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opinion | Elissa Ely

Same illness, different name

DSM-V, the latest seed catalogue from psychiatry, is in the mail. Since its first edition in 1952, the Diagnostic and Statistical Manual has informed us of what illnesses we have. Then, each updated version has firmly informed us of what illnesses we have instead.

A year ago, my patient had Asperger’s disorder. He won’t anymore — now he will have autism spectrum disorder. Someone with hypochondriasis suddenly has illness anxiety disorder. And — good news — there’s no need to fear dementia. You do need to fear neurocognitive disorder, though. It sounds gentler, but the end game is no less terrifying.

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The significance of these changes — driven by committees of great minds after tremendous thought — is unclear. Psychiatric diagnosis has always been an odd business. In the shelters, full of people in perpetual motion, it’s common to hear someone explain he has “bipolar PTSD schizophrenia with depression and panic.” A patient carries a diagnostic passport from location to location, each clinic adds a new stamp, and eventually, he has visited too many countries to keep himself straight.

The craze for re-titling is everywhere, not just in psychiatry. One shelter where I worked changed its name three times over a few years. With old letterheads flying into recycling bins, it took effort to keep straight what we no longer were. We had developed bipolar PTSD schizophrenia with depression and panic.

The old Welfare Department is the new Department of Transitional Assistance (DTA). The Department of Social Services (DSS) has become the Department of Children and Families (DCF). Food Stamps are SNAP, the Supplemental Nutrition Assistance Program (no one, patients or staff, can remember that one). It’s as if words alone could magically lead to improvement — though, of course, they cannot.

I understand this naming urge. It’s got a charm. When I was six, I briefly wanted to be Bubbles. Everyone wants to be someone else. But why would a hypochondriac feel himself better understood if he had illness anxiety disorder instead?

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In the case of people, there is still something to be said for approaching with old-fangled patience, without names (new or old), and with what a teacher once called “endless curiosity.’’ A number of us remain ever-curious about patients while at the same time, fixedly incurious about DSM-V.

Still, the latest edition is coming, and insurance reimbursement requires its familiarity: out with Asperger’s, in with Autism Spectrum Disorder. To those acronyms and abbreviations, the ones settling into new administrative offices, a little advice: Don’t get comfortable with the window views. None of you will last.


Elissa Ely is a psychiatrist.