In the past decade or so mental and behavioral health has enjoyed an insurgence that has transformed it from a sub-discipline of the medical field to nothing less than a juggernaut. This is due in large part to the introduction of SSRIs and MAOIs and the coincident culture of dysfunction, as well as that of overmedication that these treatments have spawned.

One of the most consistent questions I am asked is, "What's wrong with me?" More and more, that question comes with a preamble from so-called expert patients armed with all sorts of information they have gathered on their alleged condition. I am consistently reminded that a little knowledge and a lack of perspective is a dangerous thing.

This brings to mind my sophomore year Abnormal Psych professor who, in the hallowed, ivy-covered halls of a rather prestigious Catholic college, presented us with the case study of a delusion paranoid schizophrenic with an attendant persecution complex. After talking for over an hour, she revealed that the patient was none other than Jesus of Nazareth. Perspective, indeed.

I'm a fairly decent diagnostician. That skill does not come from my ability to pick up the DSM and read, nor does it come from my ability to hand a patient an inventory. It comes from 25 years of clinical practice wherein I have seen everything from panic attacks to alter egos, and treated everyone from bored housewives and school phobics to pedophiles and murderers.

In service to that, I have come up with something that I fondly, and not without some humor, call the ‘Crazy Scale'. It goes something like this:

  • Distracted
  • Disorganized
  • Disturbed
  • Dysfunctional
  • Dysregulated
  • Dysregulated-Disordered
  • Disordered
  • Dissociative

Most people, despite what society and the Internet may tell them, fall within the span of Distracted to Dysregulated. Dysregulated-Disordered to Disordered is where things start to get clinical. Dissociative is when things really start to fall apart.

One caveat here: ‘Dissociative' is a bucket word for anything where ego integrity starts to fail. That means anything from fixed fantasies and delusional thinking to psychotic depression and altering. Dissociative here does not mean Dissociation, Dissociative Personality Disorder or Multiple Personality Disorder...it was a ‘D' word that fit as a global descriptor.

People who fall within the first segment of the scale - Distracted to Dysregulated -- exhibit what I call ‘shadow syndromes.' Looks like a wolf, walks like a wolf, talks like a wolf, but it's really a puppy.

Regrettably, somewhere along the line shadow syndromes have become disorders. What is poor executive functioning has become ADD/ADHD. What was once ‘high strung' has become Generalized Anxiety Disorder. What was once a dissipation of sexual attraction for one's partner has become Sexual Desire Disorder.

My point is this - everyone's a little crazy. No one falls at zero on the bell curve. In fact, if you know someone who appears to fall at zero on the bell curve, be afraid - be very afraid. There is no such thing as normal.

There is also no such thing as everyone having a diagnosable disorder. Most of us have a few chinks in the armor that may look like psychiatric conditions, but are something much less.

Mental illness is, in most cases, demonstrable - or, at least, a fair certainty. But, like all such things, it needs to be bounded by a certain degree of reasonableness and rationality as well as a modicum of perspective.

Case in point - Albert Einstein had in his closet 7 white shirts, 7 pairs of black pants, 7 tweed jackets, 7 black ties, 7 pairs of white boxers, 7 pairs of black socks and 7 pairs of black shoes. During the summer months, he swapped out the jackets for grey sweaters, the shoes for sandals and would forgo the ties. He said in this way he did not have to waste mental energy on thinking about what to wear. By today's standards, rather than reasonably eccentric, he would be considered Obsessive-Compulsive, just for starters. Get it?

It comes down to this - use your head. Before putting your kid on Ritalin, think about his/her diet (processed sugar, preservatives, just plain crap, etc.), how much soda they drink and how much time they spend in front of screens. McDonalds is not a food group.

Before accepting that prescription for Adderall, decide whether or not you just need to buy an organizer and put a white board in your office - or, better yet, learn how to leave the office at the office and your Crackberry on the bureau on weekends.

Before deciding you have some exotic disorder, consider if the fact that you have an 18 hour day, your kids are morbidly over-programmed, your boss is a jerk and you and your partner work split shifts might has something to do with it.

If you think you're in trouble, trust your self and get help, certainly. But think before making trouble where there isn't any. And don't allow trouble to be created for you.

Above all else, mental health professionals of all walks are counselors - counselors in the old fashioned sense of the word insofar as they provide counsel, perspective and direction. Take counsel before jumping down the rabbit hole.

© 2008 Michael J. Formica, All Rights Reserved

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