ramblings about DSM IV

It's the weekend again. In fact, the best day of the weekend has mostly gone already! But then again, may be we won't appreciate the weekends so much if the majority of the week are weekdays. Things are more precious when they are rare. It's the problem with being human, taking things for granted, becoming tolerant of luxury. A person in the desert would see a bottle of water as the best drink in the world. People in the developed world have to make up all these fancy drinks and bubbles to make the basic necessity of life, consumable. I am probably the first to be guilty of this. I hate water and have to add various sugars/ tea/ coffee to keep myself hydrated. The exception being at the gym, when thirst drives the foulest liquid taste like honey dew. I met up with a friend last night. I was almost reluctant to do it initially. I was afraid I would have nothingn to say. I hate the feeling of "needing to find something to talk about". I always have this fear, no matter who it is I meet. It's less troublesome with close friends but the few hours prior, I still have this anxiety about me. I can only thank God (literally) that I have friends who pull me out, ask me out. At a certain point, I establish a sense of confidence that the other person actually doesn't mind spending time with me. At that stage, I'm more at ease at asking them out. I notice that I often ask Dr Fruitloop out for movies now. Eventhough he doesn't always "say yes" to the times I suggest, he's always willing. As with Dr Sexy, she's a good friend. I don't think she realises how very few people I actually confide the things I spoke to her about. Conversely, I felt previleged to hear her thoughts and her worries. It's a funny thing, human relationships. What is it that makes one person become best friend with another? One perfectly nice person does not necessarily feel comfortable to confide with another upstanding member of society. I think of The Master. He's known me since I was a house officer. He's seen me fall apart into pool of snot and tears. Yet, our conversation cannot venture beyond jokes and gossip around work. He's uncomfortable even asking me about the most superficial of matters, outside of work. That is why I dread seeing him too often. There is only so much joking around I can manage. I scramble for topics with him. At the gym today, I was so enveloped in my imagination that I really think I should become a Mills and Boon writer! Things I fantasised so far fetched, so melodramatic, it's shameful! I was plotting in my mind, all that I would say to him, in reply to his e mail, which would remain professional, yet also disclose aspects of myself. I thought about psychiatry what I would say about adversity. Anyone can thrive in optomised condition - good upbringing, good parents, good schooling, wealth and so on. It is within adversity and how one reacts or copes, that defines oneself. I suppose the problem with mental illness is that it affects the very character of a person, how a person copes and reacts. It may be relatively easy to say the someone who believes aliens are transmitting messages through his head, is ill. Even then, I'm sure some groups in the middle of nowhere in USA, it's a normal belief! It is merky when it comes to depression and anxiety type disorders, particularly at the milder end. When does "wanting time alone" become social withdrawal and isolation? When does sadness become depression? For DSM purposes, when someone is "functionally impaired" then it is diagnosable. That in itself is such a vague concept. That is "the line" drawn, so to speak. Yet one person undergoing one set of adversity may become severely depressed. Another person with the same circumstances may not, may in fact become more resilient. One's upbringing, one's relationships and supports clearly influence this. So it's not correct to totally externalise mental illness to "sickeness", like one would, with a cold, or the pneumonia. One can see why some people choose not to "draw the line" at all, that mental illness does not exist. They say it's all character weakness and demons. As a psychiatric trainee, and a Christian, I struggle with it at times as well. I think, "the line" is arbitary, but there are clear instances where one is no longer oneself. The threshold, is then, debatable. I'm sure I have over simplified the issue. Indeed, I have not come to any conclusion. In a way, I think "the line" of pathology needs to be personalised, on a person by person case. After all, each person's resources and weaknesses are different. Even their level of functioning is different. Thus an illness which is causing "functional impairment" in a professor, may be inappropriate for a street sweeper. Hmm...