Catching up with an old friend at dinner the other night, I asked him about his teenage sons. His younger one was doing fine, but as for the older one...well, my friend said, "I'd like to get inside his head and know what's going on." Then he added, "Maybe he has some undiagnosed condition." Naturally this piqued my interest, so I did what psychologists (and even normal people) do: I asked some questions to find out more. I knew his son had caused him and his wife some grief in the past few years, taking their car for a joy ride in the middle of the night--before he had a license--and ended up totaling the car. In contrast, his most recent misbehavior was less catastrophic, but still of concern. That very day he had gone off to school in their upper-middle-class neighborhood, and rather than face the consequence of not having done his homework, played hooky instead.
Both parents are hard-working PhDs in science and probably never missed a day of school in their lives. So I can fully understand their perplexity and concern about their teenage son. What struck me was this idea that he had an "undiagnosed condition." What the hell does that really mean? He has a "chemical imbalance?" He has ADHD? And what is a "condition" anyway? In the old days this might have been referred to as a behavior problem-his behavior is out of line, and must be corrected somehow. Maybe bring out the belt, ground him for a week, or some other form of punishment.
The newer, more enlightened approach is to try to understand what is causing the behavior. That's generally a good thing, especially if it's someone you care deeply about, such as your child. But understanding does not equate to diagnosis. The scientific/medical model has vast limitations in understanding the complexity of human behavior and emotions. There are many reasons why their son might want to skip school. Really, how many teenagers want to sit around all day in uncomfortable desks listening to teachers lecture to them? Of course, wanting to skip school and actually doing so are two different things.
Think about yourself, and about how your mood fluctuates throughout the day and week, and about how you make decisions. You've been down sometimes, perhaps in a state of profound despair or severe anxiety; at other times you've been joyful. Sometimes you've made stupid decisions, other times brilliant ones. Are your bad decisions or hellish moods due to a diagnosis or condition? If so, how about happy or even euphoric states--are those a sign of bipolar disorder? And what about the decisions of bankers, regulatory agencies, or millions of homeowners and home speculators who in retrospect behaved in irrational, almost delusional ways? Or baseball star Alex Rodriguez, who claimed that he took steroids because he was "young" and "immature and stupid." At least he didn't claim that as a condition, unless being in your 20's qualifies as such.
Putting the complexity of human behavior into a box called a condition or diagnosis obviously provides some comfort to people. A word or label makes something seem identifiable, understandable, perhaps even treatable. I'm not against comfort or peace of mind. If I could put it in a bottle and sell it, I could make enough money to help solve our financial crisis (in fact, the psychopharm industry is based on that premise, and some of their products do help, although the billions they spend on advertising and in "consulting fees" to psychiatrists paints an exaggerated picture of their efficacy).
But thinking again about your own experience as a human being (yes, a live sentient being, not a programmable machine or a black box), you know that a label cannot begin to describe the complexity of your thoughts, emotions, unique history, and decisions. So if it doesn't explain you, why would this work for others? Of course, I'm not the first to challenge the utility of diagnostic labels for psychological "disorders"--and I put that in quotes, because even that term is fraught with difficulty. Thomas Szasz laid out his argument against this almost half a century ago in his classic but controversial text The Myth of Mental Illness. But this has not slowed our increasing infatuation with the scientific, cause-effect view of human behavior. We do know more about the brain than ever before, yet still know so little. And just as astrophysics cannot ever fully explain why we are here, brain research cannot explain who we are and why we do what we do. And I don't know about you, but for me, that's a comforting thought.
