I used to find it somewhat odd, looking around my ex-psychiatrist's office, to see how many promotional items he had scattered around. There were Pfizer note pads, Prozac pens, Merck coffee cups, an Adderal wastebasket, and Eli Lilly toilet paper.I'm exaggerating, but not by much; the shelf in his foyer was stacked high with boxes of this stuff, as well as countless free samples of the actual medications. Often, before my session would start, I shared the waiting room with a well-groomed, young, salesman-type who was apparently the Fuller Brush Man of Psychiatry, anxious to unload his free wares, hoping, I supposed, that when my doctor picked up a monogrammed GlaxoSmithKline ballpoint pen to write me a prescription, he might be more inclined to go with Paxil over the competitors.
I know this isn't big news, but it slowly dawned on me that just as Madison Avenue works hard to get me to drink Pepsi and use Preparation H (full disclosure: both of those companies paid me for product placement in this article), there is a giant corporate pharmacological machine actively working behind the scenes to manipulate the diagnosis, treatment and progress of my not-so-private and no-longer-very-personal mental health, for profit, commissions and bonuses! This fact is even more bizarre than Orwell's 1984; "Big Pharma is Watching You; Your Misery is Our Bottom Line."
The new and improved fifth edition of what is effectively the Bible of psychiatric diagnoses is due out in 2013, and is currently undergoing careful review and revision by a team of mental health professionals. Known in brief as the DSM (Diagnostic and Statistical Manual of Mental Disorders), this oversized, thick tome has an amazingly far-reaching influence on anybody, like myself, who occasionally wanders through the doors of a therapist's office simply hoping to feel a bit better about getting up in the morning. The impact of the DSM on the average, unwitting patient is vast. It not only determines the label and diagnostic code assigned to one's condition, which in turn determines insurance coverage, but also delineates the preferred treatment approach and current drugs of choice to administer, not to mention what the entire world considers normal or not.
Homosexuality, for example,was eliminated from the DSM-II in 1973 and replaced by Sexual Orientation Disturbance, clearly a much classier disorder. Next it was altered to Ego Dystonic Homosexuality, characterized by "a persistent lack of heterosexual arousal." (Obviously, Ego Dystonic Heterosexuality, which is the persistent lack of homosexual arousal, was not included.) Homosexuality was finally removed as an illness completely in 1986, and overnight, gay people had to go into counseling to help them adjust to being normal! Our own inner worlds, literally our very self-concept, is dramatically altered and determined merely by the latest diagnostic trend, as decided by a committee behind closed doors, and undoubtedly influenced by God knows which pharmaceutical lobby. (When I mentioned to my psychiatrist that I had once been told that I had a "Borderline Personality Disorder," for example, he chuckled and replied, "That diagnosis is so ‘80s.")
The New York Times reported on February 10th that one of the new and exciting disorders that has been proposed for the upcoming DSM-V is "Hypersexuality," defined as when "a great deal of time is consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior." Hmmm. Guess I've suffered from the first half of that one (the fantasies and urges part) since age 12; I can only wish that I had suffered from the second half (the planning and engaging bit), but alas. Hard to believe I've gone through my entire life with such a fundamental disorder left completely undiagnosed and untreated! (Along with approximately two billion other men; it's epidemic.) I can't wait to see which pharmacological giant comes up with a new anti-Viagra cooling agent: "Treatment most effective when started at the onset of puberty and administered regularly, for most men, until death. When patient doesn't respond to medication, cold showers are recommended; worst case scenario, castration indicated."
This is actually a very serious matter. Consider kids who have routinely been diagnosed with today's fashionable Bipolar Disorder, which has only in recent years narrowly eclipsed in popularity the oft-diagnosed Attention Deficit Hyperactivity Disorder. And with that slim victory of Bipolar over ADHD, rampant Ritalin prescriptions gave way to much stronger anti-psychotic drugs for these kids, mostly male, who, when I was growing up, would likely have been labeled, "healthy, active boys." You remember, the kind of kids who preferred running around, playing dodge ball and riding their bikes all day rather than being quiet and sitting still at a tiny, confining desk for hours on end, memorizing gross distortions of the truth about Christopher Columbus?
Thankfully the new DSM hopes to curb this cavalier overuse of the Bipolar label with a brand new, hot-off-the-press childhood diagnosis—are you ready for this one?—"Temper Dysregulation Disorder with Dysphoria." Damn, I love that, but it's way too late for me, you have to be under Bar-Mitzvah age to qualify. I'm betting it will come with free samples of Cherry-flavored Chewable Valium, which I could actually use right about now.
Imagine impressionable parents meeting with their child's doctor or guidance counselor to hear the bad news: "I'm sorry to tell you, Mr. and Mrs. Blickstein, but your little Joey suffers from Temper Dysregulation Disorder with Dysphoria; there's no known cure, but we can help manage the symptoms." One has to wonder how such conversations affect the entire family over time—and surely this and similar conversations is not an exaggeration or satire; this is what has been going on for years, as labels routinely get assigned to kids that quite possibly affect the rest of their lives, choices, drugs, energy, self-perception, options, and the views others have of them. It certainly affects the blinders through which parents and teachers view a child; there have been well-documented studies that reliably predict how the performance of students conforms to and is dramatically altered by what teachers are told in advance about their abilities. When you look at someone through the lens of a psychiatric label, their pathology and symptoms are as clear as day, as obvious as the symptoms most medical students are convinced they have with each new disease they study. You literally see, and find, what you are looking for.
Another great new disorder being tossed around for the new DSM is "Apathy Syndrome," which will be used to describe the type of person that my psychologist brother prefers to call a "Lazy Schmuck," and which later got upgraded culturally to the slightly more respectable "Couch Potato;" now, finally, it may get the official disorder status it deserves. So please have a little compassion the next time you happen to walk in on one of your friends eating Doritos and watching reruns of My Friend Flicka in the middle of the day; they have a debilitating illness about which there is little they can do, least of all getting up.
Some people, apparently, are getting riled up over losing their diagnosis in the next edition of the DSM, as if they are parting with an old friend they have come to rely on and by which they define themselves. What happens to you if you've spent the better part of your life dealing with your Asperger's Syndrome, only to wake up one day and be told that it no longer really exists? That would piss anyone off. For in fact, the next DSM proposes to simply lump Asperger's in with Autism, robbing patients of their own unique disorder that they've come to know and love, and live their lives by. Every one of us can get attached to our ideas about ourselves. I for one have been classified as a "depressed" person much of my life. Suppose I learn tomorrow that in fact, I've merely been "out of sorts" some of the time? How depressed would that make me? Or if my Generalized Anxiety Disorder was downgraded to just being "a tad nervous" at times? That could easily provoke a full-blown panic attack.
I hereby propose a new category for the DSM: "Diagnosing Disorder," suffered with particular intensity by those mental health professionals currently deciding the rest of our fates, and meanwhile raking in all those free pens and notepads while they figure it out.