Tuesday, December 23, 2008


How about: Relapsing and Remitting Narcissistic Empathy Deficit Disorder?

Say you’re trying to give directions over the phone. A third person interrupts repeatedly. She wants you to suggest a different route – not knowing that the other party has reasons for avoiding this alternative route.

After you hang up, she says, “How come nobody ever listens to me?”

This individual suffers from RRNEDD. In other words:

In the press of the moment (Relapsing and Remitting) the self-involved (Narcissistic) third person fails to understand 1. The direction-seeker’s priorities, and 2. The bad impression she has made on you (Empathy Deficit Disorder.)

I mention this in connection with an article in last week’s New York Times: Psychiatry’s Struggle to Revise the Book of Human Troubles.

It’s struggling, all right.

Psychiatry faces many challenges as it attempts to update the DSM, or Diagnostic and Statistical Manual of Mental Disorders. The new edition, DSM-V, is a guaranteed best seller, so that, at least, is not among Psychiatry’s problems.
But a plateful remain.

According to the article, Psychiatry must fend off drug companies bent on bribing contributors and editors to hype conditions ripe for treatment by patented medicines. Otherwise, the DSM-V will come out with Prozac Deprivation Syndrome and Hypovaliumism.

Another challenge reflects Psychiatry’s ignorance of its subject matter. It does not know exactly what anything is, or what causes it, or more often than not, what to do about it. As the article points out in the words of a perceptive actual psychiatrist, “ … this is not cardiology or nephrology.”

However, the DSM does serve as a means of getting people paid. It does so by attaching a number to each diagnostic label, such as RRNEDD. This number, say 897.9, triggers the insurance company’s reimbursement (or denial) mechanism, allowing mental health care to function.

The New York Times article explores the skeptical view of the above-quoted doctor who has authored a book which summarizes Western Civilization under the title, “ Before Prozac.” He’s concerned that identifying people as having “obsessive-compulsive” disorder may impose a negative impact on their self-perception if and when they hear about it.

Also, the current approach may not give some gender permutations the encouragement they deserve.

I could see that this article was no mere exercise in industry cheerleading. That’s probably why it wasn’t in the Science section. Still, for another objective viewpoint I visited Iris, my childhood chum and on-call psychiatrist. Not having cracked the DSM for a long time, I asked her to fetch hers and together we vetted.

I was quickly reminded that Psychiatry has set itself a noble task in attempting to categorize the whole of human experience for purposes of reimbursement. This is one of its most daunting challenges -- struggling to encapsulate every facet of what goes on day by day.

My eye fell quickly on the pot section. I read sadly about Cannabis Dependency, with its compulsive and destructive aspects. “But what,” I wondered, “is meant by 305.20 Cannabis Abuse?” Turns out, this condition comprises driving high, getting busted, smoking at work, arguing about smoking dope with spouse or parents, and toking up in the presence of minors.

Nor does Psychiatry go easy on legal agents, as evidenced by 292.89, Caffeine Induced Sleep Disorder. Armed with a degree and a number, you can get reimbursed for telling people to cut down.

Oppositional Defiant Disorder involves arguing with adults, disregarding authority, blaming others for your own fuck-ups, being annoyed and annoying, and showing an angry, resentful, or vindictive side. To qualify your psychiatrist for reimbursement, these tendencies must get in your way.

The same goes for 312.89 Impulse Control Disorder, 301.50 Histrionic Personality Disorder, and 302.89, Frotteurism, or touching people on the subway. My favorite is Factitious Disorder, or making up disorders.

Psychiatry is struggling to do its best. With all the challenges it faces, it can use some help. I don’t intend to stop with RRNEDD. I’m taking notes on other troublesome manifestations, too.

I urge readers to join me in this practice and send your notes to Pappa. When we have enough, I’ll give them all numbers and forward the whole batch to Psychiatry.

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