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Opening Arguments

Silly and dangerous

If the bible your profession goes by is "silly" and "worrying and dangerous," how valuable is the service you provide?

Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and mental health experts said its new categories and "tick-box" diagnosis systems were at best "silly" and at worst "worrying and dangerous."

Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medicalising behaviors most people would consider normal or just mildly eccentric, the experts said.

At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like "paraphilic coercive disorder" - and may allow offenders to escape prison by providing what could be seen as an excuse for their behavior, they added.

If everybody is crazy, nobody is, you know? It's hard to say which is worse in the long run, the silly (treating personality quirks as mental illness) or the worrying and dangerous (giving criminal monsters an excuse), but the overall effect of both is a trivialization of something we can't really afford to trivialize. I've had some people in my life who've had to deal with profound mental illness, and it's one of the toughest rows to hoe there is. The last thing in the world they need is anything "devaluing the seriousness of mental illness." They already have too much trouble getting people around them to understand and accept what's happening to them.

And don't forget:

Psychiatry is still a very soft science (or still an art, however you prefer), but at least they now treat those with mental illness as people.


Harl Delos
Fri, 02/10/2012 - 4:03pm

I read through the DSM-III aboout 30 years ago, and reported to a therapist that I apparently had every disease in the book.  He just nodded and laughed.  That's true of everybody, he said; the DSM is primarily a handbook for getting paid.  Mental illness is nor behavior that's different than normal, so much as it's exaggerated.  When your behaviors are suffucuently unbalanced to make it impossible for you to cope, you're mentally ill. The DSM is more a dictionary for the trade so that everybody uses  the same lingo. 

ODD really does exist.  And when they wiped out Multiple Personality Disorder and replaced it with Dissociative Identity Disorder, it just meant that they understood the problem better; dissociation ("lost time") is a major symptom.  And yet, normal people dissociate; it's called "daydreaming" when it isn't a major problem.

The field would be highly frustrating for an individual like me, who likes sharp lines between OK and not-OK.

He said that in decades of work, he'd noticed only one bright line.  If someone said, "Nonsense, that was how I was raised, and it didn't hurt me none!", it was a guarantee that they were severely damaged.

Sat, 02/11/2012 - 11:18pm

Obviously, every quirk could be, arguably, defined as a mental disorder. And the result, as you pointed out, would be to make us all crazy by definition.

Part of it, it seems to me, is motivated by the understandable desire to remove the stigma of immorality or lack of self-control from harmless sexual and behavioral deviations.

Maybe we shouldn't define a behavior as pathological unless it actually hurts someone else, and we have a treatment for it that actually works.

Harl Delos
Sun, 02/12/2012 - 10:58am

Alzheimer's is a pathology, although it only harms the individual.

The common cold is a pathology, although we can't do anything about it. 

There is a tendency to medicalize what we disapprove of. Joe ignores Leviticus when it comes to gay sex?  We must treat him!  Leo's beard is neatly trimmed instead of being shaggy?  That violates Leviticus as well; should we have him involuntarily committed to an asylum for the morbidly well-groomed?

The advantages of medicalizing a behavior or condition is that we aren't viewed as being meanyheads; instead, our bigotry is considered compassionate.  Besides, maybe we can get the people we're bigoted against to pay for our bigotry! 

I can sympathize with those who need ritalin or caffeine or dexedrine in order to focus, but I've also seen normal kids medicated into passivity by those who don't want to bother with a kid who's all boy.  We need to have a certain number of goats, not just sheep, for society to progress.

Wed, 02/15/2012 - 3:13pm

Harl, Alzheimer's certainly is a pathology (my mother is dying from it), but it isn't a behavior. But Leo's beard is clearly a crime. (Just shaved mine off - I'm vain: it's the only place my hair has turned white!)

Harl Delos
Wed, 02/15/2012 - 4:24pm

Hair turn gray or disapprears because or poor circulation.  If your chin is gray, that means your chin uses its blood supply for yapping, and your beard is starved.  If your scalp is dark, the gray matter is demanding no blood, so there's plenty for your hair.

I talk a lot and eat a lot, so my beard is gray.  I think a lot so my scalp is not only gray, but thinning as well.  And looking at ditry pichurs of familiar female names, there's rarely pubic hair to be seen.  It appears that my wife isn't having sex with anyone.

Leo Morris
Wed, 02/15/2012 - 4:24pm

Yeah, but just a misdemeanor. My vanishing hairline is the felony.