Saturday, February 14, 2009

Psychiatric Diagnosis--who decides?

The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed.--Thomas Szasz (a psychiatrist himself!)

So, I've been reading a lot about PTSD (post-traumatic stress disorder) recently, and noting some interesting things. Yes, psychiatric diagnosis is useful to the extent that it guides treatment, helps someone understand themselves (or others) better, or provides insurance benefits. When is it not beneficial? When it's used as Szasz describes, of course, or when it becomes the sole focus of the therapeutic endeavor--ie, the psychiatrist begins to treat a diagnosis rather than a patient. But the very process of diagnosis can be biased and inappropriate to the particular circumstances. For instance: who is primarily diagnosed with PTSD? Yes, soldiers, but who else? If you guessed sexual assault survivors, good job.

So, what are the symptoms of PTSD? Some are arguably pathological, yes, and to the extent that any of these symptoms cause suffering it may be appropriate to approach them as treatable dysfunction, BUT I think it is essential to recognize that these are not pathologies inherent to the individual, but to the traumatic situation itself. The patient is having a normal reaction to a profoundly abnormal situation. Labeling with a psychiatric diagnosis may cause undue stigma and further suffering in addition to the "condition" the patient is perceived to have. So what about PTSD symptomatology, particularly as it pertains to rape survivors? Some of the symptoms seem not to be pathological at all when viewed from a female perspective (yes, I know men can be raped too, but roll with me here--I guess what I mean by the 'female' perspective is the 'constant awareness of being a potential target' perspective).For instance, 'hypervigilance' is one symptom of PTSD; being victimized DOES make a person more aware of their surroundings. Once bitten, twice shy, as the saying goes--and who decides what constitutes HYPERvigilance anyway? I would think being traumatized would make you pretty effing vigilant, to try and keep it from happening again (even though, of course, it wasn't your fault), and who the hell am I to tell you how vigilant you should be? Irritability--hell yes. Trauma and suffering tends not to bring out the best in anyone, and if I've been raped and you tell me I'm being excessively irritable, you're suddenly going to have a whole lot more irritability to deal with (and possibly head trauma). Intense psychological distress at reminders of the event, and subsequent efforts to avoid such triggers--well, if you have a panic attack every time you smell cigarette smoke, you're probably not going to be hanging out at a lot of bars. I mean, it doesn't take a Mensa member to figure that one out. And intense psychological distress at reminders--well, isn't that kind of a given? Does the average person, who has undergone much less acutely traumatic events, not have similar reactions? Who likes being reminded of their messy divorce, the time they broke their arm, their first car accident when they were sure their parents were going to kill them and bury them in the backyard? Yes, of course, it's a matter of degree; but it's also a matter of perspective. I wouldn't go out for a run at dusk; if I were a man, that might be considered hypervigilance. Since I have a vagina, it's just business as usual, and a man who tried to give me a psychiatric diagnosis based on my desire to protect myself from potential pervs in Forest Park would earn himself either an impromptu lesson on gender sensitivity or, failing that, a swift kick to the groin.

No comments: