A disordered time

A disordered time

A woman is on her way to meet the person who will assist her after the birth of her child – known in the German system as a ‘midwife’. This is their second appointment; the first was a formal introduction involving filling in the necessary paperwork, whilst the second is intended to prepare for the birth and address any outstanding issues.

A boy of nearly seven, who expresses his “desire to be outside, to see the world”, active and cheerful, spends his days between school and his family. On sunny days, as perhaps many would, he prefers to stop paying attention to his schoolwork and spend time outside playing or simply doing something beyond what he considers his “school obligations”.

A man and a woman who have decided to share their lives together. Each driven by what moves them within. He by his love of cooking and the so-called ‘haute cuisine’, and she by books and a love of research.

These three stories—the first two set in Germany and the third in Spain—have something in common: the diagnosis of a disorder X.

The woman, in her final weeks of pregnancy, conveys to the midwife “a certain anxiety about the birthing process, due to the pain of her first experience”. After 45 minutes of a second consultation, which is really more a matter of protocol than anything else, the midwife diagnoses the woman with “post-traumatic stress disorder”.

As she is so close to giving birth, the woman is offered the option of being treated with “a medication harmless to the baby, which will help her get through the birthing process. Since, in such a short time, it will not be possible to access psychotherapy within the health system” – where medicalisation would surely also occur, both pre- and post-birth.

As for the child, who says that “some subjects at school have become rather boring” and seems more interested in the pupils from other classes who are “having fun outside during Sport-Class”, a teacher recommends that his “mother find him a psychiatrist or some form of psychotherapy, as he may have a disorder”.

The couple, having come up against the biological impossibility of starting a family, manage to get a diagnosis so they can take leave from their jobs – one of them initially, and weeks later the other, when he began to experience the same symptoms – “with a possible disorder, a problem with a tonsil, which is causing them anxiety and depression”. They took sick leave from their jobs for a couple of weeks and began “taking medication indefinitely, whilst keeping an eye on new developments to see if they could find a cure”.

The word ‘disorder’ has become a signifier circulating so rapidly—at least in Germany, which is the context we know best—that even on the radio, by placing the word ‘science’ before using that signifier, the listener is given proof of the validity of what the person on the programme is talking about.

To continue with the radio example, this concerns someone speaking about “eating disorders”, “which are now more manageable with a new product that enhances sports training whilst reducing the urge to eat. Scientifically proven”.

Something similar to what Jacques-Alain Miller would say in his seminar Piezas sueltas regarding the lawyers’ competition mentioned in that seminar: “[…] well then, those lawyers are told from the outset whether they must be for or against, and then they begin, they set the talking machine in motion”(1).

Thus, verging on the ridiculous, from the midwife who presumes to diagnose and recommend medication for ‘anxiety’, surely because she is part of the health system; the teacher who ends up distressing the mother of the child who, according to her, surely suffers from a disorder; right through to the couple entering palliative care for depression, we see how the signifier spreads with diagnoses thrown about haphazardly.

The pregnant woman, she tells us, “replies to the midwife that, fortunately, she has been undergoing rigorous analysis for several years and that her medicine is nothing other than the speech”. She also says that, if she has mentioned the subject of her anxiety, “it was only to obtain information about alternatives to natural childbirth”.

The mother, distressed by the “possible disorder” diagnosed by the teacher, was “seriously considering seeking help for her son”; she has been advised to turn to so-called ‘normal’ methods, which could result in medicalisation or ‘behavioural education strategies’. The latter, among other things, have become the main advisors to some German clinics in their psychiatric departments. Clinical coaching.

Let us see what a brief look at the signifier ‘disorder’ might tell us. It is the product of a classification manual, the purpose of which, according to Martin Egge, is “the WHO’s International Classification of Diseases (ICD-10)” (…) “so that it can be used worldwide in a way that allows statistical data to be compared” (2).

In its most recent version, the DSM-5, says José María Álvarez, “it fosters a continuous and elastic perspective, such that disorders spread like a plague, like spectres whose boundaries are impossible to delineate” (3).

Éric Laurent, in his book, The Battle for Autism: From Clinic to Politics, quotes Allen J. Frances speaking to N. Aizenman in connection with the above. Frances, chair of the committee that had drafted the DSM-IV, says of that manual: “The implications go far beyond anything you can imagine… Add a new syndrome and suddenly tens of millions of people who until then had no diagnosis will wake up with it, and they will see advertisements on television or in magazines encouraging them to take medication […] And instead of curbing this problem, the DSM-5 will open the floodgates even wider” (4).

We are seeing how, as José María Álvarez says, […] “diagnosis has been so distorted that it seems trivial”. This has led to negative effects, of which he mentions two: “The first refers to the subjugation that any diagnosis exerts on a subject simply by virtue of being included in a classification of illnesses. The second refers to the demand for normality implied by every diagnosis—a capricious and changing normality, certainly, but one that has become a benchmark against which we must measure ourselves” (5).

Normality, which was once defined by monarchs, who decided who was or was not normal, and which was later left in the hands of other institutions. This is evident in the words of Éric Laurent, who states that, “indeed, the DSM is not a classification system like any other, as it determines how insurance companies must cover treatments. What is more, it is used by the courts as a guiding text, particularly for ordering compulsory psychiatric hospitalisations” (6).

In other words, we had a context in which the pathological was presented as an exception to the normal, regarding which José María Álvarez states that, “however, over the years and under pressure from the mental health industry, the pathological gained so much ground that the normal ended up becoming anomalous and exceptional” (…) “When ordinary people are viewed as potential consumers of psychotropic drugs, the diagnosis of mental illness becomes the gateway to a lucrative business” (7).

Allen Frances himself (8), quoted by José María Álvarez in his work Estudios de psicología patológica, prior to the publication of the DSM-5, annoyed by the new project and intent on criticising it, went so far as to acknowledge that, together with his working group, they had caused “three false epidemics”.

“Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” — attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system” (8).

We therefore have, as José María Álvarez puts it, “for ordinary people to consume psychotropic drugs by the handful, the first step is to make them sick. This requires, first and foremost, a classification of illnesses that is generous with the pathological, so that the more disturbed people there are, the bigger the business” (9).

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References:

1. Jacques-Alain Miller, Piezas sueltas, Buenos Aires, Paidós, 2013.

2. Martin Egge, El tratamiento del niño autista, Barcelona, Gredos, 2008.

3. José María Álvarez, Estudios de psicología patológica, Barcelona, Xoroi Edicions, 2017.

4. Éric Laurent, La batalla del autismo, de la clínica a la política, Buenos Aires, Grama, 2013.

5. José María Álvarez, Estudios de psicología patológica, Barcelona, Xoroi Edicions, 2017.

6. Éric Laurent, La batalla del autismo, de la clínica a la política, Buenos Aires, Grama, 2013

7. José María Álvarez, Estudios de psicología patológica, Barcelona, Xoroi Edicions, 2017.

8. Allen Frances, »It’s not too late to save ‘normal’«, Los Angeles, Los Angeles Times, 2010.

9. José María Álvarez, Estudios de psicología patológica, Barcelona, Xoroi Edicions, 2017.