Bohemian Buddhist Review

The Devil and the DSM

The changing definitions of mental illness.
The Devil and DSM by Paki S. Wright
 
If the devil's in the details, as the old saw goes, then the American Psychiatric Association's got the old goat by the tail. But just who's got who?  (And bear with me here, there's a definite BoBu angle to this.)
 
A psychotherapist friend sent me the link to a piece in this January's issue of Wired, by Gary Greenberger, titled "Inside the Battle to Define Mental Illness;" Greenberg's also the author of "Manufacturing Depression," so you can sort of guess where he's coming from.  
 
What's at stake are not only the billions of dollars of Big Pharma profits from the sale of drugs for the mentally-emotionally challenged (like most of us are, at least from time to time), but also the APA's loss of its "franchise on our psychic suffering, the naming rights to our pain."  I think this last phrase is perfectly poetic and wish I'd thought of it, hats off to Greenberg, who unpacks a sizzling story of modern-day arrogance, remorse and possible redemption.
 
The whole bilious brouhaha started when the editor of the Diagnostic & Statistical Manual of Mental Disorders, otherwise known as the DSM, Allen Frances, had an epiphany.  To wit:  "There is no definition of a mental disorder.  It's bullshit.  I mean, you just can't define it."  (At which point I imagine Frances was immediately put on the APA's list of the mentally-imbalanced.)
 
"We made mistakes that had terrible consequences," Frances now admits of DSM-IV, the last edition he was in charge of (or the last edition of which he was in charge, depending on your age group).  DSM-5 is in the works as we speak, which is why a lot of working definitions, and their treatments, are up for re-consideration. According to the Wired article, mis-diagnoses of autism, attention deficit disorder and bipolar disorder "sky-rocketed," which Frances now thinks the DSM inadvertently facilitated, fostering "an increasing tendency to chalk up life's difficulties to mental illness and then treat them with psychiatric drugs."
 
This is where some teachings of the Buddha come in.  From a purely Buddhist perspective, we're all a little off-kilter mentally because a) we believe in things that aren't really real (like our own egofied selves) and b) we keep running after things to make ourselves happy but that only, in the end, bum us out.  Given our basic mental-human condition of basic delusion, it's no wonder that the Buddha gave the dharma to us as a good doctor might give the right medicine to someone who was sick. He did not, in the First Noble Truth, say that anti-depressants were a cure for the inevitable suffering of life.  (Which isn't to disparage the use of all pharmaceuticals in severe cases of physical or mental disequilibrium or disease.) 
 
Former DSM editor Frances feels that the new DSM-5 is an "absolute disaster," with many colleagues climbing on board his dissident bus, though of course he has his detractors as well.  This isn't the first time there's been a rebellion in the ranks at the DSM.  Some categories have been changed or removed -- like PMS, homosexuality, and even the word neurosis.  To my mind, the watershed moment, again from a bohemian Buddhist's viewpoint, may have been in 1922, when two prominent psychiatrists "warned that a planned change to the nomenclature would be tantamount to declaring that 'the whole world is, or has been, insane.'"
 
Ahem. 
  
Can anyone really read the recorded history of our species and conclude differently?  Sure, we've created great architecture and great cultures as well as velcro, but also mass murders on an almost unimaginable scale.  How many people do we each know who we think are really sane and happy?
 
The APA, in dealing with the shifting tides of human discernment, seems disconcerted by the fact that things change, one of the major descriptions of reality in Buddhism, otherwise known as impermanence -- which necessarily includes our definitions of phenomena.  This actually is a sign of growth, not a reason for fear, but change of any kind freaks most of us out on some level.  Greenberg's Wired article features a fascinating chart about how the DSM's definitions of mental illness have changed in the last 50 years.  The one that caught my eye, because it's a brand new category with the 2010 edition, is called "sexual interest/arousal disorder" and cites the emergence of a phenomena between and among men and women about "excitement lags."  Could this be a cultural commentary about our multiply over-tasked, under-relaxed society?  Or possibly -- since it would seem to diminish the urge to procreate --a biological indictment of our overpopulation?  Or perhaps a precursor to 2012's magnetic pole shifts, in which male could become female and vice versa?  (Perish the thought.)
 
By DSM criteria, "epidemiologists have noted a staggering 30% of Americans who are mentally ill in any given year." (Roughly the same number of Americans who think Obama's a Muslim, not that I'm not drawing any conclusions here, just pointing out an interesting coincidence.)  Of course this is no joking matter, as anyone who's grappled with mental illness can attest.
 
The bottom line is that even with the best of intentions, we can't cure all our suffering with magic pills.  What the newest DSM is up against is the need for Americans to begin to face our underlying fears and uncertainties about life -- and most especially death -- without running to the medicine chest or the liquor cabinet or the corner street dealer.  Good luck, as I'm the first to admit, though I do find my practice of meditation very helpful in this area.  As editor Frances points out, a complete elucidation of the complexities of the brain has so far proven to be an "ever-receding target."  Granted we need maps of our inner and outer universes, but we also need to admit our fallibility and not get stuck in the common pattern of human hubris.  While this is difficult, it may be easier than latching onto supposed certainties about who we are and our multitudinous mental afflictions -- the Buddha named 84,000 of them -- only to have them vanish like smoke.
 
Which is pretty much the way of modern science, in fact.  Look at how many of our discoveries have been overturned or challenged in the last two centuries.  We are really only humble (or not-so) observers of the magical display of empty phenomena (empty meaning lacking intrinsic existence, not null and void).  While naming, labeling, and inventing things can be great fun and give our mortal egos a boost, we shouldn't confuse passing knowledge for wisdom.  Because, like everything else, it too will inevitably change.