New guidelines on what’s ‘normal’ need debate

By Tim Trenkle

Do you know what normal is? Would you trust a group of psychologists and psychiatrists, people paid a stipend by drug companies, to make the final say-so about your mental health?

Do you know diagnoses are wrong, in some cases, more than they are right? Diagnoses from the most educated professionals? Do you trust them now?

In Dubuque, a slouching, humpbacked man who wears a frayed wool cap and a gray long coat and carries a briefcase, walks from north to south along the major streets. He stops to salute buildings, raising one arm then the other, finally making a sign of the cross. He's been walking crosstown routes for years. When someone stops, asking to help, Sammy refuses, sometimes with a vehement refusal.

“I know you've been following me. I know you're with the mob. Leave me alone,” he'll say and drop, then lift, his briefcase - ambling and stopping, saluting, head bowed, eyes stern, shaggy beard tossing in the wind.

Is this normal?

In a teacher's lounge where stories about Dubuque are reviewed daily, a teacher gets on a phone and asks about medications.

“I was really agitated with my wife. Oh, I tell you, I'm right at the edge. I ran out of my meds.”

He's fidgeting, tapping a finger, turning in his seat.

“Yes ma'am, I'm on Cytropan, I think that's it. But the doctor put me on this other stuff … right, yeah the little blue tablet. Believe it or not I thought you talked to the doctor.”

Sundays, the teacher ministers to a congregation, a preacher of the Gospel and counselor, too. In years past, he's complained, saying he's tired of late night calls and divorces, the alcohol and the doubts.

Is he normal?

Recently, revisions of The Diagnostic and Statistical Manual of Mental Disorders, the bible of normal and abnormal guidelines for our society, were posted at the American Psychiatric Association's DSM5.org. Breathe deep, you will judged by the company of symptoms they keep recorded. Gambling and binge eating are new disorders. A single category for autism spectrum disorders is proposed, where once were four diagnoses. All personality disorders are in one category.

“This will be a disaster, said Valerie Porr, for The Treatment and Research Advancements Association For Personality Disorders.

A proposed category titled “Risk Syndromes” will be used for people considered at risk, without all the symptoms of a disorder - yet. Take another breath.

For Sammy in Dubuque and for the teacher/minister, the issues of stigma, of pain, of diagnosis loom like thunderheads. Stigma can be life changing. There are no biological tests for any mental disorder. Research shows diagnoses are mistaken, flawed.

“The bad news is that the scientific status of the main diseases in previous editions of the DSM – the keystone vault of psychiatry – is fragile,” a historian of psychiatry, Edward Shorter, has said.

As true to our well being as a walk, a talk with a friend, the ethics of these decisions are to be debated.

Currently, the ethical standards of the American Psychological Association include the right to limited deception in research.

Will you trust people who lay claim to an ethical right to affect your judgment by deception? People who then decide whether you are sane or insane?

Is it normal to trust people who are less than truthful?

Tim Trenkle of Dubuque teaches psychology and writing at Northeast Iowa Community College. He has also worked as a social worker and done assessments for municipal court systems regarding violent offenders.