In the magical birth year of classical television series “I Love Lucy”, the DSM-I materialized into existence with 145 pages and 106 disorders.
Based off the Medical 203 (The Armed Forces Nomenclature), this 1951 piece of psychological literature featured short paragraphs describing disorders so psychologists and psychiatrists could look up at their patients dancing across the floor, look down at their trusty Bible, compare their patient’s behavior to their book’s description, and experience that “light-bulb” feeling.
In the medical 203, experiences later labeled as disorders were considered reactions to life, to combat, to habits learned in life from friends, family, social status and environment. The medical 203, you see, included LIFE as a source of altered mental state. What a radical view, right? LIFE and VARIETY being the cause of people’s experiences. So fucking radical I almost spit my juice across my computer screen.
The DSM-I followed those footsteps closely, with the guidance of APA president and first psychiatrist-In-Chief at John Hopkins University, Adolf Meyer. He believed, at first, chemistry and physiology could explain these mental experiences, but after findings in his own research and a glance into reality, he termed what we know as disorders today, as “Reactions”. He saw that emotional states were responses to experiences in life, and life in itself.
The DSM two, in the year of Martin Luther King Jr’s assassination, contained only 136 pages stuffed full of 182 disorders. There’s a rumor in the mental health community that the DSM evolved from “reaction” to “disorder” because of science–everything is always because of advancements in science, right? They found biological proof of mental disorders, right? They were mapping neurotransmitters and the dopamine hypothesis and the amygdala and the frontal cortex and inserted fancy terms and publicized research papers and they were experts after all . . . right?
The reason the terminology and the view associated with mental “reactions” was transformed stems not from science but from a really, really weak attempt at neutrality: Robert Spitzer and Paul Wilson stated they wished the DSM to stray from adhering to any “specific theories” when labeling disorders. Neurosis entered the scene, the term “disorder” reigned prevalent, and in the year 2017 we have the DSM-5, with over 300 disorders and a creative budget of 25 million dollars.
25 million dollars to write a book that’s been re-written four other times to basically say the same shit.
Why is ANY of this important? So I can ramble and make people read my rambles? That’s part of it.
The rest of my reasoning is far more valid. When Spitzer and Wilson reasoned the term “reaction” unworthy against “disorder” and descriptions of “neurosis”, what did they think they weren’t adhering to? The idea that people were struggling in life and therefore reacted to it? The idea that life itself might actually be a bit traumatic? The idea that there is a variety of human brains and human perceptions that could at any time differ from theirs? How is that a significant and scientific reason to dismember a mental health system that intertwined social, environmental, and biological factors? How is exiting the social and environmental portion of this not favoring AND adhering to a biological theory?
So much for neutrality.
Gender is a spectrum. This is 2017: Gender and Sex are not the same, Transvestite is not an appropriate term, and non-binary is a thing. We won’t go into the slander of the DSM-2 on sexuality, but we will talk about the transformation of how homosexuality and gender dysphoria was seen in those days versus today.
Because really the only thing that changed was the words. The natural variation of human sexuality and the development of sexuality in fetal stages has never changed: there have always been people who favored intimacy with the same sex over the opposite sex, and fetuses always went through the development process of splitting up hormones and growing certain organs.
Over time, the words changed and in the world of sociology, this classifies things like Gender, masculinity, and femininity as social constructions: no one is born a girl who likes barbies and no one is born a boy who likes toy trucks. At one point in history little boys wore dresses and blue was the color for girls: the ideas and standards we create and burden people with change as society transforms and time passes.
Over the last fifty years or so, How many names have changed in the DSM? How many descriptors have changed in the DSM? See where I’m going with this?
Who’s a good little social construction? Hmm? Who’s a good itty, bitty social construction! You, DSM! That’s right! Good boy!
A bold claim I don’t feel I need to defend, the reasoning defends itself. Abnormal and normal are social constructions: we deem what is “acceptable” behavior, what isn’t, and both categories change as time passes, as new generations gain empowerment, as older generations adapt. If the definition of eccentric behaviors, odd behaviors, bizarre behaviors are based on what is acceptable and not, they too change over time, and they too become social constructions.
Take paranoia around the government for example: all the people who were sent to a psychiatrist and called crazy because they felt some agency was reading their emails–well, in 2017 with the NSA in full-force, who’s crazy now?
This is not to invalidate our experiences or our mental states, only the way they’re being described.
What does it mean for these disorders to be social constructions? Am I saying they don’t exist and should therefore be dragged to the gallows and hanged for my mental health blasphemy?
Short answer: No.
Blunt answer: I could give two shits what someone’s disorder label is, just as I could give two shits if someone is gay, lesbian, bi, transgender, and all the other PC names I don’t know. I don’t even give a shit about my own disorder labels. I only care for someone’s experience, because that’s the only reliable thing in all of this. The APA isn’t reliable, the DSM isn’t reliable, medicine isn’t reliable; Medicine is susceptible to human error (and greed), the APA consists of elite, mostly white, cis-gender, non-crazy males, (meaning no representation for the majority of the world) and the DSM is a product of both of those.
But someone’s experience? That’s raw, that’s real, however unreal it may seem. I’ve never seen someone tell more of a truth about themselves and life than when their mental state is so vulnerable they have no choice in the matter–it becomes too much pressure to NOT share. And as morbid as that sounds, it’s also rather beautiful as these states allow us access to a portion of ourselves the hustle and bustle of modern life steals from us. We think deeper and we feel deeper. Sometimes we’re stuck so far inside ourselves we have no other option than to learn to love ourselves. Not many people have that opportunity.
Disorder (as of today) implies something is wrong, defective, shoddy. In another 100 years, it may mean something different. And when that time comes in 3017, when disorder holds a positive connotation, people’s experiences will still be raw, and real, and it still won’t matter how the term is perceived. Crazy, right?