What's in a Name? Does a Diagnosis by Any Other Name Smell Just as Sweet?

More often than not, psychiatric diagnoses are identified using a set of subjective, perceived personality traits that can be observed by a "clinician" in a sterile, foreign environment. Have we not learned anything from the Hawthorne studies, when we learned that the very act of observation in and of itself changes the not only behavior, but also performance of the subjects in a given setting? There simply is no such thing as natural observation. The act of observation changes behavior, and I can tell you that the act of being observed sure changes mine!

Largely driven by pharmaceutical conglomerates, a psychiatric diagnosis can be every bit a trendy as a new pair of jeans or the latest purse gracing the pages of Vogue magazine. It seems that lately, the diagnosis is driven more and more by the latest and greatest pharmaceutical discovery and the next generation of off-label use.

Perhaps it started in the 70's when Valium was known as "Mommy's Little Helpers." The 80's brought with it the discovery of Prozac, the wonder drug. Before we knew it, everyone from the Island to the Upper East Side was popping the capsules on a daily basis. Seeing a shrink was the norm, not the exception. It was almost trendy to be depressed. So long as it stopped there.

Next? Next came the smart pills. The Adderall; the Provigil; the nap in a bottle. Stimulants were to late 90's what cocaine was in the 70's. Only this time they were prescribed, they were socially acceptable, and they were even given to children. Parents from Westchester and Scarsdale rushed to the nearest doctor in the city to get their children on the fast track to the Ivy League. It would not surprise me if Shire-Richwood (the company that developed the pharmaceutical gem) bought add space in pre-schools. ADD. It is almost cool to be diagnosed with it.

Case in point? Ty Pennington. He is a man's man. I did not need to see his face on an Adderall brochure to know that he was on speed! Ty Pennington is some kind of modern day hero to children. He is a younger, sexier, wealthier version of a fire fighter or a cop. Now we have a new generation of boys who aspire to be nothing more than the hottest carpenter on the block. Yes, a blue-collar worker turned millionaire. I am sure that happens all the time, right?

Well, no. Not really. This type of celebrity could only come of age in the era of reality show television stars.

So there you have it! A whole generation of little boys and girls who aspire to be nothing more than a person with mediocre talent and skills who strikes it rich on TV. I can almost picture some child seeing that ad and tugging on his mother's sleeve whining, "Mommy, mommy! When I grow up, I wanna be hyperactive too!" And bam-there is was! The next edition of the DSM and the latest and greatest pharmaceutical intervention for the overworked, underpaid, twenty and thirty-something's who just needed a little push to get through the day. And what did big pharma do? They came up with a new diagnosis and use for it. ADD with "Adult Onset." You do not even need to be particularly hyperactive anymore. Just N.O.S. (not otherwise specified.)

The press reported that Paris Hilton's pharmaceutical costs drove up the cost of providing a standard of care to prison populations. So Paris continued on her daily regimen of Xanax, Adderall, and maybe even a few others. Thank you, Paris for setting the bar high. Maybe next time I run out of meds, I will go knock up a liquor store so I can get CCA[i] to pay for my treatment too!

But the tides have shifted once again. This time it is bipolar. Big pharma has apparently found the answer to bipolar disorder by treating it with a number of very expensive prescription medications. Depakote, Seroquel, Geodon, and a few other atypical and off-label medications that are used to treat the growing number of people diagnosed with bipolar disorder. It seems that everyone from Britney Spears to the kid next door have suddenly developed the disorder. Even I got that one, along with a prescription for medication that cost more than my monthly grocery bill. Hmmm... which do I need more? I suppose the answer depends on whom you chose to ask. Britney's bi-polar. So is Lois Lane!

Now that I too have been diagnosed, we can just add that to the list along with OCD, ADD, PTSD; and I think you get the point. I have been diagnosed with just about every trendy new disorder, and have been prescribed every pill from Ativan to Zoloft. Unfortunately, the one condition that plagues me the most has no diagnostic criteria; no cure; no treatment protocol or guides to the best practices in medicine. There is no medical term that I can think of to adequately describe the persistent, nagging isolation of loneliness. Without a quick fix or new pharmaceutical discovery, there is no diagnosis or treatment for being lonely.

It seems the more connected I am to my "wireless" technologies, the more alienated I become from the human race. Not that I have a problem with that-I work better with a keyboard than I do a pen. And let's face it-I simply don't play well with others!

--end part two--

[i] Corrections Corporation of America (a privatized, for-profit Jail cell)