Monday, December 6, 2010

The DSM: Good For What Ails You

The Times discusses here the vicissitudes of psychiatry's DSM definitions of disease with respect to narcissism:

“There’s a lot of self-centeredness in the world, and narcissist has become an instantly recognizable type,” even if people don’t appreciate the complexity of the diagnosis, said Dr. Andrew E. Skodol II, chairman of the DSM personality disorders work group and research professor of psychiatry at the University of Arizona College of Medicine.

Stripped of most — but not quite all — of its pathology, “narcissist” becomes an easy way to flag the self-smitten (if not used as an all-purpose insult), and sounds so much more thoughtful than “egomaniac,” the older term, invoking Greek myth and modern psychiatry. “It’s a shorthand you can apply to all these powerful and famous people that allows you to feel superior and have this gloss of science,” said Dr. Michael First, a psychiatrist at Columbia and a former editor of the DSM.

A word like that is not going anywhere, regardless of what the experts working on the DSM decide. On the contrary: in recent months some of the researchers pushing to drop the diagnosis have softened their stance; the betting now is that the diagnosis is going to remain in the final revision.

You watch old movies--I saw 'The Lady Vanishes' the other day--and, one after another, Freudian references to the sub/unconscious come out, and seem ridiculously anachronistic. Then, too, 'hysteria' for women, 'homosexual neurosis' arising out of distant fathers and oppressive mothers--isn't everything mom's fault?

Narcissism, like depression, is oft considered diseases to be treated, as diseases are--by empowered professionals speaking opaquely, using medicines and other methods. Selfishness and sadness/grief, on the other hand, are part and parcel of daily life, and close to universally apparent, at least on occasion, in every honestly observed human life. I'm not sure about this one. I've benefited myself from antidepressant medications and ECT, had good and bad therapy. I'm uneasy about a self-policing, self-defining elite arrogating to itself the right to assert a unique power or competence in dealing with entities which are impossible to differentiate from, well, life as we all live it. Don't like it when priests do that, either, despite the comfort some get from them. And then, there's Scientology, which loathes psychopharmacology across the board, and some dogmatic AA meetings which see individual therapy of any kind as subverting an alcoholic's only hope of recovery. With enemies like these...


carphil80 said...

Narcissistic Personality should not have been "downgraded." This personality has its roots in some very real pain that needs to be addressed.

Yes, of course, it is always the mother's fault...Except when it is the father's, the teacher's, the priest's, the brother's, etc.

Thank you for for your comments on the "hysteria" thing. Nomenclature is horrible, as the root word is from womb or some such. I do think that Freud was on to something with respect to "hysterical conversion"--ie, that psychic pain can manifest as somatic disorders. However, the "hysteria" term needs to be thrown out the window.

ProfWombat said...

I'm ambivalent because i fully acknowledge the gravity of the issues, the blighting of lives, while being wary of defining them as diseases to be treated, oft to the exclusion of viewing them in a social context needing more than pharmacological address. And, recalling how homosexuality was once called a disease here, and dissent called a disease in the Soviet Union, I wonder what a 22nd century take on our DSM will be.

I don't divide psyche and soma all that much, and have no trouble with difficulties in either reflecting either or both. I do have trouble when people attribute, say, cancer recurrence to an insufficiently positive outlook.