thoughts about mental health.

so even while i'm out of the business, i do like to keep up with things. and as you might know, they have made some changes is the Diagnostic and Statistical Manual of Mental Disorders. the DSM-v, if you will.

and most people are stirring about this for the changes made to conditions concerning autism. and a few are spinning around on the changes to intellectual disorders, formerly known as mental retardation.

but the changes i think are truly interesting are these 3.


1. Disruptive Mood Dysregulation Disorder
Definition: Children up to age 18 who exhibit persistent irritability and frequent episodes of extreme temper tantrums.

What's Changed? This disorder is new with the DSM-5 and is meant to address concerns about overdiagnosis and overtreatment of bipolar disorder in children.


2. Oppositional Defiant Disorder
Definition: An ongoing pattern of anger-guided disobedience, hostility, and defiant behavior toward authority.

What's Changed? The criteria explain how frequently the behaviors must occur to differentiate them from normal development in children; symptoms have been grouped into angry/irritable mood, argumentative/defiant behavior, and vindictiveness.

3. Social Communication Disorder
Definition: A persistent difficulty in social uses of verbal and nonverbal communication, such as greeting or exchanging information; following rules for conversation or storytelling, such as taking turns in conversation; and understanding what is not explicitly stated and nonliteral or ambiguous meanings of language.

What's Changed? The disorder is new to the DSM-5. It is meant to identify people who have some of the communication deficits associated with autism, but who do not have repetitive or restricted behavior patterns.

The first two bring to mind a joke that i once heard Ellen DeGeneris say: "Back in my day, we didn't have all these fancy names for disorders. people were just crazy. that's all." Actually, all 3 of these put me in mind of her joke, I mean, the way the 3rd one is described could be a whole heck of a lot of people. people who are uncomfortable at cocktail parties? people who were never taught manners? people who don't know how to "smooze" the boss.

but, really i guess the first two of these disturb me more. because while i fully believe that the bipolar disorder
has been handed out like candy, i still really kind of think that we really do just have a whole lot of parents who either don't know how to-or simply don't function, as parents. and that a lot of these kids have been created by those parents. (and i would be quick to add that these non-functional parents include both the abusive AND those who because they can't stand their child to ever be hurt or can't stand for them not to shine brighter than other kids, and/or get anything wrong, make excuses for them, and don't discipline.)

but anyway, the cure to me wouldn't be to diagnose and treat the children, the cure would be to provide consistent structure and rules and consequences for them to live by. and having a court system that actually works with the schools.

As to the ODD, I guess it's good they are now giving guidelines as to when a kid truly has this or when he or she is just a normal kid going through an assy-phase. Again, i think the key to working and treating these kids is to give them clear, kind, and consistant rules to live by with consequences for not behaving nicely.

do i think there are truly mentally ill children? of course i do. i've seen them. i've worked with them. but i'm not talking about them. i'm talking about kids that get diagnosed in some way soley because of their behavior.

Interestingly enough, I wrote this first part earlier today, then I had to go into work. On my way home this evening, I heard an npr backstory that was prompted by the Dsm being changed and they talked about some of the earlier changes to the dsm manuals and some bizarre-ish things that were once labled as mental disorders. sleepwalking was one of the examples they gave. once that was defined as a mental illness. so, it appears that i'm not the only one who questions some of this stuff. they also talked about how unwise it is whenever we seek to diagnose someone as having something on the basis of it's definition. for example, diagnosing someone as depressed because they are reported as being depressed. huh? really? maybe they are really depressed. but perhaps there is a real and actual legit reason for them being depressed. such as a death. or a loss.

i don't know. i guess what i would be in favor of is less diagnosis and labeling and more just helping people if they have problems.

something else i listened to on my ride home tonight was the "moth" storytelling program that came on before the "backstory" program. one of the storytellers was describing an experience he'd had in senegal, where villager who this guy was living with had performed a rather bizarre ritual to chase out some demons or something that they believed this guy had. and he spoke about how as wierd as the whole thing was, after it was over, he truly felt uplifted and better. and at the end of his story, he told how sometime later he visited another village in Africa, but in a completely different part, and he'd told someone there of his experience. and the person he related the story to told him that in their village they had a fairly similar ritual to the one described. then the person went on to say that at one point they had had to ask some mental health workers from the u.s. to leave. and when questioned "why," he replied that rather than using community efforts and using uplifting or cathartic experiences in the open air and sunshine to bring people out of whatever condition they were afflicted with, those u.s. mental health workers kept wanting to drag people with problems into dark rooms and have them tell them all the bad things that had happened to them. this did not seem to make anyone better. only worse. so they were asked to leave. the country.

this made me laugh. because hmm. how little sense does most of our mental health system make sometimes? i think back to a time when i was sorely depressed. horribly depressed. it hurt to move depressed. i wanted to die depressed. and while yes, it was really great to be able to talk about my problems to someone, so that i didn't have to bore my friends, it did little more than make my wheels spin. i kept telling the clinicians and counselors if they could just tell me how to work out the situation that was making me so sad, that this would make me feel better. but they instead seemed to think that i needed to fix myself from the inside. instead they wanted me to talk about it and through talking about it, make revelations of some kind. arrggg.

cuz the truth was, i really wasn't needing fixed in the sense that there was something wrong with me, what i was needing help with was to feel better. and while talking about it was maybe good for me, making revelations of some kind was useless. i was already self aware. too self aware.

and maybe it was because they really had no answers to the situation that caused the pain, but don't you think the honest and more logical thing to do then was to tell me that they could not help me fix that situation? and that there would be no fix, but only that they would hang with me until i began to feel better? and you know what i think would have really helped me as i grieved? things like being read to. music therapy, where i didn't have to talk. taking walks with another person. painting pictures. playing board games. making things out of playdough. basket weaving, maybe. something, anything that got me through another minute or two. and where i wasn't alone, but nothing in particular was expected of me.

don't you think there should be places like that? recess places that you can just go to when you are feeling sad or depressed or angry or anxious. where nothing in particular is asked of you, besides you not hurting anyone else, but you can go in listen to a story or bang on a piano or a drum. or fingerpaint. or throw a pot. or dig in some dirt and water some plants. some place where you're not alone, because other people are there playing too, but it's ok (and expected) that you come alone. and stay as long as you feel like it. and do as little or as much as you want to. oh and a massage or two (-:

hmm. i'd have paid a lot of money for a place like that to go to. all that money that i threw away on mental health services would have been better spent at such a place as that.