I'm sorry, but exactly how much, how frequently, and for what duration are we, as normal people, supposed to be boinking each other? At what point in our modern history did people stop having enough sex ? ?

Of all the silly new medical fabrications...

[ 23 November 2006: Message edited by: jas ]

"Honey...I'm concerned that we may not be having as much sex as everybody else."

"What do you mean, sweetheart? You know the Joneses only do it once a year. We are much more sexually healthy than they are."

"Honey... I'd... I'd like you to see a doctor... I think you might have HSDD."

"Good lord!"

"It's very common, honey. Lots of women have it. It's just a little 'disorder' is all. There's medication for it."

The bible for diagnosing psychiatric disorders--the DSM--is rife with pathologized versions of normal behavior. My personal favorite as a student is Caffeine Intoxication, number 305.90 on Axis I. From the DSM-III-R casebook:

quote:

---

This organic brain syndrome is diagnosed when symptoms such as restlessness, nervousness, flushed face, rambling speech, and excitability are present because of the effect of recent ingestion of caffeine, usually in excess of 250 mg.

---

quote:

---

By those standards, most of us qualify for diagnosis of a mental disorder!

---

A friend I went to school with had no sexual desire at all. Her only problem with it was the reactions of other people. Maybe asexuality is another variant of normal human sexual desire. Most sane people now recognize that the palette of human sexuality is much more multi-hued than was generally recognized, say, a hundred years ago. Maybe discrimination against asexuals is the final frontier, the last sexual type to be recognized.

I’ve got the current version, the DSM-IV-TR (text revision) in front of me as I type. That’s two editions on from the edition to which M. Gregus refers. She’ll be happy to know that the Caffeine disorder is still there. We’ll see if it makes it into the DSM-V, due out in about 5 years I think.

Back in the day, around late 40’s early ‘50’s, there was no common agreement on psychiatric terms or nomenclature. When a Dr. said “this patient appears to be XYZ”, that would mean nothing to a Dr. in a different country, or even in another medical school across town. Another practitioner would have to ask “what does this particular Dr. mean when he or she says XYZ”. This was bad for patients, and a huge block in doing any kind of research and publishing. So about 60 years ago, the psychiatric community got together on a fairly monumental task, formed no end of huge sub committees, and came up with what they thought was a useful standardization and organization of terms, and the DSM I was born. In the UK by the way they use the ICD-10-CA, (International Classification of diseases). It’s pretty similar, and there are guides for translating from one to the other. The book exists to provide a common and consistent usage of terms, and a common and consistent understanding of thresholds and criteria where the terms apply. That’s pretty much all it’s supposed to do, although that’s a lot.

I think anyone who is interested in this sort of thing would do well to read the introductory chapters, especially where it discusses that the book is not supposed to replace clinical judgment. A lot of psychiatrists should read these pages. The DSM is often referred to as the psychiatric bible. Actually, nothing could be further from the truth. Where the bible is considered to be set in stone and immutable, the DSM is regarded as a perpetual working document. It really just reflects, through all the sub-committees what Dr’s. are seeing in their offices and hospitals, and what’s currently being published. It is published with the expectation that parts will be out of date by the time it hits the shelves, and people are already working on rewrites.

Just reading lists of diagnostic criteria with no particular context can be misleading. In the Hypoactive Sexual Desire Disorder for example you clearly need to rule out physiological dysfunction, take into account the persons overall life context, other factors which may affect sexual function are ruled out, and the state of being clearly causes marked distress or interpersonal difficulty. Therefore, the person has to self identify that they perceive it as a problem.

To quote from the chapter introducing personality disorders for example, where a lot of readers find their friends and sometimes themselves; “Only when personality traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute Personality Disorders”.

The good news is, homosexuality is out!
The bad news is, PMS is in.

I work in an agency that is strongly critical of psychiatry, and though I may agree in individual cases that a diagnosis can be helpful to a specific person, overall I would say that the DSM in all its forms is mostly unhelpful to individuals. Not only does it have a western bent and bias, it has a marked male, straight and white normative bias. Not a huge surprise, of course, but this has potential and actual devastating impacts on people's lives, levels of medication, etc.

There is a new commercial weekly,portraying happy boomers skipping and whistling their way to work,secure in the knowledge that their latest fix will allow them to make it to the job sexually sated and without embarrassing dribbles.The happy boinkers appear unconcerned that those nasty side effects could stop their heart or seriously limit quality of life.

I do take issue with the DSM because I think there's a huge gap between what it purports to do and what it actually does--what it ends up being used for. I've read the first few chapters (thanks, abnormal psych) and yes they do include all sorts of qualifications about its limitations and how it's a system of classification rather than immutable diagnoses, and also how before symptoms can be considered a disorder, there has to be indication of a set level of impairment or dysfunction in a person's life, etc, etc.

That's fine, especially if one is an advocate of the Western model of medicine which classifies diseases and disorders as constellations of symptoms with a common underlying cause.

The problem though I think is the institutional authority that's given to these assortments of symtoms deemed to be constitutive of disorders. The two critical questions are, who's doing the classifying and how are these classifications used? Although it's not meant to be used as a bible, the DSM commonly is and when a patient in a clinical setting is given a diagnosis along the five axes, it seems pretty official.

quote:

---

I think anyone who is interested in this sort of thing would do well to read the introductory chapters, especially where it discusses that the book is not supposed to replace clinical judgment. A lot of psychiatrists should read these pages. The DSM is often referred to as the psychiatric bible. Actually, nothing could be further from the truth. Where the bible is considered to be set in stone and immutable, the DSM is regarded as a perpetual working document. It really just reflects, through all the sub-committees what Dr’s. are seeing in their offices and hospitals, and what’s currently being published. It is published with the expectation that parts will be out of date by the time it hits the shelves, and people are already working on rewrites.

---

The DSm is very much like the bible in the manner it attempt to legitimize the power and the authority of the psychiatric priesthood. It is also as rigid and scientific as the bible. The DSM actually is no different from clinical judgement it compiled through a process of psychistrists voting. The true function of this document is to assure psychiatrists of their power and expertise and make their pseudoscience somehow legitimate. It does virtually nothing to help the person in distress or help to make sense of the person's distress. On the contrary it creates a barrier by placing a loaded categorical description on a person rather than becoming curious about their experience. Diagnosis only soothes the "experts" discomfort around humna suffering it does nothing for the suffer.

The whole clinical discourse rests on a number of faulty assumptions. The first being that the expert within a short time has a better understanding of the person's struggle than the person themselves.The second is that people are somehow incapable of speaking clearly and accurately about their own distress. It is a demonstration of profound arrogance when psychiatry speaks of "insight" To a psychiatrist someone has "insight" in to their conditiion to the extent that they agree with the psychiatrist. Given time even people in deep distress can articulate what the find distressing.

I tend to cringe when I hear reference to "clinical judgement". Research on clinical judgement has clearly demonstrated how biased, erroneous and dangerously inaccurate clinical judgement is. It also mistaken to believe that such judgement is anyway neutral or objective, psychiatric judgement is deeply embedded in a very clear ideological position. Not only is that position to pathologize human behaviour but it's normative assumptions are inherently racist, sexist and classist. I read recently in the Guardian that people from Afro-caribean communities were nine times more likely to get a diagnosis of schizophrenia.
It is also worth noting that research has found that the it takes 5-10 minutes for a psychiatrist to make a diagnosis, sometimes it can be done in as little 30 seconds.

I haven't even began to talk about the damage that psychiatric labels cause people(probalby the topic of my dissertation) making them feel hopeless powerless and immobilized and victims of discrimination in the community.

These labels reflect a very inaccurate portrayal of human suffering, human suffering does not fall into nice clean discrete categories. I have never met someone who is depressed that did not also expereince anxiety and the opposite is also true, those with other labels schizophrenia or the personality disorders also experience degrees of despair and fear.

Finally what these labels also do is remove the focus away from a person's life experience. The majority of people who end up with such labels have hisories of trauma that are generally ignored by psychiatry. The number of those experiencing trauma is even higher if we consider the ongoing insidious forms of trauma, racism , sexism , and attendant povery and marginalization, added to the trauma of coming in contact with an inherently coercive psychiatric system. Psycoemotional distress can also be the result of an existential/spiritual crisis.