Adjustment Disorder: Everyone can have a mental illness

According to the DSM, the essential feature of this mental disorder is “…the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors.” The manual defines clinically significant as either:

“marked distress that is in excess of what would be expected given the nature of the stressor”

or

“significant impairment in social or occupational functioning.”

DSM provides a number of examples of the kinds of stressors that might precipitate a diagnosis of Adjustment Disorder. These include:

– termination of a romantic relationship
– marked business difficulties
– marital problems
– seasonal business crisis
– living in a crime-ridden neighborhood
– natural disaster
– starting school
– leaving one‘s parents’ home
– getting married
– becoming a parent
– failing to attain occupational goals
– retirement
– a chronic disabling medical condition
– financial difficulties resulting from a divorce

And these are just some examples. In other words, if you encounter any of life’s difficulties, and your response to this difficulty is excessive, as defined by a mental health worker, then you have a mental disorder.

There are six sub-types of this so-called mental disorder:

Adjustment Disorder:
– with anxiety
– with mixed anxiety and depression
– with disturbance of conduct
– with mixed disturbance of emotions and conduct
– and, of course, unspecified

It’s an obvious fact that life from time to time presents difficulties, some minor, some major. It’s also an obvious fact that sometimes we deal with these difficulties fairly effectively; other times less so. But who is to decide whether our reaction to the difficulty was “excessive”? Some people respond to crises in a stoical, confined way; others are very emotional. There is no yardstick for how effectively people cope with stressful situations. Nevertheless, the APA has invented this mental disorder as a way of broadening their psychiatric net to embrace as wide a client base as possible. And because of the vagueness of the criteria, anybody experiencing a stressful situation can be assigned this diagnosis. And because no distinction is made in practice between the terms “mental disorder” and “mental illness,” these individuals are deemed to have a mental illness and are routinely prescribed drugs.

So the person who has lost his/her job and is feeling down; the family whose house was destroyed by fire or tornado; people caught up in a hurricane, flood, or other natural disaster – all of these people are eligible for a diagnosis. Even less dramatic stressors can serve as portals to Adjustment Disorder. Working in a hostile environment, an unhappy marriage, or problems with neighbors would all qualify an individual for a diagnosis of Adjustment Disorder, provided only that his/her reaction to the particular stressor was “in excess of what would be expected.” And of course, it will be decided by a psychiatrist or other mental health worker whether the response is excessive. In practice if you go to a mental health clinic and tell them that there’s a lot of tension at your place of work and that the worry is keeping you awake at night, you will almost certainly receive a diagnosis of Adjustment Disorder, you will be enrolled in the ranks of the mentally ill, you will swell the statistics cited in earlier blogs, and you will be given a prescription for a sleeping drug (and possibly some free samples).

The primary theme of this website is that the medicalization of all human problems, which has progressed steadily for the past 40 years, is a spurious and counter-productive activity, and is promoted for the benefit of psychiatrists and pharmaceutical companies. Adjustment Disorder is perhaps the most glaring example of this activity, in that it widens the psychiatric net to every conceivable facet of human life. Any problem whatsoever renders an individual eligible for a diagnosis. So when a former Surgeon General stated that a fifth of all Americans will experience a mental disorder in any given year and that fully half of the population will have a mental disorder at some time in their lives, he was including in these statistics vast numbers of people who simply were experiencing an ordinary problem of daily living.

If individuals going to a mental health center with problems of this kind received some genuine support and guidance, the “diagnosis” might have some justification as a portal to this kind of assistance. What happens instead, however, is that the individual is given a prescription for an anti-depressive or anti-anxiety drug and is encouraged to “keep coming back” for future appointments. Additional “diagnoses” are often “uncovered” during this process, and the individual becomes a client for life.

Facing and overcoming difficulties is an integral part of human existence. I’m not suggesting that life should be one long arduous uphill struggle. But the notion that we can wave away our difficulties by calling them mental “illnesses” and taking drugs is a destructive and stigmatizing philosophy which undermines the value of human life. Psychiatry’s message to mankind, embodied in the DSM, embraced wholeheartedly by mental health workers everywhere, and endorsed by the pharmaceutical companies, is
“You can’t cope without our pills.”

The message is that as a species we no longer have to strive to overcome life’s vicissitudes. Just take a pill. To see psychiatrists and pharmaceutical companies promoting this philosophy is somewhat understandable. After all, they are businesses and their primary interest lies in the area of expansion and profits. To see politicians promoting such spurious and destructive concepts, however, is scandalous.

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  • Cheryl Prax

    I was diagnosed with this after I found out that someone was stealing from my husband and we could possibly lose our home. I was carted off to the local looney bin and the next morning they broke my arm and ignored the fact for over 14 and a half hours before sending me for an x-ray. The next day they stole my mobile and due to my distress at that, injected me with a tranquilliser which knocked me out all day. Assuming I was now paranoid they started me on anti-psychotics as well. I only escaped by spitting out the drugs and by my employer getting me a lawyer once they found out where I was after 5 days of wondering why I had not come to work. I spend 8 days in that place – the worse 8 days of my life and they gave me the adjustment disorder label even though I only displayed the ‘symptoms’ for 30 minutes before being incarcerated.

  • Phil_Hickey

    Cheryl,

    Thanks for coming in. It’s a lot easier to get into a mental hospital than to get out! And, of course, they view your resistance as evidence of your “illness” and evidence that you need “treatment” – for your own good – of course.

    You were fortunate, in that you had someone to go to bat for you and get you some legal help.

    Best wishes.

  • Bo

    While I agree that you must be vigilant against people who would simply throw pills at the problem, I am going to push back against your suggestion that the APA’s broad definition of an adjustment disorder is intended to develop a larger client base and I’d like to share my experience to provide evidence to the contrary.

    I recently got married to a woman who I love. Following the event, I grew depressed. While I have experienced episodes of depression in the past, this was different. I constantly cried. I’m not a crier. I couldn’t focus at work. I’m a young professional who has held down a stable salaried position. The pain of, for lack of a better term, being sad felt almost physical. My anxiety was overwhelming. For all intents and purposes, I was rendered incapacitated and feared very much for my sanity and health.

    Textbook adjustment disorder.

    Considering my experience, I would frame your argument differently:

    The APA is comprised mostly of researchers who receive grant money from the government and other organizations with a vested interest a given researcher’s work. Stands to reason that drug companies aren’t going to advertise research that would compromise their economic interest.

    At fist blush this seems to support your argument. However, there are two facts which lead to a different conclusion. If there is evidence that people react disproportionately to life’s challenges, that’s going to be something highly publicized and spread because it could potentially mean more clients – but does that mean it’s a lie? My experience, and that of others’, speaks to the contrary.

    Secondly, you mention that if people received some sort of guidance and support, it would be a different story. Well, again, I’d offer my experience as evidence that that support exists. My therapist halved her rate so that I could afford to come and see her. She could have turned me away cause I couldn’t afford her full rate and as a person who depends on people like me to pay her for her services, halving her rate would seem to contradict her self interest and, I think, came from a genuine desire to help, guide, and support me. And that’s not to mention the myriad counselors and therapists, people who can’t even prescribe medication, who have a genuine desire to help people regardless of economic interest. Just take a look at the average salary of counselors. And still people choose the profession.

    So I am forced to reach a different conclusion. And that’s that economic forces are going to skew practice and treatment so that there will be a tendency for over diagnosis and over treatment. It’s inevitable. However, to dismiss adjustment disorder because economic and political interest coincide with its diagnosis and treatment is nonsensical. It’s analogous to saying that all banking is bad because bankers have a vested interest in capitalizing on your money. Again, you must be vigilant in defending your best interest. But I bet you still have a savings account.

  • Phil_Hickey

    Bo,

    Thanks for your comment. I’m not sure if we’re really disagreeing.

    My position is this. Human problems come in all shapes and all sizes, in all times and all places. It’s part of life. Problems come particularly in the wake of major changes. Again – part of life.

    The APA’s position is that all significant problems of thinking, feeling, and/or behaving are mental illnesses. This is how they define mental illness. Calling a problem a mental illness provides no new insight; reflects no profound discovery; embodies no fundamental truth. It’s simply what the APA calls human problems. And since 1952, their primary agenda has been the expansion of the “diagnostic” net to embrace more and more human problems, and to promote the false notion that these problems are illnesses.

    I discuss these issues throughout the website, e.g. here and here.

    With regards to your own experience, you describe becoming sad and anxious following your marriage. The question naturally arises: why were you sad and anxious? I don’t know you, of course, but I can think of lots of potential reasons for these negative feelings. But the facile APA reason is: because you have a mental illness called adjustment disorder. This looks like an explanation but isn’t. If you ask a psychiatrist: how do you know I have adjustment disorder, the only possible answer is: because you are feeling sad and anxious in the wake of a significantly stressful event. In other words, the only evidence for the mental illness is the very behavior it pretends to explain. The “diagnosis” is nothing more than a device to expand psychiatric turf and to legitimize the prescription of psycho-pharma drugs.

    You mention that you saw a therapist, and I’m not sure if you mean a counselor or a psychiatrist. It sounds like it was a counselor. If so, then there’s little disagreement between us. I think counselors in general can be very helpful to people experiencing problems in thinking, feeling, and/or behaving. But – and this is, I think, the critical question. Why does a counselor need to mess with a “diagnosis”? Usually it’s just so that he/she can bill an insurance company, or perhaps it’s a regulatory requirement. In your case, the arrangement was self-pay. Whether or not the counselor assigns a meaningless diagnosis is of no consequence. She’s going to give you the same kind of help whether there’s a diagnosis or not. It’s the psychiatrists who need the “diagnosis,” because one can’t prescribe a pill without a diagnosis. So in 1952, they started making up “diagnoses,” and they’ve been making up more and more ever since.

    If your therapist was a psychiatrist and the “treatment” was pills, then that’s a different matter. But from your comment, I don’t think that that’s the case.

    I don’t dismiss adjustment disorder as spurious because economic interests coincide with its diagnosis and treatment. I dismiss it because it is spurious. It’s a non-explanatory notion posing as a genuine explanation.

    I criticize psychiatry for two reasons.

    1. They promote these spurious concepts;
    2. Their “treatments” (i.e. drugs) are destructive, stigmatizing and disempowering to the individuals that come to them for help.

    It may simply be that we’re at cross-purposes here. I have no issues with counselors as such, except those who embrace the medical model of human problems. My contentions are directed against psychiatry, the medical model, the APA, the DSM, the corrupt alliance between psychiatry and pharma, the ghost writing, the blatantly fraudulent research, etc., etc…

    I don’t think the bank analogy is apt. Sure, bankers are in it for the money; but they also provide a service to their customers. A more apt analogy for psychiatry would be Ponzi scheme operators, where clients are lured in by spurious and well-packaged promises, but where little of value is actually delivered.

    Again, thanks for coming in. If you feel I’ve missed something, or if you would like to discuss further, please feel free to come back.

    Best wishes.

  • Sampson Greenovich

    I have seen these institutions used to destroy people who disagree with powerful people with money. It is very unfortunate that such an institution can exist, it seems like the only qualification to work in such a place is a desire to inflict pain on other people. This is a sad development in today’s society.

    http://www.doctorben.ca/

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  • If you’re interested in more information about Adjustment Disorder you can find more on our website http://adjustmentdisorders.org

  • anonymous

    Nothing of substance there – just amateurish, poorly written drivel.