No one could accuse the American Psychiatric
Association of missing a strain of sourness in the country, or of failing to capitalize on its diagnostic potential. Having floated "Apathy Disorder
" as a trial balloon, to see if it might garner enough support for inclusion in the next edition of the Diagnostic and Statistical Manual of Mental Disorders
, the world's diagnostic bible of mental illnesses, the organization has generated untold amounts of publicity and incredulity this week by debating at its convention whether bitterness should become a bona fide mental disorder.
Bitterness is "so common and so deeply destructive," writes Shari Roan at the Los Angeles Times, "that some psychiatrists are urging it be identified as a mental illness under the name post-traumatic embitterment disorder." "The disorder is modeled after post-traumatic stress disorder," she continues, "because it too is a response to a trauma that endures. People with PTSD are left fearful and anxious. Embittered people are left seething for revenge."
Now I grant that there's a lot of anger and bitterness out there. How much of it should be attributed to the last Republican administration? The question straddles psychology and politics, I concede, but in the eyes of many Americans that administration managed in eight years to bring a largely healthy economy to its knees.
To many Americans, there are additional reasons for bitterness at that outcome. The Bush administration led the country into a protracted, illegal war, based on trumped-up evidence; ignored memos that said the country faced credible terrorist threats; locked up large numbers of suspects afterwards without trial or due process; lied to its citizens about the widespread use of torture; eliminated every sensible, necessary check on financial regulation to prevent a fiscal meltdown; mocked the facts of climate change; and sat on its hands as Hurricane Katrina devastated a large city.
Heaven knows, there are reasons enough to be bitter about the untold number of opportunities squandered, the problems that have escalated in their place, and the crises now with us that were once entirely avoidable.
But when justified anger at such incompetence is discussed as a sign of mental illness, it is borderline insulting, especially because half the reason for the discussion is to ensure that drug companies—anxious to prod their faltering revenues—can promise relief from the alleged disorder with yet more pharmaceuticals.
Imagine, if you will, the inevitable ads: "Think it's just bitterness from job loss, foreclosure on your home, or that nonexistent pension for which you've been saving all your working years? It may be 'post-traumatic embitterment disorder,' a mental illness that some doctors think is due to a chemical imbalance . . ."
Nor, more seriously, is PTSD a solid model for comparison. A recent issue of Scientific American carried a detailed article on the growing need to "save Post-Traumatic Stress Disorder (PTSD) from itself." The phrase was Robert Spitzer's, architect of the third and fourth editions of the DSM. "As a diagnosis," Richard J. McNally, a leading Harvard authority on trauma and memory, conceded with Spitzer, "PTSD has become so flabby and overstretched, so much a part of the culture, that we are almost certainly mistaking other problems for PTSD and thus mistreating them."
In its discussion of post-traumatic embitterment disorder, the APA may have correctly gauged the mood of the country, but as usual it has ignored or shunted aside most of the explanatory context, to pathologize the individual in all of her or his frustrated grievance.
"They feel the world has treated them unfairly," says Dr. Michael Linden, a German psychiatrist who labeled the behavior. "It's one step more complex than anger. They're angry plus helpless."
Linden estimates that between 1% and 2% of the population is embittered, though he didn't specify whether that percentage increased during or immediately after the Bush years. Perhaps he should. Others reviewing his work note that PTED includes "a high degree of comorbidity [and] diagnostic uncertainty . . . : 66% adjustment disorder, 40% dysthymia, 34% generalized anxiety disorder, 18% social phobia, 18% agoraphobia, and 16% personality disorder."
But adjustment disorder, a highly elastic concept, is itself a capacious term to describe predictable, largely routine responses to stress. Why, then, is the APA discussing the inclusion of a new term that not only overlaps so strongly with existing "disorders," but also has so many obvious, identifiable causes in the world?
Part of the incredulity the APA discussion has generated in the media and blogosphere is doubtless because bitterness strikes the person feeling it as a justified response to a social ill or personal wrong. It may be an exaggerated, distorted perception to which, Linden wisely notes, "revenge is not a treatment." But just one of the many reasons for alarm here is the thought of the DSM, of all documents, trying with a few vague, open-ended criteria to legislate what is reasonable bitterness and what is not. (If you knew that "fear of eating alone in restaurants" and "avoidance of public restrooms" were both official symptoms of social anxiety disorder, among the most widely diagnosed of mental illnesses in the United States, you'd share my concern.)
These days, when many people approaching retirement open their 401(k) statements, they doubtless feel a bad twinge of "angry plus helpless." How about making that frantic concern and impotent rage? Do we really want the DSM telling us that those feelings—including over the need to postpone retirement by up to a decade—could soon be a symptom of "post-traumatic embitterness disorder"? Wouldn't that be comparable to rubbing salt in an already large wound?
Christopher Lane, the Pearce Miller Research Professor of Literature at Northwestern University, is the author most recently of Shyness: How Normal Behavior Became a Sickness.