No More Disorders: Debriefing from DSM Diagnoses

Over the past few months, I’ve found myself moving further and further away from the mental health profession and its view of the world.  It’s always difficult to know how these things begin, especially for someone like me, who has spent many years in front of therapists. For a long time, psychotherapy helped me.  It gave me a language with which to express the abuses of my childhood.  It allowed me a safe place in which to work out the ways in which the trauma was affecting my life.  It helped me to move beyond being a victim to a survivor, and then it helped me move beyond being a survivor to simply being Rachel.

So where did it all go wrong between the mental health profession and me?  I’m not sure it did.  As is my history with most large groups, I just outgrew it.  And once I outgrew it, I began to see all the ways in which its definitions were still limiting me, because I hadn’t dislodged those definitions from my brain.

The process of debriefing from the mental health profession began when I was still in therapy.  I had a conversation with my therapist in which I began to realize that the paradigm I was developing was altogether different from the one in which he was comfortable. We were talking about diagnoses, and I was still very much wedded to the idea of having one—or so I thought.  The conversation went something like this:

Me: When you write up your paperwork about our sessions, do you include a diagnosis?

My therapist: No.

Me: If you had to give me a diagnosis, what would it be?

My therapist: Well, you definitely have a mood disorder.

Me: I do?

My therapist: Yes.

Me: How do you define that?

My therapist: Well, you’re anxious and sad a lot.

Me: That means I have a disorder?

My therapist: Yes.

Me: But look at my situation.  I’m dealing with being disabled in mid-life.  The world is not set up to bring someone like me into full membership in the community.  In fact, I feel invisible most of the time.  It makes me sad.  I’m grieving.  Anyone would feel sad and upset in that situation.  Why does that mean I have a disorder?

My therapist: Because it’s your problem.

Me: What do you mean it’s my problem?  I live in a society that renders me invisible.  Why isn’t it society’s problem?

My therapist: Because it’s your problem.

Me: But I can’t solve it alone.  I realize that I have to deal with what I’ve been given, but you can’t possibly expect me to just bear up cheerfully under the weight of all this difficulty.  There’s a relationship between me and the world here.  What about the world’s dysfunctionality?  Why is this all on me?

My therapist: [insert patronizing therapist look here]

Me: Do you understand what I’m saying?

My therapist: Yes, and it’s still your problem.

Me: I can see we’re not getting anywhere.

I left therapy soon afterward.

I’ve thought of this conversation a great deal over the past few months.  To my mind, it encapsulates everything that is wrong with the mental health profession:

1) Having a human emotion such as sadness, grief, anxiety, or anger in response to an ongoing traumatic, life-changing, unjust, or otherwise maddening situation is evidence of a disorder.

2) The medications I was taking were never on the table as a cause of my anxiety and depression.  (As it turns out, they played a major role).

3) We don’t need to talk about disabilism, its impact on people, and how we need to change it.

4) People become transformed into patients and put into diagnostic boxes.

5) We only need to talk about how screwed up the patient is and how we need to change the patient.

Over the course of my life, I’ve been labeled (officially and unofficially) with depression, general anxiety disorder, post-traumatic stress disorder, Asperger’s disorder (also known as an autism spectrum disorder), and sensory processing disorder.  And next week, I’m going to an audiologist who will most likely diagnose me with auditory processing disorder.

I can’t tell you how depressing it is to keep collecting disorders like this.  (I suppose that means that I have DODDD: Depressed over DSM Diagnoses Disorder.)  All these labels have done a huge number on my head.  If I’m going to live a full, happy, and empowered life, I need to send these diagnoses back to where they came from, because they are not me and they have nothing to do with me.

Let’s start with autism, since that’s what got me started thinking about this whole issue in the first place. Autism is not a disorder.  It’s not a collection of impairments.  It’s not a series of deficits.  It’s not something that’s wrong with me.  It only looks that way because I live in a society that values certain things to the exclusion of others.  It values yacking about non-substantive things; I like substantive conversation.  It values social chit-chat; I don’t do social chit-chat.  It values being loud; I can’t spend any time in loud environments.  It values going fast in every way possible; I cannot follow fast speech, fast-moving objects, or fast-moving graphics.

The society I live in is fearful of silence and deliberation.  It thrives on mutually agreed upon deceptions.  It abhors directness.  It does not honor one’s word as one’s bond.  It values appearance over substance.  It tyrannizes us with the necessity for “positive thinking” above all else, as though it weren’t simply all right to give vent to one’s emotions when terrible things happen and heartbreak is the only sane response.  In short, from my point of view, the society I live in is very unhealthy.  Does that mean that something is wrong with me?  Why?  Because I’m in the minority and the majority is always right?  Such nonsense.

My acute sensitivities are not a problem in and of themselves.  My emotions are not a problem, in and of themselves.  My post-traumatic stress issues are not even a problem, in and of themselves.  All of these things can be a source of great power and heartfelt service to others if I use them properly.  All of these things only become a problem when they go against an arbitrarily defined idea of “normal.”  Then I get people trying to prescribe, discuss, and cure them out of me.  But as a friend said to me the other day, please find me this “normal” person, because I haven’t stumbled across him yet.  (And yes, the “normal” person is definitely a guy, because being male is part of the standard for “normal.”)

Of all the things that American culture values as “normal,” conformity is the most important.  We talk about respecting difference, but if we respected difference, we’d just go around doing it and not talking about it all the time, now wouldn’t we?  Here in America, the home of “rugged individualism,” we don’t respect difference. In fact, conformity is Job One.  Here’s how it goes:  You can only be a rugged individualist if you’re white, male, Christian, heterosexual, and fit into a certain unnamed place on the neurological spectrum.  If you’re something else, it gets scary for those rugged individualists.  I don’t know why all the rest of us on the racial, gender, religious, sexual, and neurological spectrum should make the rugged individualists faint, but apparently, we do.

When it comes down to it, autistic people, or bipolar people, or schizophrenic people, or traumatized people, or anyone in any other group of people, are just different from a mythic “norm” that simply doesn’t exist. There isn’t a person on the planet who won’t fit into a DSM diagnosis if you look hard enough—or who can’t be misdiagnosed into one if you don’t.  They’ve got a diagnosis for everything a human being can possibly go through, which makes life itself a pathology and human beings nothing but walking disorders.

Well, I don’t believe that life is a pathology and that people are walking disorders.  To heal this kind of mindset, I’m starting with my own distorted sense of myself as disordered—a distortion I’ve taken on as though it’s a clear reflection of who I am.  It’s not.  I know that now.

Rachel Cohen-Rottenberg’s No More Disorders: Debriefing from
DSM Diagnoses
first appeared at Journeys with Autism, and is republished here with the author’s permission. Rachel Cohen-Rottenberg’s recently published book is The Uncharted Path: My Journey with Late-Diagnosed Autism.

on 07/12/10 in Autism, featured | 1 Comment | Read More

Comments (1)


  1. Gwen McKay says:

    The empty therapist’s office is a picture well suited to this post, but when I read it I also had a mental image of a revolutionary banner waving. Quite a strong declaration of independence here!

Leave a Reply