Depression, anxiety, PTSD, bipolar disorder, dissociative identity disorder, gender dysphoria, ADHD, autism spectrum disorder, schizophrenia, OCD.....
"Do I have depression, or is that bipolar disorder? One doctor told me one thing, but my next one said something else."
In psychiatry, we learn to diagnose from a book called the DSM -- the diagnostic and statistical manual of mental disorders.
I fucking hate the DSM.
Most of the time, I hate labeling people.
Sometimes it gives people peace that they have a diagnosis, and that they are not crazy, defective, etc. There is a reason for their behavior, and there are others who experience something very similar in mood or behavior. This can be therapeutic and help acceptance of oneself. It can help a person move forward in healing and learn what to target in therapy.
But let's be honest. The DSM was written about white men, by white men.
Years ago, the DSM listed homosexuality as a diagnosis. Following arguments, the diagnosis was changed to "Sexual Orientation Disturbance," which only constituted those who identified as gay as disordered if they were distressed by it. How the fuck are you NOT distressed when you live in a society that tells you that you are sick? That gives you no rights, tells you that you are sinning and will go to hell? When your family rejects you? This 'diagnosis' was later removed.
Now, we list gender dysphoria as a diagnosis. In other cultures, identifying gender as a separate entity from sex is well accepted. But here, we consider it worth calling a disorder or illness, because our society does not accept it.
On top of that -- the DSM does not account for the impact of trauma, or the many presentations of trauma. It does not account for the socialization differences of men and women -- that girls should express sadness verbally and that boys should express sadness through anger, physically.
It does not account for the impact of in-utero trauma, intergenerational trauma, neglect, and chronic institutional traumas such as racism and sexism. There are many times I can identify that trauma is the underlying factor of the person's symptoms, but the criteria in the DSM for PTSD is not met. It may present more as what classifies as "psychosis" or "bipolar." If our brains all express and process differently, how can we always present the same way?
It does not account for the impact of poverty. People living in war zones right now are certainly feeling pain -- likely to a level I cannot even begin to understand or analyze. But they won't have a PTSD diagnosis. PTSD is a privileged label for people who can identify that they have felt trauma. That trauma is not a daily reality, and it has an end date. For some people, they will never escape the loss, pain and worry. But that is their life. It is everyone's life.
In America, it does not account for capitalism. I spent years of my life medicating poverty. Nothing ever got better, because the living conditions never got better. The schools never improved. The neighborhoods remained unsafe. I can keep kids on medication and I can keep them in therapy. But it's just to make them complacent with a life they should not be complacent with.
I have come up with my own analogies of describing depression, anxiety, OCD, and other concrete diagnoses through a 'spectrum.' Sometimes a person can have symptoms of hypomania, mania, psychosis and depression at the same time but may not fully fit the picture for either depression or bipolar disorder. But leaving it as "unspecified" does not provide a person with answers, and more importantly, insurance companies don't like that. So if a person needs special accommodations in life, I need to be a lot more concrete with the label I place on them, even if they don't completely fit the picture.
We pathologize children having tantrums. Perhaps a child has sensory issues, and is very triggered by things in the environment, or the way a parent speaks to them. Perhaps they are just sensitive, or struggle with emotional regulation. We are not born with the knowledge of self-regulation - hence, needing to be nurtured as infants. Maybe the kiddo is "defiant," and says no to everything. Maybe they are disrespectful to adults.
In the DSM, frequent tantrums classify as Disruptive Mood Dysregulation Disorder. Typically, I can find something underlying to tantrums and anger. Sometimes that means adjusting parenting styles, reducing stressors in the home/at school, helping the kiddo learn proper regulation or helping the kid focus. When kids tantrum, they shut down. They do not have a better way to express themselves. And now, we seek psychiatry for that. We seek medication to dull their ability to react. We condemn their anger. We are angry that they are angry.
Kiddo says no a lot? That counts as Oppositional Defiance Disorder. To be clear, I have never and will never use this. There is nothing organic or biological about this 'disorder.' Again, kids are going to test boundaries. They will say no -- especially if they can get away with it. Sometimes they refuse things because they are uncomfortable, do not know how to do it (and are embarrassed), or learn it from family. Sometimes they have trauma, or other underlying issues that cause them to act this way. And as adults, we cannot respect a child saying "no" to us. They must obey, and if they do not obey, this is a disorder.
Parents frequently want their children to be medicated into compliance. If they do not get along and are irritable with their parents, the parents want them medicated. There must be something wrong with them.
Feeling really nervous about things, and really sad about being isolated due to COVID? Well, now you probably are meeting criteria for Major Depressive Disorder. Despite the fact that being completely socially isolated during a pandemic is probably the reason, and that the world returning to normal would be the solution..people are diagnosed and medicated. You are grieving losses? You may be stuck on an antidepressant and hit with some diagnoses of various depressive or anxiety conditions. That's right, we even pathologize grief. If a person grieves too long, or grieves in a way society considers to be excessive, they may meet criteria for a disorder.
There are times in which I believe people need help, support and guidance. Medication can be lifesaving. I have experienced that. Medication may dull our reactions while we undergo therapy, but it is not the solution for everything. It cannot account for spirituality, mindfulness, lifestyle changes, eating well, socializing and exercising. It cannot account for the shitty job or shitty school or shitty neighborhood you are in.
I typically teach my students that diagnoses are bullshit. Sometimes we go through life, and life is just hard. Because life is hard, our brain goes through some changes which affect our mood, thoughts and behavior. If we all won the lottery by being born into perfect families in perfect environments with no problems or struggles and with no family history of mental illness or trauma..maybe we wouldn't be presenting with depression, anxiety, schizophrenia or bipolar disorder. But growth in life necessitates being challenged.
Sometimes, we need medicine to help that. Sometimes, medication could be the missing puzzle piece to help us improve our quality of life once we have tried everything else.
But let's start normalizing human emotions and reactions.
Because human emotions should not be considered 'disordered' or wrong just because society says so.
