Monday, June 14, 2010

A thousand neat little boxes

In listening to a podcast this morning, I was reminded of a theory I have heard espoused by many. It seems that people seek to solve any problem which comes to their attention by applying the tools they already know how to use.

Here are examples.

Policemen seek to address a problem by arresting it.

Elected officials who are legislators seek to pass new laws.

Carpenters treat problems as nails and hammer them.

Marathoners seek to train harder and enter more races.

Fat people eat.

Skinny people skip a meal or three.

People who typically deflect responsibility deny any involvement with the problem.

Those folks who take action by default run around and do stuff.

Doctors prescribe.

Therapists talk and listen.

Herbalists offer a new, custom-designed herbal remedy.

Strategists see the big picture, be it one which is evident or one they invent.

The podcast concerns bipolar disorder, and the guest on the interview is a woman who has experienced the illness as a family member to several affected relatives.

Her means of coping, as she shows during the podcast, is to talk about it calmly and openly. The courage and raw honesty is awe-inspiring, and her sense of humor is delightful. This is a lady who will be a great help to her two children who have been diagnosed as having the disorder.

In examining the methods of traditional medicine in dealing with mental illness, particularly when viewed with an historical perspective, it strikes me that the thousand-little-boxes analogy fits.

It's not at all that I don't think the docs aren't giving it all they've got. The problem is that their frame of reference tends toward the narrow rather than the open-minded. So, we end up with The Diagnostic and Statistical Manual of Mental Disorders, now in its fourth edition. It was published in 1994. The fifth edition is due out two to three years from now.

Definitions of illnesses come and go from one edition to the next, and while there is no doubt it is a tool which is needed by the psychiatric community, it is also a huge profit center for the holder of the copyright, the American Psychiatric Association.

As of the last edition, there are close to 300 different illnesses included. While that falls short of the thousand little boxes I allude to above, we are easily already there with all the variants which are defined within the 300 illnesses. Yes, each person who is diagnosed has a specific box into which they can be placed, said box labeled with the expectation as to progress of the illness, appropriate medications, possible dangers, etc.

One thing we can count on in 2012 when DSM-V comes out: there will be more illnesses defined, more variants defined within the old favorites, and it will be vital that everyone buy the new edition. I don't know the numbers which are sold between edition releases, but when this new one comes out, it will sell like hotcakes because everyone will feel the urgency to get on the newest of the same pages.

One certainty, though: there will be more boxes, each one will be smaller, and traditional medicine will have simply taken more steps down a road which is only somewhat able to deal with the realities of mental illness.

Yes, I am a bit turned off by the process by which the APA raises money, but I don't pretend it is just that organization which is using the conditions which brought about the need for the group to further its growth and increase its income.

Consider any high-minded group of people who come together in order to collaborate in the diminution of some entity or disease or behavior which is seen as bad for humankind. At first, such groups are pure of heart and resolute of purpose.

Over time, and as money becomes part of the equation, the group becomes, slowly but surely, less about completing the mission and more about feathering the pillows of those who run the group. If you are making six figures running a charitable organization, it isn't in your personal best interest to solve the problem the group exists to fight.

Much as no battle plan survives contact with the enemy, no idealistic notion survives translation into a mission for any group of people who are paid to manage the group.

If you have evidence to the contrary, please share it! I would love to shine a golden light on any group which has paid staff which worked themselves out of a job by solving the problem.


Olivia said...

HI, Rick,

I tend to agree with you about the APA.

I really appreciate this post, as well as the resources it refers to. I listened to the podcast, and was very moved. I loved her blog post. It really hit home when she wrote: "...the general public's understanding of Manic Depressive illness is that it causes people to be really happy and alternately, really sad. That description is so simplistic, it would be akin to saying someone in the advanced stages of cancer "doesn't feel good"." No one can possibly imagine the intensity or drama without learning more about the illness.

Bipolar is certainly a taboo topic. I'm glad that the guy from Blue October is speaking out.

In the podcast, the host says that supporting someone with bipolar disorder is a "gargantuan job". Amen to that. This was enormously supportive to me, just to hear about others that are loving and caring for those with bipolar disorder.

This was really helpful and encouraging for me! I think that Christy is an amazing person as well.

I continued to investigate and found another interesting podcast about someone else who has "a lot going on upstairs". How delightful!

What a fascinating definition of money--did it originate with you? I really, really enjoyed your discussion with Will. Unplanned and riveting.

I will not soon forget your example of losing an arm in a wood chipper, but you are absolutely right.

Yes, a delightful podcast---both of them!

Peace and love,

Rick Hamrick said...

O--it's funny how much one can learn by simply speaking in the flow of a conversation which is open and free, speaking without wasting time filtering.

I have no idea where the definition of money which I espoused in my conversation with Will came from. It was one of those times when, after I said it, I was thinking, "huh?"

We had fun creating that podcast.

To your comments about bipolar disorder and how it impacts the care givers, you need to know how lucky the person is for whom you provide support and care.

It is hardly compensation, being complimented for your efforts, but that's not the motivation for providing care in the first place. To learn that your efforts are creating a small place where light can shine, though, that's gotta help. Spirit seeks encouraging environments.

I'm a big believer in getting away, too. Breaking up the care-giving days and weeks with something different, just as you do now and then with a seminar or weekend trip, is vital.

Just as with any chronic condition, it is not one day which gets to you. It is the unrelentingly accumulating days with no end. And, in the case of bipolar disorder at its most difficult, you are caring for someone who is resisting and doing so in ways that can be maddening.