Tuesday, August 26, 2008

New for DSM-V? (Part 2)

Kids these days...One of my early interests in psychiatry was the influence of culture upon identity and psychopathology. I was fascinated by the notion of "cultural syndromes," not those from the antipodes that are rarely encountered here, but rather those operating under our very noses, and therefore potentially very common and yet overlooked. Two factors operate here, one being evolutionary psychology, and the other being historical exceptionalism, the idea that we are living in social and technological circumstances that are truly unprecedented. Of course, every generation in history has thought of itself as special in some way, but some have been more special than others. Here are five relatively novel factors from contemporary times and their speculative effects on "evolving" human psychology:

1. Changes in family structure: The rise of divorce, the increase in couples choosing not to marry, and unprecedented mobility have, many sociologists have argued, decreased the average strength of social ties and support, leading perhaps to increased prevalence of depression and borderline personality features (witness the rise of eating disorders, cutting, etc.).

2. The fragile, coddled self: As Christopher Lasch so trenchantly argued in The Culture of Narcissism from the 1970's, the emphasis upon surfaces so characteristic of late capitalism, along with the rise of the self-esteem movement in education and society generally, may have increased the prevalence of narcissism, in both expansive and depleted varieties.

3. Be careful what you ask for: While poverty and income inequality remain serious problems, on average Americans over the past few decades have lived in the most prosperous and globally influential society in history. Also, the increasingly ubiquitous media feeds images of extreme wealth into everyone's television and computer screens. Some argue that the result is "affluenza," a syndrome of entitlement coupled with the collapse of social and cultural value into economic terms.

4. The distracted, virtual self: While this area remains hugely controversial, concerns persist that the ubiquity of television and Internet has promoted distractibility and impatience on the one hand and incuriosity and self-absorption on the other. The diagnostic quagmires of ADHD and autism come into play here. Related issues are the rise of "multitasking" and the decline of reading and even intellectual standards in general. And when attention is consumed with filtering an onslaught of external stimuli, there is less interest and energy left for introspection.

5. Sexuality and the body: The unprecedented access to pornography enabled by the Internet, along with the mainstreaming of plastic surgery, have challenged traditional meanings of sexuality in relationships as well as the relation of the self to "its" body. Whether this is empowering or degrading depends very much, of course, on whom you ask. And as the self comes to be more completely conflated with the body, it may be no surprise that in psychiatrists' offices a somatic solution (for "chemical imbalance") is more often sought.

It seems to me that what all these trends share is a decentralization of value, in which the self must steer (or be steered in childhood) through a wilderness of increasingly media-driven and competing ideologies and interests. Decadent times, for better or worse...

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