Life is Not a Mental Disorder

The Bible (or really any religious text) can be made to say and mean anything the author wishes.

The "Bible" of psychiatry, that fabled and hoary text, the DSM-IV-TR (Diagnostic Statistical Manual of Mental Disorders written by the American Psychiatric Association), is no different. Conceived as an instrument to identify and help heal disorders of the mind, it has morphed as to both form and function. Too often, psychiatrists wield the DSM-IV-TR like a blunt instrument, desperate in their drive to assign names to supposed "mental conditions" and thus to be able to assign numbers to these "conditions." Discover a new widely inclusive "condition," give it a name and number and you have a winner: One more brick in the wall of sicknesses.

DSM-IV-TR is very large book. We have lots of diagnoses, the number rapidly growing. We need lots of page room. Aside from blank pages, Chapter Heading Pages, and long lists of Contributors, etc., DSM-IV-TR is chuck full of diagnoses, with detailed descriptions and code numbers for each diagnosis. This book is 952 pages long. It weighs 4.8 pounds.

There is an odd situation in DSM-IV-TR. Really odd. In its entirety, all 952 pages, there is no "No Disorder" option. Therefore, everyone is seen by DSM-IV-TR as sick, the only question being from which sickness(es) they suffer. The annual physical checkup many of us get, usually, unless there is something wrong, ends with "everything is fine." This, apparently, doesn't exist in mental health.

I have always felt that I was a crummy writer, starting from college and thereafter (including medical school, internship, National Institute of Mental Health, Psychiatric Residency). However, in writing this poorly written piece, while trudging through DSM-IV-TR, I found 315.2 - "Disorder of Written Expression." It was an AH-HA moment. I may be a crummy writer, but it's because I have a disease. Criteria, according to DSM-IV-TR, for this disease (315.2) are 3:

• a) Writing skills below those expected given the person's chronological age, measured intelligence and age appropriate education;
• b) The disturbance in criterion A significantly interferes with academic achievement or activities of daily living that require the composition of written texts (e.g, writing grammatically correct sentences and organized paragraphs);
• c) If a sensory deficit is present, the difficulties in writing skills are in excesses of those usually associated with it.

Had I been told that I had Disorder of Written Expression (315.2), I would have been talking to psychiatrists. I have been seeking help from the wrong people -- friends, teachers, editors, other writers, newspaper columnists, professors, etc.

Well, I hadn't talked to the right people. I've pretty much thrown in the towel on this writing thing. Given up. This writing is so bad, I'm not even writing this article, because I can't. My writing partner, Dr. Nicolino, does not have "Disorders of Written Expression" (315.2). I tricked her into partnering with me. There's a diagnosis for "tricking a good writer to pair with a crummy writer," but I don't have the time to look through DSM-IV-TR to find it and its code, and besides, co-factors of "Disorders of Written Expression" (315.2), are "Reading Disorder" (315.oo) and "Mathematics Disorder" (315.5), all three of which will make it hard or impossible to find the code for "tricking a good writer." Actually, I'm blind lucky to have found "Disorders of Written Expression" (315.2) in the first place because of my other disabilities. It's clear that I've turned sociopath. There is a fancy-named diagnosis, with a number for that too. For the same reasons, I'm not going to look for those.

We have a diagnosis for everything and every body. I have heard people, thought to be treehugging new agers, who think that medicine is directed to illness not health. They have an excellent point. We don't aim to make people healthy or even allow as to how they may be healthy, but we call them sick.

The above, laughter aside, is all too pathetically accurate. There really is no place in DSM-IV-TR for "no psychiatric problem." If one wanted to push the case, the absence of the chance to be wrong invalidates all of DSM-IV-TR. Any scientific experiment has to have the chance to be wrong in order to have the chance to be right. I can't be just a crummy writer, but have to have a disease, label and numbered.

Crummy writing is not a mental disorder and neither is life.

 

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Comments

[TurboKitty]

09:27 PM on 07/24/2010

Interestingly enough I have a medical/psych diagnosis noted in my regular health chart by my GP and it reads as follows: Patient is "Unipolor" ie; always happy/severe allergies to Sulfa drugs ... on an added note, I was a Liberal Arts major in college going to pursue a degree in psychology ... I gave that up after two major life changing "a-ha" moments of my own ... first I noticed that almost everyone in my psych classes were looking to cure themselves (can you imagine how many degree-ed people out there have severe mental health issues of their own, treating Joe or Josephine Q Public?), second, after having noticed that, I went to the career assessment counselor and took the career assessment test ... come to find out that the trade I had chosen for myself was exactly what I ought to be doing ... according to the test results anyway ... btw, my mother was an English teacher ... notice my crummy writing skills (insert wink) ...

[Gena Kyllo]

08:38 PM on 07/18/2010

I worked as a nurse for a loooong time, some would say too long. I recall when we first began using codes, as I worked in ER at the time and we were the only nurses who had to code. Actually I was pretty fascinated by it, having been one of those kids who would read the dictionary. What I noticed before long was that many procedures were listed under different titles, with different codes and therefore different values. An example I recall is that lumbar puncture and spinal tap were listed with different codes. They're the same procedure - same equipment, same supplies, same length of time ... but the L.P. was reimbursed at a much higher rate than that tacky old spinal tap! I brought it to the attention of someone in the business office and they weren't at all interested. Their brain didn't kick in until they received the paperwork that had to accompany the patient files to their offices. In any case, the purpose of this over-long tale is to say that in addition to not having a "no diagnosis" code, the coding Bible no doubt has a ton of stuff just like that. And the savyy coder will know that.

[Joseph A Silva]

07:56 PM on 07/15/2010

The main problem of the Manual is that it is designed to grow increasingly large as we find ever increasing excuses to classify the mundane into the unique. What was once poor writing has been shown as a mental disorder because our culture expects that everyone be a victim of someone or something that they themselves can not control or prevent. Instead of smacking a kid on the head for being a jerk to other kids...he/she has SAD and must be excused. Fault must be placed on society (for its desire to turn everything into a social welfare case) and the individuals who are forced to constantly publish in order to keep their jobs in their professions. This creates the incentive of relabeling normal everyday things and cases into the extraordinary. Remember that no one is a secretary, they are all now 'administrative assistants'. There are no 'chefs, janitors, or repairmen'..being replaced by 'culinary artists, biohazard disposal specialists, and multidisciplinary redevelopment coordinators' ... When people stop looking for an excuse as to why they suck, when people stop trying to appear to be what they are not is when our nation of adults posing as kids will actually start fixing the problems that are real and not make believe. We do these things cause it is easier to label a bad writer as disabled then it is to tell them to take a blasted writing lesson!

[Ronald Ricker]

05:30 PM on 07/26/2010

Excellent. I have found other reasons why I suck. My wife recommends I keep them secret, since some of them aren't yet in DSM IV. She says I deserve at least a modicum of self-respect and doesn't want these to end up in DSM IV since it will be easy to hook those new diagnoses with me. Besides, she says if I end up with more than 12, (I'm at 9 now), she's going to kiss me off, which will also be a DSM IV diagnosis. Thanks again for your comment. And you do write very well, which will also become a DSM IV diagnosis once I tell them about you.

[Luis Orellana]

05:28 AM on 07/15/2010

Those who do not understand your tongue in cheek commentary are the ones that actually fit the "Diagnostic Statistical Manual of Mental Disorders" and perhaps need heavy medication of some sort. Is there a pill for humor? Maybe that's what they are lacking in their lives. Can we come up with one and patent it? Or is that what we simply call intelligence?

Laughing out loud!

Luis Orellana

[Ronald Ricker]

07:03 PM on 07/26/2010

Thank you for your comment. I am late getting back to you, DSM IV Lateness, severe 8193.4. As for the heavy medication, that goes without saying. saying, without DSM IV 3567.5. Humor, sense of, is not a DSM IV diagnosis. Unless it is excessive, which is a diagnosis, which can fit into a number of categories. Humor, histrionic, severe 5556.7. For people to find out what they be lacking in their lives, DSM IV. DSM IV does diseases, not suggestions for betterment. Pills for humor----check with Rite Aid. Don't hold your breath. Intelligence----could you write more slowly.

[Tibbythecat]

09:00 PM on 07/14/2010

At what point do people start taking responsibility for themselves? Kids are being diagnosed with such "disorders" so they can take advantage of accommodations that must be made for these "difficulties". I guess the kids whose parents don't have the time or money to take them to be "examined" and "diagnosed" will just have to trudge through life, working as hard as they can.

[Ronald Ricker]

09:09 PM on 07/14/2010

Tibby You are always a bit of a rapscallion. Are you actually, I am sitting down, suggesting that some families get their kids diagnosed with ADHD, given Adderall, and then get double (that's right, Double) the amount of time to take tests and things like MSAT and GRE. I think they also get double time to answer natures calling. There are kids who really do have ADHD, require meds and accommodations. They are a drop in the bucket of those that neither have ADHD, need a stimulant drug, nor accommodations. I think I'm a trudger like you.

[Tibbythecat]

09:32 PM on 07/14/2010

I agree that there are people who have ADHD and that there is much abuse. But isn't there a point when you say, "okay I need to learn to do things for myself. I need to devise and implement some coping skills to help me do what I have to do." Your boss is not going to give you extra time to get your job done because you have ADHD or Written Expression Disorder.

[BareheadedWoman]

03:33 PM on 07/14/2010

Per a side comment below, the psyche community simply MUST review this increased DSM in the light of the current recession. Yes, it is good that the more illnesses we know, the more specialists we need, the more college graduates we can employ, the more degrees we create, the more professors we can hire, the more buildings we can build, the more construction workers we can employ, who can contract more administrative and legal help, who can outsource more specialized labor. import more resources, and buy toys...that holds up the house the Jack built.

However, the flip side that you are making is simply not "profitable". Unless, as you say, we start valuing "being and staying healthy" as a starting-point specialty. It seems as if the public ship is trying to turn that way (holistic medicine, yoga, spas, organic living etc etc) but our leaders, including those in the psyche community--which we need more advocates of a healthier path like you--are resisting conceding the old business model for the new. For now, it seems bent on convincing us all that we are sick and need this type of economically supported care (that whole wall street, legal banking thing not working out; HEALTH CARE, yeah, that's the ticket...).

It all comes back to the money...as much as people of a "care for" nature are loathe to admit, and it takes work to change an allegedly working paradigm top down.

[pooka47401]

10:56 AM on 07/14/2010

If I was a child in this era, I am sure that I would have been placed in some sort of Special Ed. I barely passed all of my grades, from first grade till 12th grade. I was labeled an Under Achiever. I was also a "Book Worm". I hated school and could not learn in it. Yet, when I took the Senior Test in Florida, which measured what you had learned, I was in the upper 1% of all Florida 12th graders. I, then, barely passed my way through 10 yrs of College. I have a "genius IQ". I don't think or learn like most people. But is that wrong?? Creativity is a diagnosis in the DSM also I bet....

Our Society progresses because there are those who "think outside the box". Perhaps there are those who want to drug kids who are different, kids who have a high energy level and require more attention, but that does not make it a Sane idea. Conformity of it's Citizens is not necessarily a good thing for Society, despite what the Drug Industry and Educational systems think.

[Ronald Ricker]

08:55 PM on 07/14/2010

Hi Pooka One of the things we have to expect out of good physicians is that they are able to 'think outside the box'. Often, unfortunately, this resource is hard to find. Although your comment is not specifically on point regards our article, you raise two issues that I think are particularly interesting. Let us imagine, which certainly, to put it mildly, occurs that you speak with an 'inside the box' Psychiatrist. In some of our minds he or she will already distinguished themselves as 'far behinders' in the, 'there really must be a creative and imaginative world', in the field of Psychiatry. Then, sadly, our unimaginative psychiatrist, armed with DSM-IV, will deal out what the totally non-creative DSM-IV has to offer. You, my friend, would have gotten what you describe, irrespective that it may have nothing to do with you as an individual. (paragraph1) I don't no much to say about your paragraph 2, except that it is obviously true. Suffice it to say that it is far easier to write a script than to have to think. Please check another of our blogs http://www.huffingtonpost.com/ronald-ricker/mental-health-psychiatric_b_559263.html Thanks for your comment

[cjsamms]

10:41 AM on 07/14/2010

I guess you touched a raw nerve. Yes, there are people with serious mental disorders. Yes, the DSM provides the necessary codes for us to obtain health insurance reimbursements. Yes, many mentally ill people went undiagnosed because they didn't fit into the strict definitions of mental disorders. And, yes, it's no joke for those who experience mental health issues and had their claims denied.

But I tend to agree with the author that the pendulum has definitely swung to the opposite extreme. Things most of us experience every day as just part of life can now be classified as "disorders" under the DSM guidelines. So much so, that a few years ago, there was an academic scandal over too many middle income student-athletes taking untimed SATs after being diagnosed with ADD or ADHD so they could qualify for college scholarships.

I certainly don't want to return to the dark ages of mental health care. But I think we might have gone too far when ordinary conditions started being treated as disorders.

[Ronald Ricker]

02:21 PM on 07/14/2010

Thank you for your comment. You write beautifully and your thinking, in my opinion is very clear and apt. Obviously I couldn't agree more with your last statement. The problem highlighted in this blog, unfortunately, merely scratches the surface. Having written it, we both plus other contributors find ourselves thinking more and more deeply about this and other related problems. One, for example, is this: if one serves in Iraw and returns upset or disorganized, etc, the army woiuld require that he be diagnosed as PTSD in order to qualify for treatment. 'Treatment' may be correct, but for the sake of discussion, what this soldier needs is discussion, re-orientation, he will still be call PTSD. His limit is 20 meetings. If he needs longer ;discussions', for the army to continue to support his treatment, his 'diagnosis' will have to be changed to a 'parity' diagnosis, to have those additional meetings---eg Major Depression. So we have the bizarre situation of a man serving in Iraq and coming home to two psychiatric diagnoses. What do you think?

[BareheadedWoman]

02:54 PM on 07/14/2010

Not so bizarre; it keeps the mental dependence circle going. You think you're finished with your duty? But you are sick...you cannot be reintegrated into society without our help...only we understand you...sign up again...only attached to the military will you ever feel whole again....

Cannon fodder becomes military-industrial-pharma-mincemeat. Who do you think they first test things with? (No permission, just orders). Think of all the mediocre psyches who will be adjuncts of the system? VA medicos are not usually enlisted (or at the head of their pack). On the other hand, just think of the enlistment opportunites offered to cover Gen Ys psyche grads--four years of loans traded for four years of couch service...a War? Grab a gun, doc.

Just get the boys and girls level headed enough to obey orders overseas or ensconced in the proletariat guard at home. Otherwise, it's the glue factory.

I've watched my grandfather, WWII vet, get the run around by the VA for 20 years now...but no, the USA can do no wrong, and will still maintain the country does everything it can for its men. Bah. No problem with having a warrior class; BIG problems with what the Feds do with it.

[BareheadedWoman]

03:15 PM on 07/14/2010

just a side note:

About PSTD per se, that's been my hobby horse for vets since a college-out liberal (in a bad way) high school teacher gave me an F on an important presentation (and very well done if I may say so myself) on "anything" having to do with the Vietnam war (this was 80s). I did a full-on presentation (graphs 'n pictures 'n everything!) about emerging PSTD as a factor of the war and got an F for doing a paper on something that didn't exist. Everyone knew it was "guilt" for the "bad things" the soldier had done...it was mind-boggling to my then 17 year old mind. Some current attitudes both within and out of the psyche and military community still are.

[nikanj]

11:55 PM on 07/13/2010

Please don't label yourself as a sociopath.

If you have ever encountered a true sociopath, you would never voluntarily call yourself such.
Sociopathy is a truly horrible disorder, which can be transmitted not only genetically but also
through other means, specifically through the medium of sexual abuse of young people by an
adult sociopath. Sexual abuse is a way for the sociopath to 'download' itself into a new body.

[Ronald Ricker]

12:36 AM on 07/14/2010

Thanks for your comment. Sorry to be upsetting. Sociopathy doesn't even appear in DSM IV. What was the ordinary usage of the term in the past was not what you describe now. Further, please try to remember there is a definite tongue in cheek element in this blog. Best.

[alcatraz310]

08:54 PM on 07/13/2010

From another mother of an LD child. My child tested at the 99th percentile for intelligence, 3rd percentile for visual processing speed, wants to be an authour and has written three books to date. Oddly enough the diagnosis does little to help - he gets help from his "friends, teachers, editors, other writers, newspaper columnists, professors, etc." Just like people did 60 years ago before this tome was created. If there is "no disorder" - you don't need the book or the doctor

[Ronald Ricker]

10:30 PM on 07/13/2010

Thank you for your comment. I think you may have misunderstood slightly our point. We are not saying that the DSM-IV is of no use, but that is written in such a way that 'no diagnosis' is not a possibility. We don't think that the DSM-IV should be discarded or that doctors dismissed. Our congratulations to your son. Perhaps he can help with with my writing problems.

[janisa]

07:21 PM on 07/13/2010

It is shameful that a diagnosis code is needed for reimbursement. there are plenty of people seen with no psychiatric diagnosis. however, the problem is made by insurance and not a fundamental problem with the dsm (though obviously far from perfect for myriad other reasons). but i think finding a somewhat obscure diagnosis that you don't fit the criteria for (i hardly believe you meet criterion b...) is somewhat hyperbolic and instills more fear and distrust than is necessary.

[Ronald Ricker]

10:38 PM on 07/13/2010

Thank you for your comment. Insurance Co. influence is certainly part of the problem. A much bigger part of the problem is the American who caves to this pressure or actually believes, according to DSM, that there truly is 'no diagnosis'.

[maattwo]

05:38 PM on 07/13/2010

Straw people are so easy to knock down. The DSM is largely designed to allow therapists to get reimbursed by insurance companies, just as medical codes are used by physicians. If you think your poor writing is due to a treatable sensory problem that is causing you to have substantial problems in functioning and you want to get help from your insurance company in trying to get treatment, having a DSM code is essential. As the mother of a special needs child, I get sick and tired of healthy people whining about the DSM.

[Ronald Ricker]

10:55 AM on 07/14/2010

you miss our point, also the sense of humor, albeit tongue in cheek. The very asset you cite and has apparently been helpful for your son, is distinctly unhelpful to many others. When the only choice one has is to make a diagnosis, even though there is none, that presents a huge problem. I don't want to have to diagnose healthy as sick. Also, I don't want to be dictated to as to the choices I have to diagnose people and children who are ill. Illnesses change and therefore diagnoses change and there should and must be the flexibility for physicians to make reasonable changes, Trust me, the DSM in the hands of some insurance companies can distinctly harm the care of many patients. Thank you for your comment. I'd like to hear more from you, if have the time. Write back.