DSM = Dosen’t Solve Mental Illness

Last month, my 22 month old was sick for the first time. She has already had a bad tummy and the sniffles, but these were minor ailments that she recovered from within a few days. So when I say sick, I mean sick enough for us to take her to the doctor’s and what necessitated that was a fever. Our doctor is actually in a private hospital where my sister-in-law works and where we get a deal. The healthcare in Turkey is quite good but like in all modern states, you get faster service at a paying establishment. The doctor checked her over whilst I literally held her down. She then declared that the baby was totally fine, in fact quite robust (probably because she tried to fight the poor lady off like a karate master) except for her higher than normal temperature. Suspecting a bladder infection, we were instructed to get a urine test. Getting a urine sample out of a toddler is not a straightforward task, there is no peeing in a cup here. Instead there are special appliques affixed and a waiting game undertaken. In our case, this waiting game took hours which gave my mind time to wander; it wandered over to the experience I was having, an experience that I imagine countless other parents of a sick child have. It is horrible to be sitting anxiously in a hospital, helpless to take your child’s hurt away and hoping that what could be a serious illness is simply something minor. You just want whatever it is that is plaguing them to go away and leave them and you in peace. I imagined that most parents felt like I did at the moment, except, I thought, parents, (most often mothers) who have Munchausen by proxy syndrome. What did they feel when they intentionally courted this situation again and again?

Munchausen by proxy syndrome is a mental disorder that is characterised by a parent of a sick child who so craves the attention once received from medical professionals, family and friends that she attempts to keep the child in a state of illness by purposeful, artificial, often fatal means. It is this attention seeking behaviour that is supposedly at the core of the syndrome but I wondered if there was more to it. One thing that struck me during our time at the hospital was that my daughter wanted me and only me. This need had a very different quality to her usual requirements. Normally, I need to give her food, water, walks to the park and viewing time of her favorite cartoon. Hugs, kisses, playfulness all get a look in too. Baths, bedtime stories, a pair of arms in the night feature as well but the sheer instinctual need to be in my arms for the 24 hours she was poorly were nothing compared to the norm. So I wondered, is it not this behaviour that every sick child must display, which is the central reward for parents with Munchausen by proxy syndrome? I believe that people, however mentally ill, make choices based on reward, so was it simply the attention they received from the wider world or the attention that they received from the specific one that was the payoff for their behavior? I am not sure if this question is even close to being answered because this controversial mental illness wasn’t acknowledged as a distinct disorder until the DSM-5 was published in 2013. Without being an agreed upon mental illness it is difficult for those in the field of psychiatry and psychology to study it. Without studying a mental illness and understanding those that suffer from it we cannot form a concrete, agreed upon set of traits for the disorder. Without consensus, it is difficult to identify and diagnose and almost impossible to treat. So we have a bit of unfortunate circular logic here and it is that type of logic which in my opinion characterises the fields of psychiatry and psychology. You see, most people do not realise that a mental illness is just a set of traits given to sufferers. These traits are identified by the DSM-5; the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It is the only accepted diagnostic measure in North America as used by medical professionals. So how does it work?

I can explain using myself as an example because I once went through a depressive episode. A very severe one, you could have called it a total mental, physical, emotional breakdown. I had all the symptoms of depression and none of the symptoms of any other mental illness so it was easy to identify my issue and treat it. There was no question that I was suffering from something else, I responded well to treatment for depression and never again relapsed. However, after the birth of my daughter, I went totally mental. My hormones were all over the place, I wasn’t sleeping (as you do), I was living in a new country, I was without my family and friends, I was totally out of my depth so I did have a sort of depression, but it was not severe and I could link it back to my hormones having to rebalance and my situation having to settle. Eventually, after about 4 months, things did settle and I never sought any treatment for my nutso behaviour (mostly comprised of crying uncontrollably one minute and then laughing uncontrollably the next). What however, if I had sought treatment? I would have a depressive episode behind me, coupled with what I was experiencing at that time. I mean, I was experiencing some hysteria, right? I wasn’t sleeping. I wasn’t eating. I was suffering paranoid delusions that something was going to happen to the baby. I… Whoa, whoa, whoa, wait a minute! For anyone with a background in psychology you can see where this is going right? If I had gone and sought some treatment then depending on the doctor or nurse who did my initial evaluation, I could have wound up being labelled and treated for a very serious mental illness because some of these traits could be spun into being representative of a manic depression sufferer. Remember, the person evaluating the other person, has only the DSM-5 as their diagnostic tool and how they apply it, based on their opinion, is the difference between one label and the next or no label at all. Many disorders have an overlap of symptoms. A schizophrenic and a manic depressive share traits such as paranoia and hallucinations but do not share some other traits such as catatonia which is identified as a distinctly schizophrenic trait. So, if the medical professional fails to uncover all of the symptoms experienced by the patient or if they are overzealous in their translation of a symptom into a trait then they will mislabel a person, leading to a wrong diagnosis. Thank about that…

I was lucky when I had my initial depressive episode because I went to the university campus clinic and saw a young serious doctor who a) took away any pressures that I had by way of writing a note to my professors asking them to defer work for me, b) entrusting me to the care of my sister and ex-boyfriend, who had got me there in the first place, and finally c) sending me away for a week and telling me to return to her after that. She wanted to know if I really was having a depressive episode as opposed to a reaction to a stressed out life. I went back a week later when she confirmed I was in the mists of a depressive episode and prescribed me anti-depressants. This doctor, did everything right under the system in which she toiled, but why is that system giving out anti-depressants to depressed patients, when cognitive behavioral therapy is proven to be at least as effective if not more effective then little happy pills? Which brings me to the second reason that the field of mental health is failing its patients: drugs for mental illnesses are big business and pharmaceutical companies push their agenda so hard that the field of mental health is no longer unadulterated by their business plans. It is all tied up together. First get a diagnosis, then get a little pill or array of pills to manage the illness. Notice I said manage because ask any sufferer and they will tell you that their illness has never been cured by taking a pill. In fact most mentally ill persons hate taking their drugs because they feel not themselves when on them. If the drugs worked then psych wards would not be full.

If you haven’t discerned already this makes me mad. It is the central reason why I never went on from my undergraduate degree in psychology to become a psychologist. It is like the Emperor’s New Clothes. Everyone can see that the drugs are not helping people but yet they continue to hold up an academic system that holds them central to a cure. One of the reasons for this is how research funding works. Do not doubt for a minute that there are clandestine ways for drug companies to fund independent academic studies on the efficacy of various treatments for different mental illnesses. If a researcher can prove that their product is effective in the treatment of a mental disorder then it is likely that researcher will get more funding for subsequent studies. This means that a researcher gets to keep working in their field and publishing in medical journals which leads to professorship and tenure. Additionally, this is all linked to the healthcare system in the USA and how they pay their customer’s bills because it is easier and cheaper to pay for 30 pills a month as opposed to a minimum 4 counselling sessions a month. Further, if researchers put pills as a treatment as the basis of their studies, then it follows that they are only studying disorders that have, at least in some patients, responded to pills as a treatment. So where does that leave disorders such as OCD, Borderline Personality Disorder and Munchausen by proxy syndrome all of which are not helped by a pharmaceutical intervention? It leaves them and their suffers understudied, and under-understood.  It also leaves therapists who are having success treating these disorders with non-pharmaceutical interventions, fighting to have their approaches legitimised and adopted by the mainstream; a fact which can keep cures from patients.

I was fortunate to have had a very common problem that is well funded, well researched, thus well understood and easily treated. I took the antidepressants for about 2 months, but I also went to counselling, did cranial sacral therapy and finally went to see a shaman. Yes, a shaman and could I have done a study to show this shaman’s success with curing a large depressed population then I would have because the morning after seeing him, I flushed my anti-depressants down the toilet and never took one again. You can say these ‘soft’ therapeutic (or controversial or crazy) approaches cannot be proven to have worked or not, but I say who the hell cares? I felt better. I took a sabbatical from school, got a job in a factory, saved up some money and went to India. In India I saw so much real suffering that any lingering depressive thoughts in my First World mind were finally cured. Yes, cured, because besides my post-partum blip, I have never again suffered from depression as I did those many years ago. I wish that I could say the same for every schizophrenic, manic depressive, Munchausen by proxy syndrome sufferer out there, but I cannot. The shifting, imperfectly applied DSM-5 and its link to research funding, private health care, and human error is what needs to change if the practices of psychiatry and psychology are truly going to offer a lasting cure to their patients. If the field of mental health refuses to look at what its foundation rests upon then it will never be more than a pusher. A pusher who pushes pills on patients and pushes around genuine therapists and researchers who are looking at alternative therapies and approaches which actually do offer relief from the terrible affliction on mental disorder.

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