I spent last week teaching a graduate course at Baptist Bible College in Springfield, Missouri and
during the week a news item showed up that illustrates the challenge of understanding the DSM5. (Diagnostic Statistical Manual of Mental Disorders Fifth revision) The news item related that caffeine withdrawal was supposed to be one of the new mental illness diagnoses in the DSM. Now, most of us have had some experience with the favorite "drug" sold at Starbucks and some of us have suffered the discomfort of missing that morning cup of coffee with headaches, fatigue, and irritability. A few of us have found that if we drink too much of the brew that our hearts skip a beat or even beat faster. I suspect more have struggled with the irritability and sleeplessness that comes from drinking coffee too late in the afternoon.
But, are these effects a mental illness? Or are they just the uncomfortable outcomes of things we choose to do, eat or drink. I would say that the latter is true. When we choose to consume any substance and then live with the effect and sometimes the undesirable side effects, it does not mean that we have a disease. Disease requires pathology or a change in our bodies that results in an abnormal function. When our pancreas is damaged and insulin production is reduced we can develop diabetes. There will be changes that can be seen under the microscope along with abnormal blood sugars. When we suffer withdrawal symptoms from missing caffeine, there is no pathology to speak of.
By calling it a disease we do set in motion several things that can lead to unintended consequences. First we identify normal people as mentally ill with a significant downside when it comes to buying insurance and
finding employment. Next, we will see more people diagnosed with "caffeine withdrawal disorder" who might have sailed right on through life without a hitch simply because the diagnosis exists. Then, the opportunity (or the risk) to be treated by some sort of therapy will follow. And, then will come medication that will either be good, bad or even just indifferent in benefit that can cost as much as two or three hundred dollars a month to take. (Roughly the equivalent of two Starbucks Cafe Mochas a day)
ow it seems farfetched, but we have watched this process happen with cigarette smoking and a host of other DSM diagnoses. As we have morphed normal sadness into depression, childhood inattention into ADHD, and the struggles of life into generalized anxiety disorder, the number of people of labeled and treated have skyrocketed.
At some point don't we need to ask ourselves the question do we really need to turn every uncomfortable or unprofitable behavior into a disease that will eventually require treatment? Or could we just choose to be responsible for ourselves? Isn’t that part of the experiment of American Liberty?
And, that brings us to Romans 14 a chapter in the New Testament in which Paul the apostle lays the groundwork for the doctrine of Christian Liberty. (In fact the whole idea of American liberty is anchored in the book.) The argument at Rome was over eating meat offered to idols or eating just vegetables. Paul said it did not make anyone any better if they ate or did not eat the meat. He was really upset that they were judging one another over it.
The church in general has taken that idea and extended to include things that we can do about which the Bible does not speak. Since caffeine is not mentioned in the Bible, we are free to drink Coffee or not as long as we do not violate some other principle of scripture in the process. Not to belabor the point, as long as drinking coffee does not harm us or cause us to harm others, it simply becomes a matter of preference.
So there, maybe it is time that we said that there are more than enough diagnoses in the DSM, and that they should leave our coffee alone! This is the kind of problem that we can figure out on our own without the help of psychology, psychiatry or even medicine for that matter. See you at Starbucks...