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.
