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Why One Size Does NOT Fit All...

by Unlisted&Twisted! 7 months ago in disorder
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Dissin' the DSM-IV and DSM-V

"The Cat's OUT The Cradle... And CRAZY!" [Picture by Olivia Petrus].

The following is an essay I wrote for my Introductory Psychology class, dated Sept. 25th, 2009, with some updated edits...

"I’ve got a bad disease. Up from my brain is where I bleed…" Soul to Squeeze. Red Hot Chili Peppers.

I always told one of my old friends, Jim Jim, that he should write a book about his life. He was never the type to ever sit down and write, however his short, twenty-three-year-old life was rich with stories and ripe with the type of material that fills up a thrilling, cliff-hanging memoir. That or builds up a minor-yet-notable fortune for the psychiatrist collecting Medicaid reimbursements for the therapy that could be given to this kid that was lovingly given up.

Jim Jim, an adopted child, ended up near endlessly revolving around, "The System" like so many other children in similar scenarios in and out of foster care. Nothing more than a number to denote that he was a Ward of the State, rather than someone's son, a human being, an individual, a life...

At some point, a kind, intelligent older man took him in permanently. However, permanent is not a concept that can be easily grasped by a young man that was flung from house to house, lifestyle to lifestyle, the way Jim Jim was. So, despite finally settling down into a warm and safe place - a home, not just some house – Jim Jim still planted his roots firmly into the one and only factor that remained a constant in his unstable life – the uneven concrete soil of the streets.

No, he did not run away. He just grew to be another tree amongst a forest of lost souls, another fish aimlessly floating in a sea filled with sharks. He smoked his first blunt and had his first drink at the tender age of eight, graduated to doing lines of cocaine at ten, and after that, whatever came around went down, if you know what I mean. This is the kind of life psychologists and psychiatrists routinely record, analyze, test and study. This is the kind of life the study of Psychology has tried to compact into an easy to understand problem with a few simple, un-individualized care solutions. I can only imagine how cold and objectively a therapist would begin to tackle his life - or should I say case? They would give scientific and politically correct names to his problems. Substance abuse - or maybe even a narcotics ADDICTION - would neatly organize his drug use into an understandable label found in the DSM-IV. There, Conduct Disorder with a hint of pronounced ADHD would conveniently sum up his hyperactive and at times, unruly behaviors, summarily. Issues with abandonment might be revealed after issuing him the standard, now outdated, Rorschach Ink Blot Test and matching his response to the set of predetermined answers and default meanings found in some upper-level psychology book.

Is this really the best way to accurately diagnose someone with a legitimate medical problem – the ability to flip open the DSM-IV or DSM-V and determine mental illness, or lack thereof, based upon being able to subjectively distinguish three out of fifteen vague symptoms for a given disorder? Many of these “symptoms” closely resemble human characteristics or typical, albeit quirky at times, personality traits. So what if Jim Jim never stopped bouncing his leg when he would try to sit still in grade school, before the cocaine short circuited his brain? Does that really mean he has ADHD or some sort of Generalized Anxiety Disorder? Were his energetic tendencies – the natural state of most children – really a medical problem severe enough to warrant a prescription of Adderall, Ritalin, Concerta or Strattera as prompted by a quick reference to a symptom list found in the DSM-IV or DSM-V.

Now, it would be pretty unfair of me to proclaim that this is how ALL doctors go about dealing with their patients who think that they might have a problem because they think they might think a wrong way, because that is what they think everybody else thinks. We must remember that the DSM-IV and DSM-V were revisions created more or less out of necessity. Psychologists, psychiatrists, doctors, insurance companies, and so on needed at least one book - with MANY revisions that laid out supposedly all the psychiatric disorders that could be somewhat agreed upon. Yet I still feel somewhat slighted that these books that are so heavily relied upon. It has the appearance of a cookbook – a slew of mental health recipes and its’ ingredients that if thrown together properly, warrant a prescription of psychoactive drugs, or validates the amount of coverage to be bequeathed to an individual in desperate need of in-patient therapy by a health insurance company. One only needs to re-read the first line of this paragraph to understand that mental illness is so much more complex than a list of symptoms. There is no way Jim Jim’s life - I mean case – could be resolved - by recognizing symptoms in a cluster and devising a health care strategy (i.e. drug regiment) with therapy that may or most likely may not be covered under his health insurance policy. Problems encountered by Jim Jim and others that are submerged in the psyche need to be dealt with on an individualized basis. Since every single person on this planet is unique - differing in thought, belief, perception, culture and mannerisms - care plans for people suffering from mental health issues, no matter how serious or seemingly insignificant, should be approached with the attitude of an explorer about to pioneer an expedition into the unknown – with a fresh perspective and expectation of the unexpected.

It is not the DSM-IV or its' revision, itself I see as being flawed. It has its’ place and purpose – mostly for insurance billing purposes. The DSM-IV and the current DSM-V, are necessary scientific nomenclature that helps LEGITAMIZE mental illness as REAL, VALID illnesses, that seem invisible, but are so disruptive and chaotic to live with, that even Hippocrates noted the practice of psychiatry to be NOT of one that treats the physical body, but treats the very SOUL. It also serves as a helpful guide for all mental health care practitioners. It’s the misuse of the book in question that can be of such a great disservice to those who bear mental scars and bruises.

Just as no primary care physician should simply write out a prescription for a psycho-pharmaceutical agent without first referring the patient to a psychiatrist or mental health practitioner for evaluation, so should no psychiatrist or psychologist simply check off symptoms found in the DSM-IV or DSM-V to determine what a patient’s real problem is, and how it should be dealt with. This is particularly true if the doctor decides pharmacological intervention is necessary. If a psychologist or therapist is an explorer about to embark on a journey into the unknown – his or her individual client’s mind – the DSM-IV and DSM-V could be thought of as a globe. A globe can help an explorer know the general location of an uncharted territory; on this planet, in this hemisphere, on this continent, in this country and so on, but the explorer has no map in his or her hand to guide them through the unexplored area. The pioneering explorer is the one responsible for writing out the first map. The therapist, or any other mental health practitioner, is responsible for helping their client lay out the map of their own unobserved mind, a feat that can not be done by looking up a check list in the DSM-IV or DSM-V alone, or knowing the content of any other psychology text book, alone.

Should the day ever come that Jim Jim would decide he needed help with his problems, I would hope his care would fall into the hands of a responsible, compassionate, qualified professional who treated him as an individual. I would hope that after talking to his doctor or therapist, he would not go home to tell his adopted father that he had been diagnosed as this or suffering from a case of that, and would have his prescription for such and such ready in an hour. I would hope he would not leave the psychiatric health care’s office feeling as though that in two or three weeks, when his medication(s) kicked in, his problems would be solved. Or that now, since he was given a scientific label for his personality, he had a reason to excuse his self-injurious behaviors. He, and any other person seeking help for their bad disease - a brain that bleeds - deserves not just some doctor or therapist who has a bookshelf loaded with empty words bearing narrow solutions. They deserve a pioneer ready to help them explore their mind, rather than tell them what their mind is. People suffering from mental illness should not have to suffer the devastating consequences of being treated with a one-size-fits-all cookbook. They can only begin to flourish and heal once the shrinks and doctors and therapists and so on realize that their problems are individual. Their cases are unique, and as such they cannot be treated by simply looking up a cluster of symptoms in the DSM-IV or DSM-V or health care strategies found in certain chapters of certain paragraphs in random psychology books alone. Worse of all, YouTube clips like Psych 101... Don't follow them, if you're looking for information on psychiatric illnesses. Subscribe to NAMI - The National Alliance on Mental Illness' channel. Or the DBSA. Again, do your own research. But beware - the internet is NOT a trained clinician. Particularly when it comes to mental illness, or mental health issues.


About the author


Welcome Readers! Thank you for checking in! I am a young, mentally ill young woman with a passion for mental health awareness, music, and love to write! I hope my stories inspire you. Follow me here or on Instagram @unlistedandtwistedblog

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