A Mind is a Terrible Thing to Waste

Grief could be in and Asberger’s out, of the upcoming fifth edition of the DSM (the Diagnostic and Statistical Manual of Mental Disorders) that is--according to the Times (“Grief Could Join List of Disorders," "NYT,1/24/12). “Depression can and does occur in the wake of bereavement, it can be severe and debilitating and calling it by any other name is doing a disservice to people who may require more careful attention,” the Times quotes Dr. Sidney Zisook, a shrink at U. Cal San Diego as saying. A follow up Op Ed piece by a writer named Benjamin Nugent ("I Had Asberger's Sydrome. Briefly," NYT 1/31/12) who’d been the subject of a film called “Understanding Asberger’s, supports “narrowing” the definition of Asberger’s and goes on to conclude, “I don’t want a kid with mild autism to go untreated. But I don’t want a school psychologist to give a clumsy, lonely teenager a description of his mind that isn't true.” Nugent appears to have been one such teenager and the film in which he appeared “was a research project directed” by his mother. So how to vote? The issue does have serious implications in that diagnosis can affect medical coverage. Those suffering from depression following the death of a loved could be covered for treatment while some patients who were once considered to be suffering from Asberger’s might find themselves in the lurch when it comes to getting help. Nugent may have suffered from the stigma of misdiagnosis, but some other young man or woman, with far more debilitating symptoms, might suddenly find him or herself deprived of a needed support system. Still defining mental illness seems to be a sometimes arbitrary and even trendy affair. In the 50’s, people whispered the word “nervous breakdown” like the characters in a Neil Simon play who are constantly whispering about "cancer." Today bipolarity seems to have taken over as the mental illness du jour. Could so many people be bipolar? And then there are learning disorders like ADD. It’s nice to know that some slow learners are simply having trouble concentrating and that a dose Ritalin might be just the cure for their hyperactivity, but could whole populations of children require medication for their supposed attention deficit disorders? One would hope that matters like these would be addressed by the editors of the forthcoming edition of the DSM, but then one would have to ask who will be applying the criteria. “A Mind is a Terrible Things to Waste,” was a slogan coined by the United Negro College Fund back in l972. But it’s resonant in the context of the current controversies about diagnosis. Is there any such thing as true objectivity when a mind is evaluating another mind?

Population on the Verge of a Nervous Breakdown

During the 1950s, “nervous breakdown” was the overall rubric under which a variety of behaviors and conditions were catalouged. High powered advertising executives of the kind portrayed in the popular television series Mad Men had breakdowns due to the stress of their jobs, and were sent away to sanitariums like the famed Austen Riggs in Stockbridge (if they could afford it). In those days, the tranquillizer of choice was Miltown, which then gave rise to Librium and Valium. The protagonist of A Stop at Willoughby, the famed Twilight Zone episode about a harried ad executive who slips into an escape hatch from the prison of his high-pressure existence, is the prototypical nervous breakdown sufferer, but his psychic break transports him into a fantasy of a euphoric, carefree world which turns out to be death. You don’t hear about nervous breakdowns much anymore. Today, the diagnosis that is increasingly being provided for a variety of behaviors is bipolar disorder. What are we to make of this? Were those suffering from bipolar disorder merely ignored, in the same way that the learning disorders ADD and dyslexia were long overlooked or misunderstood, or were those afflicted with nervous breakdowns really suffering from bipolar disorder? Sometimes the changes in labels are the result of the DSM IV, which lists and categorizes conditions, and which recently broadened the category for autism to such an extent that Asberger’s no longer stands alone as a diagnostic category. And then there are the ailments that seem to come and go, like the women who talk of Michelangelo in “Prufrock.” One of these is Chronic Fatigue Syndrome, a malady that appeared to be more ubiquitous in the ‘90s than it is today, despite the fact that no vaccine was ever developed to prevent it from striking.