Lengthening shadow
Callahan, Sidney
LENGTHENING SHADOW SIDNEY CALLAHAN Will it be 'Pull up your socks' or Prozac? Do you suffer from a "shad-ow syndrome" mental dis-order? Say what? Shadow syndromes are identified as mild mental...
...The DSM is published by the American Psychiatric Association in an attempt to reach con-sistency in diagnosing mental disor-ders...
...Family relationships are often characterized by resentment and antagonism because families can be mistakenly led "to believe that all the trou-blesome behavior is willful...
...These forms of psychic distress and maladap-tion are viewed as "subthreshold syndromes...
...Inattention, hyperactivity, and impul-sivity have to be present for at least six months and to such a serious degree that they cause impairment...
...Yes, but does that remove the moral dimension entirely...
...If you have never heard of ADD it is be-cause the disorder has been so recently recognized and defined, especially as ap-pearing in adults...
...that is, they are not full-blown enough to appear as designated mental disorders in the current 886-page Diag-nostic and Statistical Manual IV...
...It serves as the bible-Baedeker for all mental-health workers, and the in-surance companies who fund them...
...I can't...
...Healing may come in many guises, and should it ever be resisted...
...Still, how can I re-fuse to approve efforts to alleviate the human suffering that is associated with maladaptive, inadequate (or immoral) behavior...
...Included in the list of the symptoms are inattention to details, careless mistakes, losing things, forgetfulness, failure to follow through on instructions or to finish schoolwork, chores, or duties in the workplace, and (my favorite) "often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort...
...Does scientific empirical research really sup-port giving new "brand names" to con-ditions that haven't been thoroughly tested...
...Other objections to creating new cat-egories and labels of mild mental dis-orders also can be mounted, in and out of the mental-health establishment...
...we could end up a nation with universal diagnoses and rampant dependence on an array of psychoactive drugs to alleviate men-tal distress...
...Which is the better exercise of charity and pru-dence: diagnosis or moral blame...
...Many more troubled, and troublesome, individuals can now be helped to improve their lives rather than be seen as eccentrics or peo-ple with bad moral character...
...Much physical distress also can be relieved by psychological treatment...
...Yet in the end, despite my objections, I admit to being deeply conflicted over these issues...
...Prozac and psychotherapy to the rescue...
...It becomes increasingly difficult to define the boundaries be-tween psychological disorders and full moral responsibility...
...One of the most troubling examples of a shadow syndrome, for example, is the designation of a mild form of Atten-tion Deficit/Hyperactivity Disorder...
...Should shadow syndromes be so hasti-ly accepted...
...Such adult sufferers are described as not finishing reports or other projects because they get so easi-ly distracted...
...Furthermore, I accept the mounting evidence that many phys-ical ills actually mask psychological dis-orders...
...The DSM also helpfully notes that these symptoms of "inadequate self-ap-plication to tasks" often cause interper-sonal conflict...
...If this fully recognized and diagnosed syndrome in the DSM gives us pause, the milder shadow syndrome will seem more suspect...
...Worse still, won't new labels stig-matize whole new groups of people, with bad consequences...
...Medications, such as Prozac, and various forms of psychotherapy are claimed to be effective...
...Well, we see the social and moral problems in-volved in the relentless march of progress toward mental health...
...Moreover, such a move will further provoke those critics who regularly decry "the triumph of the therapeutic" and the dominance of "psychological man" in American culture...
...Surely fewer eccentrics could claim their rights to be tolerated as oddballs...
...If so many individual behaviors become psychological disorders, what then becomes of free will and moral re-sponsibility...
...Moral responsibility would be defined as the willingness to hie thee to a therapist...
...Could not Christ's commandment to "judge not" apply to much of what now looks like voluntary acts of moral irresponsibility...
...Indeed, those afflicted with these shadow syndromes are told by Ratey to stop blaming themselves and to seek treatment...
...So much for will power, discipline, and the painful mastery of the virtue of perseverance in the growing-up process...
...If we are prohibited from declaring that any sinner will be damned to hell for sure, perhaps we should cultivate equal tentativeness in moral-psychological matters...
...I once read a hilarious spoof by a shrewd internist purporting to be a case study of "the last well person in Amer-ica...
...Would a politi-cian be bumped from a vice-presiden-tial candidacy if he admitted to suffering from a "shadow syndrome...
...Naturally, a proposal to employ new diagnostic labels is going to initiate fights and conflicts within psychology and psychiatry, a field almost as con-tentious as ethics and religion...
...God only knows...
...Yes, those living intimately with these people can-not get over the tendency to hold them morally accountable...
...From a moralist's point of view the diagnostic criteria for the full-blown syndrome given in the DSM in-clude some rather suspect symptoms...
...A disorder doesn't get listed in the constantly revised DSM without a great deal of research data and hundreds of hours of debate by professionals...
...Furthermore, most of us, in the course of moral socialization, have learned to see that the suffering and negative consequences associated with avoiding sustained effort in life are our just deserts for refusing to reform bad be-havior...
...Another worry is that new categories will contribute to the overmedicalization of society, something that afflicts us al-ready...
...Shadow syndromes are identified as mild mental disorders by two psychia-trists, Doctors John J. Ratey and Cath-erine Johnson, in their new book Shadow Syndromes (Pantheon, $25.95...
...When it comes to the much more subtle and vague continuums of men-tal health, could we ever discover any-one to be normal...
Vol. 124 • February 1997 • No. 4
