Pathologizing Grief–Just For Starters: The DSM-5 and My Tripartite Expression of Displeasure, My Parting Words

Posted on April 9, 2012 by

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Your clergy, your doctor–and your portfolio manager.

Sounds like it has the makings for a cleaned-up version of an ethnic joke, I know, but it isn’t that. Instead, ask yourself: Who are the people in whom you want to have complete and un-sullied trust that they know what is right, in an absolute sense, and are actively pursuing it? Did I get anywhere near the top 3?

But let’s be real: A number of people either won’t believe in, or no longer fully trust, their clergy. And the portfolio managers? Even the people who actually have them know better than to put too much confidence in them nowadays. My bet’s on the doctors–as the group in whom most people retain a degree of faith, believing that doctors want what is good and right, for their patients, and for society at large.

[Maybe you, given your experience, personally wouldn't trust a doctor farther than you could throw him.  Good enough. But could you just buy into this premise for another few seconds, so I can complete the introduction? Then you're off the hook.]

That’s one of my theories as to why people are in such a kerfuffle about the upcoming publication (if it isn’t delayed for yet another year) of the Diagnostic and Statistical Manual of Mental Disorders 5 (or DSM-5). The DSM is published by the American Psychiatric Association, is often referred to as the ‘psychiatrists’ Bible,’ and provides standard nomenclature and criteria for classifying mental disorders.

Don’t you, for one, want to believe that the doctors in charge of determining who’s mentally ill and who’s, say, ‘normal,’ know precisely what they’re doing? I certainly do. Which is why I (and I’m in good company here) get alarmed when the arbiters of mental health seem to have stepped out of their roles as possessors of the final word on what is right and good for us all, and presented the world with some ideas that are–well, let me call them ‘perplexing.’

So, yes, as I went on about last post, I don’t think much of the DSM-5′s doing away with the ‘grief exclusion.’

And  I could have had my say and moved on. But there’s enough more just calling to me to speak out in the revision of the DSM-5,  that, really, it’s too much to expect me, human (and verbose) as I am, to let go without one, final, post. I offer you just a sample of ideas proposed at one point or another for inclusion in DSM-5 that have caused mental health consumers to really get their knickers in a twist.  You see what you make of them.

Particularly Perplexing Permutations Proffered by the new DSM-5 *

1) You just can’t stop reading my blog. Known to others–who haven’t yet had the privilege of exposure to my blog–as Internet Addiction, this one’s a new proposal that has succeeded in creating much fuss–and, if I were a betting woman, I’d wager that it might find itself left out, gone the way of the psychoanalysts’ darling, ‘neurosis.’

Internet Addiction , in its simplest understanding, is extreme and excessive overuse of the computer and the Internet to the point that it interferes with daily life.

I think we’d all agree that that much computer use isn’t good. But are we all on board that it’s a mental disorder?

Internet Addiction got off on the wrong foot, so to speak, in that it’s very existence began as a hoax. In 1995 a psychiatrist announced the appearance of a new addiction in which people abandoned their family obligations to gaze longingly as their computer screens as they surfed the Internet. It was a spoof on society’s fascination with addiction–but it also planted the seeds for where we stand today, as the hoax took on a life of its own, and Internet Addiction became planted in society’s mind as an actual disorder.

Unfortunately for the proponents for its inclusion in the DSM-5, the research into the existence of Internet Addiction as a mental disorder is somewhat less than conclusive. Dr. Shock, in his fabulous “Neurostimulating Blog,” in a post entitled Internet Addiction Research Disappointing, lists a host of problems with the studies into the addiction. Just to name two:

a) Internet Addiction hasn’t been clearly defined by the scientists doing the research. Some have utilized substance use disorder as a model, others pathological gambling, yielding  skewed results that don’t hold up to scrutiny. And as if not clearly knowing what you’re researching isn’t bad enough, adds Shock. . .

b) Researchers used different scales for measuring Internet Addiction, scales that haven’t been standardized for cross-study comparisons. Doesn’t inspire much confidence.

By the time you finish with Dr. Shock’s list of problems, you start to wonder whether the research in this topic will hold up under any scrutiny. But that’s a problem for another day.

The most significant point, in my mind, is the one about confusing the medium for the. . . well, here it is: “It seems that people mistake the medium for the message. When they hear that folks are ‘addicted to the Internet’, they blame the Internet, the medium, for the problem, whereas the Internet is simply provides a new source of behaviors for people who would have had behavioral addictions anyway.”

Just for what it’s worth–alcoholism and other substance abuse disorders are complex physiological diseases. There is a biochemical component to them that truly earns them the right to the word ‘addiction.’ I’m still failing to see how over-engagement with the Internet interacts with the body’s composition in the same way (although I’m educable)–and so I’m two thumbs down, at least for now, on including Internet Addiction in the new text.

Compulsively eating blondies I’ve baked for Passover and then hidden from myself, time after time, all through the day? Now that’s an addiction the DSM should grapple with.

2. Hypersexuality Disorder (I really couldn’t make this stuff up). Although I found locating a precise definition elusive, it seems as if it applies to people–and it’s most frequently men–who engage repetitively in sexual fantasies and behavior in response to stresses, and who repeatedly try and fail to control the desires and behavior.

Interestingly, the proposal stops short of calling hypersexuality an addiction, leaving it with the somewhat nebulous term ‘disorder.’ Unfortunately, it doesn’t seem to be fully clear what the disorder entails. Dr. Michael Miner, professor of family medicine and community health at the University of Minnesota, notes, “If we are looking at a disorder, it’s not clear what that disorder is.”

Frankly, I consider this a bad sign.

Writes Dr. Allen Frances, chair of the DSM-IV task force, in “Opening Pandora’s Box: The 19 Worst Suggestions For DSM5” (definitely worth a look, despite its datedness), this addition would be would be “a gift to false positive excuse seekers and potential forensic disaster.” A point well-taken, as we can envision possible rapists pleading not guilty in their cases due to their mental disorders. Not a pretty picture.

Frances calls it a “non-starter.”  Looks like he might be wrong there–Hypersexuality could be a strong finisher when the DSM-5 is complete.

3+) I leave you to ponder the wisdom and practicality of the inclusion of Hoarding Disorder, Binge Eating Disorder, and Oppositional Defiant Disorder (sometimes known as ‘when your kid acts like a brat and you’re at a loss to stop it’), and keeping without adjustment the diagnosis of Social Anxiety Disorder, which, writes Christopher Lane in the reference below, is “the most enigmatic and poorly defined anxiety disorder,” pathologizing those who were once accepted–and even valued–as merely shy. Oh–and doing away with the ‘Asperger’s disorder’ completely, collapsing it into a different component of the autistic diagnostic spectrum.

Yes–you ponder that. I’m off to ask my Rabbi what he thinks about all of this.

Not To Be Missed

  • ‘Not Diseases, but Categories of Suffering’ (http://www.nytimes.com/2012/01/30/opinion/the-dsms-troubled-revision.html?_r=2). This New York Times Op-Ed piece talks about how the APA can’t win in the public’s eyes in their efforts to revise the DSM–but, lest we feel too bad, points out that “once every mental health worker, psychology student and forensic lawyer in the country buys the new book, it will be laughing all the way to the bank.”
  • ‘Shyness: How Normal Behavior Became a Sickness’ (http://online.wsj.com/article/SB119402985846180627.html). An editorial by the author of a book of the same title makes the plea for accepting and appreciating, rather than pathologizing, shyness. Writes author Lane, “But shyness isn’t just shyness any more. It’s a disease. It has a variety of overwrought names, including “social anxiety” and “avoidant personality disorder,” afflictions said to trouble millions (almost one person in five, according to some estimates). And since the early 1990s, when the U.S. Food and Drug Administration agreed that powerful psychotropic drugs were suitable ways of treating these conditions, countless Americans and Britons have daily swallowed large doses of Paxil, Prozac, Zoloft, and other pills for routine emotions that experts now consider medical conditions.”
  • ‘Scientists Unveil a Bold New Definition of Addiction’ (http://www.thefix.com/content/DSM-V-new-definition-addiction-dependence-abuse8010). Why the terms addiction and dependence are not interchangeable and why one should really go; but the change for the better seems to have been voted out at the last meeting.
  • ***’How Using the DSM Causes Damage: A Client’s Report’ [abstract] (http://m.jhp.sagepub.com/content/41/4/36.abstract). So what’s the harm done, if the DSM leads to overdiagnosis, classifying a bereaved wife as suffering from depression,’ a challenging teenager from oppositionally defiant disorder, the shy young man from social anxiety? A case study in the Fall 2001 Journal of Humanistic Psychology addresses how such diagnoses “exacerbate clients’ symptoms and inhibit the healing process in psychotherapy.”