Diagnostic labels can be helpful — or misleading

The Diagnostic and Statistical Manual of Mental Disorders sits on the shelf behind the front desk at my office. It's big. It's thick. It always reminds me of a family Bible parked on a coffee table. It looms.

Published first in 1952, the DSM is in its fourth revision. The manual is a work in progress, both scientifically and culturally. Disorders are added. Other disorders are abandoned, often because The Powers That Be decide that it was actually never a disorder in the first place.

In the DSM, you will find diagnostic criteria for everything from wetting the bed to outright psychosis. It is impossible to read the book and not find yourself in there somewhere. If you cannot find yourself, then I would give you the diagnosis "Unbelievably Dull Disorder."

For those of us making a living in mental health, the insurance company won't pay you unless you label your patient with a name. It's called "the medical model." And, in that purview, no one is allowed to come to therapy merely to enjoin a process aimed at soul growth and self-knowledge. You have to have a name suggesting something is wrong with you.

And, make no mistake, sometimes something is wrong. In some cases, terribly wrong. And the clinical upside of the DSM is that it provides a way to observe, assess and talk about mental illness in a way that is reliable, consistent and meaningful.

But, there's a real downside to the medical model in therapy. The medical model tempts us to too-quickly criticize a colorful and enjoyable diversity in human type, temperament and behavior, and to overlook the quite positive attributes contained in same.

I'm bemused by the speed with which our culture adds diagnostic names to our everyday lexicon. Fifty years ago, spouses never included in their arguments "What! Are you bipolar?" Employees never blushed and giggled at supervisors and said, "Well, that's my ADD for you!"

But today we have in many ways unconsciously and certainly uncritically normalized a "medical model" way of talking about ourselves and each other.

Which explains why I spend so much of my time in session talking people out of their pejorative and sometimes hateful self-talk.

Take attention deficit/hyperactive disorder, for example. If I had been born 20 years later, I would have been a Ritalin Prince by the time I was 6! As it was, my grandmother simply would say, "Well, Steven is a little high-strung."

Or histrionic: Can't some people just enjoy responding dramatically to the great dramas they find in life? And don't we enjoy some personalities that tend to be "larger than life"?

Or schizotypal: How about simply eccentric? Or, as my friend says: "If I was rich, I'd be eccentric. As it is, I'm just odd."

Dysthymic: We used to describe these people as pensive, brooding, moody. And it's amazing to me how many highly intelligent, creative people are like this.

Codependent: My favorite label to hate. Couldn't it be that you're really, really committed to your marriage and that you have really passionate values about marriage, and because of this you're willing to suffer for a while looking for every last hope and possibility short of divorce?

Borderline: Maybe. But some people are so passionate, so fiery that they tend to hurl themselves into relationships and sometimes lose their grip on self. Then they regain their grip and make dinner.

Narcissistic: Ah, ego-identification with aggrandized images of self to protect a wounded self. But, some of those images are actually quite positive and inspirational, yielding what we used to call confidence, resilience, optimism, in some cases, excellence.

Attachment issues: How can the human ego not be overwhelmed and terrified by the rigors and requirements necessary for great intimacy!

Adjustment disorder: Are you kidding me? We used to just say, "Ah, Carl's having a helluva time."

Even significant psychological immaturities don't necessarily require a pathological label. Instead, we could enthusiastically say "yes" to the invitation to grow up! Growing up is interesting, compelling, invigorating, if admittedly sometimes very uncomfortable.

All personality types and all temperaments have strengths in which to revel and vulnerabilities that must be managed. Every strength is also a weakness. And every weakness houses a potential strength. These are not things that need to be changed, fixed or healed. The call is, rather, to know ourselves, accept ourselves and responsibly manage ourselves.

When my patients answer that call, I'm always tempted to write "Happy and Free" on the insurance form.

Steven Kalas is a behavioral health consultant and counselor at Clear View Counseling Wellness Center in Las Vegas and the author of "Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing" (Stephens Press). His columns appear on Sundays. Contact him at skalas@reviewjournal.com.