The Diagnostic and Statistical Manual: Friend or Foe?

I made a note to myself to write this post a long time ago, because as both a long-time diagnos-ee (what, I can’t make words up?) as well as a once upon a time would-be diagnos-er (yeah, I used to think I wanted to be a social worker…), the DSM is something I’ve become relatively familiar with. And I have mixed feelings about it. I think it’s those complicated feelings, not to mention the complexity of the topic (I mean, does anyone really know what they’re talking about when they try to discuss the 500 pound gospel of mental health?), that have kept me from attempting it until now. After an interesting conversation with my psychiatrist yesterday, however, I think perhaps it’s time to take it on. But first, a disclaimer: I am not an expert. I am not AT ALL an expert. I could make this post all heavy on research and facts, but that would be hard. And I don’t feel like doing any research. So I’m going to focus on what I know from first hand experience — what I’ve witnessed as the pluses and minuses of having a tome like the DSM. (side note: I did at least google around a little bit before writing this, and apparently there’s A LOT of discussion out there about the DSM and its downfalls. And it does seem to have quite a few downfalls. Case in point: I also discovered that homosexuality was recognized as a mental illness until 1973…)

To set the stage, a little background: At the age of 12, I was diagnosed with anorexia nervosa. Back then, the doctors I was seeing were using the DSM-IV (it’s recently been ‘upgraded’ to the DSM-V), so on every receipt I received for mental health services, I saw the code 307.1. That number and its accompanying diagnosis came to define me, and as I’m just now realizing, has played a significant role in how I’ve viewed myself for much of my life. So imagine my surprise when about a year ago, a doctor somewhat casually mentioned that I may not actually have anorexia after all. We didn’t really get into it, though, and I got my scrip for Prozac and left. I pondered it a bit afterward, but the more I did, the more I didn’t really give a shit. They could call it whatever the hell they wanted — It was ruining my life no matter what number you wanted to slap on it, and that’s all I cared about. So I didn’t really think any more of it.

Until yesterday.

Once again, this doctor brings up the fact that anorexia may not be the correct diagnosis for what I’ve been struggling with. Apparently the fact that I do not have a distorted body image or fear of gaining weight makes me “ineligible” for that label. (Funny that no one has ever told me that before….) According to this doctor, my symptoms may in fact be a result of untreated anxiety and depression, with perhaps a dab of OCD mixed in, which would in fact be much easier to treat. Now that got my attention. I’m all about easy to treat. So at my next appointment, we’re going to do some more investigating, maybe some über fun psychological testing, and figure this shit out.

My reaction to this new development has surprised me for several reason, one being that I was convinced I was over the whole label thing. I thought I didn’t care what I “had” as long as I could kick its ass. But all of a sudden I feel relieved. Like maybe I don’t have a death sentence hanging over my head after all. Maybe I will, after years and years of struggling, finally achieve full recovery. It’s strange to notice thoughts like these moving through my head because I didn’t realize I’d given up hope. To be fair, I’m still not so sure that I had, but two decades of fighting an illness that lives in both your brain and your body is tiring. It’s worn me down and after this long of a struggle without much to show for it, I guess I shouldn’t be so surprised that my hope got chipped away a little bit. So yes, this new development has reignited that old spark. This is something new. It’s not the same old, same old I’ve been getting from doctors for twenty years. That’s refreshing.

But anyway, enough about me. Let’s talk about that bitch of a book’s whole role in this. First, the glaring fact that out of the many, many, MANY doctors I have seen over the years, this is the first one to point out that I don’t meet one of the key criteria for the diagnosis of anorexia nervosa. In the past when I’ve told doctors (and therapists) that I don’t have a distorted body image, they’ve either A. thought I was lying, or B. thought I was unaware of it. I think the DSM is partly to blame for this, because when you walk into an office with a particular diagnosis, the treating professional (and I use that term loosely here) makes all sorts of assumptions about you. They assume you’re like every other person with that diagnosis and they forget to look at you as an INDIVIDUAL. They neglect to listen to anything you have to say that goes against what they’ve learned about said diagnosis. To be fair, I’m sure not every doctor, therapist, psychiatrist, what have you is this way, but in my experience, a hell of a lot of them are. So that’s my main beef with the book, and with labels in general, for that matter. If it were treated as a loose guide that would be one thing, but in my experience it’s not.

Another thing I witnessed while in inpatient treatment is the way insurance companies often require an official diagnosis before they agree to provide coverage. Many of the young men and women I encountered were turned away from getting the care they needed just because they didn’t meet one or two criteria defined by the DSM. Or they were discharged after just a few days (um, not enough time to recover from an eating disorder..)  Not only does this serve to deny people the treatment their lives quite literally depend on, but in many cases, it also reinforces in their minds that “they’re not sick after all” or they’re “not sick enough.” They may even use it as fuel to dive deeper into their disorders because after all, the pros say they don’t even have a problem. On the flip side, sometimes being given a diagnosis can make people feel helpless. They’re no longer individuals in charge of their own lives but pawns of a ‘disorder’ they can’t control.

And this is just the tip of the iceberg, limited as it is to my own personal experience. As I mentioned earlier, run a quick google search if you’re hungry for more. Granted, the DSM no doubt has its value. I’m certainly not suggesting it be banned or that we all host huge bonfire parties. I’m merely suggesting that it be used with care and urging professionals to maintain an open mind at all times. While a diagnosis can certainly help guide treatment, the DSM is a double edged sword and should be wielded with caution.

So, in summation:

Pros:

1. Diagnoses can help patients receive insurance coverage for treatment more easily.

2. Much like medical diagnoses, mental health diagnoses can help doctors and other helping professionals determine the best line of treatment

3. Having an illness recognized by the DSM can help to legitimize it as a real problem.

4. Yeah. Sorry. I can’t think of any more..

Cons:

1. NOT having a diagnosis can make it more difficult to receive insurance coverage for treatment.

2. Having a diagnosis can put you in a box. Just because your illness been given a particular label, professionals seem to assume you’re like every other person they’ve seen or read about with that label.

3. If your illness doesn’t fit the criteria defined by the DSM, your problems may not be treated as seriously. (see number 3 above; flip it around)

4. On the other hand, having a diagnosed mental illness can make you feel doomed or helpless.

5. I’m sure there are tons more.

I’d love to hear what others think. What have your experiences been, either as a patient or as a caregiver? Do you love the DSM or hate it? Have you ever been misdiagnosed and how did that affect you? Leave your opinion in the comments.

My “Give a Damn” is busted

My friends tell me I have a song for every situation. When I’m feeling a particular way or something notable happens, song lyrics just magically rise up from the depths of my brain that seem to fit the occasion perfectly.

Today, the country song  “My Give a Damn’s Busted” popped into my head. This is particularly odd because I haven’t listened to country music in FOREVER, but nevertheless, there it was. And it fits how I’ve been feeling to a T. Ever since I posted last week on trying not to try, I’ve felt a huge shift. It’s as though I’d been carrying around a huge weight for as long as I can remember and I finally realized I could put it down. I feel free, whole, and alive. In short, I feel incredible. I’m not really sure what happened, but I think it had something to do with my intention to be more gentle with myself and just more easy going in general. For the first time in a long time, I feel okay just being myself. I don’t feel the need to impress other people or hide who I really am. I am who I am, and people can take it or leave it. My ‘give a damn’ is quite literally busted.

I know from past experience, though, that I’ll have to guard this newfound freedom carefully. Old habits die hard, and this nascent self assurance is still relatively fragile. Nevertheless, I’ll defend it with my life, because as I’m beginning to realize, my life depends on it. Without it, I am not really me. I’m a shadow of myself. It’s only when I give myself permission to just be, that I can realize my full potential.

Normally I’d be pretty upset if I broke something, especially if I didn’t intend to break it. But breaking my give a damn is the best thing I’ve ever done. Although now that I think about it, it probably didn’t break as much as it wore down from overuse, but that’s fine with me. I say good riddance. If you still have one laying around, I highly recommend you take a hammer to it as soon as you can.

Trying not to Try

Accept.

Slowly. Reluctantly.

Hesitance settles down upon your shoulders.

Fear and Doubt gnaw at your bones.

One step at a time.

Blind trust. A leap of faith.

Release.

Let Go.

Struggling only tightens the reins.

You belong in the world —

Flying.

Soaring.

No chains to tie you down.

Free,

At last.

©Jennifer Horton

I’m trying to take it easy today. I guess it’s a little  ironic that I have to expend effort in order to take it easy, but such is my life. I read about a new book out the other day called “Trying not to Try,” and I think that encapsulates my experience perfectly. It’s a delicate balance. Often, as is the tendency with people like myself who are prone to think in black and white terms, I veer too much to one side or the other. In ‘trying not to try,’ I usually end up trying so hard that my original intent — to relax and take it easy — is completely obliterated. As though I think I can achieve peace and a sense of contentment by force. Hands clenched, muscles taught, I do everything I can to fit myself into that desired state, only to find that the harder I try the further away from it I get.

So today I’m back to square one: trying, once again, not to try. Sometimes, the best way for me to do this is to shut my brain down as much as possible. My thoughts normally spin in overdrive so much that by the end of the day my mind is utterly exhausted — from sunrise to sunset it’s an onslaught of thinking about what I have to do next and what I should be doing and how close I am to reaching my goals, yadda yadda yadda. Essentially I drive myself crazy by thinking ALL DAY LONG. I was trying to describe to my therapist once what this was like, and while I couldn’t quite come up with the words, every time I tried, my fists would clench and my jaw would tighten. THAT’s what it’s like. It’s like having your fists clenched all day long, trying SO FUCKING HARD to be the person you want to be. Occasionally, I just want to scream and say fuck it. Fuck the whole damn thing, I’ll go live in a cave somewhere and screw all this shit.

And then I hear the birds singing outside, and I feel the warmth of the sun through the window, and I know that’s not really what I want. What I really want is just to be here. In this moment. And this moment. And this one. Because life really is such a beautiful thing when I’m not adding all these unnecessary layers onto it and complicating it with my thoughts.

Accept…. Release…. Let go……

Today, I’m unclenching my fists and relaxing my jaw. Today, I just want to be here without all that baggage. So I’m putting it down.

Struggling only tightens the reins.

You belong in the world. 

I belong in the world.

No chains to tie you down.

No chains to tie me down.

Free, at last.

 

Shake off your chains today people. Put down your baggage. And soar.

 

Reclaiming Your Power

Do you know where your power comes from?

First, though, I suppose I should clarify: I’m not talking about your electricity, and no, I don’t think my readers are superheroes. I’m talking about the power that enables you to walk through this world with confidence, with your head held high, secure in the belief that you belong. That force that enables you to take risks– to take chances — and to know with all your heart that, despite the outcome, you are good enough. The power I’m talking about is that inner fire inside of you that keeps you moving forward even when it seems like everything else is trying to hold you back. That power.

On second thought, maybe it is a superpower.

Do you have it? And if so, where do you get it?

I’ve been thinking a lot about this lately and here’s my working theory: I think we all have this power or else we wouldn’t be able to function, but I believe it comes in varying strengths. I think some of us are born with it, but many more of us have to work for it.

Big surprise — I’m one of the ones who has to work for it. And I work hard. Sometimes, when I can’t seem to muster up the strength to make some of my own, I seek for help from other people. This might seem innocent enough until you really examine what I’ve said. I look to other people to communicate to me that I’m good enough. This is dangerous. It puts my fate in other people’s hands, people who I may not even like or know. I scan the looks on their faces as they pass by, taking their response to me as a judgment. She smiled? “Oh, good! I’m okay! She likes me!” He scowled disapprovingly? “Oh shit! He thinks I’m ugly! I’m worthless!” (I’m exaggerating a bit here, but you get the point). Ultimately, I’m allowing other people to determine the course of my day based on my interpretation of their reaction to me. I might as well be playing with fire.

In reality, whatever I’m seeing may not even be their reaction to me. For all I know they had a crappy day at work and are stewing about their boss. And even if they were thinking whatever it is I think they’re thinking, so the fuck what? That’s on them. I mean think about it — if I post a picture up here of my dog, and ask everyone who reads this to vote on whether she’s cute or not, does that really tell me if she’s cute? No. It tells me what you think is cute. That’s all.

So I’m taking back my power people. Sorry. You can’t have it anymore. I don’t need you to tell me I’m good enough because I know I’m good enough. I believe that. I may have to work a little harder on some days to remember it than others, but I know that inside, where it really matters, I. Am. Good Enough.

Where will you get your power from today?

 

But, seriously, she IS cute.

But, seriously, she IS cute.

 

Body Language

Historically, I’m a thinking person. I live in my head. I am not at all spontaneous, and when presented with a choice, I analyze the shit out of it before making a decision.

If you’d asked me a couple of years ago what I thought about my body, I probably would have said, “I don’t.” Because at the time, well, it was just kind of there. It held up my brain. I didn’t really notice it unless it hurt, in which case I just got annoyed with it. My body was essentially the chauffeur for my mind.

Recently, though, I’ve begun to realize how much wisdom the body holds. When I mentioned in my last post that my mind was communicating with me through alternate channels, what I didn’t mention is that said channel was my body. The tell-tale signs were all there: My jaw was clenched, my back was rigid, and my shoulders and neck were tight. Dude, I was stressed OUT. And being the thinking person that I am, my initial reaction was of course to reason with myself. “Jen, why are you stressed out? There’s no need for you to be so uptight. Everything’s okay.” And when that didn’t work I screamed. “Relax Dammit!!” (sorry neighbors…) Surprise: That didn’t work either. Unable to think my way out of this problem, I did the only thing I could think of — I flopped down on the floor and rolled around like a dog. Don’t laugh, people. THIS WORKS.

Also helpful? Phoebe running: http://youtu.be/E_0Ta_DIWuU

What I’ve realized is that when my brain uses my body to communicate with me, I have to use the same language to respond. Telling myself everything was okay and that I could just relax didn’t cut it. I had to roll around on the ground and run across my living room like a crazy person to get the message across. “See?!” I seemed to be saying, “I can run around and act like a total goofball — everything really IS okay! Now relax!” And my brain usually gets the point pretty quickly. And while I highly recommend the dog rolling in grass move and the Phoebe running, if you’re in public, a few deep breaths and shrugs of the shoulders would probably work too  ;p