What’s my diagnosis?

Americanitis Elixir A1 F&D 1906 Well, that depends. At what era in  history did you come down with a mental disorder? Many of you may not be following the discussion around the new DSM V and its changes in various mental health labels. My internet wanderings recently led me to the article referenced below:

http://www.psmag.com/health/real-problem-with-dsm-study-mental-illness-58843/

The author makes many very interesting points, but one of them is the suggestion (I haven’t checked the research personally) that the total amount of psychic distress stays the same, but the mental health diagnoses change. So we no longer have neurasthenia (Americanitis) and hysteria, but we are now blessed with attention deficit hyperactivity disorder and social phobia. On the other hand, dementia praecox has become schizophrenia, and dipsomania has become alcoholism. So some clinical entities fade away, and others change their names.

I bring a clinician’s hat to this blog more than an academician’s hat– being as I’ve done no research and little teaching, such humility is only decent. But I think it’s hearty food for thought to look at what diagnostic categories have remained recognizably the same over time, as well as those that have changed. It’s important clinically– i.e., for practitioners and patients/clients/consumers. The author of the article linked to above doesn’t discuss in detail the implications for treatment when the DSM V changes definitions of mental illness– and what your insurance will pay for (!) but does, by implication, make a huge connection to the human condition. The amount of suffering in society stays the same, even though what we call it changes. This idea would suggest reasons why, in so many studies, the relationship with the therapist is a larger explanatory factor for change than the therapist’s theoretical orientation.

The whole diagnosis issue is moot if you’re paying for your own therapy– you can be in therapy for “relationship issues” or for I get overwhelmed when my boss acts like my mother used to.” But if you’re hoping your insurance will pay for it, then you  have to have something that’s in the DSM. So if you’re down for Asperger’s you’ll need to get re-diagnosed when your insurance company changes from DSM IV to DSM V.   But now, despite the fact that in the Victorian era people used to wear black for up to a year after the death of a family member, now your grief may become depression in a couple of weeks.

http://www.nejm.org/doi/full/10.1056/NEJMp1201794

Two weeks to get over the death of a spouse, child, parent? Wow. It’s enough to make my neurasthenia act up.

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About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
This entry was posted in behavioral health, mental health, Recovery, stigma of mental illness, Uncategorized and tagged , , , , , . Bookmark the permalink.

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