I’m reading a very interesting novel called The Four Fingers of Death. It’s somewhat science-fiction, with a distinctly Vonnegut-esque tone to it–very sarcastic and cynical. The story takes place in the 2020s, and the author, Rick Moody, gives several hints as to the general milieu of the future. Few people have cars as gas is very hard to come by, India and China are dominating the world, and paper books are mostly a thing of the past. One little detail that the narrator mentions several times–a detail that most readers would skim over, but that the author undoubtedly meant to make a point with–was the 8th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Currently the DSM is in its fourth version–DSM-IV–but the DSM-V is in the works. However, in the world in which Four Fingers takes place, the DSM-VIII has medicalized all sorts of everyday issues, such as a disdain for hygiene (“aggravated hydrophobia with hygiene avoidance”), opening a game of chess in an unusual way, being rude to waitstaff, and speaking unusually (“conversational pseudo-uremia”). What completely got me, though, was when the narrator diagnosed a new friend with “mixed caffeine obsession with chronic caffeine dependence” when–get this–the friend suggested that they meet up at a coffee shop!
The author’s point, of course, is easy to see. It’s a satire of the supposed overdiagnosis of mental disorders even today, and of the presence of useless and non-clinical “disorders” in the DSM. As in, hahaha, at the way things are going, soon we’ll call not showering a mental disorder! To this point, the narrator of the story mentions that everyone has been diagnosed with a mental disorder these days. The way he talked about the DSM–”I flip through it looking for symptoms I have yet to contract”–makes this attitude even clearer. Through his satire, Moody implies that mental illnesses are not something to be taken seriously.
Forgive me for making a big deal out of a (probably insignificant) novel, but this mindset right here–that mental disorders are just some sort of farce invented by people yearning for attention for their minuscule problems–this is what’s responsible for one of the biggest threats to adequate mental healthcare in America. I’ll attack this mindset point-by-point.
First of all, contrary to popular opinion, “everyone” does not have a mental disorder these days. I’m sure you’ve heard someone comment, perhaps after hearing of another person’s diagnosis with a disorder, something to the effect of, “Oh, lord, everyone’s popping pills for something these days!” No. Everyone is not popping pills for something these days. Many people do, at some point in their lives, take medication for a mental issue. But most psychotropic medications are meant as temporary solutions while the person works on their problems in therapy or on his/her own. People aren’t meant to take them for their whole lives.
And even if every single person in this country does, at one point or another, take psychotropic medication, that doesn’t mean much on its own. Almost everyone takes drugs for colds or headaches at some point, but nobody seriously advocates against this. I use the word “seriously” carefully here–a radical diet book I came across recently, Skinny Bitch, claims that we should basically never take medication for anything. It says, “Yeah, getting cramps totally sucks. It’s supposed to. Every month you endure cramps (without medication), you are preparing for the physical pain of childbirth. So suck it up. Stop interfering with Mother Nature.” Pardon my coarseness, but I actually nearly crapped myself when I read this. What?!
Most of us are glad that with things like modern surgical techniques, dentistry, drugs, and diagnostic tools (like x-rays and blood tests), we now live happier, healthier lives. Before these things were developed, people had 40-year lifespans and got all kinds of gruesome illnesses. Similarly, back in the good ol’ days, people with mental disorders either spent their lives in misery, got committed to mental asylums, or simply offed themselves, depending on the nature of the disorder. If we can prevent that by having “everyone pop pills,” so be it–at least until we can find a better solution.
Second, the fact that some mental disorders may be overdiagnosed does not mean that every diagnosis is illegitimate. Some parents, for instance, push for their children to be prescribed medication for ADHD in order to help them get ahead in school, even if they do not actually have ADHD. It should be noted that there are standard screening procedures for this disorder that ensure that people are diagnosed correctly. If a parent gets their child to somehow cheat the screening tests, or if an unscrupulous doctor prescribes medication even though the child doesn’t fit the diagnostic criteria, well, guess what–these people are being unethical. That does not mean that ADHD isn’t a legitimate disorder that many people–adults included–legitimately suffer from.
Furthermore, although some people probably do “imagine” their disorders and seek treatment in order to get attention, I should point out that this can only be a minority. There is nothing at all pleasant or fulfilling about spending hundreds of dollars, taking medications that give you really crappy side effects, and telling a complete stranger about the most shameful aspects of your life. This is not fun. Anyone who invents a mental illness and seeks treatment for it as a way to entertain themselves is an idiot.
I should also point out that even though some people do falsify their problems and some psychiatrists do overprescribe, this is a general trend that you can’t really apply to individual people. Unless you are a psychiatrist, you are simply not qualified to judge whether or not a particular person’s problem is “real” enough to merit treatment. Everyone told me there was “nothing wrong” with me and that I should stop being a crybaby, until it got so bad that my daydreams changed from imagining that cute guy from class asking me out to imagining which method of suicide is most effective. Don’t be the person who trivializes someone else’s illness. Just don’t do it.
Third, Moody suffers from the mistaken assumption–shared by many people–that the trend in the field of mental health is for increasingly insignificant and non-clinical problems to be classified as mental disorders. With this view in mind, it’s easy to see how the author could come up with the hypothesis that in 20 years, a disinclination to take showers could be considered a clinical disorder.
However, if there’s any trend here at all, it’s in the opposite direction. For instance, premenstrual dysphoric disorder–more commonly known as PMS–was in the DSM until the revision of the DSM-III in 1987. Much earlier, in the 19th century, women who suddenly showed a strong desire to have sex were labeled with the diagnosis of “hysteria.” The cure? An orgasm. (This diagnosis was also a catch-all term for any medical complaint made by a woman. Obviously, it’s not longer considered a disorder.)
Finally, I’m pretty sure that nobody who has this author’s opinion of the DSM has actually looked at one. I’m no DSM expert, but I’ve looked through it a number of times, and I can tell you that very few of the disorders listed in it seem trivial to me. (There are disorders that shouldn’t be there, perhaps, but for different reasons. For instance, gender identity disorder, which refers to a very strong feeling that one has been born into the wrong sex, is probably in the DSM because psychologists have assumed that it leads to a lot of distress and problems for the person who has it. Before it was possible to change one’s biological sex, that was probably true. But today, it has become clear that if a person who’s “suffering from GID” is able to change their sex, things get better. The remaining problems are caused more by society’s lack of acceptance for trans* people than by their psychological makeup.)
However, Moody is echoing the prevailing cultural sentiment that mental disorders are nothing but insignificant little problems that people have in their daily lives. If this were true, popping pills to solve these problems would indeed seem pretty silly. However, it’s not true, and unfortunately for those of us who have to struggle to find adequate mental healthcare and to get friends and family to accept and understand that struggle, people like Moody are busy spreading this misconception around through various media–in this case, a satirical novel.
Contrary to what Moody seems to think, recognized mental disorders cause significant problems in daily living, relationships, and work. Some involve hallucinations or delusional beliefs. Some involve uncontrollable episodes of panic, which are said to feel somewhat like heart attacks. Some cause people to be unable to experience pleasure from anything they do (this is called anhedonia). Some cause people to become so preoccupied with cleanliness, order, and performing particular rituals that they are literally unable to go through the day without taking care of these things. Some keep people from getting a good night’s sleep–ever. Some cause people to try to throw up every bit of food they eat, or stop eating altogether. Some cause people to want to kill themselves.
Do you see anything trivial here? I don’t.