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Pass the Prozac
October 22, 2002
by Tresa McBee

In eight years, you will be sick.

Or, rather, your relationships will be sick. Not sick, as in take two aspirins and call in the morning. But sick, as in the mental illness of a relationship between two people.

This is how it would work: Sparring spouses seek counseling, where they are diagnosed with "relational disorder," meaning the relationship is causing problems, not the people.

Relational disorder -- RD in the inevitable shorthand -- is not a recognized mental illness. Yet. If two psychiatrists convince enough people, RD could be added to the American Psychiatric Association's Diagnostic and Statistical Manual -- DSM to those in the biz -- that mental health professionals consult to diagnose mental and emotional disturbances. DSM's fifth edition, however, isn't due out until 2010, so we've got eight years until most of our relationships could be deemed sick.

Leading the charge, reports The Washington Post, are Michael First of Columbia University, editor of the previous DSM, and David Reiss of George Washington University. They and some colleagues say that people often go for psychiatric help because of troubled relationships, and improving said relationships can improve depression and physical problems. Thus RD.

If accepted, this new illness would initially apply only to families, so someone could be considered perfectly healthy except for that always difficult relationship with mom, dad or spouse. Siblings are considered the next big category.

At a recent APA meeting, First insisted family relationships are his only target, which is a little like saying Big Tobacco would be the only industry targeted for its cash potential.

Peers who think there should actually be a medical component to psychiatry worry about the potential for expansion. Consider the possibilities; strained relationships do abound.

What student doesn't encounter a disliked teacher or jerk coach? Who hasn't worked for someone who makes repeatedly banging one's head against a brick wall preferable to daily interaction? Ever supervised someone who defines irksome? How about the co-worker who stabs everyone in the back before their back is even turned around?

Annoying, insecure, arrogant, stupid -- insert your adjective -- people are an unfortunate and often numbingly awful fact of life. Should RD be legitimized as an illness, it will surely creep into areas now accepted as the realities of sharing space with imperfect people and all our foibles.

Now we cope, grumble, move on, consume adult beverages with equally tortured souls, whatever. In the future, it'll be similar stuff, only with the addition of a RD note from the doctor prescribing counseling for the sick relationship. Surely some law will follow to ensure that both parties appear, because, well, how to counsel a relationship if only one side shows up?

RD represents a huge break from the medical model of psychiatry, so you see why some oppose this proposed new classification: After years of trying to educate professionals, the public and insurance companies that mental illness is a real disorder caused by a real brain imbalance, RD would label relationships themselves as the problem. Not so medical.

But First and Reiss don't worry about such technicalities. Please, they're doctors. As the Post writes, they "argue that whether the new classification fits the (medical) model is less important than whether it can help people."

Ah. Such altruism.

Or, just maybe, opportunity.

A passing thought only, but could the potential for research into sickly relationships, new drugs and insurance coverage that allows more bickering moms and daughters to pursue "help" propel the quest to include RD as a completely new category of mental illness? Pathology casts a wide net in our culture, particularly when attached to dollar signs. So, the abusive husband or father isn't a pathetic excuse for a man, but someone who doesn't function well with his target. The controlling mother isn't in need of someone telling her to lay off but rather in need of treatment for whatever ailing relationship she's trying to control. The bratty child isn't a spoiled heathen in need of actual authority but rather the other half of a mentally ill relationship. DonŐt forget the drugs. Relationships often need a lot of help to survive and thrive, but they aren't mentally ill.

I'll reserve judgment about those who would classify them as such.

Tresa McBee is a columnist at the Northwest Arkansas Times. She can be reached at tresam@nwarktimes.com.

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