels from now on will be partly due to the drugs and partly due to withdrawal from the drugs.  The perfecta of pharmaceutical self-sufficiency.

The magic of the diagnosis is clear. Some people will deny that feeling tired or frustrated or depressed is an illness. Some people might think its just part of life. You put up with it. You endure it, and get on with the things you have to do.

But it’s easy to convince people otherwise. If you have the proper label for something, people will assume that adequate research and scientific analysis has determined that this condition really exists. We trust doctors. They’ll assume that a doctor made the diagnosis, and everyone knows how smart doctors are. They’ll assume that everyone thinks it is a real condition because it has become part of the language. It becomes shorthand, to a lot of people, for complexities that are too hard to explain quickly.

When I was a lot younger, if I heard someone say something like, “he has attention deficit disorder”, I would just assume that there was such a thing as “attention deficit disorder”, and therefore we better do something about it. Now I’m a lot more skeptical, but I can remember how easy it was to accept sophisticated-sounding terms like that as if they referred to clear, objective realities.

When you look at the “symptoms” of chronic fatigue syndrome, you realize how utterly subjective and arbitrary labels can be. Tiredness. Depression. Loss of appetite. Headaches. Difficult to get up in the morning. And so on. Sounds like just about anyone’s rotten little life. Label it, and we can blame someone or something else. Label it, and we can talk multi-million dollar lawsuits. Label it and we can make a drug that fixes it. Then we are not “doing drugs”. We are doing “therapy”. We are taking the “wonder drugs”, Lithium and Prozac and Paxil, and whatever. It’s okay– we have to take these drugs: we have a condition.

The drugs, of course, don’t really fix anything. They give you a sustained high. It is one of the great myths of our society that drugs like Lithium and Prozac actually treat real conditions. That is utter nonsense. They simply make you feel good. But we have to believe in the myth, or else we would have to admit that we’re really not much better than your average drug addict or alcoholic.

Well, we’re not.

I heard some parents on the radio recently (the CBC) talking about their “hyper-active” child. The parents of this child were at their wits end. They didn’t know what to do. They went to the doctor. He prescribed Ritalin. They tried it. It worked! Hallelujah. However, their child just didn’t seem to be herself anymore. She lost her sense of insatiable curiosity. She lost her spark, her zest for life. They took her off Ritalin and tried different parenting techniques instead. From the details the father gave on the air, it was clear that he and his wife simply got better at parenting. They learned to anticipate when problems might occur. They planned ahead for family outings. They became more flexible and adaptable. Amazingly, the problems seemed to go away.

Was their child ever really “hyper-active”? If you read the definition of hyper-activity from the DSM, it is an amazingly accurate description of just about any two-year-old.

Beware of labels.

Update 2022-04-26

And I will concede that this will not a popular post.  I am regularly astounded at how many people I know are taking psychotropic drugs, and obviously I am very skeptical of their use.  I am wary of hurting people’s feelings.  But there is good reason to voice my dissent no matter how small a minority I represent.  We in danger, as a society, of building a world in which we continually anesthetize ourselves against our deepest anxieties.  We have good reason to be anxious: we are melting the ice caps.  We are promoting intolerance and bigotry.  We are more divided than ever before.  We should be anxious and the worst solution is to address our anxiety with palliatives.