The People's Therapist

Maynard Solomon’s biography of Mozart quotes a delightful letter of 1778 from Mozart to his friend Gottfried von Jacquin:

We all invented names for ourselves on the journey [to Prague].  Here they are.  I am Punkitititi.  My wife is Schable Pumfa. Hofer is Rozka-Pumpa.  Stadler is Natchibinitschibi.  My servant Joseph is Sagadarata.  My dog Gauckerl is Schamanuzky.  Madam Quallenberg is Runzifunzi.  Mlle Crux is Ramlo Schurimuri.  Freistaedtler is Gaulimauli.

This is Mozart at his most relaxed, giggling with old chums in a stage coach and reinforcing bonds of friendship by inventing silly nicknames for one another while playing with a little dog named Gauckerl, whom Punkitititi liked to call Schamanuzky.

It got me thinking about names – the names you assign yourself, and the names others assign to you.

Naming yourself can be empowering.  With this act, you claim a right to define your own identity, whether you choose to be referred to as Johannes Chrysostomus Wolfgangus Gottlieb (Mozart’s official name) – or just plain Punkitititi.   Naming takes on a special significance when a group of people select names for themselves.  It is a sign of respect – and good manners – to call someone by the name they’ve chosen.  That’s why a person who asks to be called “African-American” or “Latina” or “Cantonese” – or just “Randolph” instead of “Randy” – should be called the name he has selected for himself.  It’s a sign of respect – and simple manners.

Assigning names to other people is where things get tricky, and potentially hazardous – especially in the field of mental health.

The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is a book containing names for every possible sort of mental disorder the mental health powers-that-be have managed to devise.  A psychiatrist or other mental health professional uses the DSM to guide him when he diagnoses you.

But what does that really mean?  The problem with mental illnesses is that they are largely invisible, at least with contemporary technology.  I can’t peer down your throat or listen to your chest and diagnose you with acute depression.  I have to observe your behavior.  So this book, the DSM, is really a catalog of behaviors that our society has decided are indicative of a pathology.

I am not a knee-jerk critic of the DSM.  It has its uses.  For one thing, it standardizes symptoms and assigns names to them, and to groups of symptoms that form syndromes.  That way a therapist discussing a patient with another therapist can rely upon a common vocabulary of clearly defined terms.  This can be especially useful with rare, or very serious diagnoses.  Theoretically, at least, everyone is on the same page.

The biggest problem with the DSM is that the definitions are rarely all that clear.  DSM diagnoses also have a disturbing tendency to become popularized and expand to cover vast swathes of the population.  Right now, ADHD, Attention-deficit/hyperactivity disorder, seems to affect more people each year, and one can’t help but wonder if the pharmaceutical companies, which make enormous profits on the drugs used to treat ADHD, aren’t somewhere behind that trend.  Another syndrome, Bipolar Disorder, has been applied to a growing population, and is now being diagnosed in very young children, which seems disturbing, especially since the pharmaceutical companies have a hot market developing for bipolar drugs, too.  “Generalized Anxiety Disorder” and plain old mild depression – in its various DSM guises – also seem to apply to more and more people with each passing year.

Terms for mental illnesses can “drift” over time, as well.  I remember being shocked years ago when I read that the great leader of the Modern Psychoanalytic movement, Hyman Spotnitz, claimed to have successfully treated schizophrenic patients with talk therapy. Later, it was explained to me that the definition of who was “schizophrenic” had changed over the years.  The patients Spotnitz was treating were far less severely ill than the patients I thought of as suffering from schizophrenia as it is defined nowadays.  This issue of “drift” has also cropped up with regard to the little-understood term “autistic,” which has recently been expanded to encompass such a broad spectrum of symptoms and degrees of severity that – even with the DSM – it’s disintegrated into a confusing definitional muddle.

These names in the DSM – mental illness diagnoses – can also be used, even inadvertently, in ways that can be demeaning and dismissive of the complexities of the human soul.  For example, I sometimes refer to a patient as having a “borderline pattern” or displaying a “borderline tendency.”  I simply mean that this person swings rapidly  from extremes of vulnerability to anger.  It is a common pattern, and, as I’ve said elsewhere, I think everyone is probably a little bit borderline.  It’s part of human nature.  What I object to is referring to someone as “a borderline” – as though he were no longer a person, but the objectification, the embodiment of this one emotional pattern.  That’s unfair, not least because most of my patients who display a borderline tendency recover – they are able to become conscious of that tendency and effectively address it.  People change – they are capable of enormous change.  They are moving targets.  They are not walking diagnoses.

Mozart and his friends made up silly names for themselves and had a grand time.  But when other people make up silly names and impose them on you, it’s time to speak up and demand the right to self-definition.  A diagnosis from your doctor should help both of you – you and him – to understand something about you.

Never forget that you are unique, and diagnoses are generalizations.  They can never capture the essence of who and what you are inside.

One of the greatest nicknamers of all time – and another musical genius – is George Clinton, of Parliament/Funkadelic fame.  He has appeared in his on-stage funk extravaganzas under various guises and monikers, including Dr. Funkenstein, Mr. Wiggles, The Undisco Kid, Starchild, Sir Nose D’ Voidofsense, Lollipop man and Bumpnoxious Rumpofsteelskin.

I can’t seem to locate the exact quote, but I recall seeing a documentary somewhere in which Clinton discussed his unique status in the music industry.  He said something like “Yeah, now I’m considered a visionary genius…but back when I got started I was just ‘that crazy mother-f-er.'”

Perhaps in naming himself, George Clinton assisted the process of changing perceptions of who he is – and bringing across his unique musical-dramatic vision.

We would all do well to follow Dr. Funkenstein’s – and  Punkitititi’s – examples.

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