Over the past couple of decades we have seen new categories of disorder. Some of these disorders would not have been classified in a medical category years ago and were just put down to the type of personality. Some categories have sprung up because of our technical lifestyle and others are purely addiction.
Examples are, initially, the obvious ones, such as anorexia and bulimia, which are related to the impact of lifestyles and body image. Other examples are the recently discussed addictions to all things technical, such as laptops, computers and tablets, with particular emphasis on children, who can’t seem to manage for just one day without interacting with a link to social media or a games console.
Then there is attention-deficit/hyperactivity disorder, or ADHD, the diagnosis for hyper-active children and adults who can’t seem to be calmed down.
The intangibility of diagnosing a disorder without being able to look at the damage, such as a broken leg, or a skin disorder, is always difficult. Stress disorders are very good examples of the difficulty of diagnosing the pain, trauma and mental difficulty someone could be experiencing due to a previous trauma in life.
Military staff who have served in war zones are a good example of this issue. Happily, they have much more support now than in previous world wars. All this is leading up to a new disorder relating to people who are eccentric, anti-establishment or oppose authority. This mental health problem has been given the tag of ‘oppositional defiant disorder’ (ODD). According to recent documentation, this can be treated with powerful anti-psychotics.
ODD was first designated a mental disorder in the early 1980s, but has only recently been redefined by the American Psychiatric Association (APA). The latest edition of the Diagnostic and Statistical Manual of Mental Health Disorders, or DSM-V, is a major reference textbook that lists and explains all known mental illnesses that can be treated by psychiatrists.
ODD is mainly seen as a childhood disorder, characterised by defiant, angry or irritable behaviour. However, ODD apparently can affect adults too. This is accordingly defined as ‘an ongoing pattern of disobedient, hostile and defiant behaviour’.
The symptoms include questioning authority, negativity, defiance, argumentativeness and being easily annoyed.
Clinical psychologist Bruce Levine says that the new mental disease of ODD is a declaration that “any non-conformity and questioning of authority is a form of insanity”. What were once called personality traits which described a difficult, antisocial or creative outsider are now mental diseases. In the previous volume of DSM-IV, other personality traits such as arrogance, narcissism, above-average creativity, cynicism and anti-social behaviour, also became treatable mental illnesses.
A diagnosis for ODD is often made in conjunction with ADHD
A diagnosis for ODD is often made in conjunction with ADHD. For example, children who display four out of eight behaviours persistently for more than six months could be diagnosed with ODD.
The behaviours include being easily annoyed, argumentative, actively refusing to comply with the requests of ‘the majority’ or ‘consensus-supported rules’, spiteful, blaming of others and doing things to ‘deliberately annoy others’.
The APA are not sure why some people suffer ODD and others don’t. They believe it can be the result of a combination of biological, psychological and environmental factors. Treatment can range from behavioural therapy, positive reinforcement, praise for ‘appropriate behaviour’ and, of course, the well-known drug for ADHD, now highly prescribed, worldwide.
Unsurprisingly, the whole issue of ODD is mired in controversy. The definitions vary, for example, the World Health Organisation works to a different criteria. In addition, a diagnosis is ultimately subjective and could lead to annoying, eccentric or creative people being labelled ODD.
Given some of the description, I could have been ODD in my teens, as could many teenagers. Also, virtually every genius, artist or radical reformer could be considered mentally ill. The list would include Leonardo, Einstein and even Jesus.
It is so subjective that Thomas Insel, the director of the US National Institute of Mental Health (NIMH), stated in 2013, that the DSM’s diagnostic categories lacked validity and that the NIMH would be “reorienting its research away from DSM categories”. One has to ask why there is such a controversy between huge organisations. Allen Frances, former chairman of the task force that defined mental diseases for DSM-IV, broke ranks and announced that psychiatric diagnosis (as administered by the APA) was out of control.
It was felt that it had become another delivery system for the pharmaceutical industry (PLoS Med., 2012). This subject could be an article in itself. However, it is worth ending on a dubious diagnosis example. The subject of a diagnosis of a mental disorder was laid bare by a landmark experiment in the 1970s by psychology graduate David Rosenhan (Science, 1973).
He arranged for eight sane people, including himself, to attend various hospitals and declare they were hearing voices. Using the then current edition of the DSM, psychiatrists diagnosed seven of the eight with schizophrenia. They were admitted to a mental institution. During their stay, they reverted to their normal behaviour, yet their sanity was never noticed by the staff.
Even when they were released, the participants were still labelled schizophrenic, except one, who was given a new diagnosis – schizophrenia in remission.
kathryn@maltanet.net