A furor is obviously escalating as to who gets diagnosed for what, psychiatrically speaking. In particular, the New York Times on Jan. 25, 2012 had a front page article by Benedict Carey, entitled "Grief Could Join List of Disorders," which includes the current discussion of whether grief and its agony could and should be considered a part of depression and thus be funded by insurances for medical and therapeutic treatment.
It seems noteworthy that the anguish and utter despair which are often a part of bereftness do not currently qualify for insurance benefits unless they are part of a disorder. This means that in order to account for funding possibilities, the only way presently open is to further pathologize one more human condition which simply and not, at times requires professional care. Grief, like some other conditions of human stress to the max, requires professional intervention all the more when there is no context for family or friend supports. And few of us are equipped or encouraged to show care for raw emotions, leaving us all in need for help with our resilience in the face of deep feeling in general.
But just as important is the fact that we live in a society which at present exacerbates the pressures on people of all ages to perform according to standards which are often arbitrary. That means that aside from issues of grief and disappointment that are part of any life's journey, we have all kinds of "disorders" coming from a twisted mentality that puts performance above a child's unique learning styles and emotional needs. Thereby we can "treat" depressed kids, or bullies for that matter (Hmm, what does the psychiatric diagnosis need to be there?), or not, but rarely if ever do we take a look at how culturally we may be causing some of the conditions we are diagnosing.
Under the present system of diagnosis, as the article states, "... a depression diagnosis requires that a person have five of nine symptoms -- which include sleeping problems, a feeling of worthlessness, and a loss of concentration -- for two weeks or more." Now, this isn't meant to be a critique of the article or of the studies or of the bickering and money issues involved in diagnosis, but rather to raise a question about just who diagnoses whom in our nation and beyond. For instance, those of us involved in mental health know that psychopathic people, who are known for their lack of guilt combined with opportunistic and/or compulsive antisocial actions, are notorious for not seeking out mental health. Hey, this might be a warning sign.
For the purpose of this piece, my question is about when we who are in one aspect of the mental health field might come to demand attention be paid to the sick elements in our society at large. What would happen if we face, not only issues of depression and even grief and the more serious illnesses of people who most frequently seek help, but also the more conditions and people more subtle and less amenable to asking for and accepting any care at all? What about the leaders in our nation who have too little guilt, and who perpetuate a system whereby grandiosity wins the day? And what about the additional fact that religious beliefs are preempting scientific evidence for so many of our people?
What about the mental health practitioners who seem loathe to speak out about the illness and illness-promoting mechanisms of a society that shuns people who speak authentically about how much pressure is too much and leaves us feeling we are the failures? What if mental health practitioners as a group have been, and I have to include myself because of my own inactivity on the subject for years, negligent and even abusive in continuing in a system which diagnoses many people who are suffering because of injustices done them? What do we say about a system that has left many veterans with shabby doses of care (see "Body of War," I beseech you), and many employees fired with a dose of positive psychology which tells them to make lemonade out of really bad lemons?
When would it be time to discuss in conferences and out loud that our society is suffering from deficiencies in self-worth and fluency in metabolizing emotion in general -- both of which are part of a foundation of resiliency that can face a real examination of our actions and some of the mistakes we have made? If we say that health includes learning from history and mourning mistakes and missed opportunities, when do we as a people get an apology for a war into which we were seduced by lies? And when do we as mental health practitioners become advocates of health, and become healthy enough to stand for what we imagine ourselves standing for?
Actually, among the most primitive defenses are denial and projection, denial in terms of avoidance and making believe things are not the way they are, and projection in terms of taking our own feelings we hate and fear and putting them on others to blame and blame and blame. I would put forth that it might be time to stop the bickering about who has got enough pathology to deserve care, and to focus on just how much care we need as a society at large. There are too many people feeling crazy because there is so little validation for vulnerability, honesty, sensitivity, clarity and -- well actually, sanity.