The article linked below briefly discusses how the person gets left out of a DSM-IV diagnosis. This is relevant to Steve Benson's thread and my comments on Joseph Smith being mentally ill and to the fact that many of us here have been given psychiatric diagnoses and misdiagnoses. I agree with the author, by the way.

http://www.psychiatrictimes.com/blog/dsm-5/content/article/10168/1784622

I found that by using my browser's stop-button, I could "freeze" the article before the log-in prompt overlayed it.

Timing is tricky, however ...

Perhaps you could copy-and-paste a few extractions...

I agreed with your post, BTW, and I didn't really have anything to add. Narcissism/sociopath seems to cover a lot of the ground with JS, and while a comorbid diagnosis of a bi-polar disorder can't be ruled out, what I've read of the history of Smith leads me to beieve he was "too functional" for that jacket. Even his critics don't report seeing him displaying the sort of impairment we might expect. Well, except for some obvious episodes of drunkeness, but I think an alcoholism determination would also be unwarranted or at least premature (it might've emerged had he lived longer). He "seems to have medicated" his addictions with sexual excesses... And his charm was such that he didn't seem to want for willing partners...

As I said, I couldn't read the article, but the DSM-IV is a "consensus tool" for "pinpointing" some really difficult and often nuanced case histories and clinical impressions. That doesn't mean it's not useful, only that it must be recognized as such.

Years ago, I was in "rounds" discussing "one of my kids," and the psychologist--a really good PhD--was quizzed on why he wasn't "hanging a borderline diagnosis" on her. His reply was that was such a "heavy jacket" that he didn't want to because it would "follow her" and create more problems since she was so young and the prognosis so grim in the case of BPD. He said he would go with "histrionic tendencies" for now, and such an approach wouldn't have any impact on the clinical approaches. I've come to admire his wisdom and restraint.

And in another classic story, the "senior shrink" is quizzed about another patient, and he replies, "Well, my considered clinical opinion is this guy is definitely fucked up!"

Joseph Smith was definitely fucked up as well.

My apologies for the language, but I don't know how to otherwise translate that one properly...

The larger issue is how we was able to draw followers into his cult... We know he began with Sidney Rigdon's congregation (the extent of SR's involvement in producing the BOM is still being investigated and debated), and a clinician who spoke at an ExMormon Conference a few years back identified Rigdon as an obviously bipolar individual; his "Salt Sermon" was the sort of inflammatory and provocative rhetoric consistent with mania...

Thus it looks like the relationship between SR and JS needs to be evaluated as some sort of pathological symbiosis... Smith's charisma (and his ability to draw in men like the Pratt brothers as "missionaries") can be understood as a factor, but there are many other issues as well...

Some--perhaps most--early Mormons were doubtless good-and-faithful believers, and then there are the John C. Bennett types... It's difficult to believe it was strictly a straight Mafia-type organized crime operation; I mean my ancestors [:)!] that were there at Far West would never be involved in such shenanigans, obviously (/sarcasm off and I could sure use italics on this one to communicate a bit of phoney sanctimonious bullshipping). Shoot, none of them in that branch of the family were even polygamists... At least there's no evidence they were, even after coming to Utah....

And as for Oliver Cowdery's role, well, that one beats the heck out of me... He condemns JS for the "dirty, filthy affair with Fanny Alger," and yet many would identify him as a principal co-conspirator...

Same with the Whitmer family members...

"The conclusion of these reflections is that when we follow the medical model and leave the person out of the diagnostic model, we know too little about the person. Our patients often fit our diagnostic categories rather poorly—cheap suits from the bargain-basement rack, to borrow a metaphor from the previous blog—and we are forced to squeeze them into the Procrustean beds of our existing categories—or, in the much bruited routine of DSM-IV, to individualize them with the clumsy tactic of comorbidity—or in the equally bruited promise of dimensions in DSM-5, to individualize them with dimensional scales.

So what to do? How do we return the missing person to the manual? As I mentioned in the previous blog, the WHO International Guidelines for Diagnostic Assessment (IGDA)1 has proposed a dramatic and quixotic approach to this problem: create a narrative dimension to the manual, effectively providing each patient with a diagnostic statement that is the equivalent of a full psychiatric evaluation. This is at once a solution and a non-solution. It is to lift the full evaluation that should be part of any patient’s chart and make it part of the diagnosis.

Here’s an alternative proposal for resolving the problem of the missing person in the DSM. In a word, eliminate the problem by forgoing this expectation of the DSM. Give up your expectations that the manual should tell you what is essential in your assessment and treatment of your patient. Think of it rather as a crude guideline that, we hope, will land you in the right diagnostic ballpark—and not much more. When we have given Ms Smith the diagnosis of bipolar disorder, that’s not the end of our assessment, it’s barely the beginning. We now have to get to know her, and figure out how to conduct our treatment. We don’t expect to find her in the manual; we will find her in our consulting room."

My reasoning on Joseph Smith matches yours, Cabbie. I also like what the psychologist you described did for that kid rather than to her. Those heavy diagnoses do follow people around and can have nasty consequences if they are not correct--and even if they are. It is usually better, in my opinion, not to hang them on kids, because kids incorporate them into their identities or use them as justification for bad behavior.

I am seeing a Vietnam vet who was diagnosed early as paranoid schizophrenic--as the military psychiatrists had a habit of doing in the 70s--when he was actually experiencing combat trauma. It had distressed him many years and he was relieved when I, and the VA psychologist who evaluated him for compensation, told him the earlier diagnosis was wrong.

One of the things the Mormon Church has tried recently, although I don't see as much of it lately, has been through their spokespeople to imply critics of the church or somehow mentally not well. That really aggravates me. "Excuse me, but *who* is it making claims about angels, gold plates, visions, and drawn swords?" Then there is the Shaken Faith Syndrome--spare me.



Edited 1 time(s). Last edit at 03/09/2011 05:25PM by robertb.

@SLCabbie,

It's a "saving face" thing.

The cultural expectation of the era was to insure that those associated with you--that could in turn damage your good name--were kept out of the mud. Besides, if he knew that Joseph wasn't completely honest, then it's possible he didn't want his own doings to be looked at too closely.

So the "saving face" amounted to a "political power play"?

Makes sense that he wouldn't want his motives questioned... More "dysfuntional family" crapola...

Having been a "perennial black sheep," that sort of dynamic is always foreign to me...

Thanks, I hope I understood what you said correctly...

I've seen it work both ways. I've seen a person get labeled, and have it become a negative thing many times.

But I've also seen people be misdiagnosed, and then when they get a correct diagnosis, it makes so much sense and relieves them. It makes them feel not so alone, because there are other people with the thing that is making life difficult for them.

One case that I know of is a guy that fit the diagnosis of Asperger's in all the dimensions. It was a great relief to him to know that the oddities about him were a "something" not just him being uniquely strange or difficult.

Once he knew that it was a something with a name, he could read up on it, and go to a support group and learn more. For him it was almost exhilarating to have a diagnosis.

I like people who give a "tendency towards"... type of diagnosis. So they would tell a client that hey have a tendency towards Histrionic features, rather than "You are histrionic."

The DSM is pretty black and white. Either you meet all the qualifiers or you don't. It seems that it would be more helpful if it had about 10 shades of gray. Perhaps go from a mild tendency towards, up to something more extreeme.

The ten shades of gray appeals to me being we're all on the spectrum somewhere.

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