TDD (Temper Dysregulation Disorder with Dysphoria)

At a luncheon recently I mentioned, intending to share my skepticism about the evolving DSM and its 5,000 new categories eligible for lucrative psycho-pharmaceutical medications, Angry Baby Syndrome.  I smirked as I brought up the newly minted diagnosis: Temper Dysregulation Disorder with Dysphoria, a proposed addition to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), among other things the guide for what insurance will pay for by way of pharmaceuticals.  

One of the strangers at the table, a woman with some professional familiarity with these matters, immediately nodded knowingly.  “Yes, it’s a real condition, there are some babies who just start off angry,” she informed us and the conversation drifted quickly from where I was trying to steer it.  In truth, though I am opinionated, I had no real interest in steering this particular conversation, I was merely stroking one of my pet peeves– the madness and brutality of runaway capitalism.  I worked on my vegan lunch plate, smiling neutrally as I chewed, and let my mind drift in and out of the talk around me.

I’d read a great article, given to me by my friend the now retired judge, about the meteoric rise of mental illness diagnoses.  The article was a review of several books on the boom in psychopharmacology, I’ll find it for you.  A long review, but fascinating, well-written and worth a read.  Marcia Angell begins:

It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades.  Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.  

(click here to read the article)

I can’t help thinking of TDD, Angry Baby Syndrome, in the context of a story my parents told, and believed, until the end of their lives, a myth I always took pains to demythologize.  At ten weeks old I became red and rigid, my little fists clenched, with a look of rage on my face that no amount of concerned staring or direct questioning from my frightened parents could wipe away.  With great anxiety, they rushed me to the pediatrician.  The good doctor took one look at me, began to laugh and said: “this child is having a temper tantrum!  I’ve never seen it in a baby so young, but this is definitely one angry baby!”  I recall thinking “fuck you, doc.  I’ll live to laugh at your fucking anger some day, you articulate, quack prick.  Just wait until I can talk, assbite.”  By ten months old, according to my proud mother, I was talking, though neither at ten months nor at any time after that did I bother to track the cavalier pediatrician down.

The point of this story to me was always that rather than figure out why their child was so unhappy as to be having a temper tantrum, the two young parents took comfort from the quack’s diagnosis that the kid was just irrationally enraged.  The expert confirmed my parents’ fear that their baby was just one of those born pricks– adversarial, angry, vindictive, challenging, defiant, hating all authority.  Who knew a ten week old could have the worldview to make all these judgments?   I have to believe it helped set the course of my adversarial childhood, this expert’s glib diagnosis that did not extend past a relieved chuckle.  He concluded, essentially, that this baby suffered from nothing more than being an enraged little asshole.  Kind of funny, in a way, no?

I always thought a good doctor might have felt the kid’s little fists– said to the parents, “I’ll be damned, even though it’s August, feel how cold this little guy’s hands are… maybe he’s pissed off because nobody has made sure he’s warm enough.”  Indeed, my mother reported that I always immediately calmed down whenever she gave me a warm bath, but of course, it was impossible to carry around the baby bathtub full of warm water to bathe me whenever I started becoming irrationally enraged.  

But my point in writing this is not to wonder whether TDD with Dysphoria is not a perfectly good diagnosis (why not give a pill to a young child who is just an irrationally angry bastard all the time?) or to muse about whether or not that pediatrician 57 years ago did anyone any favors, or to belatedly defend my, admittedly, infantile behavior.   

I replaced a roll of toilet paper backwards just now.  I noticed it and calmly removed the roll, reversed it, snapped it back into place.  This struck me as a great moment.  The calm fixing of a minor problem was unaccompanied by any sort of snarl, curse word, smirk, clucking of the tongue.  I still fly into a Tourretic rage when I’m leaving the house in a hurry and my ear buds are violently yanked out of my ears as the cord whips around a doorknob, or the long horn bicycle handlebars.  Part of my rage is at the randomness, seeming cruelty and absolute regularity with which these little delaying things always seem to happen, as though the universe is giving me the finger when I most need its silent cooperation.  But with today’s toilet paper tragedy, I was happy to notice myself fixing a minor problem as calmly as the Buddha.  

I took a breath and thought about the progress I’ve made from that vicious little ten week old I once was, the raging TDD poster baby.  It made me think of my father’s terrible temper, and his insistence, until right before the end, when he smartly reversed himself, that people are what they are programmed to be, by genetics and upbringing.  He always dismissed as delusional the idea that one can consciously change this programming.  My dad’s reflex, when a mistake was made by himself or anyone else, was to become instantly enraged.  I spent decades being mad at myself when I did something careless, or stupid, things that earthlings do all the time.

Follow if you can: you are snipping the ends off string beans, nipping the stem off and a bit of the tip on the other end. In one bowl the prepped beans that will be steamed or sauteed, in another the ends you will be discarding.  One after another, bing, bing, bing, the stems into the little metal bowl, string beans into the strainer.  Then, bip! stem into the string beans, whole string bean into the bowl of ends.  One would expect, at most, a little smile and head shake, a plucking out of the stem, an extraction of the string bean, and quickly restoring them to their desired places.   It would be hard for many people to understand the reflex to a paroxysm of rage when the stem gets flipped into the wrong bowl, but it is there for some.

Did my father have his face whipped all through his early childhood, and the angry course of his life irremediably stamped on his little soul, because he had undiagnosed TDD?  Did his mother, an insane little bitch, as far as I can make out, suffer from untreated TDD?  Is the reflex to be enraged carried in the DNA?  If this reflex is then reinforced by infallible repetition, can the programming to react this way be undone by mere mindfulness and a desire to not react with rage to every frustration, no matter how minor?  

Let us not underestimate the practice of mindfulness, working in tandem with a strong enough desire to change a painful reflex.   I’ve been trying to apply this principle to my dealings with others, with some success.  I have remained fairly mild in situations that would have provoked me to major unmildness before.  Imagine my delight to find myself the recipient of this forgiving gentleness in the moment of realizing how maddeningly idiotic my placement of that roll of toilet paper had been.  Noticing these small, valuable steps is a great gift we can give ourselves.

Or, an old reflex suggests, the wishful thinking of a fucking idiot.  Though I think not, whatever my father or a respected doctor might have once said to the contrary.

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