Mind Matters - May 2006
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

The Problem with "Disorder"
by Ron Sterling, M.D. -- May 2006

    Dear Dr. Ron:

      I was recently diagnosed as having an adjustment disorder. I have been told that this diagnosis falls within the realm of normal psychology. If this is true, then why is it considered a mental illness? It makes a difference to me whether I am classified as mentally ill, which seems like something very serious, or whether I am just having a difficult time coping with a recent divorce. Signed -- Looking for What's Normal.

    Dear "Looking":

      I have been looking for what's "normal" myself. What I have found out is that you just have to take a stand on the word. Either it is going to mean "ideal" or it is going to mean "average." It can't mean both. I use normal to mean only and always "average." No confusion.

      The short answer to whether an adjustment disorder is average is: yes, it is average. There are very few people who have not met the criteria for an adjustment disorder diagnosis at some point in their lives. The short answer to your question about mental illness is that an Adjustment Disorder is officially a "disorder" found in the current United States classification of mental disorders known as -- take a deep breath -- the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition ("DSM-IV").

      Most government agencies, such as the National Institute of Mental Health, utilize this definition: "Mental illness refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning." The pertinent question is: If a mental disorder is a health "condition" why not just leave it at that? -- call it "mental condition." Why go down the slippery slope of the word "disorder"? The word disorder generally sends more chills up and down our spines than the word condition.

      Unfortunately, illness has been defined as a "disease of body or mind." Can you really have a disease of the mind? It is a fundamental flaw of the dictionary to define illness as a disease of the mind. The mind is not a physical entity, so how can it have a disease? Look up disease: "a pathological condition in an organism resulting from infection or genetic defect."

      "Mind" refers to consciousness. There may be conditions of the mind, reactions of the mind, perceptions of the mind, and programming of the mind that lead to problems in behavior and thinking that are self-destructive or destructive of others, but they can hardly be called diseases. They are conditions.

      Sometimes my cynical side says "give professionals a chance to make something more complex than it has to be, and they can do a pretty good job of it." In my humble opinion, the DSM should be called "The Official List of Mental and Emotional Conditions." Some of those conditions will be illnesses or disorders. Many of them will not.

      In summary -- you have been diagnosed with a disorder. The word disorder comes from a scientific manual which uses the word disorder in ways that can make it feel generally more serious than it is. Your condition is within the average experience of most people and, thus, normal (by my definition). "Condition" is a better word for what you are experiencing than the word disorder.

      The good news is that most adjustment conditions generally last no longer than six months. You are already working on your concerns, so you are well on your way to finding solutions and relief.

      However, for the sake our society in general, we either need to get better at not taking the word "disorder" so seriously, or we need to change the words we use for mental and emotional difficulties so that they more clearly reflect what we are really trying to say. I hope this helps. -- Best wishes, Dr. Ron.

        Author Bio:

        Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement

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