Feeling Bugged? Write Doctor Debug for "Psychological advice with punch!" (tm)
Dear Dr. Debug:
I was having a difficult time coping with my recent divorce. I went to a psychiatrist who diagnosed me as having an "adjustment disorder with mixed depression and anxiety." I was told this falls within normal psychology. If so, then why is it considered a mental illness? And am I normal or mentally ill? It makes a difference to me. -- Signed: Looking for What's Normal.
Dear Looking for Normal:
Thanks for your question. In my book, you're normal. But keep in mind that what I have to say may not conform to the party line of our current medical system or with my psychiatric colleagues. With the word "normal," you simply have to take a stand. It means either "ideal" or "average." It can't mean both. I use normal to mean only and always "average." No confusion.
The short answer to your question about mental illness is that an Adjustment Disorder with Mixed Anxiety and Depressed Mood 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 (a.k.a. the DSM).
Hmmm ... This may not be very reassuring to you. Hang in there. I am going to give you a longer answer, which should help you completely debug the word "disorder."
The National Institute of Mental Health (NIMH) posts the following statement on its Web site: "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." So, according to the NIMH, you not only have a diagnosable disorder, but you are also experiencing a mental illness, since all disorders are illnesses.
Here is the big question for the NIMH: If a mental disorder is a health "condition," why not just leave it at that? Why go down the rocky road of "disorder"? For most people, the word "disorder" ramps the stigma and fear factor way up.
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. Thoughts, reactions, perceptions and programming of the mind can lead to destructive behavioral problems and flawed thinking, but these are hardly diseases. They are conditions.
Give psychiatrists 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, Emotional, and Behavioral Conditions." Some of those conditions will be illnesses or disorders; many of them will not. A good dose of skepticism is appropriate when the seriousness of a condition's name can potentially yield a higher payment from a health insurance provider.
For many years, mental health professionals have discussed the question of what word to use when referring to something not so average—"difficulty"? "problem"? "condition"? "disorder"? "illness"? Most psychiatrists stand by the DSM "disorder" language. This does not mean that you have to. To a certain extent, we can each decide what word we want to use to describe our situation.
Your "disorder" equation goes like this: You have been diagnosed with a disorder. The word "disorder" comes from a scientific manual which uses that word in such a way that it can make a condition sound more serious than it is. Your condition is average, and thus, normal. There are very few people who have not met the criteria for adjustment disorder at some point in their lives. "Condition" is a better word for what you are experiencing than "disorder."
The good news is that most adjustment conditions last only about six months. You are working on your concerns, so you are well on your way to finding solutions and relief. Even people with average conditions can benefit from good therapy.
However, for the sake of our society, we either need to get better at not taking the word "disorder" so seriously, or we need to change some of the words we use for mental and emotional difficulties so they more accurately reflect the wide range of conditions. -- Best wishes, Dr. Debug.
Ron Sterling, M.D. (Dr. Debug) is an award-winning psychiatrist in Seattle, Washington. He has been writing for newspapers and magazines since 1998 on subjects ranging from good manners to senior mental health. He hosts and maintains the well-known Internet mental health center, DearShrink.com. The Doctor Debug column is dedicated to assisting with the "debugging of malfunctioning elements in our own personal programming."
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