July 11, 2011
How will you do your next Step 4? Do you use the AA Big Book list of resentments, fears and sex- conduct? Or will you us the newest version of the DSM (Diagnostic and Statistical Manual of Mental Disorders). The first one in 1952 was 150 pages and 180 disorders. The current on DSM-IV is 900 pages and 365 disorders. DSM-5 will come out in 2013 and, while some insist that there is plenty of neurocognitive evidence to broaden definitions even further, critics see it as pharmaceutical cash cow that will help create a pill for everything.
Consider that OCD (Obsessive Compulsive Disorders) weren’t even part of our language when Bill Wilson wrote about how we work the Twelve Steps. The latest survey suggested that 60% of AA members are double winners, blessed with a psychiatric diagnosis as well as addiction. Chances are the new DSC check up from the neck up will increase that number. In the Globe and Mail on July 9th, Ian Brown ponders how much today’s science will look like quackery in another 100 years.
I mean, how much do we laugh at the wisdom of the ages that came from 1911; or better still, 1811?
Consider that if you have been branded “Borderline Personality Disorder,” “Bi-Polar” or “OCD” there is only a 20% chance that if you got a second opinion that it would be the same opinion. Twelve Step Programs, sponsors and this blog don’t profess to have an intelligent opinion on the use of drugs vs. psychotherapy vs. working the Twelve Steps to cure what ails us but going by what trends are, more of us are finding ourselves with colorful new labels beyond “addict” or “co-dependent” and we have difficult soul-searching ahead of us about how to deal with these diagnoses.
Do you discus your diagnosis with your higher power? Wouldn’t it be great to follow God on Twitter and take or do what He (She, It, They) says and be done with it? Yes, that would be nice, but just talking about such things could be a symptom of one of the new disorders coming to a doctor near you soon.
In the continuum of recovery the Twelve Steps stay the same while our understanding broadens and our belief and spiritual condition waxes and wanes. It seems so simple compared to the hyper-diagnostic world of mental health care. There is more help and greater choices than ever before. The increase in diagnosable conditions would suggest that as society evolves, our Subjective Well-Being is tragically on the decline. Yes, the more we know, the more we realize how little we know.
For some the Steps are largely a bridge to better living, a way to get on with life and away from navel-gazing. For many of us, recovery is a process, not an event and the layers to the onion exceed the time on earth we have to explore them.
As Ian Brown puts it, “The controversy over the proposed DSM-5 is forcing psychiatry to analyze its own issues – its fervid embrace of drugs; its enthusiastic use of genetics and brain imaging to expand existing diagnostic categories, perhaps prematurely; and the limits of its ability to understand the human mind.”
The one thing we know is that whatever the latest-greatest-thing is, it will be branded as expertise. History may not view it so generously. At least in the rooms we have the humility to know our currency is our experience, not expertise.