Anal-Olecranon Confusion, an Epidemic

Anal-Olecranon Confusion

I wrote recently to the American Psychiatric Association to comment un the inexplicable absence from the D.S.M. - the Diagnostic and Statistical Manual of psychiatric disorders - of anal-olecranon confusion, by no means a rare ailment.  I’ve known of the syndrome from the experience of a friend.  Here’s what I wrote to the A.P.A.:

American Psychiatric Association 

Dear A.P.A., 

Around 1972, my young lady friend was consulting a psychiatrist in New York City.  Meg, a Barnard College student, had many issues with her father.  After hearing quite a bit about him, the good doctor told her, “Your father is afflicted with anal-olecranon confusion.”  After Meg’s quizzical look, he added, “That means he doesn’t know his ass from his elbow.” 

Some years later, I earned the M.S. Ed. degree in special education and learned a bit about the D.S.M.   I remembered this indispensable diagnosis and looked it up.  But it doesn’t appear in the D.S.M., and this seems to me a grave omission, given the wide diffusion of A.O.C. as a syndrome, and the severity of its effects on the afflicted and everyone around them.  Much time has passed; I hope you will remedy this for the D.S.M. VI. 

I claim no expertise in these matters, but A.O.C. clearly has multiple etiologies.  Given current conditions in the U.S. and the world at large, it appears to correlate highly with service in elected office and positions of great responsibility, although it is by no means limited to such societal roles.  Young children, with their ingenuous clear-sightedness, are almost never afflicted.  Onset for many is in adolescence, especially among males.  It tends to worsen with maturity, although with some subjects it goes into remission, what lay people call “getting smart”.  Little or no progress has been made in finding effective treatment, although anecdotal evidence suggests that a knock on the side of the head rarely suffices. 

It could be that this doctor was the first to identify the syndrome and name it, and in that case he deserves recognition.  As an achievement it is obviously on a par with Freud’s discovery of the unconscious.  I regret that at this remove I can’t remember his name with certainty, but it may have been Dr. Nardi.  I spoke with him by telephone once when he was calling Meg, and he had a European accent - I would say German-Jewish, despite the Italian name.  At the end of the conversation he said to me, “Be well, Allen.”  Even now it moves me to think of it.  He was like a perfect grandpa.  I suppose he is no longer among the living, or he’d be 110 or 120.  (I see that there are a few other Nardis in the profession, perhaps children or grandchildren.)  His warmth surely had curative properties of its own, and I will never forget it. 

Allen Schill 

Torino, Italy,
June 6, 2023

Leonardo da Vinci, la meccanica muscolare dell’ano, ca1508-09.

I’ve used this drawing before as the opener to the article about my Turbine Voodoo Missile, elsewhere on this blog.  Usually I don’t care to re-use illustrations, but in this case I could have done much worse.

Another word about the diagnoses defined by the D.S.M.:  some years back, when I still lived in New York and had a few things to work out in therapy, I went for several months to a psychotherapist.  The expense was very modest, 50% of the therapist’s fee covered by the health insurance policy I had as a teacher in N.Y.C. public schools, and so a member of the U.F.T., the United Federation of Teachers.  (I’m a firm believer in labor unions.)  Every week I signed for the session to send to the insurer.  I paid no attention to it, but finally noticed that the therapist had written in, under diagnosis, ”adjustment disorder”.  I laughed.  Of course she had never told me that this was my problem.  To me it was a pointless term, and probably to her as well - you could just as well say that I was “going through some changes” that were giving me trouble.  But I guess they need catch-all term to satisfy the needs of the insurer.

P.S. - I recently read a wonderful novel, ”Bewilderment”, by Richard Powers.  It’s about an astrobiologist - who studies faraway planets to speculate on whether life might exist there - and his young son, a boy who is troubled, above all (as is his father), by the sudden death of his mother in a road accident.  She is/was an activist on behalf of wildlife preservation; it seem she swerved to avoid hitting an animal one night and lost control of her car.  She was also an avid birdwatcher.  The boy has trouble at school, and is even prone to violent outbursts.  The doctors and psychologists are urging that he begin taking medication.  The father - narrator of the story - resists putting an eight-year-old on drugs.  In passing, he remarks that the D.S.M., strangely, hypocritically, has no designation for the compulsion to diagnose people.

P.P.S. - The subject of psychiatric disorders reminds me of a film from way back, by Woody Allen, with Alan Alda.  The usual Upper West Side liberal intelligentsia.  But the weirdo of the family was Alda’s son, inexplicably a Buckleyite conservative.  Part of the all-around happy ending was the discovery that the young man’s problem was merely a local vascular problem in his brain - he was successfully treated, and thus transformed into the benign liberal he always was underneath.  (“And then they all had tea”, which is either James Joyce or Beatrix Potter.)