On not being broken

An article in today's NY Times covers the problems that the American Psychiatric Association is having with the forthcoming edition of the Diagnostic and Statistical Manual (the DSM). For those not familiar with the DSM (officially the Diagnostic and Statistical Manual of Mental Disorders), it is the fat book that creates a taxonomy of mental disorders.  Mental health professionals use it to assign "mental illnesses" to patients. It is essentially the document that decides how the profession determines if you have, for example, depression or anxiety disorder, or both. I'm simplifying things, but if you want to know more about the DSM (and if you have one of the mental or emotional conditions that modern  psychiatry "treats," you should know more about it) the Wiki page is pretty good.

The article discusses, in particular, the category "personality disorders," which contains a grab-bag of "disorders" that are difficult to diagnose and treat. The problem is that not all experts agree on anything regarding these: they cannot agree even on definitions for the disorders, much less on diagnosis. In the cases of most of these "conditions" nobody has been able to show that these are "real" conditions in the way that influenza is a real disease. What, for example, is narcissistic personality disorder? Is it something with an actual existence within a person, an existence that can be demonstrated with a test (like pregnancy!), or is it just a pattern of behaviors that may or not be linked to specific causal mechanisms? To what extent are these "disorders" the result of modern society's tendency to treat certain types of behaviors as medical rather than social problems?

Don't care for the ads

Sometimes the ads really get me down. The ones on TV. And not so much the ones that show two people in deep loopy love: you know, commercials for things like diamonds, commercials that try to convince us that your love is not truly profound or even real until you have blinged it up with the right sorts of commodities (generally expensive commodities, of course). I hate those too, don't get me wrong. Those, however, don't bring me down. They mostly make me mad, because with their emphasis on high-dollar material expressions of love they, in fact, cheapen the emotion.

To say or not to say

One of the problems anyone with depression and/or dysthymia will come up against is the problem of "coming out" as it were. How much should you say about your condition, and to whom?? Unfortunately there are not any easy answers to these questions. Also, unfortunately, the consequences for telling people what you are going through can be pretty  high, both socially and professionally. As if we did not already have enough shit to deal with. Some random thoughts on the matter below:

Unchained Metaphor

A year and a half ago or so, I was trying to claw my way out of a major depressive episode. "Double depression," they call it when someone with dysthymia descends into a major depression. The language here, by the way, is absolutely unsatisfactory: major depression ("major depressive episode") is not, in my experience a more significant or "major" issue than dysthymia. This despite what the usual sources have to say on the matter: The Mayo Clinic calls dysthymia "a mild, but chronic, form of depression." To their credit, they do go on to say, "Although dysthymia symptoms may be less intense than those of depression, dysthymia can actually affect your life more seriously because it lasts for so long." And even that understates the destruction dysthymia causes in the lives of those who suffer from it.  More commonly, I read that dysthymia is "less severe" than major depression.  It is true that someone in a major depressive episode is more severely hobbled by the disease than is someone suffering from dysthymia. But, as the Mayo Clinic  suggests, and as my experience confirms, over the long term dysthymia is the more debilitating condition.

But I digress.
I do that sometimes.

Anyway, I was crawling out of the major depression, struggling just to return to the alienating unhappiness that seems to be my "normal," and I began thinking of depression as a parasite. Not literally, of course. But when thinking of my own experiences with depression and with dysthymia I began to see that parasitism could be a useful metaphor.

I try to explain myself after the jump. . .

I used to be smart

Some years ago, when I taught test prep classes for the Princeton Review, I tutored a high school junior who was struggling with the materials tested on the SAT. He was a sweet kid, generally a hard worker, but he was often so frustrated that his will to keep trying would start to collapse into a heap of anger. When he was in ninth grade a severe bout of encephalitis had left him with permanent learning disabilities, and so nothing came easy for him. That in itself—the fact that his struggles and frustrations were the result of having been improbably and permanently damaged by a mere virus—was sufficient reason to extend to him all the empathy one might imagine the world containing. But what really broke my heart was that much of his frustration was not the result solely of the struggles he had to endure in order to understand and retain new lessons. The worst of it was this: the virus had not been merciful enough to take his memory when it took a sizable chunk of his cognitive skills. The virus left him able to remember all too clearly the time before the encephalitis, when learning was easy and he did better at school than most of the other kids. And so every torturous step of his journey was made all the more cruel by the memory of his capabilities before his brain was damaged.

On the coming darkness

The recent darkness here, or more appropriately my recent silence, was due to computer issues. My aging iMac was giving me the spinning pinwheel of death much too often, and my backup (an even older Mac Mini) had a hard drive too small for my current needs. So after days of trying to install the OS again on the iMac, and then trying to erase the hard drive for a clean install, I finally just bought new hard drives for each. All a pain in the ass. But now my iMac is fresh, with lots of new space. And my backup mini has everything I might need on it. A small bit of light!

But as to the coming darkness: there is the literal darkness of winter, and, especially of this weekend's time change, and then there is the metaphoric darkness of the inevitable affective decline that sets in as the days get shorter and first the evenings and then the afternoons get shorter and darker. After the change it is usually just a few weeks before I'm kicked to the ground by Seasonal Affective Disorder.Yes, in addition to the dysthymia, and the increased chance of major depressive episodes, I am subject to SAD.