When you begin the study of psychopathology, you don’t get very far before you encounter a severe looking tome that is large enough to prop open a very heavy fire door and brick-like enough to knock unconscious a medium-sized lab rat.
The book is called the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition Text Revision), or in the vernacular of therapists, the DSM-IV-TR. It is the Bible of diagnosable mental disorders. Every psychopathology student must bow before it or, at the very least, become familiar with it.
It is organized in groups called “axes.” These are not things you use to chop wood, but rather, the plural of axis. There are five of them in the DSM and they go like this:
Axis I: Clinical Disorders
Axis II: Personality Disorders
Axis III: General Medical Conditions
Axis IV Psychosocial and Environmental Problems
Axis V: Global Assessment of Functioning
I’m just getting started in my studies here, so I’m not sure yet what all these things mean. Two seasoned therapists have told me that once I read the DSM more carefully, I will recognize myself in many of the conditions it describes. Oh boy. I can’t wait!
When the first edition of the DSM appeared in 1952 it contained 86 pages. In the year 2000, when the fourth edition was released, the page count had blossomed to 943. The number of disorders increased from 106 to 365. Wow. Either we are getting more disorderly or we are getting more excited about giving these things names. I would say it is probably the latter. In fact, this phenomenon is known as “the social construction of psychopathology.”
Here is how this works: we see a pattern, we give it a name, we give it an acronym (like ADHD or OCD), we create drugs to cure it, we get insurance companies to cover its treatment. If we stopped at “see a pattern, give it a name,” we might be closer to creating poetry than new strains of mental illness.
But hey, we live in a culture with 47 different kinds of toothpaste. We like variety, apparently, not only in our toothpaste but also in our mental disorders.
“Once the ‘disorder’ has been socially constructed and defined, the methods of science can be employed to study it, but the construction itself is a social process, not a scientific one. In fact, the more ‘it’ is studied, the more everyone becomes convinced that ‘it’ really is 'something.’” (Maddux and Winstead).
Sounds like the emperor’s new, disorderly clothing to me.
If you have “a preoccupation with a defect in appearance” that causes “significant distress or impairment in…functioning” (p. 507) you have Body Dysmorphic Order. I don’t like the fact that I am bow-legged, but it does not keep me from wearing shorts in summer when it is hot, so I guess I cannot say I have this particular problem.
If you drink too much coffee, you may develop Caffeine Intoxication (Starbucks, beware). If you are a cigarette smoker, you have Nicotine Dependence. If you rub yourself against someone on a crowded bus to stimulate yourself sexually, you suffer frotteurism. There is schizophrenia, borderline personality disorder, agoraphobia, post-traumatic stress disorder, eight different disorders related to inhalants. The list goes on. I’m skipping around here to give you a taste. All this is just the tip of the iceberg. It is overwhelming and you have to read it for yourself to believe it.
The DSM-V-TR will appear in 2013. It is already causing a buzz in the psychotherapeutic world. Each section is worked on by a team of MDs and PhDs. There is the Premenstrual Dysphoric Disorder Work Group and the Delirium, Dementia, and Amnestic and Other Cognitive Disorders Work Group. Each different work group gets to recommend what is in and what is out. I'm not clear yet on who makes the final decision. I will ask my professor tonight.
Once upon a time, homosexuality was listed as a mental disorder in the DSM. It was removed in 1973. Thank God.
The word on the street is that in the new revision, we may lose narcissism as a personality disorder. I guess it is becoming normal to be grandiose and lacking in empathy. We may, however, gain hoarding as separate from obsessive-compulsive disorder. That seems useful. Some people barricade themselves in their homes with mountains of useless stuff and therapy might help them. Interpret that as you wish.
The one possible change that seems completely and utterly insane to me is the proposed removal of pedophilia as a mental disorder. My professor mentioned this on the first night of class and I was so disturbed by it, I had to do some investigating on the Internet. The argument being, as far as I can gather, that pedophilia can be thought of as simply another in-born tendency of human nature. Ah...so can murder. That doesn’t make it okay.
While I can cave on narcissism, and will allow the Personality Disorders Work Group to do what they think is right, I will get down on my bow-legged, bended knees and plead with the Sexual Disorders Work Group to use some common sense when they assess pedophilia. (In fairness to the mental health profession, the effort to de-pathologize pedophilia seems to be coming from, yes, you guessed it, pedophiles! Not the therapists. So please don't go around saying that this is a done deal. It is simply that the question is on the table at this time.)
No one can make the argument to me that engaging in sexual acts with a child is just one more aspect of human nature. And if someone does make that argument work for them, then, our world really has gone haywire. Please, get us all to a lobotomist, stat.
