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.















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