The New Social Worker Vol. 20, No. 4, Fall 2013 | Page 26

complained and nagged, telling me I
was not home enough. She just did not
understand the demands of my work and
that it was her job to care for our home
and kids.”

A few at the table offered polite
comments, attempting to change the focus of the conversation. But the psychiatrist persisted: “Then five years ago, out
of the blue, she spent thousands of dollars on a piano that she does not know
how to play, and a piece of art, featuring
of all things, a man and a woman having
sex. I immediately knew I had been
overlooking that my wife is bipolar. A
couple of weeks in the hospital and her
meds have made our life manageable.”

I quietly responded to my dinner
companion that perhaps these purchases
were his wife’s plea for someone to hear
her music—someone to talk to and connect
with. His response was a smirk, as he
turned to someone sitting on his other
side to converse with, keeping his back
to me for the rest of the evening. Later in
the evening when I had the opportunity
to introduce myself to his wife, I sat down
next to her. What she told me was bonechilling: “I am no longer here, you know.”

Now the newly published DSM-5
has taken this growing “take a pill and
fix it” approach to even more dangerous
ends. Normal sadness after the loss of a
beloved partner falls under the heading
of clinical depression. (Isn’t deep, persistent sadness following this kind of trauma
a continued love letter to a beloved?)
Angry outbursts fall unto the category
of an intermittent explosive disorder.
(Who, I would also like to know, takes
into account that certain ways one may
be treated can lead to such explosions?
Or in the words of one of my former
professors at the University of Pennsylvania, Dr. Richard Lodge, “Every house
has a chimney, and people need them
too!”) Further, there is a dire lack of
research on the impact of drugs readily
prescribed for the long term. (Think of
what research revealed about long-term
use of hormone replacement therapy.)

How do we distinguish, then, between what is illness, requiring medication, and what is a manifestation of life
faced by the “worried well,” which does
not?

Wakefield (2013) presents this
conceptual framework: There is a difference between mental disorder and normal
range problems of living. Mental disorders are
not merely problematic or harmful; they are

‘‘harmful dysfunctions,” in which the harm
can be any negative or undesirable condition
according to social values, and the dysfunction
that causes the harm is the failure of some
internal psychological process or mechanism
to function as it was biologically designed to
function. There is impressive agreement by clinicians and lay people on many judgments of
which problems represent disorders and which
are part of normal distress and problems of
living, suggesting that the concept of disorder
is widely shared, even if inherently fuzzy.
However, nothing in the concept of disorder
determines that every psychological dysfunction— that is, every failure of mental processes
to operate as they were biologically designed to
do—must be a brain dysfunction rather than a
problem strictly at the level of the interaction
of thoughts, emotions, and other meanings.

And, Wakefield adds, most emotional problems are not due to genuine
psychological dysfunctions at all, but
to normal psychological processes that
yield suffering that is problematic but not
disordered, but may fall under expansive
DSM definitions nonetheless.

Using Wakefield’s distinction, how
do we recognize the “normal range
problems of living”? When I was in
graduate school, I was taught by professors I deeply respected that the best
way to understand psychic pain (and the
human condition) was to study literature,
the classics, theatre, and art. I was also
taught that to label people, rather than
to understand how they got to be who
they are, and why, and recognize the
individuality and worth of every person,
was disrespectful and hostile. The gifted
and wise psychiatrist, Eli Marcovitz, MD,
once shared with me, as we discussed
one of the cases I presented to him for
discussion and consultation, “Everyone
has some psychological frailty that another could label ‘sickness.’ But to label
a human being, rather than offer solid
help, always thwarts true healing.”

The head of residency training when
I was a young social worker at Philadelphia Psychiatric Hospital in Philadelphia,
Morris Brody, MD, put it another way:
“Each member of humankind has some
degree of crazy within. Mental health is
working to understand this about yourself, so that you can love and be loved.
Always remember that we each live in
glass houses.”

Many of the normal range problems
exist on a gradation—meaning anyone
in certain circumstances can be pulled
back from the edge or pushed off of it.

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Fall 2013

The New Social Worker

And yet, mo