Existential Psychology

Cut Yourself A Break During Times Of Adjustment

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The DSM has a sort of catch-all diagnosis that a lot of clinicians will admit in private to using in order to help their clients qualify for services with their insurance companies. This diagnosis is adjustment disorder. Here are the diagnostic criteria in the most recent version of the diagnostic and statistical manual of mental disorders, the DSM-V:

Adjustment Disorders

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)
B. These symptoms of behaviors are clinically significant, as evidenced by one of both of the following:
1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
D. The symptoms do not represent normal bereavement
E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

The diagnostic criteria for adjustment disorders are a prime example of the extreme subjectivity that creeps its way into a supposedly scientific document. Who gets to decide at what point severity of symptoms are out of proportion with the intensity of the stressor, and using what criteria? What is ‘normal’ bereavement? What is ‘significant’ impairment? Yes, it says in there ‘taking into account the external context and the cultural factors’ but this assumes that professionals who are themselves culturally bound are capable in the first place of taking the external context and cultural factors into account.

From an existential point of view the criteria are basically worthless, offering a superficial view of what’s going on and in the process pathologizing a human experience that is expected under the circumstances. Actually in the existential paradigm more concern would be raised by a lack of distress in the face of changed circumstances than by pronounced distress. From the diagnostic point of view the only real question is whether the distress is in proportion to the severity and intensity of the stressor, a question riddled with subjectivity. No two people have ever sat in the same room; each of us has our own subjective filter through which we experience objective reality, our own take on the world based upon our unique genetic constitutions, our individual experiences, and the cultural milieu in which we find ourselves.

Our point? Take all DSM-V diagnoses, and especially this one, with a grain of salt. The DSM-V allows clinicians to cloak their subjectivity in the guise of hard science, endowing their often superficial, certainly culturally biased, understanding of what is going on with ironclad authority. We aren’t saying the text doesn’t have its uses, it’s often a great starting point for grouping the most important features of a situation into a coherent whole, but the problem is that most people, clinicians and patients alike, view a diagnosis as an ending point when it should be viewed as a starting point.

This article is about dealing with the distress caused by adjusting to new circumstances. Our main point is for you to remember to cut yourself a break during these times of adjustment. Distress is to be expected, the only real question is its intensity and duration, and you’re not necessarily dysfunctional just because your distress is more pronounced than what someone cloaked in authority finds acceptable. Indeed, your pronounced distress may be telling you in no uncertain terms that your new circumstances are intolerable for your long-term mental health and happiness, and in this case learning to adjust to these circumstances would result in the true dysfunction. It might be a very good thing that you’re putting up a fight through your emotional or behavioral symptoms.

As we wrote recently, humans can live under the most varied environmental conditions but this doesn’t mean they should. There are a set of environmental conditions that are most conducive to your health and happiness. These conditions are unique to you because you are unique to everyone else. If you were surrounded by those conditions and they suddenly changed is it any wonder that your reaction would be pronounced distress? This is why the DSM-V and all the previous versions of the DSM are such dangerous documents. At bottom they must start with the premise that everyone is or at least should be the same, a premise we might call the pathology of normalcy, and then they set out to draw lines in the sand where that normalcy ends and dysfunction begins.