The Diagnostic and Statistical Manual of Mental Disorders is a giant catalog of behaviors and other complaints that cause people to suffer psychologically. If a person claims or admits to having a constellation of problems which fits one of the categories in the DSM, they can be diagnosed with that Mental Disorder. Most people who make these diagnoses as part of their living take this process very seriously, distinguishing between subtypes of ADHD in a client with the same seriousness as a doctor distinguishing between subtypes of breast cancer in a patient. This book has the answers. It is like the Bible for mental health diagnosticians.

Every decade or so, we get a new version of our Bible. Here are the six versions we’ve had since 1958.


We are about to get a new version this spring. This change-over is both exciting and awkward in a way that I don’t imagine new versions of other Bibles can be. When a new version of the Christian Bible come out, I imagine that the impact is mostly academic, and the new version may or may not catch on. With a new DSM, there is no choice for diagnosticians or their clients. In 1973, you could diagnose someone with Homosexuality Disorder. In 1975, you could not. The debate was over.

More often than disappearing, new disorders become available. Asperger’s Disorder, for example, appeared in version IV, in 1994. At other times the categories change in big ways, such as the much-talked-about removal of Asperger’s Disorder in the upcoming version V in favor of a more inclusive “Autism Spectrum.”

The awkwardness of this process is especially salient to me, just starting my internship as a family therapist. Since I live in California, I must do my 3,000 client-contact hours for licensure at a community clinic, which means I have to diagnose each of my clients with a qualifying Mental Disorder. To that end, I have been boning up on my diagnostic criteria in the DSM-IV-TRI have to be really good at this to get the resources flowing for my clients. At the same time, I am aware that in a matter of weeks I will be learning not only new criteria and new Mental Disorders, but a whole new diagnostic process spelled out in the DSM-V.

It has been almost exactly two years since Reanna and I started our long-distance relationship. Yesterday she had her interview for her K1 fiance visa and we are on track to finally live together in nine days. I haven’t written much about our relationship or being long distance (except here,   hereherehere,   and here) but it has been a huge part of my life for two years. It has been a challenge at times, but mostly just amazing and beautiful, mostly because of what an amazing and beautiful person Reanna is. Yes, an amazing and beautiful experience that I am SO GLAD IS ALMOST OVER!

Nathen & Reanna by Ruth Pike

I don’t have good language for this experience, but as soon as I held my new nephew I could tell that the existence of this tiny person changes everything, that my knowing him is one of the major before-and-after events of my life.

With Oliver Lee, June 22, 2011

I am leaving Eugene in the morning for Joshua Tree to see my first nephew, Oliver Lee. I am very excited. Here are three of my favorite photos of him so far:

Oliver Lee by Steve Lester

Oliver Lee and Maya, by Reanna

Oliver Lee and Damian, by Maya (I think)

I have received several letters from my past self, as part of a ritual we do sometimes at Not Back to School Camp. The idea is to send the feeling and ideas of an experience forward, a reminder of the sense of clarity, inspiration, and purpose that is common at the end of a session of camp. It’s always interesting to get one of these letters, but they don’t often hit home like this one that I just received from myself of one year ago, just before I started seeing clients.

Hi Nathen,

I just did this guided imagery thing w-Jonathan Stemer in Child & Family Assessment and am to write or draw to you, my just-graduated self. I imagined myself as an old man, wrinkly, bald, spotty & beaming. The thing is, you will be an old man and you will look back on your just-graduated self with real love, with fondness & satisfaction. One thing you would want to say to yourself is that everything works out. You wouldn’t exactly say not to worry about it, because the worry is part of everything working out, but it has that flavor. Your story is good. You are worthwhile. People have been better off for knowing you. You are, right now, doing great. Notice it if you can.

Have a great summer, Nathen.



Add drawing of old-man Nathen here –>

It has been four years of sitting in hundreds of hours of lectures, reading thousands of pages of theory and research, writing hundreds of pages, and seeing clients for hundreds of hours. It has been long weeks, late nights, steep learning curves, and lots and lots of thinking. It is amazing how much learning you can do in four years of 60-80 hour weeks!  In 2009 I finished a Bachelor of Science degree in psychology, with a research assistant position in Sara Hodges’ social cognition lab, a practicum position at a residential treatment facility for teenage sex offenders, an honors thesis entitled “Differentiating the Effects of Social and Personal Power,” and a GPA of 4.23. Yesterday I graduated with a Master of Education degree, Couples and Family Therapy specialization, 455 client-contact hours at the Center for Family Therapy and Looking Glass Counseling Services, one term as a counselor for the University of Oregon Crisis Line, four terms volunteering for the UO Men’s Center, a GPA of 4.19, and a “Pass With Distinction” on my final Formal Client Presentation. It has been a wonderful, exhilarating, exhausting four years.

It has also taken a bit of a toll on my health, but the major loss was in community. If you do not live in Eugene and we have not made a point of a regular visit, I probably have not spoken or even written to you much, if anything, since 2007. For that I sincerely apologize. It is not how I prefer to live but I could not seem to do this any other way. Know that I miss you. Let’s reconnect. Call me up, write, send me your unfinished song, your idea for a book, something to read and talk about. Let’s go for a walk, go swimming, have lunch, see a show. I am looking forward to it.

Couples & Family Therapy 2011 Cohort

Me & My Dad, June 14, 2011