PRISM, Volume 1, Part 5
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PRISM, Volume 1, Part 5
Dangerous Dwarf Proudly Presents
George C. Chesbro's
PRISM: A Memoir as Fiction
Volume One: "Dark Engine"

Published by Apache Beach Publications

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Copyright © 2001 by George C. Chesbro. All rights reserved.
Reprinted here with by permission of the author.

Installment #5
iii

He has observed that people deal with their emotional afflictions in a wide variety of ways, usually self-medicating with a regimen of religion and prayer supplemented by alcohol, cigarettes, quests for money and expensive trinkets, self-improvement books and gurus, crystals, meditation, exercise, sex and violence. Sometimes professional help or intervention by law enforcement agencies is required, and it is at this point that both the afflicted and the afflicters begin to play an even larger role in weaving the economic fabric of the nation. Records must be kept, filing systems devised and maintained to facilitate the flow of capital these people will generate. Criminals like his son who disrupt the journeys of others will have their own travel plans interrupted and be sent to prison, where their names will be replaced by numbers and a note made of their various offenses for easy future reference. Those who steal from and strangle only themselves will often seek relief from the physician's tool chest, dosing their psychic cramps with prescription drugs like Prozac, Zoloft, or Valium. When ministrations from a psychiatrist or other therapist are sought, a sufferer's anxieties, which may have been free-floating up to this point, are in essence captured with a net of language, assigned and given a code number from the Boschian tour guide of purgatory and hell called the Diagnostic and Statistical Manual of Mental Disorders, a professional reference book published and periodically revised by the American Psychiatric Association. With an individual's demons properly introduced by name and number, a descriptive vocabulary can be selected, information shared, research facilitated, psychotropic medication prescribed when deemed necessary, appropriate treatment begun, and insurance claims filed.

Psychiatrists and other mental health professionals who contribute to and use the DSM IV employ a palette known as a multiaxial evaluation system in painting a psychiatric portrait of a patient, assigning one or more specific, numbered behavioral traits and associated physical maladies in up to five different categories, or "axes."

Axis I consists of what are known as "clinical syndromes," usually but not always the constellation of negative or self-destructive behavioral traits that initially beckoned the patient to the therapist or mental hospital. Thus a patient who fears leaving the house because she or he suffers from panic attacks might, after it is determined that the individual meets several other criteria, be assigned an Axis I diagnosis of Panic Disorder With Agoraphobia. 300.21.

On Axis II are listed what are known as Developmental and Personality Disorders, deep-seated and chronic grinding of the patient's mental gears that may be the cause of the rattling symptoms described on Axis 1. These can include everything from mild mental retardation, 317.00, to Paranoia, 297.10, to Voyeurism, 302.82. Thus a psychiatrist might infer that a patient's Axis I panic attacks are caused by the underlying Axis II Schizoid Personality Disorder, 301.2, a condition characterized by, among other things, withdrawal from affectional, social, and other contacts.

Any physical disorder that might be causing the symptoms described on Axes I and II are noted on Axis III. These conditions might include heart trouble, Alzheimer's disease, brain lesions, or even diabetes.

Axis IV cites "psychosocial stressors," recent events in the patient's past that may be aggravating the Axis I and II symptoms such as loss of a job, divorce, death of a loved one, or perhaps an unwanted pregnancy, abortion or miscarriage. The evaluator assigns a numerical rating to predict what effect, if any, these stressors may be having on the patient, from 1, being negligible, to 6, catastrophic, to 0, indicating inadequate information or no change in condition.

Axis V is a "global assessment of functioning," another numerical tool designed to predict a patient's ability to lead his or her life in a reasonably productive manner. The ranking may range from "code 90," indicating absent or minimal symptoms with good functioning in all areas, to "code 10," indicating a persistent danger of the patient hurting himself or others.

In addition, evaluators may assign a "V code" to a condition or behavioral pattern that does not fit neatly into a category of psychiatric disorder. A "parent-child problem" is recorded as V6 1.20, while "malingering" is noted as V65.20.

Believing as he does that an aversion to rational thought is endemic to the species and that there should be a very high threshold of distress to cross before an individual can be judged not responsible for his or her own behavior, he views DSM, its practitioners and acolytes, with a jaundiced eye. He is certainly not insensitive to the horrible physical and psychological abuse suffered by most of the children at Little Ark, but he nonetheless tends to personally code not a few of the patients in the hospital simply as PIAs, or Pains in the Ass. Adding to his skepticism and reluctance to regard DSM as a Holy Book is his awareness that the psychiatric profession, in league with the pharmaceutical companies that manufacture and mass market an ever-growing panoply of tranquilizers and psychotropic drugs, are constantly pressing to expand their "medicalization" of classic PIA behavior that was once considered just bad manners, laziness, or simply poor judgment in an effort to increase profits and power by establishing more patterns of behavior that can be categorized, diagnosed and officially coded as mental illness, thus making the cost of treatment for these "conditions" reimbursable by insurance companies; without a DSM code attached to a patient's bill, there is no insurance payment. Consequently businessmen, researchers and doctors in the mental health industry, all of whom have a vested interested in an expanding market, work diligently as a triad to reduce virtually all bad behavior to discrete modules of symptoms that can be observed, properly coded, and profitably treated like so many pesky viruses. Reputations are made by creating new categories of "mental illness," and ambitious doctors mount publicity campaigns to have some pet aberration like "Road Rage" included in the next edition of DSM.

He believes that such things as sadness, failure and anxiety are a normal part of the human condition, and yet myriads of middle and upper class American men, women and children, somehow having come to believe that happiness and contentment are their entitlements and not states of mind to be painstakingly sculpted over a lifetime through observation and experience, are lamed on their spiritual journeys by the double blade of questionable DSM diagnoses and the overuse of prescription drugs.

But he knows that questions of DSM politics and ethics are moot in the place where he is going. Garth Fugue, this writer who is at yet another crossroads in his life and once more at bay, knows there is nothing marginal or questionable about the diagnoses and dangerous, irrational behavior of the children who will be in his charge, children who long ago have passed over an impossibly high threshold of pain and are very sick indeed.

Read the next installment.


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Last updated 14-NOV-2017 09:33:51.10.