Friday, April 22, 2016


“If your child displays extreme irritability, anger, and frequent, intense temper outbursts, they may benefit from being screened for disruptive mood dysregulation disorder (DMDD), which is fairly new diagnosis.”

“The symptoms of DMDD resemble those of other childhood disorders, notably attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and bipolar disorder in children. DMDD first appeared as a disorder in DSM-5 in 2013. Little is known about its course or etiology.”

“DSM-5 includes several additional diagnostic criteria which describe the duration, setting, and onset of the disorder: the outbursts must be present for at least 12 months and occur in at least two settings (e.g. home or at school), and be severe in at least one setting. Symptoms appear before the age of ten, and diagnosis must be made between ages 6 and 18.  The diagnosis for DMDD should not be made for the first time before 6, or after the age of 18. This new diagnosis was implemented to help children who, although may have been diagnosed with bipolar disorder, their explosive rages were not being treated properly.”  [i.e. wrong meds.]

This is taxonomy medicine, the 19th century approach to the unknown, an impulse to make lists based on observation and subjective judgments of the variations.  It is met and encouraged by profit-linked pharmacopia, lists that match the “diagnosis” with the approved pill.

But I know of whole categories of society where the children and some of the adults, (in fact, I myself) have extreme irritability, anger, and frequent, intense temper outbursts.  I’m a hermit — the cats are the only ones who really know about my fits and their strategy is not pills — it’s avoidance.  On the reservation next to me, these kids are easy to find.  In fact, they are not well-hidden even in the little white ag towns that are supposed to be havens of normality and love.  

Nevertheless, I suggest that the treatment AND the cause is cultural and iatrogenic (at least partly caused by the present treatment).  Also, closely related to the variations among the array of things like painkillers, antacids, cough syrups, and detergents on our supermarket shelves.  The cause and cure are locked together so tightly that it’s very hard to just dump both unless one goes to the base cause: over-reliance on one-to-one understandings of symptoms and cures presenting options that are not suppression.

This morning my newsfeeds showed a Mexican woman sitting in water while being suffocated with a plastic bag.  My guess is that sitting in water has something to do with body temp extremes and something to do with electricity.  Torture is meant to take the victim to the edge of homeostasis where their survival is in doubt.  The homeostasis may include the ability of the brain to process and the damage may persist after the action stops.

But it wasn’t my mother or sister or lover being tortured so my empathy was thinned.  No intimate categories in my life look like that woman, except for all my Blackfeet, Cree, and Metis friends.  If that woman survives, my premise is that she (and her children) will suffer from extreme irritability, anger, and frequent, intense temper outbursts.  For those people there are two strategies: change their society or get the hell out.

If children in white, adequately prosperous, respectable communities are showing these symptoms, there must be something going on that we are not recognizing.  Or that we don’t know what to do about and so deny.  If we were taking a taxonomic approach, we might say:  broken families; unhappy jobs; global shifting of weather, economics; substance abuse; confrontational politics;  unwanted children.  Abuse begets abuse which makes a cycle but  there has to be a hub and a pathway — a point of attachment and a way to go.

But I’m wandering.  The subject is disruptive mood dysregulation disorder, part of a suite of trouble-making behaviors from kids who just won’t get along.   Maybe not just kids.

“On National Children’s Mental Health Awareness Day May 5, NIMH is hosting a Twitter chat on DMDD and severe irritability from 12-1 p.m. ET with expert Dr. Ellen Leibenluft. Please follow our tweets on NIMH’s Twitter page. To ask questions, you must have a Twitter account and include the hashtag #NIMHchats in every tweet. If you won't be able to make the chat, you can submit your questions in advance. You may submit questions via email, Twitter using #NIMHchats, or NIMH's Facebook page.”

This “symptom” justifies the dedication of a day, an expert, and an e-conference.  It seems aimed at parents and teachers of “nice” kids — or at least kids who should be nice, but aren’t — spotted here and there around the country.  So from my chosen vantage, I testify that there are whole classes and categories of kids where this is the norm, not the exception.  They show extreme irritability, anger, and frequent, intense temper outbursts because they are thrashing.  “Thrashing” can be a technical term, a biological description of a trapped creature who cannot find a way out and whose body, abandoning thought, has resorted to random extremes on the chance that they might accidentally trip some kind of release or tear something loose.

Thrashing can also refer to beating someone at a drastic level to punish them or force obedience, usually accompanied by a high level of incoherent emotion.

“In computer science, thrashing occurs when a computer's virtual memory subsystem is in a constant state of paging, rapidly exchanging data in memory for data on disk, to the exclusion of most application-level processing. This causes the performance of the computer to degrade or collapse. The situation may continue indefinitely until the underlying cause is addressed. The term is also used for various similar phenomena, particularly movement between other levels of the memory hierarchy, where a process progresses slowly because significant time is being spent acquiring resources.”  

If I were confronted with a kid with extreme irritability, anger, and frequent, intense temper outbursts, my first strategy would be to look for what is trapping him or her.  If there is nothing that can be seen by an outsider, I would look for the inside traps, using empathy to discover why the kid believes he or she is trapped.  Is it memory, illusion, too much television?  Loss of identity?  Fear?  In my case it is most often having my identity and existence questioned, blocked, and belittled that makes me rave and smash and drive all cats under the bed.  I think a lot of nice people are doing it to their kids.

I also think the world is doing it to whole classes of kids so that they never feel safe, lose touch with who they are, and can’t see which way to go.  I see several relevant image tropes on television, repeat and repeat.  One is the little phalanx of heavily armed, dressed-in-black, SWAT teams moving as a unit to find and destroy.  Another is the corresponding small group of fleeing kids: hoodies, tennies, jeans, wheels.  And a third is a long machine-polished hallway with identical doors down both sides: hospital, school, jail.  The fourth is the infrastructure labyrinth of pipes and circuits with the occasional metal ladder leading up and — presumably — out.

It’s enough to make an alligator thrash.  Unless he can climb ladders.

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