Oldsocialworker - Needless Pathologizing

Rampant Misuse of Psychiatric Diagnoses:

I believe one of the most insidious and compelling threats to the continued existence of our once freedom loving and independent thinking culture is the rampant misuse of psychiatric diagnoses, which reduces people to hapless victims of illness rather than willing actors indulging their appetites regardless of the costs to others.  “Well, she’s bipolar”,  “He’s ADD, so what can you expect?”, or, “Well, he didn’t take his meds this morning” are common rationalizations I  hear when talking with teens, parents, and even faculty about various behavioral issues.  I am not suggesting that there aren’t occasions in which behaviors are affected or under girded by a physiologically based cause but, in my experience, it has been the exception and not the rule.  Today, we have made the psychiatric condition and subsequent diagnosis the “first line of defense” when addressing human behavior, particularly bad behaviors.  We have made medical pathology the rule.

Diagnostic and Statistical Manual:

The Diagnostic and Statistical Manual, or DSM, was first published in 1952 in effort to collect and document various psychiatric symptoms so that medical charts would reflect a standardized understanding among mental health practitioners of what symptoms a given patient was manifesting.  Initially, the DSM was used primarily by psychiatrists for gathering data about and treating military personnel.  Over the decades, it has been revised a number of times (its is now the DSM IV R) and – when I started in the mental health field in 1984 - was supposed to be used primarily for billing third party payers for mental health services or qualifying for government subsidies such as SSI.  Each diagnosis has a corresponding numerical code, which justifies billing for medical services- which is what most mental health services are considered. 

Ever-metastasizing Entitlement Mentality:

This sounds innocuous enough and perhaps once was.  Unfortunately, the ever-metastasizing entitlement mentality has given rise to the tendency of many to abdicate personal responsibility on a number of fronts.  For some, a medical diagnosis is very attractive because it can serve as a pass for various choices and behaviors.  For others, it affords access to public funding for services and payments available to the disabled.  This has unleashed the need for all manners of social and psychological “experts” to deal with the personal and social chaos that has indeed ensued.    In too many cases, diagnosis has come to wield an institutionalized and patently destructive power that produces considerable collateral damage.  Following are some actual cases I’ve worked with that illustrate my point:

Case Study of 'Jake': (actual name withheld)

A fourth grade boy was referred to me because he brought printed pornographic materials to school and was physically and sexually aggressive toward classmates.  “Jake” frequently drew genitalia and pictures of people engaged in sexual acts.  He had a sister in kindergarten that would suck her thumb and preferred to remain crouched beneath her desk to doing anything else.   Over time, working with Jake (the parents wouldn’t give permission for his sister to receive counseling) yielded much information.  He spoke about his father being “bipolar” and having a “seizure disorder”, as well as being both on disability and taking a lot of medication.  The father’s primary symptoms of “bipolar” were heavy drinking, violent outbursts, openly engaging in sex in the home with women from the go-go bar next door, along with frequent masturbation in front of the kids (which constituted the seizure disorder- the father claimed he “blacks out” when masturbating).   The mother- who had an annoying habit of nearly nonstop giggling- was completely invested in her husband’s “illness” and maintained that, “he (father) couldn’t help himself”. Mother was receiving disability for “nerve problems” and was on “nerve pills”.

 This charming couple also made pornographic movies in their basement and sued various businesses from time to time when funds got low.  Child protective services had been involved numerous times over the boy’s nine years of life.  The word from the prosecutor’s office was that as long as the children weren’t “forced to watch or participate” in the pornographic movies or with the women their father brought into the house, there was no legal ground for intervention.  The family was advised to “restrict sexual activity to a designated area closed off to the kids” so that the kids couldn’t directly see it.    The father received “counseling” for his bipolar disorder at a hospital clinic, and he continued to torture his kids with the full protection of experts and laws that defend the “disabled”.   His reign of destruction was successful- Jake ended up adjudicated for robbery and arson at the age of 16 and the girl was finally sent to a residential alternative school for “emotionally disturbed” kids (which the school district had to partially pay for).  “Emotionally disturbed”… Gee, I wonder how THAT happened?  Now both teens are receiving services for the emotionally disturbed and being “treated” for their “mental illnesses”.  Both are now “disabled” and on “appropriate medications”.   What an expedient system we have- we can help create, maintain, and treat disabilities!

Case Study of 'Nadia': (actual name withheld)

Sixteen-year-old “Nadia” came to my office the other day upset from her mother’s latest antics from the night before.   Given to unpredictable violent outbursts and stealing the money that Nadia makes working at an ice cream store, Nadia’s mother is on disability for bipolar disorder.  Nadia is a thoughtful and gentle girl who clearly sees and does not want to repeat the hellish familial patterns of her parents- so she works for good grades and has a part time job while helping to care for her two younger step siblings.   Nadia is what is called “parentified”- she assumes the role her mother should.

 Nadia’s father has another wife and kids, having divorced her mother 8 years ago; he wants little or preferably nothing to do with Nadia (responsibility is what he’s avoiding- but that’s for another day).   According to Nadia, her mother frequently talks about her teen years and how beautiful and popular she was back then.  Now forty-five years old, her mother has developed a preference for 18-25 year old men, because they are “more fun”.  When Nadia speaks about the drama and often all-night fights between her mother and the boys she brings home, she often interjects apologies and says, “I know she’s got bipolar, so I feel bad complaining…”.  Nadia has also mentioned that she’s afraid that she too might “come down” with bipolar disorder, because she’s heard it runs in families.  To Nadia “bipolar” means you do nothing but live to satisfy the demands of base appetites and violently attack anyone who interrupts the feeding process, because that’s what she’s witnessed and its backed up by an Official Diagnosis that comes with paychecks.  This is obviously a bastardization of legitimate medicine, and it is far too common.

Nadia’s mother manages to consistently have time, money, and energy for the pursuit of men, evenings out, and daily workouts at a gym, tanning, frequent concerts, travel, and any other self-indulgent entertainment pleasure.  The only time she evidences a downturn in affect is if anything remotely mature is required of her. I have known Nadia and her mother for two and half years and believe Nadia’s mother to be malignantly selfish with a legal and medical escort system that helps keep it all going.  Child protective services have been involved from time to time since Nadia was nine- and the recommendations are “family counseling” and psychiatric treatment for bipolar disorder.  Nadia was even told by a caseworker to “be patient” with her mother because she’s “ill”.  Talk about the bending the hell out of reality and putting inappropriate responsibility on a kid!

Moreover, Nadia is and has been consistently subjected to the perilous fallout of her mother’s behaviors, including an ongoing stream of random men often staying overnight in her home.  The most recent paramour was a drug dealer who offered to buy Nadia a car if she would do business in the high school for him.  Thankfully, that particular great, glittering jewel of a “father figure” is now in jail for some reason or another.  This is yet another way kids get hurt and become accustomed to the absurd as a lifestyle- complete with expert intervention and oversight, which adds to the ghoulish festivities.

Case Study of 'Leah': (actual name withheld)

Last week one of my students wanted to discuss a situation with her boyfriend.  “Leah” was wondering if it was unreasonable for her to be angry with him because he got drunk at a party and had sex with another girl.  Boyfriend told her he did it because his ADD medication and the alcohol didn’t mix well and he didn’t know what he was doing.  Leah thinks it is important to offer understanding to people who have problems, which can’t be helped and wanted to avoid being “mean”.    I advised Leah that it is worse to become desensitized to the selfish and manipulative behaviors of others, diagnosis not withstanding.  It is never “mean” to hold someone accountable and protect yourself, and is –in fact-completely healthy for both of you.

Summary:

 At times I’m looked at as if I’m speaking Swahili when I broach subjects such as human will and appetite based choices being at the helm of bad behaviors, as was the case with Leah.  Given the propensity of many to confuse indulgence with compassion, this is no easy feat.  It is, at times, rather like doing a kind of “deprogramming” work, as is done with people who have been involved with a cult.    The fact is, the indulgence of bad behaviors is the least compassionate response that can be offered, because we end up shaping and cultivating monsters and tyrants.