Has Congress Developed a Psychiatric Disorder?

Routine decisions are crises. The whole legislature suffers panic attacks. Is there a clinical term for these emotional difficulties?

Lately, the U.S. Congress has had more and more trouble with its everyday life.

It has turned routine decisions into gigantic meltdowns, with stalemates over the Bush tax cuts, the funding of the federal government, the national debt limit, and, now, the funding of the federal government again. It is having trouble at work. Emotional conflict abounds.

Friends, Congress needs help. The dysfunctional symptoms are all there:

• Congress suffers panic attacks when faced with commonplace decisions, failing to make them until the last minute

• It treats regular, expected events as crises

• Congress has a terrible time managing its money

• It refuses to accept advice, as the public consistently tells Congress to get its act together

So what's wrong with Congress, in clinical terms? AllPsych.org's summary of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition, the definitive professional guide, offers some promising leads.

First, Panic Disorder:

Etiology
Often the symptoms of this disorder come on rapidly and without an identifiable stressor. The individual may have had periods of high anxiety in the past, or may have been involved in a recent stressful situation. The underlying causes, however, are typically subtle.

Symptoms
Panic Disorder is characterized by sudden attacks of intense fear or anxiety, usually associated with numerous physical symptoms such as heart palpitations, rapid breathing or shortness of breath, blurred vision, dizziness, and racing thoughts. Often these symptoms are thought to be a heart attack by the individual, and many cases are diagnosed in hospital emergency rooms.

Treatment
Although medication can be useful, psychotherapy (especially behavioral and cognitive/behavioral approaches have proved quite successful). The key to treatment is accepting the panic attacks as psychological rather than physical (once these causes have been ruled out by a physician), practicing relaxation exercises, and working through the underlying issues.

Prognosis
Prognosis for this disorder is very good if the above conditions are met. Left untreated, however, symptoms can worsen and Agoraphobia can develop. In these cases, the individual has developed such an intense fear that leaving the safety of home feels impossible.

Makes sense. Every couple months, Congress flips out without a reasonable stimulus. Simple budget decisions trigger fight-or-flight reflexes, manifested by a lot of screeching for the goal of partisan self-preservation.

Second, it might have a touch of the mood syndrome Bipolar Disorder:

Symptoms
Bipolar Disorder has been broken down into two types:

Bipolar I: For a diagnosis of Bipolar I disorder, a person must have at least one manic episode. Mania is sometimes referred to as the other extreme to depression. Mania is an intense high where the person feels euphoric, almost indestructible in areas such as personal finances, business dealings, or relationships. They may have an elevated self-esteem, be more talkative than usual, have flight of ideas, a reduced need for sleep, and be easily distracted. The high, although it may sound appealing, will often lead to severe difficulties in these areas, such as spending much more money than intended, making extremely rash business and personal decisions, involvement in dangerous sexual behavior, and/or the use of drugs or alcohol. Depression is often experienced as the high quickly fades and as the consequences of their activities becomes apparent, the depressive episode can be exacerbated.

Bipolar II: Similar to Bipolar I Disorder, there are periods of highs as described above and often followed by periods of depression. Bipolar II Disorder, however is different in that the highs are hypo manic, rather than manic. In other words, they have similar symptoms but they are not severe enough to cause marked impairment in social or occupational functioning and typically do not require hospitalization in order to assure the safety of the person.

Treatment
Medication, such as Lithium, is typically prescribed for this disorder and is the corner stone of treatment. Therapy can be useful in helping the client understand the illness and it's consequences and be better able to know when a manic or depressive episode is imminent and to prepare for this. As with all disorders, poor coping skills and lack of support will make the illness more pronounced, and this is often a focus of therapeutic treatment.

Prognosis
For more severe cases, prognosis is poor in terms of 'curing' the illness, as most people need to remain on medication for their entire lives. The manic episodes may slow down as a result of the natural aging process. With medication, the illness can be kept at a minimum level, with some people not experiencing any overt symptoms for months and even years.

However, there are definitely varying degrees of this illness and it is not difficult to misdiagnose due to it's similarity to other mood disorders. If the illness is not severe, often times medication and therapy can do very well in terms of treatment. And, life experience, strong support, and an openness to improve can be enough sometimes to make a difference in outcome.

Congress has certainly undergone manic highs. It passed President Obama's $787 stimulus bill. It passed health care and financial reform. It felt invincible. Now, it's suffering the consequences. Periods of depression and inaction alternate with spurts of partisan mania that bring the government to the edge of shutdown.

The diagnosis depends on whether we think Congress's spending fights constitute anxiety or mania. Since the prognosis for Panic Disorder is usually "very good," let's hope it's the latter, though if that's the case, Congress could develop a case of agoraphobia, likely meaning fewer August-recess visits to home districts.

Speaking of August recess, that brings us to maybe the best diagnosis for Congress's problems: Acute Stress Disorder. It's possible that the August town-hall meetings of 2009 traumatized Congress, and that all the shouting and death threats of that strange time left their psychic mark. Maybe Congress now relives that unrest, detached from the entreaties of the public, which is actually far more moderate than all the angry protesters.

AllPsych.org explains Acute Stress Disorder:

Etiology
By definition, acute stress disorder is a result of a traumatic event in which the person experienced or witnessed an event that involved threatened or actual serious injury or death and responded with intense fear and helplessness.

Symptoms
Symptoms include dissociative symptoms such as numbing, detachment, a reduction in awareness of the surroundings, derealization, or depersonalization; re-experiencing of the trauma, avoidance of associated stimuli, and significant anxiety, including irritability, poor concentration, difficulty sleeping, and restlessness. The symptoms must be present for a minimum of two days and a maximum of four weeks and must occur within four weeks of the traumatic event for a diagnosis to be made. See also Post-traumatic Stress Disorder.

Treatment
The disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. Medication can be used for a very short duration (up to four weeks) or psychotherapy can be utilized to assist the victim in dealing with the fear and sense of helplessness.

Prognosis
Prognosis for this disorder is very good. If it should progress into another disorder, success rates can vary according to the specific of that disorder.

Let's hope the issue resolves itself with time. If not, psychotherapy and medication are probably in order.

Image credit: Kevin Lamarque/Reuters