September 11, 2002

By Loree Cook-Daniels

Those who work with situations of elder and vulnerable adult abuse know that mental illness is frequently present, as well. But if some leading psychiatrists get their way, there will be a whole new category of mental illness within which vulnerable adult abuse itself may well fit: “Relational Disorders.”

Dr. Michael First, editor of the existing Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) of the American Psychiatric Association (APA), and colleague David Reiss are among those who are circulating a monograph calling on the APA to include the new category of illnesses within the DSM-V, due out in 2010. Time magazine quoted Dr. First as saying, “There is evidence that relationships and how people interact in particular relationships can be disordered in a way that’s very similar to mental disorders.”

Part of the proposed definition of this illness is “persistent and painful feelings, behavior and perception involving two or more partners in an important personal relationship.” Currently, the diagnosis would only pertain to people in family relationships.

The new category of disorders would represent the first time illnesses would be diagnosed not in individuals, but within groups of individuals and in the relationships between them. The Washington Post suggests this would be a “profound conceptual shift” that could lead to labeling “relationships, themselves, as pathological.”

Not surprisingly, the proposal is extremely controversial. The September 16, 2002 Time essay on the idea says “it could be applied to every living American” and that we should “ponder the wisdom of formally recognizing a new disease that people can prevent only by living alone in locked rooms that don’t have telephones.” Psychiatrists who were presented with the idea at a recent APA meeting in Philadelphia were also critical. Some pointed out that the category could quickly be expanded to include manager/worker problems and road rage. Others feared that the Church of Scientology would be among those using the new diagnosis as fresh ammunition against the whole idea of psychiatry. Some were concerned that the diagnosis would blur the line between social problems and medical ailments.

It should be an interesting debate to watch.