Why There Should Not Be An Adjustment Disorder

Reading Petra Boynton's blog, I see that the APA are taking comments about the forthcoming fifth edition of its Diagnostic and Statistical Manual, or DSM-V to the masses. In psychiatry this weighty tome has roughly the status that Halsbury's Laws of England does in the legal profession. Most important, if your particular screw-up doesn't fall into a DSM-IV (the current edition), your insurance company is not going to pay out for your treatment.

There's a thing called Adjustment Disorder. You have this if you become overly depressed, anxious or start behaving oddly within three months of a stressful or traumatic event, carry on doing so for at most six months after the event stops, and for that time have difficulty coping with work and life. If the event goes on and on (the boss is a bitch), the condition is chronic. If you go on being depressed, anxious or behaving oddly for six months after the boss moves on (or whatever) then you have something more serious. This looks okay, but...

You can hear the bullies lining up now, can't you? Your employer sacks you with no money - hey, get drunk on the day, curse them, let it go and move on. If you fall into a depression, that's you having an adjustment disorder and has nothing to do with them. They aren't responsible. Or your wife cashes you in, taking the house, kids, half the pension and maintenance. Adjust little buddy, no moping for you. It happened, move on and get on with your life. If you can't, it's not her fault, it's yours, because you have an adjustment disorder. It's all about what counts as over-reaction: who decides that? For the people who hand out the harm, that would be any sign of depression or reduced functioning at all; for the poor bloody victims, that would be all the blues they can feel. Your co-dependant friends would indulge you and your colleagues at work would get irritated if you came in the next day still moping.

Now compare this with the symptoms for a major depressive episode. To have one of these, you need at least five of the following nine symptoms, which must manifest for most of the day: 1) feeling sad, blue or depressed; 2) a loss of interest and pleasure in things you used to do; 3) significant changes in weight and appetite; 4) significant problems sleeping; 5) agitated or lethargic body movements; 6) feeling fatigue at least once a day; 7) low self-worth and inappropriate guilt; 8) persistent difficulty concentrating; 9) thoughts of death or suicide. The symptoms must persist for a two-week period and must include one or other of the first two. But here's the catch, which most casual readers of DSM (if there could be such a thing) miss: if you're hauling your ass out of bed, making it to work, paying the bills, baby-sit your brother's kids, keep the larder and the fridge full and even making it to the gym a couple of times a week, you don't qualify for being depressed. You qualify as feeling like crap and needing a change of life, but not as depressed. Because you're functioning, and if you're functioning, a psychiatrist can't diagnose you as crazy.

Notice that all these symptoms are as "objective" and "observable" as anything about human behaviour and psychiatry ever will be. Weight is objective, so is the time you wake up or the number of hours before you fall asleep; you get to report if you're feeling sad and anyone can see if you don't get as excited by football as you used to, can't concentrate or are dragging your sorry ass around the place instead of being spritely. No-one can impose their ideas of what's "normal" on you, though they can take a swig of denial and say that it's not as bad as you're making out. Imposing their denial is not imposing their values.

Many people criticise the DSM for what they see as the creeping medicalisation of normal behaviour. They have in mind the famous definition of ADHD as "behaviour that irritates primary school teachers". But that's the clue: it's the teachers, social workers, GP's and parents who medicalise the actual boisterous boy, not the DSM-trained psychiatrist, who is most likely to say "he's a boy, and you want him to behave like a girl?". There's a context to the DSM - it's for psychiatrists, not "councillors" or "therapists". On a daily basis psychiatrists see people who are severely fucked-up, people that we never see. They get the context and know what the words mean, we don't.

The real criticism isn't about medicalisation, it's about the use of social norms in psychiatry. It's that use of "overly" in the definition of Adjustment Disorder. It's maybe in the whole idea that we should "adjust" to the slings and arrows of outrageous misfortune at some rate that optimises our social and economic effectiveness while maintaining a facade of feeling humanity. I once read an account of children's attachment to their mothers. It was based round how the kids reacted when Mommy left them at the nursery. "Appropriate adjustment" was when the kid cried for a little - just enough to show it was missing mommy but not enough to be a nuisance to the teacher - and then went to play with the other kids. Too much crying was unhealthy, running straight off without missing mommy was unfeeling. That isn't psychology, it's manners at best and competitive parenting at worst: look at my appropriately-adjused child.

Being screwed-up is one thing, but not fitting in with the straights and normals is another. No-one is under an obligation to do that.

Dumb Security Questions When Buying A Car

The other day I had to call Mastercard to let them know I was going to spend some money on my card, so they didn't automatically block it when someone tried to put the price of a second-hand car through. (That happens all the time with credit cards - which have computer routines to highlight alleged suspicious spending.)  I keyed in my credit card number, the three-digit code on the back and my date of birth. The young man who eventually answered had my details in front of him, but insisted that I give him my name and address and if I there were other people who could use the account. Then he asked me how much I had spent in Foyles a month ago.

Huh? If he'd asked about how much I'd spent at Richer Sounds around a month ago, I would have known. I don't buy electronic kit that often (it was a Sony BDPS 760 and an excellent purchase it was as well, plays well with my Sony Bravia flat-screen and gives new life to DVD's, but I digress). I read over a hundred books a year, most of which I buy in Foyles or Blackwells, so I buy books "all the time" and no more remember what I bought for how much than anyone else would remember what they spent in Sainsbury's a month ago. Maybe it would have been a memorable thing for that young man to have bought books in Foyles in the Wicked West End, but not for me. (In fact on the date he mentioned, I think I bought Being and Nothingness and Being and Time for stock, as reading Hegel's Phenomenology has given me a taste for some heavy continental stuff.) So since I flunked that, he said I'd failed the security question and he couldn't go on.

In the end, it turned out that Cargiant don't take Mastercard, so I called my bank and explained the situation, and they gave me an extra £2,000 on my overdraft, which was enough to pay for the car on my regular debit card.

This does not count as "working out all right" because there's still a silly young man out there who thinks that you can remember what you spent at Sainsbury's three weeks ago. And he may block your card if you don't get it right.

Eva Yerbabuena's Lluvia

It's the annual Sadlers Wells flamenco festival - tonight was Eva Yerbabuena's amazing Lluvia performance. The comments on the Sadlers Wells website do not do it justice. It is quite simply one of the best things I have ever seen on a stage in any genre. I don't think I've ever seen a group of performers work so seamlessly: the intensity never dropped. With a first half that was modern dance with a flamenco edge, and moments like a cantore singing his heart out and making no sound, it's simply unlike any flamenco you will have seen. There's nothing on it on You Tube yet, so just try a look at this earlier Solereas...

Every part of her troupe is strong, and the band are so good they almost vanish into the music they are making. If you have nerve seen Yerbabuena, you need to. She's simply one of the most creative artists working in any medium or genre today.

Roissy in DC

There are few times I've read or heard something and thought: what are you doing inside my head? One is Rands' essay on Nerds. Another and more recently was looking at the Roissy in DC blog. I'm a little less proud of this one, as Roissy, who is at a guess a decently good-looking thirty-something DC-based professional, has an attitude towards women and the dating / mating game that resembles an earlier me at my more bitter. The guy has had a lot of bad experiences and it shows.

When I was a young lad back in the 1970's, girls were looking for two things: husband material, and quick flings. Here comes a perverse piece of girl logic that I've had confirmed several times: girls choose bastards or losers to have quick flings with because then they don't need an excuse for the early exit. If they choose a nice guy, they have to explain why they left him. "Because he was a cute fuck but not husband material" is not an acceptable answer - nice guys are supposed to be husband material. As a result, "nice guys" tend to get short shrift in the dating market - and all those unrelieved hormones turn bitter after a while. Bitterness is never gracious, so it never reads well.

Roissy and I have something in common. Both of us from an early age decided that we were not doing marriage. There are many reasons why not, but my favourite is that a perceptive boy looks at how much fun Dad seems to be having being married and draws the appropriate conclusion. This is the sort of thing that comes out in body language and behaviour. Well-balanced girls looking for marriage take one look and don't see the body language they saw in their father (who liked his marriage) and so no more approach us than a vegetarian would a butcher shop. This leaves us with the girls whose Daddies didn't get much fun out of their marriage: they recognise our body language and it's familiar, so they come our way. But the whole thing is doomed to failure from the start. The girls get upset because we're not up for commitment, but we're all they can get, because the well-balanced boys who want marriage don't see in those girls the body language they saw in their mothers (who liked their marriages).

The harsh truth is this: people from happy marriages marry people from happy marriages, the rest are left with each other: a rag-bag of girls and boys with various hang-ups, fears, traumas, resentments and suspicions. The girls don't want to be miserable like Mom, and the boys don't want to be trapped like Dad; maybe there was some sexual abuse in childhood; maybe you were the misfit and teased by the normals in Junior school; maybe you fell in love with whoever and they laughed at you; maybe you just weren't born with confidence the way most people aren't born able to do double somersaults and five years of peak adolescence left you with bitter hormones. In one of the rare denial-free brain zones, the boy knows this and the girl knows this and neither of them like it: they have a choice of being single, or settling, or divorce.

There is one thing Roissy gets right without saying it. Adults have sex with each other because they want to, not because it's a way of getting someone to marry you or fix the plumbing. Those women who make their sexual favours conditional upon the man doing this or that or whatever else give the rest of their sex a bad, bad name. He's right to resent it but wrong to express it.

The next time a woman runs a number on you, Mr Roissy, don't play the game: say something polite but meaningless (and I mean as empty as "I really don't know what to say to that, but, Sandra, it's been really nice meeting you, and have a good day tomorrow"), excuse yourself and leave. Right then, right there. Women who play games are not happy people and you don't need them, anymore than they really need you. This doesn't make the bitter hormones any easier to take, but nothing does that.

If you have to "go along to get along", you're in the wrong place

There's an old New York proverb: "first you go along, then you get along." First you prove you belong, then the good things start to come your way. The price is that you have to ignore the bad stuff that your benefactors do, pretend to believe things you think are not true, and behave and speak in ways that strike you as wrong, pretentious or undesirable.

Does it seem that everyone else does it all naturally? They don't wince when they use the latest pretentious catch-phrase? (My current bete noir is "a call to action" when they mean "something we should do"). They believe that people who earn £10 / hour should be loaned upwards of £5,000? Or whatever it is? You begin to think they must be faking it, and maybe if they can, then so can you.

You can't. They aren't faking it. They believe everything you think is nonsense. They believe what they are doing is worth losing family time for. This is their life: it's who they really are. It may be hard to believe, but it's true. They are where they fit in.

If they went where you feel natural, they wouldn't fit in. They'd feel like they were faking it.

There is no guarantee that there is anywhere you will feel natural, nor, having found it, that it won't go bust after a couple of years. But you have to keep looking.

Going along to get along is corrupting and it's a trick that can only be worked for about ten years before you go off the rails in whatever manner you choose: drink, drugs, women, fast cars, gambling, divorce, heart attack. If you don't, you wind up withdrawing from everything and everyone around you at the weekends so you can recover for another week in spiritual hell. Personally, I think that's worse than booze and heart attacks.

The really irritating thing is that there are people who can live with exactly what it takes to win the beautiful wife, the daughters at Godolfin and Latymer, the six-bedroom house and the senior partnership in a top four law firm. It would kill you, but they do it as naturally as breathing. Hey, no-one said the right place for you was somewhere you would get rich.

If you feel like you're "going along to get along", you're in the wrong place.

Wednesday - Winter Cold Day One

I woke up this morning and tried to get out of bed. My body wondered if I had any other dumb ideas I wanted to try. I thought about going to work and it stopped me halfway through. I dozed, finished reading Zak Smith's We Did Porn, which is fascinating, dozed, read this month's Esquire, made ham sandwiches, dozed, listened to the Keith Jarrett Solo Piano: Bremen / Lausanne concerts, dozed, read some of the Roissy in DC blog, made a soup of celery, green beans and Borlotti, watched a couple of episodes of Dirt series one, wrote this and now I'm going to bed. Because tomorrow's dumb idea is waking up at 05:30 to catch an early train to Chester. Which I'd like to do.

Richmond Lock

What I really meant to do that day my car got flooded was take some photographs from Richmond Lock... this is looking at it downstream from the Richmond side

... with a close-up of those seagulls - do you notice that all seagulls look exactly alike? I suspect that seagulls are the particle creation operators of a bosonic field.

This is the river side of the Old Deer Park. At the other side is Richmond Swimming Pool and in the middle are football pitches and a couple of weeks a year the Circus pitches there.

Looking upstream to Isleworth. The river goes round the corner towards Kew.

Don't ask about the car. The insurance company wants to write it off - which means I will have to find another £3,000 or so in addition to buy another second-hand runabout. Ouch.