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Here is one of the many exposes of psychiatry. This is where you learn that psychiatrists have invented a new disease -- called a "relational disorder." The truth about "wrong relationships" is on this page. The terrible evil that would arise from saying that a "wrong relationship" is caused by some sort of chemical imbalance in the brain -- that evil is immeasurable. If you go this psychiatric direction, you will, I guarantee, have wrong relationships and more illness!
I'm O.K. You're O.K. We're Not O.K.
Some psychiatrists want to start treating "relational disorders." Are they nuts?
There is still only one way to be sane — enjoy your friends, family, faith and job — but every year there are new ways to be crazy. Like the automobile industry, which once sold only sedans and station wagons but now offers endless variations on the SUV (including two versions of the Hummer), the American Psychiatric Association now has an illness for almost every lifestyle. The current edition of its professional bible, the Diagnostic and Statistical Manual of Mental Disorders IV, contains — among scores of other diagnoses — a long list of specialized labels for a condition that was known in my grandmother's era as the jitters, including Attention-Deficit/Hyperactivity Disorder, Social Phobia, Panic Disorder with Agoraphobia, and Panic Disorder Without Agoraphobia.
Given so many maladies to choose from, a person who can't find at least one of his problems covered somewhere in DSM-IV must have something really wrong with him. Unless, that is, his problem is someone else — a child, mate or parent, say. Until recently, being driven mad by others and driving others mad was known as life. It didn't have a name — at least not a medically sanctioned name that could be listed on insurance forms and used in advertisements for pharmaceuticals.
The big news in psychiatry is that this may change. Some powerful practitioners, according to a story that broke in the Washington Post last week, are lobbying for official recognition of a new and controversial category of mental illness: Relational Disorders. Dr. Michael First, associate professor of psychiatry at Columbia University and one of the principal figures behind the push, puts the case for the novel diagnosis this way: "There is evidence that relationships and how people interact in particular relationships can be disordered in a way that's very similar to mental disorders."
That people can make each other nuts — and sometimes seriously, violently nuts — is not a new discovery. My grandmother knew it, and my grandpa too, which is why he kept his power tools in the basement. Still, scientific protocol demands that whenever doctors set out to repackage a perennial human sorrow as a modern, billable disease, they have to act as if they are on to something big. How else could chronic sleepiness have become Primary Hypersomnia?
The process of designating new mental disorders by pretending to misplace everyday experience and then trip over it in the laboratory is easy to satirize, but it has high stakes. If Relational Disorders exist (let's say they do) and doctors or drugs can make them go away (let's say they can, though heaven only knows), then a DSM listing is required or the insurance companies won't pay for treatment. Even with the listing, they are sure to grumble about it. Shelling out for even one-twentieth of the cases of "persistent and painful feelings, behavior and perception involving two or more partners in an important personal relationship" (the proposed definition) could drain the Treasury in about 24 hours.
What makes the proposed diagnosis controversial, aside from the possibility that it could be applied to every living American, is the question of how the "patient" will be defined. A relationship can't make an appointment. Only the individuals in it can. But if only one of them shows up at the clinic, how do you effectively treat the relationship? And if they both come, what if only one feels poorly? For First and his like-minded colleagues, these are sticky issues but solvable ones. They point out that psychiatry deals every day with similar dilemmas and ambiguities. "To me," says First, "the bottom line is treating people. If this is something that can improve people's lives, that's worth the conceptual murkiness."
When a psychiatric disorder makes its debut, patients and doctors join the ticket line first, but eventually the lawyers queue up too. That's when the trouble tends to start. For America's attorneys, who might be said to specialize already in Relational Disorders — in creating them and making them worse — the prospect of such a fuzzy diagnosis must look like a row of cherries on a slot machine. By clouding the notion of personal responsibility even as the classification opens up vast new realms of mutual and collective liability, RD, as it will inevitably be referred to on daytime-TV talk shows, may generate even more in legal fees and damage awards than in insurance reimbursements.
Whatever happens, it won't happen right away. DSM-V will not be published before 2010, giving us plenty of time to ponder the wisdom of formally recognizing a new disease that people can prevent only by living alone in locked rooms that don't have telephones. Maybe the first Relational Disorder that we should be concerned about is the one between psychiatry and the public.
09/08/2002 - Updated 05:44 PM ET
Troublesome friendship or a relational disorder?
By Karen S. Peterson, USA TODAY
There is just a chance that if in the future you and your spatting spouse go to a marital therapist, your relationship may be diagnosed as a "relational disorder," a proposed new form of mental illness. Or if you get along well with one of your kids but cross swords constantly with another, a psychotherapist just might slap the entire family with the same label indicating a psychiatric disorder.
The American Psychiatric Association is considering adding "relational disorders" to the list of mental illnesses they publish in their Diagnostic and Statistical Manual (DSM). It spells out the symptoms and behaviors that constitute various types of mental and emotional disturbances. The book is used by most mental health professionals to diagnose patients.
If the change takes place, this would be the first time the DSM defines a mental disorder involving two or more people in a relationship, rather than a problem involving just one individual.
The concept relies on the belief that relationship problems cause genuine illnesses of both of body and mind. Both should be diagnosed and treated. And it is the relationship itself causing the problem, not the people involved in it.
"When couples go to counseling, trying to communicate, neither member is the 'sick' one," says Michael First, associate professor of clinical psychiatry at Columbia University. "It is the relationship that needs to be worked on." Recognizing a relational disorder could prevent a divorce down the line, or the possibility of child or spouse abuse, he says.
Changing what is defined as a mental disorder is a long process. The fifth edition of the DSM won't be out until 2010, but some leading psychiatrists are circulating a white paper now urging research on the change. First is the lead author.
Study co-author David Reiss of George Washington University says the research supporting relational therapy has advanced enough that it warrants inclusion in the medically based DSM. "We have a better sense about how to characterize and measure these relationships."
Although most folks have some rocky relationships, Reiss says only the most dysfunctional would be diagnosed. But the question remains for many professionals: Why should a relationship problem be called a mental illness?
"Suppose you treat a child with poor school attendance, who is performing below expectations and exhibiting symptoms (such as acting out). It does not take a rocket scientist to figure out the real trouble is probably with the parents," says Ronald Fox, past president of the American Psychological Association. "You treat the parents and the kid gets better. But where is the mental illness?"
He says the DSM already defines too many problems as mental illnesses. "We pathologize everything under the sun. But the DSM is the coin of the realm. It is the water we swim in as clinicians."
The DSM is not must reading for the public, but it is for mental health experts. It is put out by psychiatrists, who are seen by many as the top of the food chain of mental health practitioners. They are physicians and can prescribe drugs such as antidepressants, while some other specialists cannot.
The book is used by many types of psychotherapists to make a diagnosis that an insurance company will accept, if the company covers mental health at all. Experts note even generous companies may not cotton to the idea of coverage for a relationship instead of an individual.
Listing relational disorders in the DSM would officially recognize what specialists, such as marriage and family therapists, have already been doing for years. Instead of dealing with just one individual, they look at the dynamics among various members of the entire family.
"The fact they want to put this in the code book gives family systems therapists some recognition," says Terry Hargrave, a family therapist with West Texas A&M University in Canyon, Texas.
Hargrave has mixed feelings about the proposed addition to the DSM. "Family therapists don't like the idea of diagnosing people," of giving them a label that they can carry for a lifetime, he says. He also says there is a risk of "making everything a medical problem."
The psychiatric profession is based on a "medical model" and increasingly sees connections between mental disorders and brain chemistry. Psychiatrists often favor using drugs to help correct problems, as well as some talk therapy.
First says he does not see drugs as part of a treatment program for a relational disorder. Entire families are not at risk for being put on antidepressants, for example.
Couples or family therapy might be the treatment of choice. But finding a good therapist could be a problem. Many psychiatrists and other mental health professionals are not well trained to deal with family dynamics, says Michael Bowers of the American Association for Marriage and Family Therapy.
Some critics suggest the label could be spun out of control to include other categories of relationships, such as those between employers and employees. First doesn't see that happening and says the profession is not considering it.
He is not trying to say everybody is sick, First says. "The challenge is to reliably distinguish between the bumps, the ups and downs that normal relationships go through, and relational disorders where treatment could help. If we cannot, we will not go there."