Dsm Life Quotes

The power to label is the power to destroy.

One day I would like to make up my own DSM-111 with a list of “disorders” I have seen in my practice. For example, I would want to include the diagnosis “psychological modernism,” an uncritical acceptance of the values of the modern world. It includes blind faith in technology, inordinate attachment to material gadgets and conveniences, uncritical acceptance of the march of scientific progress, devotion to the electronic media, and a life-style dictated by advertising.

Loose diagnosis is causing a national drug overdose of medication. Six percent of our people are addicted to prescription drugs, and there are now more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs.6

I was much crazier than I had imagined. Or maybe it was a bad idea to read DSM-IV when you're not a trained professional. Or maybe the American Psychiatric Association had a crazy desire to label all life a mental disorder.

The great unspoken paradox of the arduous process of psychoanalysis is that the best patients are the ones who never really needed it in the first place. Abnormal

Taking a pill is passive. In contrast, psychotherapy puts the patient in charge by instilling new coping skills and attitudes toward life.

[W]e have far too much faith in pills, far too little trust in resilience, time, and homeostasis.

Mental disorders should be diagnosed only when the presentation is clear-cut, severe, and clearly not going away on its own. The best way to deal with the everyday problems of living is to solve them directly or to wait them out, not to medicalize them with a psychiatric diagnosis or treat them with a pill.

[W]ay too much treatment is given to the normal "worried well" who are harmed by it; far too little help is available for those who are really ill and desperately need it. Two thirds of people with severe depression don't get treated for it, and many suffering with schizophrenia wind up in prisons. The writing is on the wall.

Overcoming problems on your own normalizes the situation, teaches new skills, and brings you closer to the people who were helpful. Taking a pill labels you as different and sick, even if you really aren't. Medication is essential when needed to reestablish homeostasis for those who are suffering from real psychiatric disorder. Medication interferes with homeostasis for those who are suffering from the problems of everyday life.

Patienthood can become a way of life and rationale for people who are struggling for other reasons.

Time heals so well because many of our ills are short-term, situational, and self-limited - our bodies and our minds are programmed to be resilient without any active effort on our part.

It is equally dangerous at either extreme - to have either an expanding concept of mental disorder that eliminates normal or to have an expanding concept of normal that eliminates mental disorder.

DSM definitions do not include personal and contextual factors such as whether the depressive symptoms are an understandable response to loss, a terrible life situation, psychological conflict or personality factors.

I was much crazier than I had imagined. Or maybe it was a bad idea to read the DSM-IV when you’re not a trained professional. Or maybe the American Psychiatric Association had a crazy desire to label all life a mental disorder.

I was much crazier than I had imagined. Or maybe it was a bad idea to read the DSM-IV when you're not a trained professional. Or maybe the American Psychiatric Association had a crazy desire to label all life a mental disorder.

Stigma takes many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the extrusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt a child or pilot a plane. But it is also the reduced expectation, the helping hand when none is needed or wanted, the solicitous sympathy that one cannot really be expected to measure up. And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of the trouble comes from the change in how you see yourself: the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of the group. It is bad enough that stigma is so often associated with having a mental disorder, but the stigma that comes from being mislabeled with a fake diagnosis is a dead loss with absolutely no redeeming features.

ADHD is spreading like wildfire. It used to be confined to a small percentage of kids who had clear-cut problems that started at a very early age and caused them unmistakable difficulties in many situations. Then all manner of classroom disruption was medicalized and ADHD was applied so promiscuously that an amazing 10 percent of kids now qualify.

The DSMs have a mixed record. They have served an extremely valuable function in improving the reliability of psychiatric diagnosis and in encouraging a revolution in psychiatric research. But they have also had the very harmful unintended consequence of triggering and helping to maintain a runaway diagnostic inflation that threatens normal and results in massive overtreatment with psychiatric medication.

We feel so superior to the dead. For example, if Michelangelo was so damn smart, why'd he die? How I feel reading the DSM is, I may be a fat stupid dummy, but I'm still alive. The caseworker's still dead, and here's proof that everything she studied and believed in all her life is already wrong. In the back of this edition of the DSM are the revisions from the last edition. Already, the rules have changed. Here are the new definitions of what's acceptable, what's normal, what's sane. Inhibited Male Orgasm is now Male Orgasmic Disorder. What was Psychogenic Amnesia is now Dissociative Amnesia. Dream Anxiety Disorder is now Nightmare Disorder. Edition to edition, the symptoms change. Sane people are insane by a new standard. People who used to be called insane are the picture of mental health.

Nature abhors homogeneity and simply adores eccentric diversity.

Labels can also create self-fulfilling prophecies. If you are told you are sick, you feel and act sick, and others treat you as if you are sick.

Binge eating disorder is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a standard classification used by health professionals, as a mental disorder.

Manual of Mental Disorders, 5th Edition (DSM-5)—a person must be distressed by their drug use. In addition, the individual’s drug use must interfere with important life functions, such as parenting, work, and intimate relationships. This use must take up a great deal of time and mental energy and must persist in the face of repeated attempts to stop or cut back. Other symptoms that the person may experience include needing more of the drug to get the same effect (tolerance) and suffering withdrawal symptoms if use suddenly ceases.

The grief exception revealed something that the authors of the DSM—the distillation of mainstream psychiatric thinking—were deeply uncomfortable with. They had been forced to admit, in their own official manual, that it’s reasonable—and perhaps even necessary—to show the symptoms of depression, in one set of circumstances. But once you’ve conceded that,4 it invites an obvious follow-up question. Why is a death the only event that can happen in life where depression is a reasonable response? Why not if your husband has left you after thirty years of marriage? Why not if you are trapped for the next thirty years in a meaningless job you hate? Why not if you have ended up homeless and you are living under a bridge? If it’s reasonable in one set of circumstances, could there also be other circumstances where it is also reasonable?

THE DSM-V: A VERITABLE SMORGASBORD OF “DIAGNOSES” When DSM-V was published in May 2013 it included some three hundred disorders in its 945 pages. It offers a veritable smorgasbord of possible labels for the problems associated with severe early-life trauma, including some new ones such as Disruptive Mood Regulation Disorder,26 Non-suicidal Self Injury, Intermittent Explosive Disorder, Dysregulated Social Engagement Disorder, and Disruptive Impulse Control Disorder.27 Before the late nineteenth century doctors classified illnesses according to their surface manifestations, like fevers and pustules, which was not unreasonable, given that they had little else to go on.28 This changed when scientists like Louis Pasteur and Robert Koch discovered that many diseases were caused by bacteria that were invisible to the naked eye. Medicine then was transformed by its attempts to discover ways to get rid of those organisms rather than just treating the boils and the fevers that they caused. With DSM-V psychiatry firmly regressed to early-nineteenth-century medical practice. Despite the fact that we know the origin of many of the problems it identifies, its “diagnoses” describe surface phenomena that completely ignore the underlying causes. Even before DSM-V was released, the American Journal of Psychiatry published the results of validity tests of various new diagnoses, which indicated that the DSM largely lacks what in the world of science is known as “reliability”—the ability to produce consistent, replicable results. In other words, it lacks scientific validity. Oddly, the lack of reliability and validity did not keep the DSM-V from meeting its deadline for publication, despite the near-universal consensus that it represented no improvement over the previous diagnostic system.29 Could the fact that the APA had earned $100 million on the DSM-IV and is slated to take in a similar amount with the DSM-V (because all mental health practitioners, many lawyers, and other professionals will be obliged to purchase the latest edition) be the reason we have this new diagnostic system?

No wonder the current Diagnostic and Statistical Manual of Mental Disorders (DSM) defines detachment as a condition known as ‘depersonalization disorder’, a sense of being ‘detached from, and as if one is an outside observer of, one’s mental processes or body’. So anyone capable of detachment is mentally ill, indeed scarcely even a person at all. Yet, achieving personal detachment was considered to be a key factor in mental health by every thinker from Buddha to Sartre.

The DSM-5 defines depression as a person having multiple symptoms, which may include a depressed mood, loss of energy, diminished ability to concentrate, changes in appetite, and decreased interest or pleasure in normally enjoyable activities, for more than a two-week period. It also states that depression is disruptive, meaning that a person’s decreased mood is interfering with their ability to comfortably live their lives. A person with depression may have a lot of trouble getting out of bed in the morning, finishing basic tasks, or connecting with friends and family. One of my patients once described depression to me as what happens when life loses its color—and I think that’s a very illuminating description.

A ranting psychotic is far enough away from mean to be recognized as mentally sick by your aunt Tilly, but how do you decide when everyday anxiety or sadness is severe enough to be considered mental disorder? One thing does seem perfectly clear. On the statistical face of it, it is ridiculous to stretch disorder so elastically that the near average person can qualify. Shouldn’t most people be normal?

we neglect what are the best forms of prevention—i.e., promoting exercise, proper diet, moderation in alcohol use, abstention from tobacco and drugs. These extremely useful and remarkably cheap prevention measures aren’t profitable for the medical-industrial complex and therefore lack its powerful and well-financed sponsorship.

We also know that ADHD can crop up for the first time in adulthood. This often happens when the demands of life exceed the person’s ability to deal with them. Classic examples are when a woman has her first baby or when a student starts medical school. In both instances the organizational demands of daily life skyrocket and the person shows the symptoms of ADHD that he or she had been able to compensate for in the past. It is then that ADHD can and should be diagnosed. Indeed, adult-onset ADHD is a recognized condition in the big book of psychiatric disorders, the Diagnostic and Statistical Manual (DSM-5).

Diagnostic inflation has led to an explosive growth in the use of psychotropic drugs; this then produced huge profits that have given the pharmaceutical industry the means and the motive to blow up the diagnostic bubble into an ever-expanding balloon.

the drug companies had to get an indication for bipolar disorder and then they had to advertise a conception of bipolar disorder so broad as to be unrecognizable. Antipsychotics were soon being prescribed promiscuously, even by primary care physicians, to patients with garden-variety anxiety, sleeplessness, and irritability.

Much of the increased prevalence of ADHD results from the “false positive” misidentification of kids who would be better off never receiving a diagnosis. Drug company marketing pressure often leads to unnecessary treatment with medications that can cause the harmful side effects of insomnia, loss of appetite, irritability, heart rhythm problems, and a variety of psychiatric symptoms.

CBD has become the most inflated bubble in all of psychiatric diagnosis, with a remarkable fortyfold inflation in just one decade. CBD satisfied three essential preconditions for excessive popularity: a pressing need, influential prophets, and an engaging story.

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). Back to the DSM. We were at point C, a criterion I'd like to shout from the rooftops: symptoms are present from childhood, but It's entirely possible they don't manifest until challenges in your life exceed your capabilities and coping skills. This is also referred to as the autistic burn-out: someone who was previously able to speak in coherent sentences, suddenly can't utter a single word or bursts into tears at the slightest change. It's the result of years of asking too much, of hiding and of "acting normal". The person in question shuts down and seems to become more autistic. But that's not the case: The person was always this autistic, they just ran out of energy to hide it.

The DSM, and medical discourse in general, are not the only entities governing the operation of mental disabilities in university culture. We, academics, are also governing ourselves.

Note that a loss of interest and pleasure in life is enough for a diagnosis of Major Depressive Episode—the presence of sadness, hopelessness, or depressed mood is not necessary.

There is no definition of a mental disorder. It's bullshit. I mean, you just can't define it.

[E]ligibility for disability and other benefits should depend more on the person't actual level of functional impairment, less on whether or not he has a psychiatric diagnosis.

The definitions of mental disorder generally require the presence of distress, disability, dysfunction, dyscontrol, and/or disadvantage. This sounds better as alliteration than it works as operational guide. How much distress, disability, dysfunction, dyscontrol, and disadvantage must there be, and of what kind? [...] Not having a useful definition of mental disorder creates a gaping hole at the center of psychiatric classification, resulting in two unanswered conundrums: how to decide which disorders to include in the diagnostic manual and how to decide whether a given individual has a mental disorder.

Others argue that an increasingly demanding society is exposing previously subclinical ADHD symptoms. As performance standards are ratcheted up and external stimulation becomes nonstop and blaring, previously well-adapted individuals with mild ADHD may now be reaching a clinically significant level of impairment that qualifies as a mental disorder and requires treatment. My point back is that the difficulties people have in meeting society's expectations should not all be labeled as mental disorders. [...] If we, as a society, choose to help people enhance their performance to meet (perhaps excessive) demands, this should be an open policy decision - not one cloaked under medical auspices, done by medical prescription, and enhanced by drug company marketing.

[M]onolithic opposition to psychiatry is far too undiscriminating in its broadside critique. Indeed, it seems to me equally impossible to be enthusiastically an uncritical psychiatric loyalist or a dedicated psychiatric debunker. Both positions miss the truth in their one-sided extremity. [...] The antipsychiatry movement, generalizing from worst cases [...], goes way overboard and condemns all of psychiatry. Their extremism would deprive those who really need treatment and can benefit greatly from it.

DSM-IV unwittingly contributed to three new false epidemics in psychiatry—the overdiagnosis of attention deficit, autism, and adult bipolar disorder.

3. Paul Enright, “A Homeopathic Remedy for Early COPD,” Respiratory Medicine 105 (2011): 1573–75.

We need either to get the primary care doctors out of psychiatry or to teach them how to do it and give them sufficient time to do it properly.

The technical skills of medicine are becoming increasingly routine and may soon be done better by computer programs - but the shamanic skills of medicine will always be important to patients and to society.

We should not have the ambition to label as mental disorder every inconvenient or distressing aspect of childhood.

Our classification of mental disorders is no more than a collection of fallible and limited constructs that seeks but never finds the truth - but this remains our best current way of communicating about, treating, and researching mental disorders. [...] It is good to know and use the DSM definitions, but not to reify or worship them.

Psychiatric disorder consists of symptoms and behaviors that are not self-correcting - a breakdown in the normal homeostatic healing process. Diagnostic inflation occurs when we confuse the typical perturbations that are part of everyone's life with true psychiatric disorder[.]

[D]iagnosis needed to rest in order to let research catch up. It made no sense to keep rearranging the furniture of descriptive psychiatry, creating new diagnoses or altering the thresholds of existing ones, based only on the whims of the experts who happened to be in the room. [...] Changes in diagnoses should be few and far between until we gained much deeper understanding of what causes the mental disorders and how best to define and treat them.

Some radical critics of psychiatry have seized on its definitional ambiguities to argue that the profession should not exist at all. They take the difficulty in finding a clear definition of mental disorder as evidence that the concept has no useful meaning - if mental disorders are not anatomically defined medical diseases, they must be "myths," and there is no real need to bother diagnosing them. [...] This shibboleth can be believed only by armchair theorists with no real life experience in having, living with, or treating mental illness. However difficult to define, psychiatric disorder is an all-too-painful reality for those who suffer from it and for those who care about them.

We don't have to fully perceive or understand the underlying nature of our world to negotiate it well. Our senses and reasoning powers evolved as they did because they work just fine in the everyday, nonphilosophical business of survival. Mental constructs of reality are imperfect, but indispensable, ways to organize the otherwise bewildering phenomena of the world.

Disease mongering cannot occur in a vacuum—it requires that the drug companies engage the active collaboration of the doctors who write the prescriptions, the patients who ask for them, the researchers who invent the new mental disorders, the consumer groups that advocate for more treatment, and the media and Internet that spread the word.

Elusive reality does not discourage Umpire Two. We don’t have to fully perceive or understand the underlying nature of our world to negotiate it well. Our senses and reasoning powers evolved as they did because they work just fine in the everyday, nonphilosophical business of survival. Mental constructs of reality are imperfect, but indispensable, ways to organize the otherwise bewildering phenomena of the world.

I sometimes joke that the only way to define mental disorder is “that which clinicians treat; researchers research; educators teach; and insurance companies pay for.

It is good to know and use the DSM definitions, but not to reify or worship them.31,32

When someone has symptoms in each of those four categories, the DSM label is PTSD. It is really important to remember, however, that PTSD is not the only way that trauma impacts our mental and physical health. The adverse effects of trauma that we discussed at the beginning of the chapter can have just as significant an impact on someone’s life. In fact, the majority of the long-term effects of trauma don’t manifest as PTSD.

[T]he DSM alone does not establish standards. Physicians, other mental health workers, drug companies, advocacy groups, school systems, the courts, the Internet, and cable TV all get to vote on how the written word will actually be used and misused.