Epidemic

photo-Le Love

Validity is a weird thing. What determines what is valid?

If we perceive something to be valid is it? Is it a judgement call? If someone perceives something as invalid at the same time, how do we know who is right? Do we empirically measure validity? Science can be a way of measuring validity, how valid a certain claim is, that claim being a hypothesis, a belief based on some evidence or probable theory. But then we put that belief to the test, quantifying it until we have some statistical evidence to say that is valid or that is invalid. If a belief cannot be tested is it still valid? If someone believes their opinion is valid, is that enough? Is a belief in validity enough to make something valid or does it need a majority vote, or must a quantitative backing be provided? It seems to depend what the subject of debate is at the time.

I’m of the opinion that… I don’t know.

Sometimes I am a die hard believer of science and of empirical evidence and proof and facts. But then, I work with people, and I work with emotions and opinions and first hard accounts of hazy memories. For someone with scientific training you’d think I’d have no patience for this, because I can’t measure someone’s sadness and say definitively yes, yes you have a problem or no, no you’re dealing with a rational amount of grief that I can indisputably say you can overcome. Psych tries really hard to be a science. It is a science. I work in research, we use Microsoft Excel and SPSS… that’s science, right?( I can hear my brother, the bio-chem major, laughing in my head). Since these things are so hard to measure, but we felt the need to standardize the issues, we tried to come up with a way to measure these immeasurable feelings, thoughts, beliefs and experiences in what is called the DSM- Diagnostic and Statistical Manual of Mental Disorders. It’s a very concrete, very serious encyclopedia of diagnosis. It is usually found in hard cover with gold lettering, and if the DSM was a person it would be an old man with a white curly mustache and a monocle, in a blue uniform with gold trim, who stands behind a curtain like Oz and projects his image onto a large screen that people would step in front of to receive the bellowing declaration of “Alcoholic!” or “Anorexic!” etc. etc. At least that’s what they were going for when they made this up I think. But there’s the thing, THEY MADE THIS UP.

Okay, before you start thinking the entire world of mental health is some sham, let me elaborate.

They took their scientific knowledge gleaned from exposure over decades and decades of practice and millions of studies and to the best of their abilities compiled the criteria for diagnosis of varying disorders. Like any medical handbook, this is based in research and exposure and of course as time goes on we learn more, we change our perspectives, we are proven wrong where we were once so sure. SO, now we are on DSM IV soon to release DSM V. Unlike the hard sciences, mental health is clearly a more complex thing to try to pin down. A broken arm is a broken arm is a broken arm, the doctor can see it and feel it and the person with the arm can see it and feel it and everyone knows when it is broken and when it is fixed. I wish mental health were that simple, I wish the diagnosis criteria that we use was always fool-proof and obvious to both the clinician and the patient. I think it’s a lot easier to deal with a challenging situation if you can understand it, because otherwise it’s just scary.

Unfortunately the media doesn’t do a whole lot to de-scarify mental illness. There is this weird mess of fear, fascination and even glorification of mental illness, but very little explanation. There is even resentment, and sometimes jealousy. A girl who is anorexic becomes resented by peers because she has things like “discipline” that reward her with a “good body” and people don’t see the illness, the compulsion, the sadness, they only see the desirable figure left behind… until that desirable figure is in a wheel chair with a feeding tube through the throat.

One of my favorite movies, that despite casting the most beautiful woman in the world as a sociopath...seemed to get a fairly well-rounded picture of the varying degrees of mental illness and the pitfalls of diagnosis, without too much glorification is Girl Interrupted, with Wynona Ryder and Angelina Jolie. It takes place in a psychiatric hospital in the 1960’s, and in the movie they mockingly call a diagnosis “diagnonsense.” I have issues with diagnosis in general, the whole concept. Sometimes it can be really helpful for people to have a name and a description of what they are going through, to know that they are not alone and that they are not so beyond recognition but that they are simply in this category of other people also going through similar experiences. Then again, sometimes labels can be detrimental, “am I always an alcoholic even after I am sober?” Just like any labels, they classify and they can bring a feeling of togetherness or a feeling of isolation and everyone reacts differently. It’s even harder when the criteria for these labels is always changing, or if you don’t quuuuiiiite have the exact amount of criteria listed to make the cut then where are you? If you have 3 of the needed 4 out of 5 criteria for a given diagnosis then are you totally fine? The answer of course, is no, but people can use the strict criteria as a way of denying a need for help.

Say it another way, invalid- a sick person, someone who has a disability.

But what if your problems are not valid enough for you to be called sick… see what I’m getting at… that’s right… if your issues are not valid enough you can’t be an invalid, you’re not sick, but you’re not healthy, so what the hell are you then? Well, your arm isn’t THAT broken… not something we really hear.

To invalidate, to make invalid, to make sick, to make wrong.

One of the most common issues surrounding what is called Borderline Personality Disorder (also the diagnosis of Wynona’s character in Girl Interrupted, which I should add, is a true story). This diagnosis has become in “vogue” recently meaning that it has become very common in a very short amount of time. It generally involves teenage girls who have self-harming behaviors and significant difficulty forming healthy interactions and relationships (to give a very general summary). This can manifest very severely, where the individual is putting him/herself in extremely dangerous situations or actively self-harming or both. One of the major sensitivities of this population surrounds feeling invalidated. We have all felt this way, when you feel sad or angry over something and you are told that it’s all in your head, or that you just don’t understand what happened. Sure, sometimes these statements might be true, but are they ever therapeutic when someone is really upset… not really.

To invalidate, to make sick, to make wrong. My most difficult patients were BPD and I admit I really struggled to develop the skills to help them in the ways that they needed me to. However, just like any mental illness it is just “you or me magnified,” to quote the movie. What I had to offer, was the empathy that came from knowing how I felt when I was invalidated. You feel sick, you feel crazy, you feel wrong and it is just the worst.

People are complex and while some aspects of our experiences can be quantified and measured, mental health is not the easiest aspect to chart. My point is, a diagnosis doesn’t make you sick, it doesn't make your illness more valid or your lack of a diagnosis doesn't demean your struggle, it is a label, the issue is there before that and the issue might very well be there at least to some extent after the official diagnosis is removed. The person labeling might be misinformed or the person expressing the issue may be struggling to articulate the problem because it is so complex and so mislabeling occurs. We are almost on DSM V, and the criteria continues to change and the labels themselves change and we are doing the best we can with a very amorphous task.

However, in the mean time, there is no reason to get attached. We just need to do our best to try to make each other feel heard, feel healthy feel valid, because we can’t hold up a ruler when someone says “I’m sad” and say “umm nope, you are 2 inches away from sad actually; you don’t get to say that!” I don’t know of BPD behaviors existed to this extent before the diagnosis came about in such large numbers, we never know whether it’s just that now that we have the label that it seems to spike because we have a way to identify it, or if the glorification in the media plants some seeds for behaviors or if the awareness leads to over diagnosis, we don’t know. What I do know is that teenage girls are one of the most consistently invalidated groups in our society. If you are told you are wrong, and told you are sick, and told it is all in your head enough times you’d start to believe it. We need to stop invalidating, we need to stop making each other sick.