The Good, The Bad & The Ugly of The DSM-V

If someone doesn't have a neurotypical brain, others can be too quick to judge and point out how abnormal this individual is. Most people have trouble relating to minds that function completely differently than their own. Due to a slew of chemical imbalances, usually genetic or developed during childhood, society is full of people secretly struggling to regain balance throughout their lives. This is understandable, given that those suffering with stigmatized conditions such as depression, ADHD, OCD or bipolar, often don't share their personal experiences due to fear of rejection, immense shame, or embarrassment. Perhaps this unique portion of society (whom for consistency's sake we're going to call Atypicals, or AT) -grew up being told it was their fault for feeling too sad or that they should just try harder. Maybe their parents and teachers punished them for being different than other kids. Regardless, sometimes it can be difficult to differentiate between neurological issues and problems that are purely behavioral. While the latter can be remedied situationally, abnormal neurochemistry is invisible to the naked eye. However, if people struggling with debilitating diagnoses don't get the individualized help they need, their problems can worsen over time and ultimately morph into isolation, addiction, psychotic breaks, and even suicide attempts. Therefore, neglecting to address one's psychological issues can potentially lead to some dangerous consequences for everyone involved. So how does society deal with all this?

Chaos is scary, so we feel a sense of safety (on a personal and societal level) when order is maintained. Over the past century, we've collectively grown increasingly comfortable with the notion that mental illness is something we humans can control and correct. We form logical conclusions in attempt to make sense of what can't be predicted nor measured. We invent cures that get manufactured and mass marketed, only to be sold to the public along with false promises of a better tomorrow. When you really think deeply about it, we've constructed an entire "health care" system that employs millions of Americans with the purpose of finally putting an end to all our anguish. Keep in mind that if this system truly worked and everybody lived happily ever after, nobody would need mental health services--meaning jobs would be lost, products wouldn't be sold, corporations would bankrupt, the stock market would take a dive, and billions would be thrown down the drain. Clearly this scenario isn't ideal; we'd much rather label the brain's amorphous cerebral matter as if trillions of synapses follow some distinct pattern that we can mess with by ingesting various chemicals and getting a therapist.

Today, Big Pharma companies like Pfizer and GlaxoSmithKline offer endless prescription options, touting them as safe, reliable solutions to our psychological ailments--this is where things get irritatingly subjective. For example, who decides what degree of anxiety is considered abnormal? Or at least abnormal enough to warrant a hefty benzodiazepine script? Why do some people with panic attacks get a bottle of Xanax while others are told to get their ass into some meditation workshops and load up on chamomile tea? Where exactly is the line that separates normal feelings of sadness from Major Depressive Disorder? And appropriate suspicion from burgeoning Schizophrenia? Does she have Social Anxiety Disorder, or is she just a little shy? He must have OCD, why else would he always be super organized? That kid either ate way too much sugary candy today or he has ADHD. You ate an extra donut yesterday...or, you're afflicted with Binge Eating Disorder. Does mom tend to exaggerate when recounting stories, or is she maladaptively Histrionic? As you can see, the conundrum of "what's wrong with ________" needs a definite solution with clear guidelines that determine appropriate mental health protocol on an individual basis...and the closest thing that a bevy of health professionals came up with to promptly satisfy this is The DSM, or The Diagnostic and Statistical Manual of Mental Disorders.

But wait, we humans are special, right?! We can't just establish a one-size-fit's-all, universal criterium to sort people based on their flaws then puts them in categorical boxes with offensive labels...right?? Let's rewind to 1952, back when the very first edition of the DSM was officially created for clinical use. Since then, there have been numerous revisions, which mostly haven't been too significant. It's an enormous text, so I'm going to do my best to break it down for you as concisely as possible. And keep in mind that this is a very small piece of the puzzle. It is, after all, almost a thousand pages long. Anyway, I found a lot of this diagnostic information to be rather disquieting, and I have a feeling you'll concur. So here are the overarching sections. Take a quick skim if you feel like it. Who knows, you may even recognize some of your own qualities...

1. Neurodevelopmental Disorders: This category includes Intellectual Disabilities, Communication Disorders, Autism Spectrum Disorder, ADHD & Tic Disorders
2. Schizophrenia & Other Psychotic Disorders (there are tons--Schizotypal, Schizoaffective, and an ominous section entitled "Catatonia;" many Americans likely experienced this disturbed state of stupor when Trump got elected.)
3. Bipolar & Related Disorders: Bipolar I (the most severe subtype, characterized by dangerous manic episodes and prolonged periods of hopelessness) Bipolar II (mood lability, but less severe) & Cyclothymic Disorder (frequent mood swings throughout the day)
4. Depressive Disorders: There's Major Depressive Disorder & Dysthymia, which is a milder type of depression characterized by a profound sense of apathy and lethargy.
5. Anxiety Disorders: Separation Anxiety, Phobias, Social Anxiety Disorder, Panic Disorder, Agoraphobia & Generalized Anxiety Disorder (people with GAD apparently worry too much...again, here's that subjectivity I discussed earlier, because what constitutes "too much" worrying? What's the standard for an appropriate amount of worrying?!)
6. Obsessive-Compulsive Disorders: OCD, Body Dysmorphic Disorder, Hoarding, hair pulling disorders (Trichotillomania) and skin picking (Excoriation)
7. Trauma & Stressor-Related Disorders: PTSD is the most well-known in this category
8. Dissociative Disorders: Dissociative Identity Disorder (depicted somewhat accurately in Psycho as well as Fight Club) Amnesia, Depersonalization, and Derealization (feeling detached from yourself, or that the world isn't real)
9. Somatic Symptom Disorders: when you believe you have an illness or feel phantom pain that doesn't exist, sort of like a malingerer (or Eminem's mother, who has Munchausen by Proxy. Listen to "Cleanin Out My Closet" if you have no clue what I'm referring to)
10. Eating Disorders: Anorexia, Bulimia, Binge-Eating, ect.
11. Sleep Disorders: Insomnia, Narcolepsy, Sleep Apnea, Circadian Rhythm Disorders, Sleepwalking & Nightmare Disorder (because in this day and age, having bad dreams indicates that there's something clinically wrong with you)
12. Disruptive, Impulse-Control & Conduct Disorders: Oppositional Defiant Disorder (these are the kids who enjoy rebelling against authority figures just for the heck of it), Intermittent Explosive Disorder (here's looking at you, Chris Brown) Kleptomania (you too Winona), Pyromania & Antisocial Personality Disorder--this is is a blanket term that includes sociopaths as well as psychopaths, both of which lack empathy and will often take advantage of others for personal gain. For those who don't know the difference between these two, it may help if I give you some references. Some famous sociopaths are Wolf of Wallstreet's Jordan Belfort, Angelina Jolie in Girl Interrupted, and Donald Trump. Psychopaths use cruder tactics to get what they want and can be violent, unlike Sociopaths who are adept at manipulation and coercion. Some well-known Psychopaths are Patrick Bateman of American Psycho, Ted Bundy and Charles Manson. I want to be more thorough with this category because it's important to be aware of these dangerous types and know how to defend yourself. From the literature I've studied, it's a bad idea to challenge people with Antisocial Personality Disorder; it were only incense them further to wreck havoc upon your life. The safest strategy is to immediately stop all contact with the Sociopath/Psychopath and ignore their attempts to blackmail you. If their threats continue to escalate, don't hesitate to contact the police or find an organization that specializes in emotional/verbal/physical abuse.
13. Substance/Addictive Disorders: this is pretty self-explanatory
14. Personality Disorders: The Three Clusters (I find it funny that the DSM uses the word "cluster" to describe personality disorders, as if they were talking about a cluster of peonies, or pecan turtles)

• Cluster A: Paranoid, Schizoid & Schizotypal Personality Disorders (here's the difference between these last two diagnoses: Schizotypal people have distorted perceptions and often believe they have magical abilities, while Schizoid folk are aloof, lack emotion, and have absolutely no interest in other people, not even their own family. Also, Schizotypals usually benefit from antipsychotics and can potentially lead normal lives. Yet there aren't really any known pharmaceutical nor behavioral interventions for Schizoids, which seems unfortunate, yet they actually aren't bothered by the fact that they're alone; they enjoy staying isolated.
• Cluster B: Antisocial (which we've already gone over), Borderline Personality Disorder (this one's complicated; people with BPD tend to have all-or-nothing thinking, fears of abandonment, inconsistent self-image, unstable relationships & are known to self-harm as a desperate ploy to draw worried loved ones back into their lives) Histrionic Personality Disorder (attention-seeking, hyper-sexual, and overly dramatic people), Narcissistic Personality Disorder (this basically applies to our entire freaking generation, thanks to the proliferation of selfies, online dating, fame as the ultimate goal, plastic surgery, Instagram filtering and whatnot)
• Cluster C: Avoidant PD, Dependent PD, OCD Personality Disorder (this is not full-blown OCD with compulsions to perform ritualistic acts to assuage crippling anxiety--OCD PD has to do with unyielding perfectionism, a fixation with order, neatness and structured routine.)

Whew! If you've gotten this far, congrats!! You just powered through A LOT of very taxing material. All the diagnostic info above is crucial to develop a thorough understanding of the influence and tacit power that the DSM wields over society. For this single book is used by all health practitioners throughout America; it's the end-all-be-all when it comes to deciding whether or not someone has a true clinical disorder. But how could a book possible be able to make that call? What if someone appears to fit the description for a diagnosis, yet has a negative reaction to the suggested treatment protocol? Or what if someone benefits from a particular med that isn't traditionally associated with their condition? Should doctors trust their instinct or the fine print?

For the most part, clinicians and psychiatrists are hesitant to defy the dictum of the DSM because they're held responsible for their patients' safety and wellbeing. For example, if they were to prescribe something contraindicated for a given condition and it didn't work out, their career would be at stake and their license could get suspended. Before they can begin their practice, all medical students have to take the Hippocratic Oath that states, "first, do no harm." Moreover, doctors have a responsibility to educate patients about the risks and side-effects to their prescriptions. It's crucial people understand they're taking pills that alter their natural biochemistry and changing their brains on a cellular level. Please know that I'm not trying to persuade anyone to disregard their doctor's orders; I'm merely suggesting that having a little bit of skepticism is wiser than blindly buying into everything a health practitioner tells you. Because at the end of the day, their verdict is just that--theirs. It shouldn't be an ultimatum binding you to an upsetting label for the rest of your life. So many aspects of the mental health field and psychology in general is open to interpretation. Personally, I wouldn't take anything new without getting a second, and even third opinion beforehand.



Don't get me wrong, I'm a big fan of modern science. If taking something to ease your nerves or help you focus makes you feel good, I say go for it. Who'd want to suffer when it could be easily avoided, right? Currently, 1 in 6 Americans take antidepressants on a daily basis. It isn't surprising that some people would rather take a re-uptake inhibitor (so that more serotonin, norepinephrine and/or dopamine lingers in the synaptic cleft, thus enhancing their mood) than spend hours engaged in dialectical or cognitive behavioral therapy--and there's nothing wrong with that. To each his own. Some practice Kundalini Yoga to slow down, others pop Clonidine (or vistiril, gabapentin, klonopin, ativan, xanax, librium, valium, intuniv, buspar, benadryl, beta-blockers, alpha-2 agonists, I told you there were a lot of options!) But to clarify, if you're facing neurological conditions that would be dangerous without proper medication, please disregard this article because it isn't for you. And that goes for everyone who feels satisfied with their health regimen, confident their diagnosis is spot on, and confident in the professionals they work with. Not to mention the slew of people who enjoy taking prescriptions recreationally--as long as you're making safe choices, all the above doesn't pertain to you.

However, if you've been told by a psychiatrist, teacher, family member, your ex, an evaluation, Dr. Phil (you get the point) that there's something inherently wrong with who you are, remember that you're not obligated to take these words as fact. I'm talking about personality, attitude, and sensitiveness--all vulnerable elements of the self that warrant acceptance, not judgement. I'm positing that nobody has the right to define what your normal should look like. Each and every one of us is in charge of finding our own personal destiny. Why enable a board of crusty, old psychiatrists who know nothing about you to determine if your unique way of behaving and interacting with others is acceptable or not? This may sound trite, but I say follow your heart when ever it comes to questions concerning your innate human essence. And to connect this concept to my initial point, if there's no pressing need to pharmaceutically modify your mood, energy levels, and sociability to match the DSM V's status quo, why not leave your brain alone? You know the old adage, "everyone has problems." This is completely normal and part of the human condition; solely medicating our innermost issues until they disappear isn't a reasonable solution. Unless, of course, you're a danger to yourself or others (in that case, pack your toothbrush because it's very likely you'll get 5150'd within the next few days) In any case, you aren't alone if you wound up with atypical T-Scales on your MMPI. According to this graph, around 15% of American adults have abnormal personalities, while the second reveals that around 18% have officially met the criterium for mental illness. It also breaks down this percentage in terms of sex, age, and race, clearly proving that younger generations comprise the majority.

And lastly, if you're currently facing some psychological distress and are overwhelmed by the infinite array of self-help & healing options out there, consider trying alternative methods or addressing your situation with a multi-faceted approach. People tend to target the more substantial, obvious symptoms while failing to notice the underlying reasons behind their chagrin. For example, someone may display outward signs of aggression that indicate he needs help with anger management. Yet upon closer inspection, one may realize that his rage stems from pent up frustration over giving up his childhood dream of being a drummer. Hypothetically speaking, merely forcing someone like this to attend anger management classes wouldn't be an optimal choice, whereas signing him up for percussion lessons could heal the deeper wounds that cause him to explode. And for all stifled creatives desperate to reignite their love for writing, art, music, or film, check out Julia Cameron's life-changing The Artist's Way series. It's chock full of ingenious strategies, spiritually fulfilling exercises, and uncanny wisdom.

Now I can't wrap up this extremely lengthy post without discussing herbal supplements as a gentler, more natural route for treating everything from insomnia to fatigue. Health nuts, you know what I'm talking about here! Who else goes ham at the Vitamin Shop? The past six years, I've researched and spent hours studying Herbalism, Eastern Medicine, and Nootropics. Plus, I'm part Cherokee and related to a tribal medicine woman, so I'm definitely qualified to give you this kind of advice. All jokes aside, I truly want to help in any way I can. So without further adieu, here are some great options that not only worked for me, but were proven to be beneficial in numerous accredited scientific studies. Quick Disclaimer: if you're on medication, always ask your prescribing doctor if there are any negative interactions before trying any of these. For this reason, I've purposely omitted the supplements that potentiate Serotonin (like St. John's Wort, SAMe, and 5-HTP) because these can cause toxicity if taken in excess with sertonergic medications.

• L-Theanine: an amino acid found in green tea that helps reduce anxiety and enhance focus; it has a comfortable, relaxing effect without inducing drowsiness, so it's great for when you're stressed out but still need to work. Its method of action inhibits glutamate (the excitatory neurotransmitter) and increases GABA (the inhibitory neurotransmitter) It's also been proven to lessen the negatives effects that chronic stress leaves on the brain and improve cognitive functioning. (sidenote: if it's typically hard for you to chill out, get yourself a quality B-Complex formula that includes all 8 B vitamins)
• L-Tyrosine: this amino acid is a pre-cursor to dopamine, the "feel good" neurotransmitter. So if you're feeling apathetic, fatigued or overloaded, try taking this in the morning. It makes you more attentive, calm under pressure, and improves learning ability. However, it doesn't directly cross the blood-brain barrier, which means you'll only feel a subtle benefit over time. If you're looking for a more noticeable boost or are experienced with supplements, try Mucuna Pruriens. A few years ago, I was stuck in a terrible depression and I felt significantly more energized, optimistic and motivated immediately after I began taking these with breakfast. Plus, my ADHD symptoms were greatly reduced, which was awesome. This is because i's also an adaptogen that contains a ton of Levodopa (a potent pro-drug that directly converts into dopamine) that can can cross the blood-brain barrier and regulate executive functioning. It's one of the only supplements for enhanced mood and focus that can do that.
• For Insomnia: Valerian Root (known as "nature's valium") Kava Kava (a stronger supplement  for insomnia that also relieves severe anxiety; *don't take this with CNS Depressants) GABA (popular sleeping pills like Ambien work so well because they bind to GABA receptors, which is the brain's primary inhibitory mechanism, and therefore in charge of calming neuronal activity) Melotonin & Cal-Mag-Zinc
• Nootropics for Memory, Attention & Learning: Gingko Biloba (a plant w/anti-oxidant and anti-inflammatory properties that increases DA & ACh and facilitates neurotransmission), Phosphatidylserine (this one is naturally occurring, and one of my favorites; it's neuroprotective, reduces cortisol, and increases acetylcholine to improve memory) & Vinpocetine (a plant alkaloid that up-regulates critical receptors, improves memory, concentration, circulation, and soothes blood vessels that lead to the brain)
• For Insomnia: Valerian Root, Kava Kava, pure GABA, Melotonin & Cal-Mag-Zinc
• Finally, an organic Omega-3 supplement (make sure it has both DHA and EPA)

In conclusion, I can't help but wonder if society would be different today if the DSM never existed. If mental health conditions never existed, there would be no incentive for manufacturing psychotropic meds, and therefore no reason to see a psychiatrist to prescribe them. And if that 19% were never labelled with a diagnosis, perhaps their self-esteem would be a higher, they'd be more confident, and their lives likely would have turned out completely different. On the other hand, people living with psychological problems would sort of be in the dark, since they'd have no understanding of their conditions and no one to help manage them. Today, so many Americans are convinced they need to take medication in order to be "normal." But who even knows what normal is? Moreover, it seems the DSM's goal for America is to establish a baseline standard of normalcy for sake of national cohesion. But what no one's asking is how on earth did they arrive at these conclusions? How did they decide which personality traits and behaviors were acceptable, and which weren't? They couldn't possibly have averaged out the most common characteristics of every single American, which would have been a more honest method of action. So by deduction, it's clear that The DSM's founders got together and reached a consensus about which personality types weren't good for America at large. They weeded out unacceptable behavior patterns that could put others at risk. They set the ceiling for how weird people are allowed to be before they're deemed crazy and forced to reform. Does this mean that in the future, people will become eerily similar? Only time will tell...

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