Defending DSM-5 -- Sort Of

Good mental health reporting takes research, careful analysis, nuance and a whole lot of work.  And in the end, it doesn't sell newspapers.  Which is why you see so much bad mental health reporting, even where you thought you'd find better.


[I like to think that opening sentence explains why I post no more often than once a week.  I work to provide a quality product.  But that is for you to judge.]

The long awaited publication of the Diagnostic and Statistical Manual, Edition V has generated a blizzard of easy-to-whip-off articles with sensationalist headlines, just the thing for you to share on Facebook on a boring weekday afternoon, and get a nice Ain't it awful rant going among your friends when, really, you should be doing your life.

The Spectre of the Butterfly Net

Most of these articles follow the same tired theme, Psychiatrists are out to diagnose half the population, turning normal human conditions into mental illnesses, because they are in cahoots with the pharmaceutical industry to put the nation on medication.

These articles write themselves.  Pick any diagnosis that the DSM-V has dared to update from a work last revised nineteen years ago, add a quote from the disgruntled old man who was editor-in-chief of said nineteen-year-old document, which only barely tinkered with the 1980 edition anyway, plug in a statistic on drug sales, and there you have it.

Next, pick another diagnosis, substitute a humanistic psychologist for the disgruntled old man, and you are good to go with next week's article.

I, who love links, am not going to link to any of this trash.

Now I have my problems with the DSM.  But I do have some sympathy for its revisers, caught in the middle of a sea change, trying to update a system that will be tossed into the deep within the decade, and would have been already, if we spent any halfway reasonable amount of money on research.

For now I will do my own op ed piece and offer for your consideration the following assertion, based on my own experience in the system and reports of friends who have been at this a whole lot longer:

There are no psychiatrists running around on the streets, chasing toddlers with temper tantrums, trolling funeral parlors for grieving widows, whipping up business.  People!  There are not enough psychiatrists to deal with the loonies already identified.  They do not need you!

You don't get to see a psychiatrist and submit to trial by DSM until

• denial
• snapping out of it
• hiding
• behavioral modification
• herbal remedies
• and prayer

have not worked, and there is no choice but to go where you do not want to go, in the face of your drinking buddies who all tell you, You'd have to be crazy to see a psychiatrist.

Well, maybe you are.  Maybe you are on the knife's edge.  Be prepared to stay there a while longer.  It will take three months to get an appointment.  Longer, if you don't have insurance.

Seriously, they don't need you.

Diagnosis is Your Best Friend

Do you know anybody who has suffered for years with some unidentified illness, bouncing from doctor to doctor, treatment plan to treatment plan, feeling crazy and out of control, because there is no reasonable explanation for these vague, though debilitating symptoms that come and go, and your friend begins to think that you all think he/she is crazy and not really sick at all?  Lyme Disease, Fibromyalgia, TBI, MS, ALS, Lewy Bodys...

The day that person receives a diagnosis, even a difficult one, is a day of rejoicing.  Now he/she knows, can make plans, can learn about the illness, follow a course of treatment, maybe even find one that helps.

Diagnosis, if it is the right diagnosis, even if it is more serious than the previous diagnosis, even if you really, really don't like the diagnosis, is the first step toward recovery.

I mean, think about it.  If you get out of breath climbing a flight of stairs, do you listen to your friends tell you to rest mid-flight?  Or do you go to a doctor who might tell you that you have a blocked artery?  Is the doctor drumming up business?  Or is he/she saving your life?

Mental Illnesses are Made of Normal Experiences

Let's break out some dialectical thinking.  I know, it's hard.  That is why mental health reporters for USAToday and even the New York Times don't ask you to do it.  Prozac Monologues does ask you to do it.  But we can take it slow.

First, what is dialectical thinking?  It is when you hold two truths that seem to contradict each other in your mind at the same time.  Truth is not about either/or.  It is mostly both/and.

So our first statement is this:

Mental illnesses are made of normal experiences.  Everybody gets sad.  Everybody gets angry.  Everybody gets up in the morning sometimes and just can't get started on the day.  Everybody who walks by a group of scary people thinks they are saying bad things.  Everybody catches something out of the corner of the eye that isn't really there.  Everybody throws something against the wall.  Everybody persists in believing something that is false.  Everybody has an occasional impulse to jump off the bridge.

The symptom lists of the DSM are filled with behaviors that everybody does.

News Flash:  Us loonies inhabit the same planet as everybody else.

That is the first truth in our venture into dialectical thinking.  And it is the source of all those headlines about how the DSM is turning normal behavior into mental illness.  How is this for a thought -- mental illness really is not that weird after all.

The Suffering of Mental Illnesses is not Normal Suffering

But.  Here is the other statement to hold in your mind while remembering the first one:

There is a difference.  You get a diagnosis of some sort of mental illness when a whole lot of normal experiences and a whole lot of normal suffering pile up beyond your ability to function in a normal world.

That's it.  If you are not at the end of your rope, you do not have a mental illness.  Rather you are having a bad day, or week, or year.  If you are functioning well in the world, you do not make an appointment with a psychiatrist, and do not receive a diagnosis.  And the psychiatrist is just fine with that, because he/she doesn't have time to see you anyway.  The DSM is not about you, and does not try to be about you.  So leave it alone and let it help those of us who need its help.

When your loved one dies, you will not be diagnosed with depression just because you are going through a normal grieving process.  A normal grieving process looks like depression, but only on the surface.

If what you have is Major Depressive Disorder, then you don't go through a normal grieving process.  You don't think about your loved one; you don't remember the good times; you don't share those scandalously funny pokes in the ribs during the funeral; you don't cling to your sister; you don't even get mad at the person who deserted you by dying.  You just sit under a black cloud and think about how miserable you are.  So you do not get better, and -- get this -- you do not do normal grieving, until you get treated for your depression.

Grieving widows are in no danger from the DSM, if their grieving really is normal.

When your child throws a temper tantrum, you don't run out for a diagnosis of Disruptive Mood Dysregulation Disorder.  A badly behaved child has good days and bad days.  If the parents are consulting with school and other resources and genuinely working on the issue, things get better.  When they have tried every recommendation in the book, when they fear for their lives, when the child is out of control and scared and miserable about his/her own behavior, and this has gone on for years...

then it is insulting, it is cruel and it is simply not helpful to tell these parents that there is nothing wrong with their child and that the doctor's attempts to figure it out are part of some grand conspiracy that threatens to medicalize normal behavior.  If you don't know, if you have not walked in their shoes, then shut the hell up.

Naughty children are not diagnosed in the DSM, if they can get better without it.

Diagnosis of Mental Illness is Not Easy

The DSM V does not make diagnosis easier.   Yeah, well -- diagnosis of any sort got more complicated when they threw over the four humours theory.

There is more to say in the DSM's defense.  I will get to it.  It will make me work and make you think.  And I don't imagine you will share it on Facebook.

Oh well.  My ad revenue never did pay the mortgage.

flair from Facebook.com

The Brain on Tetris

What happened to that hour?  That other hour?  The one after that?  Where did they go?

My son's best friend from childhood, whom I haven't seen in ten years, sent me a message with this link to a BBC story, The Psychology of Tetris.  When he saw it, did he remember that I used to ask my son to hide the Gameboy?

More Guns = More Suicides

Compare states to states.  Compare regions to regions.  Compare states within regions to other states within the same region.  Compare people of the same age group, in any age group, men to men and women to women.  Compare unemployed people to unemployed people, working folk to working folk.  Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it?

Homicide and Firearms - Some Facts

While I was researching this post, a Facebook friend posted this  picture.  I commented, giving information I discovered and found surprising.  The stats are below, under domestic violence.  A friend of my friend then commented, Dearest Willa......useless, worthless statistics.  Lies, damn lies and statistics.  Go back to class and learn forgiveness, and while you're at it....drop dead!

Well.  That was disturbing.  To my knowledge, I do not know the person who called me Dearest Willa, said I need to learn forgiveness, and then told me to drop dead.  It occurs to me that facts have power, if they evoked this response.

My facts come from the Centers for Disease Control, Bureau of Justice and Federal Bureau of Investigation, from reports and data bases that count people who died and how they died.  That is all these sources did -- they counted.  They made no policy recommendations.

I make no policy recommendations in this series, either.  I am reporting their numbers.  I do hope they are not useless numbers.  I offer them to you to help you weigh the costs and benefits of gun ownership.

How Many Killed Since Newtown?

Technical difficulties have delayed my research on homicide and firearms.  I can't figure out how to make the story not tedious.  So I will skip it.  Maybe next week...

Until then, here is a resource to keep you up to date.  Slate Magazine and the Twitter feed @GunDeaths are crowd sourcing data to answer the question:

How Many People Have Been Killed by Guns Since Newtown?

The answer is not easy to find.  Coroners do not publish this information in real time.  Perhaps you noticed that my statistics last week were from 2009 and 2010.  The tally is collected only at the end of the year, and it is not official for some months after.  Suicides, in particular, are underreported, even in official statistics.  They get caught up in investigations that take months beyond the reporting date.  Eventually the numbers for 2011 will be corrected, when these investigations are completed.  Meanwhile, the smaller number has been published in places that will not be corrected and will nonetheless be repeated (including Prozac Monologues, if I try to publish the most current sources.)

Guns and Death, Death and Guns

I have a friend, a young mother of two toddlers, whose New Years resolution is to get her license to carry.  This series is for her.  Live long and prosper, dear one!

My Next Series -- Facts About Firearms

I have a plan.  No, not that kind of plan.  Well, yes, I do.  But that is not the plan I mean right now.  I plan to do a series about firearms.  It is my intent to provide facts, just facts.  There are a lot of facts out there about firearms.  A lot of nonsense is disguised as facts.  But genuine facts are available, and more useful than our impressions for making sound decisions.

I am not going to write about my opinions about firearms, because, well really, who cares about my opinions.

Keeping Track of How People Die

Firearms are a cause of death, which means that the US Centers for Disease Control keeps track of them.  Wait, wait -- it doesn't keep track of the firearms, just the deaths.

Best of 2012 - Which Do You Choose?

Healthline.com is sponsoring a Best Health Blog of 2012 Contest, and Prozac Monologues is one of the contestants.

Click on Best of 2012 to vote Prozac Monologues the Best Health Blog of 2012!  The list is long -- find Prozac Monologues alphabetically.  You can vote every day until February 15th.  The contest started on December 21, so I am behind on the multiple vote front.  Tell your Facebook friends!  Tell your neighbors!  Tell the people using their SmartPhones at the coffee shop!  I guess you have to use a Facebook or Twitter account to cast your vote.

Meanwhile, I went back to look over my own work for the year, and invite you to do the same.  Click on the word comments at the bottom of the screen to weigh in on what you think of this body of work, or any particular piece of it.

Favorite Post

Judging by page views, the Popular Vote far and away goes to Dopamine - Can't Live Without It from March 23, 2012.  Coming in the middle of a series on the Stages of Change approach to changing the way we eat, this post traces the brain circuits that brought you from your grandma's cocoa to your daily Starbuck's habit, or from The Cocoa That Ate Your Brain to Pimp My Cocoa.