According to the DSM, the essential feature of this mental disorder is “…the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors.” The manual defines clinically significant as either:
“marked distress that is in excess of what would be expected given the nature of the stressor”
“significant impairment in social or occupational functioning.”
DSM provides a number of examples of the kinds of stressors that might precipitate a diagnosis of Adjustment Disorder. These include:
– termination of a romantic relationship
– marked business difficulties
– marital problems
– seasonal business crisis
– living in a crime-ridden neighborhood
– natural disaster
– starting school
– leaving one‘s parents’ home
– getting married
– becoming a parent
– failing to attain occupational goals
– a chronic disabling medical condition
– financial difficulties resulting from a divorce
And these are just some examples. In other words, if you encounter any of life’s difficulties, and your response to this difficulty is excessive, as defined by a mental health worker, then you have a mental disorder.
There are six sub-types of this so-called mental disorder:
– with anxiety
– with mixed anxiety and depression
– with disturbance of conduct
– with mixed disturbance of emotions and conduct
– and, of course, unspecified
It’s an obvious fact that life from time to time presents difficulties, some minor, some major. It’s also an obvious fact that sometimes we deal with these difficulties fairly effectively; other times less so. But who is to decide whether our reaction to the difficulty was “excessive”? Some people respond to crises in a stoical, confined way; others are very emotional. There is no yardstick for how effectively people cope with stressful situations. Nevertheless, the APA has invented this mental disorder as a way of broadening their psychiatric net to embrace as wide a client base as possible. And because of the vagueness of the criteria, anybody experiencing a stressful situation can be assigned this diagnosis. And because no distinction is made in practice between the terms “mental disorder” and “mental illness,” these individuals are deemed to have a mental illness and are routinely prescribed drugs.
So the person who has lost his/her job and is feeling down; the family whose house was destroyed by fire or tornado; people caught up in a hurricane, flood, or other natural disaster – all of these people are eligible for a diagnosis. Even less dramatic stressors can serve as portals to Adjustment Disorder. Working in a hostile environment, an unhappy marriage, or problems with neighbors would all qualify an individual for a diagnosis of Adjustment Disorder, provided only that his/her reaction to the particular stressor was “in excess of what would be expected.” And of course, it will be decided by a psychiatrist or other mental health worker whether the response is excessive. In practice if you go to a mental health clinic and tell them that there’s a lot of tension at your place of work and that the worry is keeping you awake at night, you will almost certainly receive a diagnosis of Adjustment Disorder, you will be enrolled in the ranks of the mentally ill, you will swell the statistics cited in earlier blogs, and you will be given a prescription for a sleeping drug (and possibly some free samples).
The primary theme of this website is that the medicalization of all human problems, which has progressed steadily for the past 40 years, is a spurious and counter-productive activity, and is promoted for the benefit of psychiatrists and pharmaceutical companies. Adjustment Disorder is perhaps the most glaring example of this activity, in that it widens the psychiatric net to every conceivable facet of human life. Any problem whatsoever renders an individual eligible for a diagnosis. So when a former Surgeon General stated that a fifth of all Americans will experience a mental disorder in any given year and that fully half of the population will have a mental disorder at some time in their lives, he was including in these statistics vast numbers of people who simply were experiencing an ordinary problem of daily living.
If individuals going to a mental health center with problems of this kind received some genuine support and guidance, the “diagnosis” might have some justification as a portal to this kind of assistance. What happens instead, however, is that the individual is given a prescription for an anti-depressive or anti-anxiety drug and is encouraged to “keep coming back” for future appointments. Additional “diagnoses” are often “uncovered” during this process, and the individual becomes a client for life.
Facing and overcoming difficulties is an integral part of human existence. I’m not suggesting that life should be one long arduous uphill struggle. But the notion that we can wave away our difficulties by calling them mental “illnesses” and taking drugs is a destructive and stigmatizing philosophy which undermines the value of human life. Psychiatry’s message to mankind, embodied in the DSM, embraced wholeheartedly by mental health workers everywhere, and endorsed by the pharmaceutical companies, is
“You can’t cope without our pills.”
The message is that as a species we no longer have to strive to overcome life’s vicissitudes. Just take a pill. To see psychiatrists and pharmaceutical companies promoting this philosophy is somewhat understandable. After all, they are businesses and their primary interest lies in the area of expansion and profits. To see politicians promoting such spurious and destructive concepts, however, is scandalous.
Next Post: Mental Retardation: A Stigmatizing Label