WASHINGTON -- Peter De Vries, America's wittiest novelist, died 17 years ago but his discernment of this country's cultural foibles still amazes. In a 1983 novel, he spotted the tendency of America's therapeutic culture to medicalize character flaws:
"Once terms like identity doubts and midlife crisis become current," De Vries wrote, "the reported cases of them increase by leaps and bounds." And: "Rapid-fire means of communication have brought psychic dilapidation within the reach of the most provincial backwaters, so that large metropolitan centers and educated circles need no longer consider it their exclusive property, nor preen themselves on their special malaises."
Life is about to imitate De Vries' literature, again. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry's encyclopedia of supposed mental "disorders," is being revised. The 16 years since the last revision evidently were prolific in producing new afflictions. The revision may aggravate the confusion of moral categories.
Today's DSM defines "oppositional defiant disorder" as a pattern of "negativistic, defiant, disobedient and hostile behavior toward authority figures." Symptoms include "often loses temper," "often deliberately annoys people" or "is often touchy." DSM omits this symptom: "is a teenager."
This DSM defines as "personality disorders" attributes that once were considered character flaws. "Antisocial personality disorder" is "a pervasive pattern of disregard for ... the rights of others ... callous, cynical ... an inflated and arrogant self-appraisal." "Histrionic personality disorder" is "excessive emotionality and attention-seeking." "Narcissistic personality disorder" involves "grandiosity, need for admiration ... boastful and pretentious." And so on.
If every character blemish or emotional turbulence is a "disorder" akin to a physical disability, legal accommodations are mandatory. Under federal law, "disabilities" include any "mental impairment that substantially limits one or more major life activities"; "mental impairments" include "emotional or mental illness." So there might be a legal entitlement to be a jerk. (See above, "antisocial personality disorder.")
The revised DSM reportedly may include "binge eating disorder" and "hypersexual disorder" ("a great deal of time" devoted to "sexual fantasies and urges" and "planning for and engaging in sexual behavior"). Concerning children, there might be "temper dysregulation disorder with dysphoria."
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