DSM5 for Laymen

The Devil’s Hole Sinkhole

“The Committee of Doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived…” was how the Times described the process of creating the new DSM5, “the so-called bible of mental disorders (“A Tense Compromise On Defining Disorders,” NYT, 12/10/12).  Even without having looked at the new DSM-V, here are some of new redefinitions that might run through the mind of a lay person who has followed some of the controversies surrounding diagnosis. The increasingly popular bipolar disorder would be changed from a shift in the mood of a patient to an environmental problem involving global warming. In short bipolar disorder is now melting of the ice caps at the North and South Poles. Manic depression, a condition that was formerly characterized by feelings of almost unbearable exhilaration tempered by countervailing feelings of worthlessness would be changed to a geological malady. For instance, sinkholes of the kind that effected the city of Berezniki (“A Russian City Always on the Watch of Being Sucked into the Earth,” NYT, April 10, 2012) and quicksand pits would both qualify as examples of manic depression. Borderline personality disorders, which rank amongst the most serious of mental disorders would currently be treated as territorial disputes. An obvious borderline problem would be one in which two countries (and in particular the personalities who occupied them) actually disagreed about their borders. The conflict between China and Japan over the Senkaku Islands and the conflict between Britain and Argentina over the Falklands both qualify as borderline disorders under the new paradigm. In the new DSM5 the symptoms of multiple personality disorder would include the creation of aliases in order  to avoid paying bills and/or alimony.

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.