Night Shift

“What the heck are you reading at this hour?” my wife moaned after being awakened by my bedside lamp. She took a moment to clear her eyes and leaned over to read the title on the screen of my computer. “Diagnostic and Statistical Manual of Mental Disorders. You’ve got to be kidding me. It’s 2 o’clock in the morning. You’re the one with the mental disorder.”

“I’ve worked nights for twenty years,” I said. “Sometimes I can’t sleep. According to this, I might have disorder 307.42: Primary Insomnia.” She showed no academic interest in a discussion.

“You’re going to add a broken nose to that diagnosis if you don’t turn that light out.”

“No wait, I might have disorder 327.xx: Circadian Rhythm Sleep Disorder, formerly known as Sleep-Wake Schedule Disorder.” I paused, reading. “And you, my love, are exhibiting signs of the psychiatric disorder V61.10: Partner Relational Problem.” She sighed deeply, pursing her lips and raising one brow.

“OK,” she said in resignation, “tell me about what you are reading. Maybe it will bore me back to sleep.”

“Well, this is the 2000 ‘text revision’ of the DSM IV, published in 1994. The first DSM was published in 1952. Critics of the DSM, such as psychiatrist Niall McLaren,” I read authoritatively, “argue that it lacks validity because it has no relation to an agreed-upon scientific model of mental disorder and therefore the decisions taken about its categories were not scientific ones; and that it lacks reliability partly because different diagnoses share many criteria.” I sounded like one of our kids giving a book report. I could see her eyes glaze over and knew she would be sound asleep in minutes. “The 1952 version listed homosexuality as a mental disorder. But then it was removed. And now it is considered malpractice if a psychiatrist treats it as such.”

My wife’s eyes popped open. “What are you talking about?” she said sitting up. “It doesn’t say that, does it?”

“No, the first part is from Wikipedia. The other bit I heard on NPR.” I got a devilish delight in seeing her wide awake. That’s probably sadistic, but since I couldn’t find it in the DSM I was comforted that I wasn’t over the edge yet. “Did you know that there is a code for a ‘Religious or Spiritual Problem’ – V62.89 – or a ‘Phase of Life Problem’?” There’s a DSM code for just about everything.”

“Interesting factoid,” I continued, “DSM is a registered trademark belonging to the American Psychiatric Association. The APA makes a ton of money off this thing. When the first DSM was published in 1952, it was only 130 pages and listed 106 mental disorders. Now it’s 886 pages and includes codes for 297 disorders.”

“I don’t get it,” she said. “There’s three times as many mental disorders as when you were a kid? Is the whole nation getting crazier?” She paused. “Come to think of it, you’re several times crazier than when I met you.”

“Is that your diagnosis, doctor? Crazy? I’m sorry, but that isn’t in the Diagnostic and Statistical Manual of Mental Disorders.”

“Oh I can find out what’s wrong with you,” she said, yanking the laptop out of my hands.

“Hey, I was reading that.”

“Oh, here’s a section that applies to you: ‘Mental Retardation.’ Oh, and yes, here’s your problem. Diagnosis number 312.9: Disruptive Behavior Disorder.”
I looked down my glasses at her and put on my professor voice. “These are serious problems that shouldn’t be made light of. Maybe you should think about contracting diagnosis 313.23.”

“Selective Mutism?” she responded after scanning the screen. “I’m more likely to suffer from 312.32 – Intermittent Explosive Disorder, ‘characterized by discrete episodes of failure to resist aggressive impulses resulting in serious assaults that are, nevertheless, associated with the experience of pleasure, gratification, or relief at the time of the act. Following the act, there may or may not be regret, self-reproach, or guilt.” She looked at me with a smirk. “Not.”

“Seriously, can you believe this stuff?” I said, carefully removed the computer from her hands.

“What do you mean?”

“It seems like anybody and everybody has some sort of mental disorder.”

“Like what?”

“OK, remember when Graham found Kyrie in the baby crib playing with Blaise?”

“She’s five. He’s one. She likes to get in the crib and play. So what?”

“Remember, when Graham saw that the crib was broken and asked Kyrie who broke it, she lied and blamed the baby. Then when he asked her why she was lying she said she wasn’t lying. She claimed she’d forgotten her own name and had accidentally said ‘Blaise’ instead.”

“That was pretty quick,” my wife said admiringly. “If Graham hadn’t been on his knees laughing, Kyrie might have gotten a spanking from her daddy for telling a whopper.”

“But was that an ‘Identity Problem – V62.89?” I said mechanically as if reading from a catalog. “When she won’t eat green beans is that ‘Eating Disorder of Early Childhood’ – 307.59? My sister used to feed me dirt when we were little kids. And I would eat it!” I exclaimed. “Was I suffering from Pica – 307.52?”

“You must have been a weird little kid,” she said, starting to bore with the conversation. “What’s your point?”

“It seems like everyone could be fit into one of these diagnoses to one degree or another.”

“So? All that says is that we’re all a little crazy.”

“But that means that a psychiatrist can see anybody and find something wrong with them.”

“Isn’t that what you do?”

“No, sweetheart. I think you are perfect in every way.”

“I know there’s a diagnostic code for being a pathological liar,” she said with a benevolent smile. “But thanks. I still don’t get it though. Why do you care about what diagnosis a psychiatrist makes?”

“Don’t you see? If some doctors can charge $200 an hour and find something wrong with everybody, how are we ever going to control health care costs?”

“You’ve got to be kidding me,” she said with a look of astonishment. “You’re wide awake at 2 o’clock in the morning – no, 2:30 – obsessing about controlling health care costs? There’s got to be a code for that.”

“There is,” I said in meek resignation. “It’s called ‘Rumination Disorder’ – 307.53.”

“Oh, sweetheart,” she said with sympathy. “Does it hurt?”

“Not really,” I said with a shrug.

“Well, it’s going to hurt if you don’t shut that computer and turn out the light. Count sheep, take a pill, I don’t care what you do. Just don’t keep me awake any more discussing all your disabilities.”

“Disability? You think I’m disabled?” I said, reaching for the light.

“Will you hush?” she said, rolling over and pulling the comforter up over her ears.

“Hmm,” I said in the dark. “Maybe this could work. Do you think I could get a handicapped parking sticker?”


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