DSM
Wikipedia:
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is
published by the American Psychiatric Association and provides a
common language and standard criteria for the classification of
mental disorders. It is used in the United States and in varying
degrees around the world, by clinicians, researchers, psychiatric
drug regulation agencies, health insurance companies, pharmaceutical
companies and policy makers.
I have used parts of the DSM-IV-TR as a reference or starting point
such that I could attempt to articulate my own situation. In the past
I have felt a lot of frustration because professionals might have
used the DSM or similar tracts, checked off a few symptoms of mine
that seemed to fit, worked out the appropriate medication and token
therapy without seeing me as an individual, or without listening to
me when I said that I thought it was necessary to talk to me further
before coming to a conclusion. At any rate it was necessary for
me to understand the situation before consenting to any
treatment.
In looking at the actual manual, I have seen that it allows for a
multiaxial diagnosis. Different aspects of the patient's situation
are examined and taken into account when it comes to diagnosis and
treatment, including psychosocial and environmental factors, and
effects of medical conditions. I see that even from the start, the
potential existed for a helpful diagnosis in my case.
The DSM is not about understanding causes. It's based on a
compilation of statistics. Some of the information originally
gathered may have been influenced by prejudices common to the times,
and this may still be the case. Some things that were originally
considered mental disorders, e.g., homosexuality, have been removed
from the list. In the DSM itself, it is noted that 'mental disorders'
might be an inaccurate term for conditions, or not the best term, but
that at present they can't come up with anything better. While it may
be a step in the right direction to compile the kind of information
used in determining criteria for mental disorders, we still have a
long way to go toward understanding the human mind and psyche. At
best the DSM can only be a guide that is rough and unfinished, quite
likely prejudiced in its language and diagnoses, and may contribute
to misunderstanding and stigma when it comes to people's behaviour,
mental functioning, and 'normalcy'.
There are those who tell people to 'get help' or 'take your meds', as
if it's simple and easy for everyone to get the appropriate help,
or even that it's assumed there is something wrong with certain
individuals when it may be society itself that is sick. 'He went off
his meds,' is often all that is needed for people to hear in order to
believe that a person is sick, noncompliant and irrational. In
popular culture, this 'understanding' is reinforced all the time in
TV shows and movies which give a one-sided view of a person as highly
befuddled, violent or self-destructive. 'Noncompliant' in DSM terms
may actually include that a person can't afford medication or
treatment, has no transportation to therapy, or that the patient's
values or philosophies conflict with some aspect of the proposed
therapy.
I have found parts of the DSM to use judgmental and stigmatizing
language, while ostensibly being about objectivity. Also, it must be
emphasized that while the DSM is not meant to be interpreted by
nonprofessionals, who lack the necessary training and education to do
so objectively, those who interpret the manual are themselves human,
with their own prejudices and failings. In diagnosis, a lot hinges on
interpretation of diagnostic criteria itself as well as perception of
symptoms in any individual - and both of these factors may be highly
influenced by subjective factors in the diagnostician, as well as
trust and communication issues between a patient and a doctor. In
some cases professionals may themselves be brainwashed by their own
education, may cling to the status quo, may be burnt out or cynical
about actually helping anyone, may rightly realize that many causes
of 'mental disorders' are social in nature and that if those causes
are too big to tackle the easiest thing to do is medicate all
objectionableness out of people, or, they may even have financial
incentives to diagnose certain disorders and prescribe certain
medications.
In studying psychology, I have seen some of the reasons it is so
difficult for those who work in psychology and psychiatry to come to
a consensus.
When it comes to my own personal situation, in my teens and early 20s
it was not easy to research my situation. By the time I had internet
access at age 30, all I cared about researching was suicide
methods.
At first, I trusted a doctor who said I had a chemical imbalance and
needed meds to correct that imbalance. After a couple of months of
taking the medication, I did not feel any less depressed, and in fact
I felt more hopeless, several months later using my prescription to
OD. I didn't understand then, and neither did any of the adults in my
life, including professionals, that I had actual concrete reasons for
my anxiety and depression that needed to be addressed. The assessment
had been superficial. If it was not, important facts had not been
shared with me.
People can look at a list of symptoms, and stop seeing you as a
person. Many symptoms arouse suspicion or mistrust. That is one of
the negative impacts of such manuals - they encourage others to view
you as something 'other', not 'one of them'. They set the tone, and
they decide what is extraneous or not relevant. The DSM is not meant
to be used in this way, but as I stated earlier, even professionals
may end up using it in such fashion - even if they do not wish to
admit doing so.
Some people take a kind of comfort in having a diagnosis. They
identify with their diagnoses, willingly take whatever meds or
therapies are prescribed, and may be willing to try a whole lot of
different combinations of meds/therapy. I don't especially have a
problem with this except that in my case, when I am pretty sure that
relevant information has been left out of the equation, it doesn't
make sense to me to start treating only the parts which could be
identified - because there may have been more significant symptoms or
causes that resulted in those that could be more readily identified.
I don't see the sense in attacking the problem superficially.
In my three hospitalizations I have seen enough psychiatric patients
to realize that the vast majority are those nobody really cares
about. Their treatment is not about identifying the real issues and
looking for a real solution, it's about trying to keep them as calm
and unobtrusive as possible, a kind of juggling act that mainly
requires occasional tweaking of medication. Patients are also
encouraged to scour their memories for clear instances of abuse or
trauma, and to talk about it so as to deal with it - but it's a
simple-minded approach that gets people to behave as they think they
should behave, and to think they have been affected by what they
think they should have been affected by, and helped by what they
think they should be helped by, and basically it's a type of mass
brainwashing. Even if patients are considered sick, they are also
considered to be responsible for their problems, and the way to take
responsibility is to take the steps outlined in this paragraph.
Basically, do and believe what you are told. If you refuse, or it
doesn't make sense to you, you are not taking responsibility for
yourself, and you will be labelled noncompliant.
In the past, I have been left out of the process. In one case this
was egregious to the extent of being malpractice: I was ridiculed
when I tried to find out my diagnosis and the reasons I was
prescribed certain medication. In a more positive experience later, I
didn't know what to ask, or I wasn't persistent enough, or although
those involved may have been considerably better, they still didn't
know how to interpret the information I gave them other than through
guidelines meant to suit those with similar symptoms. Also, although
the diagnosis and prescribed treatment may have been on the right
track, significant information was still lacking, and there was a
lack of coherence in the treatment: only the diagnostician had an
overview of the situation, and when a series of others took over when
it came to treatment, it was to address parts only, not context or me
as a whole person, and everything lost focus.
I can take some of the blame myself for not being assertive or
articulate enough, but when a person is seriously distressed, it is
often not easy to know how to explain that distress to others. At age
15, I recognized there was a significant problem, and I asked for
help. I was willing to offer whatever information was necessary. I
had no frame of reference. If the so-called professionals can't
identify the relevant material, or figure out what questions to ask,
what are you supposed to do? At age 15, how much responsibility was
I supposed to take?
Professionals can make mistakes, and a patient has a right to know
the diagnosis, and to question it. If I had access to something
similar to the DSM much earlier, I might have had more of a base of
knowledge that enabled me to ask the right questions and offer the
relevant information, and participate effectively in my own
treatment.
Not having a diagnosis can have other associated problems. If you do
not have a recognizable diagnosis, the people in your life may not
understand if you do not lead a normal life, and they may attribute
this to unpleasant character traits such as laziness, lack of
willpower, or manipulativeness.
At age 24, I looked up the medications prescribed for me (another
patient had a book about psychiatric medications, which he lent to
me), and I didn't like what I read about any of them: most of them
included possible or probable side effects like impaired sexual
functioning and weight gain, and one included possible permanent
tardive dyskinesia. I still find it difficult to believe that anyone
finds the possible side effects acceptable. I suppose the thinking is
that people are so desperate just not to be
depressed/'dysfunctional'/'abnormal' they are willing to accept
something that in comparison seems minor to them, but that approach
hardly seems to address a person as a whole. Sexual functioning is
part of the whole of who a person is. If that is not working, it is
unlikely that the system is working. It seems like a possible vicious
cycle in which you perpetually have to keep trying to address new
symptoms, any of which might further decrease functioning as a whole
and make the possibility of understanding the original causes more
remote. This may say something about my values or about my world
view. Why add increased dysfunction when there is no guarantee that a
medication alone can change that I could see no place for myself in
life? I don't know how to express how distressing I found it that no
one actually seemed to think it was important to talk, to discuss, to
debate options.
It could be argued that my website itself is about my frustration at
the lack of communication.
...It seems obvious, doesn't it, that someone who is ignored and
overlooked will expand to the point where they have to be noticed,
even if the noticing is fear and disgust...
Jeanette Winterson, Sexing the Cherry
For the most part, I think patients just take meds that are
prescribed without being fully aware of the possible side effects or
what the objectives are, just trusting the professionals and feeling
relieved that someone else is taking responsibility. In so doing, new
symptoms or complications must be accepted as just part of the
process.
It's necessary to me to be seen as an individual, and for my
symptoms to be interpreted within the context of my own individual
circumstances, values and aims. If professionals think it's too
inconvenient to talk to me to the extent that I can understand why a
particular diagnosis fits me or why they think their prescriptions
will help me, while remaining willing to take into account my
criteria regarding what is acceptable or not for me personally
regarding side effects, I am not going to trust them.
Professionals with access to manuals like the DSM have not improved
my quality of life. In most cases, contact with them compounded my
problems, or I was left with a pervading sense that I was not worth
helping.
While researching suicide methods at age 30, I stumbled upon a
suicide discussion newsgroup called alt.suicide.holiday, which is
composed not of professionals, but so-called sick individuals, many
who are so distraught they want to die. This newsgroup changed my
life (for the better), more than any professional mental help ever
has. It is perhaps no wonder that I am skeptical of professionals,
the diagnostic process, and normalcy.
The system did not help me. My father himself was not helped by the
system when he sought help. The system did not help my family to
understand what any of us had been going through. Although family
therapy is about recognizing that the family as a unit is not working
well, with one member often presenting with symptoms or as a kind of
scapegoat, the process of my diagnosis and treatment did not leave
any of us with a clearer understanding that perhaps in order to help
each of us individually, we had to learn in depth about the family
system as a whole.
When people think you are 'not all there', or 'not like us', they
stop seeing you as a person who is conscious and perceiving. Popular
culture reinforces this. It's like you're not there, not worth the
same consideration. Since you are 'out of touch with reality', what
you do experience doesn't count, it's invalidated.
For years I have struggled to get someone to listen to me, to see
that all these years there has been an actual person inside here,
whose thinking cannot just be dismissed as 'disorganized' or
'unclear'. I wanted someone to listen to me, and to talk to me in
depth. I wanted non-superficial communication. It's not that I think
that doesn't exist in the mental health fields, but it may be
rare.