The Dirtiest Word in the DSM

dsm-5The use of the word “disorder” as a label for most mental health syndromes is, put simply, irresponsible and ill-conceived.

There are two serious problems with describing psychological syndromes as disorders. First, the concept of disorder is an inadequate and illogical description of what is happening. Second, it often has negative, sometimes disastrous, effects on self-image.

Finding Order in Chaos

The word disorder is defined as a confused or messy state: a lack of order or organization. Thus, if we take the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) literally, anyone who meets the criteria for grief, depression, anxiety, posttraumatic stress, or hundreds of other syndromes is considered to be lacking psychological organization.

This couldn’t be further from the truth.

If you pay close attention to the psyche of most anyone experiencing a mental health issue, you’ll see that the symptoms they’re experiencing are not a disordered collection of random and meaningless responses. What you’ll find is the exact opposite. In my experience, nearly every psychological syndrome, other than ones which are largely organic in etiology, is an orderly, strategic, and purposeful response to suffering. In other words, mental health issues are not disordered; they are ordered and normal responses that exist for the purpose of preventing the individual from being hurt again.

Imagine a person—let’s call him Oliver—who’s been diagnosed with having a borderline personality by his mental health provider. Oliver tends to “split” people in a way that those with a “borderline” constellation often do. Splitting is the process of shifting between states of idealizing and devaluing others and oneself.

The part of Oliver which devalues, when activated, views others as “all bad.” So if Oliver’s girlfriend does something that triggers his vulnerability—say, by choosing to spend time with someone else or perhaps by criticizing him—Oliver’s devaluing part, in an effort to protect him from feeling rejected, worthless, and unlovable, psychologically hijacks him and manifests as hatred toward his girlfriend.

Oliver is so livid and hateful toward his girlfriend at times because, as many psychotherapists have noted, the power and intensity of a person’s protection is equal to the power and intensity of his or her vulnerability. The act of viewing his girlfriend as all bad, embodying rage, feeling contempt, and lashing out at the external trigger of the suffering helps Oliver to automatically and powerfully obliterate and shield from the feeling of worthlessness, which is the real source of his suffering—internalized worthlessness and shame that he took on as child as a result of verbal abuse, emotional neglect, and abandonment by caregivers, parents, or peers.

This part of Oliver which devalues and vilifies his girlfriend, as well as other people in his life who trigger him, has an important job to do: it’s trying to help him from feeling the old feelings he felt in childhood. If Oliver were to fail to vilify and blame others who trigger him, he would likely feel overwhelmed with the same old worthlessness. This is why people with this sort of internal constellation have a reputation for self-harm and suicide; they’re not always successful at keeping the overwhelming feelings of shame, worthlessness, and hopelessness out of their awareness.

The protective ego state that forms the other end of the splitting polarization is a part of Oliver which idealizes his girlfriend, as well as other people in his life, and views them as “all good.” This part helps the parts of him which harbor the shame and worthlessness to have hope for redemption, hope of finally being loved. By idealizing, worshiping, and viewing his girlfriend as the manifestation of perfection, Oliver’s parts which carry the worthlessness can have hope that someone exists who will love and care for them in a way they’ve always needed—essentially redeeming the young parts which have felt so rejected and worthless. Oliver is essentially borrowing love from his girlfriend, using his association with her to avoid feeling unloved. Of course, many of us do this, not just those with borderline systems.

I’ve used one symptom of the “borderline” constellation, splitting, to demonstrate that there is an organized and orderly response to suffering and that the term disorder is inadequate. The same goes for nearly any other emotionally based syndrome.

Depression, for example, in its protective form prevents an individual from feeling the pain of failure, which can include many related feelings. It does this by shutting a person down and keeping one from trying again. In depression’s vulnerable form, it overwhelms a person with sadness and feelings of worthlessness. In psychodynamic talk, the person is consumed by the pain. Likewise, anxiety, addictions, anger, self-criticism, guilt, grief, and many other issues all serve a function and have their own organized and orderly logic. The point I hope I’m making is that the term disorder, when used to describe the majority of mental health issues, is inadequate because it fails to capture the positive intention behind most forms of protection, regardless of how destructive they may be.

People Are Not Fundamentally Flawed

It would be easy to dislike Oliver. Imagine being his girlfriend. One day she’s practically worshiped by Oliver, probably redeeming her own needs to be seen and loved; the next day she’s hated and vilified.

Many of us can relate to Oliver’s girlfriend. We all have people in our lives who can trigger us and, if we let them, get on our nerves. The trigger doesn’t always come in the form of contempt, like what Oliver dishes out—it comes from anything that’s destructive and hurtful or from anything with the potential to activate vulnerability within us, such as anxiety, self-doubt, criticism, depression, sadness, grief, addictive behavior, and so on. Some of these protective strategies cause harm to self and others, and some just bother us because they threaten to awaken our own vulnerability. That’s why we don’t like them. And it’s no wonder that as a result, the tendency exists, both within and outside mental health circles, to view others as the problem and as fundamentally flawed.

Most people don’t take the time to be curious about someone who’s being destructive or self-destructive; we just want them to change. So, really, what often happens is a judgment is made that the person is “crazy,” “effed up,” or, of course, disordered. Additionally, many in our culture are influenced by the idea of original sin, believing that we don’t come into the world whole, and many in certain circles believe that bad things happen only to bad people.

Seeing past this kind of thinking requires a gigantic paradigm shift. This paradigm shift has been encouraged by many innovators within the field of mental health, especially visionaries from the humanistic, psychodynamic, and depth traditions. The shift consists of two ideas that form the basic tenets of the Internal Family Systems approach to psychotherapy, one of the fastest-growing contemporary models of psychotherapy. They are as follows:

  1. Everyone is doing the best they can to survive based on their experiences and their physiology.
  2. Every part of a person (defense mechanism, issue, ego state, or aspect) has some positive intention, even when it’s destructive to self or others, whether it’s depression, addiction, anxiety, anger, self-criticism, or anything else.

Because all of our parts are doing the best they can to help us survive, they are fundamentally good, not fundamentally flawed. Even if what they do can cause damage. When we see that goodness, that positive intention, it’s easier to have compassion for a part.

Other than a small percentage of people born without the requisite hardware, all of us come into the world fully equipped to experience empathy, remorse, compassion, and other positive qualities. If the caregivers and peers of our youth can nurture us adequately, we flourish; we experience joy, satisfaction, and connection to others. But because there is suffering and danger in life, because things happen to us and around us which burden us with extreme feelings and beliefs, few of us mature into adulthood without some wound and/or protection. Nearly all of us, to some degree, are among the walking wounded. Wounded, though, is far different than fatally flawed.

Depending on a number of factors, including temperament, personality, and how exactly a person has suffered, everyone develops, most often unconsciously, particular and specific strategies to survive, to cope, to self-soothe, to numb pain, to escape, and to never be hurt again. Those who have experienced significant and/or frequent trauma have to work harder psychologically than those fortunate enough to have not suffered as much. Regardless of the kind of strategy, be it addiction, self-criticism, guilt, grief, anger, depression, anxiety, avoidance, or something else, it is just a survival strategy, not who the person is. Were it safe for these protective strategies to relax, the true Self, the indelible core that lies unharmed behind all of our defenses and wounds, would shine through.

Infuriated by the idea presented above—that all parts are good, that all people are good at their core—many people assume that I’m letting perpetrators off the hook and declare that there is no positive intention in the act of, say, sexual abuse. I’m not justifying, excusing, or condoning the behavior of perpetrators and predators. I’m simply stating that these individuals (when not simply lacking the capacity for empathy and remorse, as is the case in sociopathy) are deeply wounded, often from the same sort of abuse they desire to act out on others, and have protective parts trying, in the only way they know how, to actualize a positive intention.

Let me explain by way of example. Years ago I provided therapy to a man who had been sexually abused by his father. The experience was terribly confusing and painful for him. He felt tainted by what he described as a “darkness of shame and damaged goods” in his body that, when felt, made him want to throw up. Although what his father did violated his body, violated the trust that should exist between a father and a son, and violated the commitment a father should have to cause no harm to his children, the act was, sadly, one of the few ways this person ever felt loved by his father. As a result, he wrestled with urges to act out the same abuse on others so that he could experience the love and affection that had become associated with the abuse he endured.

This conditioning is a powerful and often overlooked part of the compulsion to carry out sexual abuse. The majority of perpetrators, in addition to being stopped from abusing and hurting others, benefit from therapy and compassion. Of course, if you or someone close to you has been sexually abused, you may have a difficult time accepting this compassionate approach. I encourage you to look at your anger and judgment as an indication that there might still be pain to heal.

Why the Term and Concept of ‘Disorder’ Is Harmful

Labeling a person who presents with symptoms resulting largely from life experience as disordered is not only ill-conceived and inadequate, it can be harmful to the person’s self-concept, spirit, and his or her access to hope. Why should one try to heal themselves, reclaim their Self, face their worst fears and the skeletons in the closet if they’re disordered and destined as flawed?

Receiving a professional diagnosis can be an enormous relief and provide new hope to those who have not understood their symptoms, especially long-standing ones. But being viewed and labeled as disordered is much different than receiving a diagnosis. Even mentioning or including a reference to the concept of disorder as part of a clinician explaining a new diagnosis significantly changes what is communicated.

The term and concept of “disorder” is particularly harmful in the context of “personality disorder.” By labeling an individual as personality disordered or, in its more gentle form, stating that one has a personality disorder, the essential claim being made is that one’s personality, one’s person-hood, one’s essence, is fundamentally flawed. Such a diagnosis is very likely to add shame, worthlessness, and hopelessness to a person who has had enough. It doesn’t matter how such a label is framed, normalized, or expressed; having a diagnosis called “personality disorder” says one thing: you are fundamentally flawed.

Please don’t misunderstand me: I’m not claiming that people don’t fit the criteria for the DSM categories of borderline, narcissism, and other personality constellations. Rather, I’m concerned about the impact of using a label that communicates to those with certain personality constellations that they are fundamentally flawed. Indeed, those who fit the criteria for the personality constellations listed in the DSM are usually deeply wounded and powerfully protected. But are they fundamentally and irreparably flawed?


A person labeled as borderline, for example, does not start out with such a polarized and fragile inner system; he or she was born as a loving and lovable child, fully equipped to develop healthy self-esteem, confidence, self-soothing, and other positive qualities. But significant things happened (abuse, trauma, neglect) or did not happen (attachment, connection, love, soothing), resulting in extreme feelings and beliefs that cover over and hinder access to the qualities of calm, self-compassion, self-esteem, confidence, etc.

Even more harmful than using the term disorder or personality disorder in diagnostics are those therapists who view people through the lens of pathology. Often implicit, sometimes quite explicit, the telltale sign is a therapist viewing the person’s symptoms as negative features to be eliminated, amputated, overcome, disposed of, or medicated away rather than as important messages from the psyche about what is needed for deeper and lasting change.

For many years, this pathological lens was the standard method of viewing and treating those labeled with personality disorders. Years ago, when I worked in community mental health, I was horrified to witness the level of disdain and judgment passed on people who fit the diagnostic criteria for personality disorders. Now I understand how those clinicians who reacted with contempt and irritation were feeling scared, confused, helpless, unsure, or vulnerable, consciously or unconsciously. Unable to identify and take ownership of their vulnerability, they lashed out and numbed themselves by pathologizing people who came to them for therapy.

If you’ve worked long enough helping people to grow and heal, you see that people do indeed bring temperaments and tendencies into the world, but you also see that emotional wounds are generally not something one is born with. Most often they are received as a part of life experience and, of course, many people are physiologically predisposed to certain protective functions which activate as a result of an environmental trigger or experience. Whatever the case, through witnessing people heal and transform long-standing, integral wounds, you realize that most symptoms are not destined to permanency.

With sufficient time, attention, and care, anyone is capable of healing. Emotional and psychological transformation may not happen in this lifetime, but pathology-focused treatments and pathology-focused therapists should not present an additional barrier to change. It’s simply not in the best interest of the individual, the community, or the future of humankind to focus on judging, exiling, or amputating human qualities we misunderstand or fear.

If, like me, you believe that the term disorder is ill-conceived, inadequate, and harmful as it is used in psychotherapy to describe emotionally based issues, please help generate support by sharing this article. Twenty years from now, when the DSM-6 is published, my hope is that the term disorder will be entirely absent other than in reference to the dark ages of pathology-focused treatment.

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Janie

    January 31st, 2014 at 3:44 AM

    So can I ask something in all sincerity? What word should we use then to describe this? Is mental illness okay? I would never want to hurt someone’s feelings or seem uncaring, so I want to make sure that I use the terminology that is correct as well as sensitive to the needs of those in the community.

  • Douglas Frederick

    January 31st, 2014 at 5:41 PM

    Beautiful, Noah, and beautifully said. Thank you for sharing this.

  • David Caton

    February 1st, 2014 at 4:28 AM

    Thank you. Your article is spot on. I add in the absurdity of notions like “self sabotage,” or euphemisms a like “if you want it badly enough, you will change…” All this ignores the reality that all our problem tai behaviors are at their basis actually efforts to cope and get through it all. Seeing the behaviors as a form of inner darkness out to get me or some secret masochistic tendency is absurd. These are parts of self created and employed in an effort to alleviate my suffering and most were on e quite adaptive. It is she they cease to be adaptive that we notice and seek to change them. As far as naming….why not simply, as Thomas Szaz sated, “problems in living.”

  • Dillon

    February 1st, 2014 at 5:23 AM

    I would hope that the key to better understanding is simply seeing that a word like this denotes that there is something wrong. How would you feel if this is how you are always labeled and characterized? I am not saying that you gloss over things, but if we could begin to think about all of these things in a more positive attitude then I think that this would do the whole community a great service.

  • Beverly Mason, LPC, PC

    February 1st, 2014 at 7:24 PM

    I am so happy that someone of authority finally said something about this. The word Disorder is basically why I am a fee-for-service corporation. I, as a therapist, refuse to make up a “disorder” or “diagnosis” for someone because they are depressed, or were abused as a child. Their problem is a broken heart that needs to heal, not a “disordered” mind that doesn’t work. In order to have an insurance company pay a therapist, we would have to write some disorder on the line. Poey! And, that doesn’t even begin to mention what that diagnosis does to their future ability to buy health insurance or life insurance or be treated fairly in court. I hope it’s not 20 years before DSM-VI gets here. A good DSM-V TR is in order right now. Thank you Mr Rubinstein for your stand for the clients.

  • Elaine Ellis

    February 2nd, 2014 at 2:53 PM

    This has to be one of the most fantastic, well-written, erudite, insightful and instructive articles I have ever read. It is as though you have taken words straight from inside my own head… you encapsulate perfectly all that I have long felt about the Mental Health “care” system, and its failings.

    I live in the UK, where the DSM is also used. My life is complicated, in that I am both the daughter of a parent with Bi-Polar Disorder; as well as a qualified Social Worker, and Postgraduate Psychology Student. Sometimes, this has left me feeling “cut in two”. I have worked in Mental Health Services (in-patient), and have grown up with a “mentally ill” parent (I use inverted commas, to show that this is another person’s diagnosis of my parent, not necessarily my view entirely).

    I have always found it VERY difficult to “square” my concept of my parent, with the way in which “mental health professionals” tend to see patients. I understand my parent to be a human being, with thoughts, feelings and a life to live. This understanding naturally influences how I view ALL patients, and I choose to see them therefore as fully-rounded, individual people. They system, however, tends to “see” them as labels, as diagnoses, as pathologies. The human being is utterly lost, and only an “illness” remains.

    I utterly admire, and agree with with what you have to say here. Once the human aspect of the patient is “lost”, it is ever so easy for the “Therapist” to commit all sorts of wrongdoing. Their “care” becomes impersonal, no longer care. They do not see a fellow human being before them (albeit a human who needs help and support to sort out problems) – they see a disorder. A nasty, belittling, stigmatising, de-humanising LABEL!

    Perhaps, here, I would go further than you, in arguing that the term “disorder” is inappropriate and wrong. Personally, I find it downright offensive. You are correct to suggest that it pathologizes patients, implying that there is something inherently wrong with THEM. But,it is worse than that. To use the term “disorder” implies somehow a level of revulsion, of disgust. It clearly singles out the person thus labelled as “abnormal”; as someone problematic, perhaps a failure, or a danger to society!

    For years, the NHS in the UK has kidded itself; and society in general; that the days of Workhouses and Mental Asylums are long gone. That people who would once have been locked away there, shunned as “mentally ill”, can now live happily in the community. The lie, the hypocrisy, rests in those final few words… “live happily in the community”. It is as though we are to believe that people labelled as “mentally ill” are no longer shunned, humiliated, subject to negative discrimination and prejudice.

    Such absolute NONSENSE! The buildings may have gone; Asylums and Workhouses torn down, converted, or built over. But, the ATTITUDE is very little changed. Society, and Mental Health Services, are STILL stigmatizing people who experience mental ill health. It is all there, to be seen in the language and terminology. Words like “disorder” and “pathology” and “clinical” are still widely used.

    I reckon it’s high time that the mental health system had a complete overhaul. Out with the old, and in with the new. Therapy needs to be grounded in a holistic view of the HUMAN, not in notions of “disorder”. To label somebody in a stigmatizing manner, in the name of Therapy, is not helpful. Rather, it further entrenches in said person the belief that they are “worthless”, “crazy”, “unable to cope” and “at fault”. Real Therapy should be about soul-searching, about allowing a person to be truthful with him- or herself; about permitting the person to visualise their journey through life, acknowledging successes, learning from mistakes.

    NOBODY has any right to make another person feel somehow “less”. Good Therapy; that which is genuinely intent upon healing; contains NO place for judgement, accusation, or labelling. It recognises that we are ALL human, and all capable of error; just as we are all equally capable of learning, growing, changing and developing. Given the right circumstances. It is not right for a “Therapist” to knowingly, or otherwise, create an atmosphere in which a patient feels “shamed”. Use of such terms as “disorder” does just this.

    To experience a negative or traumatic event, and to come out the other side, a person needs support. They also need the ability to be honest and open; to recognise that something is not right. This cannot happen where a person is made to feel stigmatised by a label such as “disorder”, placed upon them by a system that criticises in the guise of “care”. Only when we can face up to the fact that it is perfectly natural to experience traumatic events as unpleasant and disturbing, and to suffer as a result of them; only when we recognise that the feelings and behaviours that we may display as a result of such events are NOT a pathology, but rather are ways of alerting us to a problem… Only then can the Mental Health Care system begin to function as it should. FOR THE GOOD OF PATIENTS.

    Elaine Ellis.

  • bella

    February 3rd, 2014 at 3:53 AM

    But when even health care professionals use the term very loosley then what is the general public supposed to think?

    If it is sanctioned and bandied about even by providers, then it is only natural that other people are going to use the term, not even knowing that the use of the word can be hurtful

  • Jonas

    February 4th, 2014 at 3:59 AM

    what others think of as disordered may actually be my version of what is normal, so why should I have to apologize for that?

  • Edna

    February 5th, 2014 at 3:58 AM

    You have to know that it would be very hard to see this behavior as anything but warped unless you are living inside that beautiful mind. But when you are living with the day to day hurt that this person is causing you, I would presume that thinking of it as anything BUT disordered behavior would be all kind of hard.

  • stressmom

    February 6th, 2014 at 3:47 AM

    The whole negativity surrounding the word could have terrible side effects on one’s self esteem.
    What is the point in working to get better when what you have is already classified as something that is wrong, and perhaps in your mind, even beyond repair?

  • Max Berrey

    May 28th, 2014 at 3:04 PM

    I think the issue is not so much the use of the word “disorder” as the pejorative, stigmatizing way (some) therapists and other “mental health” professionals use it.

    Do we call cancer patients “cancers” or “the canceled”? No. Because we don’t identify the person with what is wrong with them.

    But that is what is done by many to people stigmatized by therapists. Hence we called who have been diagnosed with Borderline Personality as “borderlines”. Similarly, consider the following commonly used terms of the same stigmatizing ilk: “narcissist”, “schizoid”, “schizophrenic”, “depressive”.

    Who is at fault? The APA, mostly, who control the diagnostic categories with their worthless and unscientific DSM.

    How about calling people who have the type of problems we are discussing “people who have endured trauma” or “people who have suffered inadequate parenting”, or “people with emotional difficulties”.

    It is true that someone with these kinds of problems needs to take responsibility for their life and their actions. But change is difficult, and stigma does not help.

  • Vindicated

    September 11th, 2015 at 11:37 PM

    I am now vindicated by your article. You have articulated what I have been trying to say and tell the so-called “Mental Health” system for years. This is the reason I finally gave up on “therapy”, after it almost killed me, emotionally– made me 100-times worse. I always thought that it must be my fault that I either never got anything out of it, or else, ended up feeling worse by it. I sensed the inner dynamics which you so clearly elucidate here. I am not a professional anything (except, perhaps, recluse), so I can’t share it with my colleagues; I live in semi-isolation and pain. However, I am bookmarking it, and if I ever do have the chance to share it– perhaps by citing it in one of my writings (with your permission), I will.
    I often wish I could see a therapist– just to have someone to talk to. However, I am not sure that the disdain and abuse I have suffered in so-called “therapy” justifies my putting myself through additional trauma. There is a point at which one heals by invoking and safeguarding one’s personal integrity. Thank you.

  • Connie Branham, LMHC

    November 2nd, 2015 at 7:21 AM

    Thank you so much for this insightful article! I, like some others here, am a fee-for-service licensed mental health counselor or “psychotherapist”. ( I have to say I’m not even crazy about that terminology for my title. ) Like it or not, this society stigmatizes mental health issues so much more than physical issues. I explain to my clients, (not patients!,) That if they plan to file with an insurance company for reimbursement of their fees, I will have to give them a medical diagnosis to “justify” the treatment. I don’t think most people think about this when they go to therapy and use their insurance, nor are they aware of what happens with that information once it’s released to the insurance company. I stopped accepting insurance about 25 years ago. I explain to my clients that I don’t believe in the term “disorder” and that people exist on a continuum and when somebody is not functioning well and are well outside the bell curve that does not make them crazy but it may mean there is a need for more intense therapy. We are all broken in some way, based on our histories, negative coping skills we had to use and have practiced for many years, the lack of caring and nurturing parenting, or abuse and neglect. And that doesn’t even touch on what happens to us in utero! Your article almost perfectly describes my philosophy of counseling and I didn’t know that I was in good company with my beliefs. Thank you for this!

  • Janet

    December 1st, 2015 at 5:51 PM

    I couldn’t disagree more. When someone is physically ill, finally receiving a diagnosis, even dismal, provides relief and hope. Finally something unknown is known. I have suffered with attachment disorder for decades and my two therapists have been aware of it, yet didn’t feel they wanted to burden me with a “label.” The therapy was appropriate, except that I never knew there was a particular wound that needed tending. Had I known, I would have invested myself wholeheartedly in the therapeutic process, as well as enjoying the relief at realizing that I am not inherently substandard, lacking, incomplete, or simply incapable of trusting and loving. Don’t you think treating your patients as adults, explaining your working hypotheseis, the current literature, and why you think “disorder” is an inappropriate label is less patronizing than refusing to mention what the label attempts to describe?

  • Susan L. Johnson

    August 11th, 2017 at 7:25 AM

    Noah thank you for this insightful writing. I wholeheartedly agree with you! To take it one step further, are the majority of the diagnoses listed in the DSM-5 really disorders or symptomatic adaptations to underlying developmental trauma? As you stated, disorders are “ordered” behavioral adaptations that develop in response to developmental trauma, which can be both a cause and an effect of unhealthy attachment in early childhood. These maladaptive behaviors or survival/coping mechanisms work to protect the individual in the context of their abusive, neglectful, rejecting, invalidating or otherwise traumatic relationships, but are maladaptive to functioning in safe, healthy interpersonal relationships. So whether or not a person’s behavior is perceived as disordered depends on whether the need or function of the behavior is adaptive, so when no longer in the context of the abusive environment the previous functional or “ordered” response now becomes dysfunctional or ‘disordered”.
    In my experience, at the root of most of the “disordered” behaviors is developmental trauma, which is quite complex. For example, how do we justify the mind/body separation, the psychological from biological, when there is such a synergistic relationship. Even in the womb, their is an environment, and if the mother is under stress, the baby is affected. Thanks to the ground-breaking work in Neuroscience, it is now known that the brain is impacted by trauma even in utero, which research has shown, may result in babies that are born with brain deficits that impair executive functioning. Hmmmmm – sounds like the disorder ADHD, but the core issues is developmental trauma! I am in agreement with many others in understanding that most of the maladaptive behavioral constellations (disorders) described in the DSM-5 are the superficial protective layers that when peeled back expose developmental trauma. Of course, as always there are a few exceptions. Noah , again, thank you! Your point is well portrayed. It is time to re-evaluate the way we view the mind-body connection and the concept of “dis-ease” and “dis-order.”

  • AC

    February 18th, 2020 at 1:04 PM

    Great article – I’ve thought the same thing; and I agree with most of the comments, especially Max Berrey’s, which I’ve also thought about.
    I’ve had a psychiatrist and a psych nurse both tell me those labels are used FOR THEM – says it all. People aren’t canisters on a shelf!
    It’s strange that so-called experts and professionals can’t see or hear what they’re saying; then they have the gall to tell the public not to stigmatise the traumatised… The public are using THEIR words – ridiculous.

  • Crystal

    December 22nd, 2020 at 11:34 AM

    I agree with most of what you’ve written. However, I’m curious to know why you believe people with anti social personality disorder (sociopaths) should be excluded from your list of people who’ve adapted due to childhood trauma. I’ve read posts from people with ASPD who have gained self awareness and found healing through therapy.

    I’m of the mind that whenever a clinician — medical or otherwise — identities a particular condition as untreatable what they actually mean is they are unaware of a treatment for it. It’s unnecessarily discouraging for a person who has such a condition to be told that experts believe they are a hopeless case.

    No science is fixed, knowledge about conditions and how to treat them is ever-evolving. I’d like clinicians to avoid making finite statements about what kind of healing is possible because, in reality, they really don’t know what’s possible.  Possibilities are indefinable and limitless. I’d like to see more clinicians admit this — especially when it comes to conditions they themselves lack expertise. There are therapists who treat ASPD. People who think they have it should have this information rather than left to believe they will never heal, which is what your article insinuates.

    Even people born without the “requisite hardware” as you put it can undergo healing. The brain — as with every part of type human anatomy — can change and is always doing so.  With the right stimulus even people who the psychiatric community has currently written off as incurable can see progress. It’s just that treatments for these condition haven’t been discovered yet. That doesn’t mean they NEVER will be.

    Lastly, you listed depression as one of the conditions with strictly a psychological basis. But as with all things related to living beings,  the mind, body, and environment are connected, not separate. So, for instance, the brain of a person with bipolar depression or chronic unipolar depression has neural connections that are different from a non-bipolar brain. Their brains are wired differently than the norm. They can overcome this but, medication may be required given what is currently known about treating these conditions. Taking effective medication for bipolar depression has made a tremendous difference in the quality of my life for instance.

    All in all, as I said, I agree with most of what you’ve written. I would have preferred, however, that you highlighted some of the gray areas I’ve mentioned here with the recognition, in reality, most areas are gray and ever-evolving.

  • J

    January 19th, 2021 at 3:57 PM

    There are some comments in this thread that speak to the fact that it is very emotionally and psychologically relieving and beneficial to have a name for what they are experiencing, as it helps people realize they are not alone, this happens to people, and it is scientifically verified and proven to be, well, REAL. And it is. It so, so is. But these comments also lecture the author about dismissing these conditions and names. I personally don’t think at all that was what Noah was trying to say. These conditions, constellations, thingy-ma-bobs, do exist. They should have names. The point is, “disorder” is the worst possible name for them. The thing we need to do, as a whole, is find a better goddamn word.

  • Susan

    January 20th, 2021 at 2:10 PM

    Noah, thank you for the excellent article. I explain this very concept to each of my clients, that there is order in their “disorder.” I educate my clients to see themselves as having developed an adaptive way to deal with whatever negativity they have ben through in their life. It is most often the case that the level of psychological and emotional impairment, is in direct relationship to the severity of trauma experienced. Additionally, those who have experienced extreme abuse or neglect during the very critical period in childhood development (between age 1 to 5) unconsciously develop adaptive ways of coping (such as disassociation, or compulsive masturbation) to only name a few, that quickly become labeled as maladaptive. Adaptive behaviors that develop during childhood in response to an unsafe, disordered environment then become maladaptive and problematic in an adult world. The individual needs help to repair the damage to the body and brain that keeps them stuck in the fight, flight or freeze modes created by their childhood trauma. So until the wording of the DSM is modified to be more positive, I work to help my clients understand that all behavior has a function and that their diagnosis/disorder was an intelligent and adaptive way they learned to cope, and sometimes even stay alive, in a childhood world of varying degrees of fear and sometimes absolute horror.

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