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Five hundred ways to say you're crazy, just not over the phone

What we consider psychiatric disorders depends on time, place and context. But the creation of new disorders is far more common than the removal of 'outdated diagnoses'.

I recently left the bright blue skies of Abu Dhabi for an ice-bound UK. Waiting for a taxi at the airport in the bitter winter cold, I began to shiver uncontrollably. I had forgotten how cold cold actually gets.

A taxi finally arrived: "Where to, mate?" chirped the pathologically happy driver. Chattering teeth rendered my response incomprehensible: "Verr verr verrr please." The driver stared bemusedly trying to work out whether I was a foreigner, crazy, or both. Regaining control of my facial muscles at last, I made myself understood: "The Lowry Hotel please."

The purpose of my visit was to present a paper at the Division of Clinical Psychology's annual conference. My paper was rather ironically titled "Sunshine and sadness: 25-hydroxyvitamin D and depressive symptoms in the UAE". The conference went without a hitch, papers were generally well received and psychologists gossiped, networked and drank coffee.

All was well, that is, until the final day of the conference when it was hijacked by protesters. An invited keynote speaker, Professor Kenneth Zucker from the University of Toronto, was fiercely heckled during his speech. I've never encountered anything like this at a conference, so what exactly was the offence?

Prof Zucker is an authority on gender identity disorder. He views this condition as a mental disorder, arguing that it should carry a psychiatric diagnosis in the upcoming 2012 revision of the American Psychiatric Association's diagnostic system, the DSM-5. The DSM is often referred to as psychiatry's "bible", and contains descriptions of all of mankind's mental health woes.

The problem with psychiatric disorders, however, is that they are often socially constructed: one man's disorder may be another's lifestyle choice. In the US, for example, up until 1971 homosexuality was considered a psychiatric disorder, for which "reparative interventions" were offered. And Prof Zucker is at the heart of a noisy debate about gender identity disorder.

What we consider psychiatric disorders depends on time, place and context. But the creation of new disorders is far more common than the removal of "outdated diagnoses". Since the 1950s, the number of disorders listed in the DSM has grown from 60 to more than 400. The new version will probably give us at least 500 ways to say "you're crazy".

If I was involved in its development, I'd focus on the social changes brought about by the information revolution. My hypothetical, and mildly satirical, category of psychiatric illnesses would be called communication technology disorders, or CTDs for short.

My first candidate for the new CTD category would be "phantom phone friend disorder", an illness characterised by pretending to receive or make phone calls. Sufferers can often spend hours in pseudo conversation with non-existent people. Such behaviour also extends to messages, and sufferers will pretend to type out messages, or repetitively reread old ones.

My next hypothetical disorder is "obsessive compulsive message checking", characterised by intrusive thoughts focused on the receipt of important messages. These thoughts lead to repetitive and excessive message checking.

Checking behaviours are compulsive, as sufferers check for messages at inappropriate times, often leading to interpersonal conflicts and relational discord. It's often associated with depression especially when most messages received are banking transaction receipts or unsolicited spam.

A final proposed CTD is "narcissistic volume disorder". This disorder is characterised by insisting on speaking in an extremely loud voice when making or receiving phone calls in public. The volume narcissist appears to delight in excessive gesticulation, laughter and over-disclosure of personal information over the telephone.

While such behaviours cause little distress to the narcissist, other people in the vicinity often suffer severe migraines and are forced to vacate public premises.

My make-believe disorders might caricature reality, but this is not too far from how psychiatric taxonomy works. Perhaps psychiatry's insistence on a categorical system based on a dated medical model is the actual problem. The whole system may be in need of a radical rethink rather than just a revision.


Dr Justin Thomas is an assistant professor at Zayed University Abu Dhabi

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