by Jay Neugeboren
When the American Psychiatric Association’s newly revised 1,000-page “bible of psychiatry,” The Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) was published in May of 2013—its first new edition in 19 years—The New York Times reported that “the controversies about the revisions of the DSM have highlighted the influence of the manual, which brings in more than $5 million annually to the association and is written by a group of 162 specialists in relative secrecy.”
What The New York Times failed to mention was that on the same day the DSM-V was launched (and at a price of $199), a masterful alternative to it, The Diagnostic Manual of Mishegas (D-MOM) was also launched:. At 74 pages and selling for $10, the D-MOM has proven not only a more delightful, readable, and less expensive alternative to the DSM, but more importantly, a more useful guide for dealing with the ordinary—and the extraordinary—mishegas of daily life.
Compare, for example, this from the opening page of the DSM, entitled “Use of the Manual.”
“Subtypes (some of which are coded in the fifth digit) and specifiers are provided for increased specificity. Subtypes define mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis and are indicated by the instruction ‘specific type’ in the critera set. In contrast, specifiers are not intended to be mutually exclusive or jointly exhaustive and are indicated by the instruction “specify” or “specify it” in the criteria set. Specifiers provide an opportunity to provide a more homogeneous subgrouping of individuals with the disorder who share certain features. Although a fifth digit is sometimes assigned to a code or a subtype or a specifier, the majority of subtypes and specifiers included in the DSM cannot be coded within the ICD-9-CM system and are indicated only by including the subtype or specifier after the name of the disorder (e.g., Social Phobia. Generalized.)”
The Manual of Mishegas, based upon a newly discovered document by the brilliant if frequently farmisht Doctor Sol Farblondget (M.D., Ph. D., P.T.A.), approaches the matter in a different manner. “A Selective Serotonin Re-uptake Inhibitor,” Doctor Farblondget writes on page one of the D-MOM, “is no substitute for a good piece herring.”
And now, on the first anniversary of the publication of the D-MOM, the true and unexpurgated story of its origin can be revealed. Here’s what happened:
*
At 8:32 P.M. on a cold mid-summer night, Doctor Sol Farblondget entered a crumbling east side brownstone where a clandestine sub-committee of the American Psychiatric Association was inventing new psychiatric disorders they intended to add to the hundreds of disorders already listed in the 943 page fourth edition of the DSM.
Having donned a disguise in an abandoned phone booth—a moustache drawn with black magic marker, dark horn-rimmed glasses, a sombrero, a serape draped over his left shoulder, and an unlit cigar stub lightly pasted to his lower lip—Sol made his way into the brownstone’s vestibule, where he was stopped by a security guard sucking on a Sherlock Holmes-style briar-and-porcelain pipe.
“Who are you, and would you like to tell me why you’ve come here this evening?” the guard asked.
“I’m Gaucho Marx,” Sol replied, “and I’m here to talk to a shrink.”
“Aha—a shrink rap! Of course,” the guard said. “But do you belong to our club?”
“I don’t care to belong to any club that will have me as a member,” Sol said.
“I feel for your ambivalence,” the security guard said while holding Sol in a long embrace before wishing him a safe journey and generous third party reimbursements.
Minutes later, Sol entered a fifth-floor room littered with empty designer water bottles, its air reeking of cigar smoke, shameful desires, and repressed memories. On two sides of a long table, ten psychiatrists were napping in stress-free lounge chairs beside couches devoid of patients.
“Take off the funny clothes, and get out of here, Sol,” said Doctor Herbert Luftmensch, chairman of the sub-committee. “We already got more input than we can turn into output.”
Sol whipped out a thin sheaf of papers from under his sombrero. “I’m here with the answer to your prayers, Herb,” he said. “A miracle manual that the whole world will be able to understand, unlike your over-priced doorstopper of a book no one can understand even after a gezillion years of psychoanalysis and pharmaceutical company junkets to beautiful Caribbean islands.”
“Aren’t you Sol Farblondget—author of Strudel and its Relation to the Unconscious?” a psychiatrist asked.
“And editor of the Irish-Jewish classic, The Book of Kvells?” asked another.
“So whatcha got, Pops?” asked Morris Milchadig.
“What I got here—The Diagnostic Manual of Mishegas—is an ingenious alternative to your DSM, and to all the fershlugenah therapies that flow from its unfathomable run-on sentences,” Sol said. “Hey—let’s face it, guys, we’re all a little mishugah, right? So what I do is to simplify the whole shmeer by dividing the world into two groups—those who suffer from mishegas major . . . and those who suffer from mishegas minor.”
“When I use the the term mishegas major I’m talking about people who are really, really mishugah—for example, a person who talks with God without first getting permission from his Rabbi, priest, or health insurance provider. And by mishegas minor, I’m talking about everyone else—for instance, an alter kocker who believes his beautiful, brilliant, sexually voracious young wife when she tells him she is going to love him forever.”
Doctor Emanuel Bulbenick raised his hand. “Does being sexually voracious qualify as an eating disorder?” he asked.
“Is it covered by Medicare? asked Doctor Shimmel Dreckstein. “And what about pharmaceutical companies? If we don’t play patty-cake with them, where will we get our pocket protectors and ball point pens?”
“Consider my visit a peace offering,” Sol responded. “Keep your DSM, but add the D-MOM! Let’s unite, throw off our non-profitable categories, and make everyone a potential patient! Because while your DSM makes distinctions between thousands of cockamamie conditions few people have experienced, it doesn’t say a word about the mishegas-of-everyday-life and what-to-do-about-it! It never even mentions the healing powers of food, drink, travel and sex, which can provide our clients with pleasures that go beyond the wellness principle.
“Let me give you some for-instances,” Sol continued. “For people suffering from mishegas major, especially those living in mental hospitals or on locked psychiatric wards, the cost can come to well more than a thousand dollars a day. But a two-week vacation in Paris or Tuscany in the spring, or the Caribbean or South America in winter, in the company of a C.D.M.O.M.T. (Certified D-MOM Therapist), comes to less than half that amount, including taxes and baggage fees.
“And when it comes to most varieties of mishegas minor, a hot corned beef sandwich on rye, followed by a full body massage with a happy ending—or a large tumbler of a favorite alcoholic libation imbibed while watching a movie featuring Buster Keaton, Charlie Chaplin, Mel Brooks, Oscar Levant, or—most favored nation of all—the Marx Brothers, will prove a mechaieh. And for feelings that arise from the ordinary tsuris of life, such as losing a job or being called for jury duty, a walk in a sylvan setting with your sweetheart—or someone else’s—will do wonders.”
“But if there’s no DSM and no DSM codes, how will we make a living?” Herb Luftmensch asked. “And what about our royalties?”
“You can keep your DSM and your royalties,” Sol explained. “But by publishing the D-MOM for a mere $10 a pop, we rake in additional millions. Next we offer regionally marketed editions, with ads from travel agencies, dating services, cruise companies, luxury spas, fantasy baseball camps, and beer, wine, and booze companies.
Herb Luftmensch banged his fist on the table, and declared that he voted ‘No!’ to any book that was so short, clear, and simple that anyone could understand it. If Farblondget’s book were published, who would ever need therapy again, much less the DSM? He called the question, and the vote of members who were not asleep was three to two in favor of The Diagnostic Manual of Mishegas.
At which point a delegation of three members of the C.F.C. (Farblondget Camp Followers)—Neugeboren, Friedman, and Sederer—known to the American Association of Psychiatrists as “The Mayvens of Mishegas,” arrived.
“Mazel Tov!” they cried. “Alevai!” they shouted. “Shehechayanu!” they sang. They marched around the room chanting, “Long Live the Manual of Mishegas!” after which they joined forces with Dr. Sol Farblondget (M.D., Ph,D., P.T.A.) and started potchkieing together the utterly delightful and sublimely farkaktah D-MOM.
Jay Neugeboren is the author of 21 books, including three prize-winning novels (The Stolen Jew, Before My Life Began, The American Sun & Wind Moving Picture Company), two award-winning books of non-fiction (Imagining Robert, Transforming Madness) and four collections of prize-winning stories. With Dr. Lloyd Sederer, and Michael Friedman, he is co-author of of The Diagnostic Manual of Mishegas.
