Bipolar Disorder, ADHD and Man’s Soul

Bruno Bettleheim

One of the lagniappes of psychoanalysis is the philosophical attitude it takes towards mental illness. There is no cure for life. In fact in Charlie Kaufman’s masterpiece Syndechoche, New York (2008) that is precisely the mysterious illness that afflicts the main character, Caden Cotard, played by Philip Seymour Hoffman. The DSM-5 offers a smorgasbord of diagnoses that offer the illusion or delusion that there is some sort of cure for mental states which is achieved by 1)naming them 2)medicating them and 3)making them insurable. This is not to say that there aren’t severely ill patients who don’t benefit greatly from medication. But these days every other person you talk to is either bipolar, ADHD or if their behavior is more over the top, borderline. And having received one of these diagnosis a buffet of medications awaits these sufferers. It’s not surprising that the Times recently ran a front page piece about the abuse of  attention deficit disorder diagnoses, emphasizing the beneficial effect the diagnoses are having on the profits of the drug companies (“The Selling of Attention Deficit Disorder,” NYT, 12/14/13). What’s most disturbing is that much of the medicating is being done willy-nilly by the worst kind of practitioners, those suffering from the arrogance of not knowing how little they know. Moliere would have had fun writing a parody of these Tartuffe’s of psychiatry. Perhaps he might have called it “Le docteur imaginaire.” When Bruno Bettleheim wrote Freud and Man’s Soul :An Important Reinterpretation of Freudian Theory back in l982, he was dealing with the American psychoanalytic  establishment’s need to use language as way of making psychoanalysis more scientific sounding. The fact is that while analysis may be quite helpful to the small number of patients who have the time and money to afford it, it’s hardly what one would classify as a scientific discipline. And that’s probably the good part. Psychoanalysis might not be the cure for ADHD or bipolar disorder, but it offers a broad view of human existence that attends to the one part of the human being that you can’t locate on an MRI or FMRI for that matter--the soul.

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?