An intro to Life as a Lunatic (and some words on the DSM)

(A picture of the author, in her natural state.)

Welcome to the first edition of Life as a Lunatic, and thank you for reading.

What is Life as a Lunatic? Broadly, it’s a newsletter about mental health. More specifically, it’s some tips and tricks I’ve learned for coping with trauma and symptoms of mental illness, informed by a lifetime of lived experience.

Why should you read it? I mean, you certainly don’t have to. But, if you’ve ever struggled with your mental health (or know someone who has) and are looking for some resources to cope with depression, trauma, anxiety, self-harm, low self-esteem (and much more) this might be the newsletter for you.

How often will it come out? Life as a Lunatic will drop between panic attacks, trauma flashbacks, and depressive episodes (read: whenever I damn well feel like it).

Who am I? I’m Miranda, a 29-year-old writer from Toronto. I’m not a doctor, nor an expert on treating mental illness, and nothing in this newsletter should be interpreted as medical advice. I am; however, a lifelong sufferer of mental illness and have gleaned a lot of useful coping methods that might be of help to others.

I come from a trauma background (more on that later, or read this piece), and symptoms of my mental illness started appearing in my childhood. I began child and youth counselling in my teens, have had long-term outpatient cognitive and dialectical behaviour therapy, have been in inpatient psychiatric care thrice, and am currently working with the Internal Family Systems Model, Somatic Experiencing therapy, and DBT skills.

I’ve been formally diagnosed with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder. Though I haven’t received an official diagnosis, it’s also been suggested I have borderline personality disorder (BPD) so I occasionally end up in BPD treatment groups. However, these are far from my first diagnoses, which brings me to:

Some Words on the DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fifth edition or the DSM-5, is a classification system for the diagnosis of mental health issues. Published by the American Psychiatric Association (APA), the guide is viewed as “psychiatry’s bible,” and is used primarily by North American clinicians to diagnose and treat mental disorders.

While the DSM has received its share of praise for standardizing psychiatric diagnoses, it has published guidelines that are just plain wrong. The DSM-II, published in 1968, listed homosexuality as a “sociopathic personality disturbance.” Though the APA reclassified homosexuality as a “sexual orientation disturbance” in 1973, homosexuality wasn’t removed from the DSM as a mental illness until 1987.

Later versions of the DSM have also been on the receiving end of well-founded criticism. As Stuart A. Kirk pointed out in a 1994 article, “twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliability by regular mental health clinicians.”

With the publication of the DSM-IV, concerns cropped up over cultural biases and relationships with pharmaceutical industries. As Arthur Kleinman, a member of the task force on culture in the DSM-IV, wrote in 1997:

The Cultural Formula Section, arguably the single most important clinical product of the cultural Taskforce… was intended by its authors to appear in the Introduction [of the DSM-IV], so that everyone who uses the book would learn a method of taking culture into account in the clinical application of the DSM to patients. It does not appear in the Introduction but in the ninth appendix. The not-so-covert message is clear: culture is optional—a remote option, in fact.

In addition to cultural concerns, reports surfaced over financial ties between DSM-IV panel members and the pharmaceutical industry. A 2006 article found that of the 170 DSM panel members, 56 per cent had one or more financial associations with companies in the pharmaceutical industry. The publication was also a huge breadwinner for the APA. According to the New York Times, by 2012, the DSM-IV had earned the association over $100 million.

Even the latest version of the DSM, DSM-5, published in 2013, faced criticisms before and after publication. It was met with notable vocal opposition from Allen J. Frances, concerned the loosening of diagnoses could lead to diagnostic hyperinflation, and Brent Robbins, co-author of an open letter to the DSM-5 task force and APA requesting revisions to the publication. And, I’ve just scratched the surface when it comes to concerns surrounding the DSM, which include a lack of transparency on the part of DSM task forces, the possibility that clinical diagnosis might exacerbate stigma, and more.

Much of my early journey in mental health treatment was focused around finding a diagnosis. If I could just label what was wrong with me, I’d find some relief. While this line of thinking wasn’t entirely misguided—many clinicians do develop treatment plans based on diagnoses—it ultimately did very little to serve me. I’ve been diagnosed with everything from schizophrenia to obsessive-compulsive disorder (two illnesses I genuinely don’t have), experiencing a microcosm of the reliability problems that have plagued the DSM.

Given North America’s messy diagnostic history when it comes to mental illness, my advice to current patients navigating the system is to be very cautious about internalizing diagnoses. I’ve found it far more helpful to take a treatment-oriented approach, focusing on the therapies and skills that prove helpful, as opposed to trying to fit a label devised by medical professionals who can’t seem to agree amongst themselves.

Mad History

Each issue, I’ll dedicate a little space to a section I’m calling Mad History, facts that demonstrate the truly fucked up history of mental health treatment.

This issue: António Caetano de Abreu Freire Egas Moniz

Egas Moniz was a Portuguese neurologist, writer, and politician widely regarded as one of the founders of the leucotomy (also known as the lobotomy, a form of knifing around in a mentally ill person’s brain in hopes of symptomatic improvement).

In 1949, “for his discovery of the therapeutic value of leucotomy in certain psychoses,” Egas Moniz was awarded the Nobel Prize in Physiology or Medicine. Approximately 50,000 patients in the US were lobotomized and, at its peak, doctors in the UK were performing 1,000 operations per year. Patients who received lobotomies often experienced negative changes to their personality, inhibitions, empathy, and ability to function on their own, in addition to risking death.

Today, lobotomies are largely seen as inhumane and barbaric, and rarely performed. Like the DSM, the medical community’s understanding of effective treatments has changed over the years. What hasn’t changed? Though there was an effort by the families of lobotomy patients to have his prize formally rescinded, Egas Moniz still holds his Nobel.

Recommended Reading

This section is surely self-explanatory.

The Body Keeps Score: Brain, Mind, and Body in the Healing of Trauma
By: Bessel van der Kolk

The Body Keeps Score, in my opinion, should be “trauma’s bible.” Van der Kolk outlines the ways in which trauma actually rewires the brain, and how these areas can be reactivated through treatments like neurofeedback, yoga, play therapies, and more. This book offered me a deeper understanding into my own trauma, concrete techniques to start moving past some of the symptoms of my PTSD, and the ability to feel more at home in my own body. I would highly recommend it to anyone who has experienced any form of trauma and is looking for a path to recovery.

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