Saturday, February 23, 2013

Time for a New Tale: Diagnosis: 411.07, Privileged Dystopian Syndrome

It is time for a new tale.

I'm proposing a novel diagnosis for the DSM-6. Yes, 411.07, Privileged Dystopian Syndrome. I hope the APA will move swiftly and assemble a committee to review this new proposal. In fact, throughout recent history, there are vast examples of how this sociomedical disease has wreaked havoc on individuals and families.  More on this soon... bear with me.

I lectured in class yesterday about how far removed Western culture has gravitated from the center of our hearts.  What prompted this was an email I received from a client of the MISS Foundation.

I met with her for a few hours, provided some psychological first aid, perhaps, and bore witness to the immense pain she was experiencing over the tragic death of her beautiful 19-year-old son to cancer.  After our meeting, and not uncharacteristically, her story - her beloved child, resonated in my heart for days.

So, I sent her a card telling her how deeply I care, and I sent her a book I thought would be meaningful for her. A few days later, I sent her an email to check on her.

She responded with deep expressions of gratitude and an emphatic "You are AMAZING!" intended for me.

While I do so appreciate her sentiment, this is woefully overstated. Since when, in our history, does basic human compassion and kindness qualify as "AMAZING"?

I wrote back, thanking her; but indeed, it is I who feels tragically-privileged to have been invited into her sacred space where memories and pain and love for her son exist.

Really. How did it come to this?

How did it come to the place where loving another through their time of suffering is some sort of heroic or extraordinary performance of the human being? Is this not our natural state? Or, should it not be?

Back to my proposal for the DSM-6.

411.07, Privileged Dystopian Syndrome

A woefully self-absorbed sociomedical elitist system which is disconnected from the suffering in the world, causing it to keep others who are hurting at a safe emotional distance by pathologizing them, making them the "other", so as not to disrupt its own delusion of security. Often seems to be hubris-based disorder but is, in fact, rooted in deep-seated fear of vulnerability, extinction, annihilation, and death anxiety (Becker, 1970). This system often hides behind numbers, codes, and superfluous vernacular as a means through which it can mesmerize and enchant itself. In particular, normal, authentic human emotions are often medicalized in this syndrome as it helps the system feel more in control and powerful. It derives most of its gratification, valuation, and self-fulfillment, though transitory, from these pathological states, and takes pleasure when other, less powerful systems bow at its throne.

Intolerance for deep emotional expression; a persistent sense of entitlement for happiness at all costs yet with a nagging inability to actually ever experience such joy; persistent disillusionment of impermeability not to be interrupted by the psychological, social, economic, spiritual, and physical distress of others; forced detachment and disconnection often co-morbid with over-intellectualization; inability to experience compassion (from com- meaning to be with the other and pati- suffering); reactivity to high cultural variability resulting in the system's self-soothing (note that the primary resolution of such conflict is forced nosological labeling of said "other", hasty utilization of less sophisticated, laconic interventions, and the personification of a prescription pad as "best friend"); a tendency to prioritize economics over humanity; failure to recognize the collusion between its own existence and exogenously powerful stakeholders; a morbid preoccupation with monoculturalism combined with an unrelenting and maniacal desire toward social and emotional conformation of the masses; incapacity of the system to accept responsibility for the immense harm it has foisted on powerless others, from immigrants and minorities to women, children, and elderly to war veterans and the homeless. Oh, and let's not forget the grievers.

To date, the only known treatment for such a system is a well-informed, courageous, and educated countermovement. Oh, and human connection, compassion, and love.

Unfortunately, my profession, puts all the emphasis on genetics rather than the environment which of course is a simple explanation but it really takes society off the hook... if behaviors and dysfunctions are controlled by genes, we don't have to look at child welfare policies, we don't have to look at the kind of support we give to pregnant women, we don't have to look at the non-support we give to families...  and society becomes innocent, 
and we don't have to take a hard look at it and its role... 

-Gabor Mate, MD

Our ongoing reductionist view of physical and mental illness is killing us in more ways than we know.   And, the system is a danger to self and others. People are buying into PDS-induced disillusionment that normal behavior is somehow abnormal: For example, "bipolar disorder" in two-year olds (really parents? Aren't two year olds, by definition, "bipolar"?), schizophrenia as a life-long disease from which there is no recovery, and grief as precursor to serious mental illness.

Our sociomedical system is stagnate, it is sick, it is mentally ill, it is wounded, broken, diseased (dis-eased), and it costs us all in many ways. The system doesn't know it yet. But, often such serious illness isn't easily recognizable from the inside.

PDS'ers promulgate dangerous ideology, the slippery slope toward the automotonizing of our race: No touch. No tears. No apologizing. The pathology interferes with their ability to to be, uh, well, human. Doubt it?

Many years ago, we had to euthanize a much-loved family pet, Bandit. One week later, we received this from our veterinarian and his staff:

So, after the death of our pet, we received this beautiful expression of sympathy from our animal doctor. How grateful, how wonderful, how human.

Yet, after the death of my precious baby daughter in 1994, the hospital sent nothing. The psychologists and psychiatrists sent nothing (except a message which was clearly inappropriate and misguided: You are "depressed" and need medication). In other words, your grief has incited a mental illness). What is wrong with us? Is it that we cannot profit from caring? There are no lobby and special interests group, no cuts of legislative porks as perks for caring?

Whatever problem we are hoping to resolve or prevent- 
be it war, terrorism, economic inequality, marital disharmony, 
climate change, or addiction- the way we see its origins 
will largely determine our course of action.  
-Gabor Mate, M.D.

So, when the psychologist says to me: "You are mentally ill. You need medication. Maybe you should consider an inpatient program?" I can offer a dose of anti-PSD reality contained right on the pages of the DSM-6. No, no, no, you, Dr., are sick. You have a mental illness that came from the system within which you work. Here, let me show you (points with an authoritative finger):

You have 411.07, Privileged Dystopian Syndrome or PDS. It's not your fault. It's the system. It renders your psyche helpless in my presence, paralyzed by your own dis-ability. I'm so sorry that you are uncomfortable seeing me break down and cry in your office and that it disrupts your plans of a nice day.  I am so sorry that I'm using your entire box of Kleenex, the one that matches your pretty plaid drapes. I'm so sorry if my nasal and lacrimal discharge makes you nervous and your OCD compels you to walk out until I get my hysteria under control. I'm so sorry if I stain your shirt with my mascara and bad lip gloss. I am so sorry it makes you think about your own baby at home, sleeping in her crib, and the possibility that she, too, might die. Terrible, I know, especially for someone with PDS. My existence utterly undermines that self-created delusion of security and protection, doesn't it? Well, mea culpa.

A culture which does not tolerate grief is diseased. Yep, the system, itself, epitomizes mental illness. Sorta ironic, isn't it? And therein, lies the problem.  We are dealing with a system here, not a human being. I know, human beings make up the system. However, a system cannot be good or kind or compassionate. It's a system. It requires humans, who make up the system, to care. And if one person can foist responsibility for caring onto another in the system, then how is that healing connection made? A system is limited by its own homogeneity and homeostasis and boundaries and stagnation. This sociomedical system cannot feel. It cannot connect. It cannot care and thus it perpetuates its own dysfunction.

Bereaved people need, and deserve, our pause. They deserve heroic love and compassion. This should be the norm not the extraordinary. And let us not forget that, one day, we will all be bereaved. The healing cannot come from within the PDS-ridden system. The healing happens in the space between words, between people.

And so here is our alternate story, with a nod to the one and only Ivan Illich:

One day, if we continue to work toward curing the system, ridding it of its mental illness, then caring for another and deep connection with one another and loving each other through moments of tremendous suffering will no longer be the heroic.

It will be commonplace, it will be normal.

And we will all be healers, and we will all be healed.


This blog is dedicated to Blake and his mother. I hold you both in my heart. Thank you for inspiring me with your fearlessness and your courage and mostly your grief and love.

And to a spirited, spicy little monkey-teacher, Ronan and his fearless mom, Maya. Thank you Ro for  helping me speak my truth.


Anonymous said...

Very true but just to let you now I agree and its getting worse and worse. Kids go through alot expecialy when moms and dads are having hard times. Now teachers can not even hug a child when they are hurt its out of policy. I guess feeling and emotions are out in the usa. Soooo sad and we are doing it to ourself.

Robert D. Stolorow, PhD said...

This post is wonderful! And wise! Some weeks ago, I suggested a new diagnosis too: "psychiatric classification compulsion disorder."

Dr. Joanne Cacciatore said...

That's sounds about right Dr. Stolorow. Would you care to chair the steering committee for version 6. We'll add both these disorders to the next iteration. I think there are more, and we'll design some studies to assess the system's biological basis for its pathology.

Mary said...

Joanne, as I read this blog post I could feel the depth of these gutteral feelings and the pain and sadness.. I have seen so much of this in my field and in the world of education in my 40 years as a therapist...previously a teacher...rules that are fear based and inhuman. we live in a society where a teacher or therapist is disallowed from hugging a 6 year old student or client or anyone and that is frightening. The fear we have, as a society, of the expression of deep feelings is in itself frightening. My friend retired when the rules at her school disallowed hugging a 6 year old. You said this soooo well and I find
it so sad that we live in a culture that is so critical and fearful of real feelings and which condones robotic behavior and claims , as you said so well, that normal compassion is amazing. Thank you for being a beacon light in this darkness. Mary Friedel-Hunt MA LCSW

Dr. Joanne Cacciatore said...

Mary- you are a beautiful woman. Please, send us your professional contact information we can refer families to you in your area, if you'd like. <3

Anonymous said...

People cant imagine the harm that can be done at the hands of hospital staff who are so cold and cruel. I will never forget the way I was treated, no dignity or compassion or anything. Pyschiatrist I saw after our 3 year old was killed in a wreck was awful and gave me 3 medicines that made me like a zombie. He spent 10minutes with me then said i was having post traumatic disorder. This was not even a week after he died. Your right. The system is crazy. I wasn't crazy. They were.

Robert D. Stolorow, PhD said...

Sounds good, Joanne, let's co-chair it!

Paula J Caplan said...

Joanne, your courage and your great heart illumine the dark places in the world and help so many others to know that their feelings are deeply human and not "sick." You are a great light to the world.

Pageturners said...

Perhaps a large part of this cold distance comes from our attitude to money - that those who are in 'high-status' jobs should be paid better, and in fact are better, than others. When we are more equal, we can be closer.

Thank you for this wonderful post. Especially the line 'Since when, in our history, does basic human compassion and kindness qualify as "AMAZING"?'

Tahm said...

Very interesting - although I didn't understand most of the acronyms. US medical/legal stuff?

I think about this kind of stuff a lot :-)

I am coming to learn that the great problem we all sense (in some way) lurking at the heart of western society has already been identified. It has existed for as long as people people began to think that because they had separate minds, this somehow meant they were separate from the rest of existence including one another. A great many spiritual beliefs and philosophies have identified the problem; Zen Buddism is a good example. The native Americans knew that westerners carried an insanity with them that was very confusing to them. In my opinion, largely arrived at through reflection on my own experiences and observation of others, it is the root cause of many forms of mental illness. I think it is when we 'forget' that we are not our minds, our egos, the thoughts that we grew up believing we had to remain identified with in order to remain whole, not realizing we are whole in the first place. Smart thinkers from Descartes to Freud have re-enforced this basic lie, but it is self evident and can be proved quite simply.

Yet most people end up in a place where to a lesser or greater extent because of pain, anger, loss and isolation, we strive as individuals to create a world that can never exist because the parameters of what we think the world should be are in our head. The extent to which you can ignore this problem determines how mentally well you are in our society. If you can't cope with it you get plonked into one of the boxes of depression, anxiety, borderline, schizophrenia and so on. A mind cannot solve a problem like overwhelming grief - there is in fact, no problem to be solved at all - it can't be thought or reasoned to completion like a crossword or maths problem, so the mind turns inwards and that person becomes classified as mentally ill, when actually all that's happened is their mind is stuck in a loop where it is trying to solve a problem it cannot, and sadly becomes isolated. Different manifestations, same basic problem. This happens to me every day. And I see it happen to others every day as well.

I think the only solution is for each and every one of us to look to our own selves and ensure that we remain as awake as possible, so that we can bypass those odd ideas that our minds or other people's minds or the collective consciousness tries to force upon us and say that, because such a thing as pedophiles exist, we should all pause and give worry to the idea of picking up a child that is in distress. Or that it is somehow 'intruding' on someone's grief to acknowledge it. Really look at what goes on inside ourselves when we feel and think these things and ask ourselves: Is this real? Do I want this idea? Is it *my* idea / behaviour in the first place? Does it make sense to me? I don't of course mean we ignore other people, it's about clearing the mental and emotional fog from our own inner space so we can properly connect with one another. And be here. Now.

Dr. Joanne Cacciatore said...

Paula- in this area, it is your lamp that had led the way for decades. We all bow, deeply, to your work.

Pageturners, I would not at all disagree. Money means power and vice versa. Certainly not always but often corruption isn't far behind both those states.

Tahm, beautifully, eloquently stated, thank you. There is no problem to solve in grief. There is, just, grief. We need just to be, to stay, to mourn, to still. As Rumi said, the longest journey, is, indeed, the inward one.

Dr. Joanne Cacciatore said...

Anon- I am so sorry that you and your son were treated this way. I truly am sorry.

Greer said...

Thank you so much for this brilliant and beautifully spoken piece.

Two years ago I lost my beloved husband to cancer at the age of 46 -- shortly before news articles began appearing about how grief was going to be included as a disease in the DSM -- so this hit home.

As part of the community of spousal caregivers, I knew so many who were medicated to numb themselves to the anticipatory grief that is inherent in the situation.

But I utterly rejected both then and now that this spiritual pain is a mental illness. Instead it is a sign of being alive, actively loving in the face of the unthinkable. And although I had to give him up long before either of us were ready, we both grew tremendously as we faced his impending death together. It was the finest partnership I may ever know.

Real life is a hard journey full of tremendous beauty and in the end it is the beauty I remember.

Anonymous said...

Thank you for this powerful post. So many of agree with you and we couldnt agree more.

Dr. Joanne Cacciatore said...

Greer-- thank you so much for sharing your story and I"m so sorry for the loss husband to cancer. Your words are sage.

Anon, thank you for reading and for your support.

Suri said...

It took me three years to find a competent therapist who could tolerate the horror of my child's murder and rape. The medication they would prescribe to me over and over again was a projection of their own anxiety and fear just like you said they could not stand to be with me and listen to me. Tell me that isnt a problem? Thank you for this post.

Dr. Joanne Cacciatore said...

I'm so sorry Suri, about your child's murder and rape. I cannot begin to imagine the pain of losing your child in such a violent and senseless manner. I am also very saddened to hear of the difficulty finding a therapist who could bear witness to your suffering. I hope you have been able to get the social and clinical love and support you need to help you, moment by moment, get through life. My heart with yours.

Karla said...

So true Jo. So sadly true. I will say though, that you are amazing. You are shining a beacon of light onto the world and to caregivers and clinicians of how we can be when we are not afraid to go into a place of pain with another person. Without having to pathologize it or apologize for it. It hurts me every time I hear stories of people who have been damaged by therapists who cannot accept and embrace them as humans who are in need of compassion and love and acceptance. And I hear those stories so often. They don't need fixing, they need compassionate witnessing, support and love. We all do.

Karen Wycliffe said...

I haven't ever read a more insightful and honest piece while following this issue. I am so thankful to have found your blog. Thank you for this. Maybe one day I'll be able to tell you my story. For now just thank you.

Unknown said...

Thank you for writing this insightful piece, full of truth and caring. The pathologizing of grief seems to persist, even in this day and age, and I am happy to be one of those trying to "tell a different story", as you suggest.
In training bereavement workers, I am always looking to instil in them a knowledge of what grief is (and is NOT), as well as a courage to withstand and support the difficult feelings brought by their clients.
I am constantly hammering the point home - labelling, medicalizing and sending someone off to their doctor makes things WORSE for people, and for society as a whole.
Sadly, for some friends and family members the tolerance for grief is so low that they are the ones suggesting a visit to the doctor to "get something to help you feel better". The problem is made by the medical/disease model, but also supported by society.
We must continue to challenge the medical view, and work to change cultural attitudes towards grief.
I am right behind you.

Dr. Joanne Cacciatore said...

Karla- your patients are blessed to have you walk with them through their struggles. Bows to Theo.

Karen, thank you. Please email me anytime with your story. While it may take me awhile to get back to you because of the sheer volume of emails, I promise I will read it and contact you.

Ian, thank you, really. Deep bows.

Shirley said...

My child was killed in a place where he was supposed to be "treated". He began to suffer from "depression" so they said. But only a year earlier we lost his dad and my husband. I wish I had recognized what I know now. He was grieving and didn't have support he needed because I couldn't and didn't know how to support him. He wasn't that bad really. His grades dropped, not too much but they dropped. He withdrew. But he still had love to give and receive. I wish I never took him to the doctor. Oh how I wish.

I would rather have my son sad than dead.

Doug McVay said...

Thank you for this.
About 9 years ago I was diagnosed with a stage 3c cancer. A few days after our first meeting, I spoke with my oncologist who asked how I was doing. I told him I was holding up, that I cried when I called my mom to break the news to her but otherwise was doing all right. The doc immediately suggested I try going on anti-depressants. I got a new oncologist after that because I knew that to cry when I did was perfectly normal, in that situation it would have been abnormal to have any other response. Thankfully after I moved to Lancaster, PA, I found a good one, Dr. Peter DeGreen. Still, that earlier experience taught me a lesson about being too open with a physician.

Dr. Joanne Cacciatore said...

Oh Shirley- I am so sorry. Losing two so important men in your life- I'm just so sorry.

Doug, thank you for sharing that. Deep bows, again, to Dr. Peter DeGreen for being fully present with you and your rightful tears. I am sorry for the suffering you're enduring and the pain your family must feel. I hope your treatment is going well for you.


The soul still sings in the darkness telling of the beauty she found there; and daring us not to think that because she passed through such tortures of anguish, doubt, dread, and horror, as has been said, she ran any the more danger of being lost in the night. Nay, in the darkness did she, rather, find herself.

--St. John, Dark Night of the Soul

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