In May, the American Psychiatric Association will publish the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which will commonly be referred to DSM-5. The current edition of each DSM is perceived as the bible for those in clinical and psychological practice. DSM-5 is already being criticized for expanding the number of possible mental diagnoses. But as a long-time fan of Thomas Szasz, the psychiatrist who authored, among many other writings, The Myth of Mental Illness, that should be no surprise.
With no disrespect to any practicing psychiatrists, psychologists, clinical social workers, etc., it would seem that the options of mental diagnoses for people suffering are currently available— just relying on DSM-4—is quite ridiculous. Every emotional hiccup or physical tremor can have its own clinical diagnosis. In so doing, the truly serious and disruptive afflictions are made light—and that should not be.
Without wanting to make light of any true emotional and mental disorders, I would suggest that we need a DSM for nonprofits. A bevy of recent conversations with executive directors, board presidents, board members, and staff have me beginning my Diagnostic and Statistical Manual of Nonprofit Disorders. Perhaps others will add to my work.
Gratitude Syndrome: evident throughout organizations, from boards to supervisors throughout the organizational chart, this syndrome destroys morale, prevents an organization from maximizing its potential and, perhaps in its worse form, causes good talent to flee. The symptoms of this condition are a failure to remove individuals who are not performing their jobs to the fullest.
Evidence of this syndrome is found in board members who allow non-performing and underperforming board members to remain on the board long after they should; boards who do not fire an poorly performing executive director even though the poor performance is noticed and negative consequences of that performance are evident. It is also found in supervisors, from executive directors down who, allow people to remain in their positions even though they are not performing the full compliment of their positions and/or are not doing it to a level of performance that the job, their colleagues and their clients deserve.
While the condition itself may be hard to detect, as there are no readily visible indicators, the source of the spawning of this condition—the underperforming person—is easily recognized and widely known. Gratitude Syndrome reveals itself only in the failure to remove the underperforming position because the individual(s) afflicted with this syndrome is so grateful that someone is in the position, that someone is willing to do the job despite the poor compensation, pitiable conditions, etc., so that s/he doesn’t have to step up and do the job or go through a hire process. Negative effects of this syndrome to the diagnosed individual are few, though some may suffer occasional guilt; however, negative consequences for others in the organization (beyond the underperforming individual who blithely continues as s/he is) are far more deleterious, ranging from low morale to leaving for employment elsewhere.
It Must Be Me Disorder: frequently confused with Gratitude Syndrome, this condition leaves an individual unable to see fault in others’ performance and assumes, instead, that s/he has failed and it is her/his behavior that must be corrected. The easiest way to spot this disorder is to look for signs of repeat, negative patterns of behavior on the part of one individual, frequently over a long period of time. Despite the fact that there is the one constant in all of the situations, the individual remains in her/his position. Why? Because the individual afflicted with this disorder sees the problem as himself rather than the person who is the constant; and this diagnosis is then handed down, situation after situation, even though there are new players added to the mix. For example, the executive director who is acerbic in a variety of interactions with board members, over time and with different individuals is not seen as having a problem; it is the others with the problem. Perhaps they overstepped their boundaries? Perhaps they were catching him at a bad time? Perhaps they didn’t fully understand their new position as a committee chair or officer? Perhaps they are troublemakers?
This disorder reveals itself in the repetition of the pattern and the embracing of the constant individual and the blaming of the others. The consequences are often insidious and not identified until it is too late: a funder has been affronted by the executive director’s behavior; board and staff members are fleeing an unrighted ship; a partnering organization throws its hands up and walks away. And, obviously, the wrong individual has been protected.
Pity Complex: this disorder is a tricky one as it can afflict individuals in an organization or whole organizations. It is, therefore, perhaps the most deleterious, as if left unchecked it can bring down an entire organization. There is a contagion effect, so that one individual can be a carrier and, before you know it, it has consumed the entire organization.
This complex manifests itself in a variety of ways, each its own condition, from the “I am working on the side of angels” to “No one can do it correctly/well/right but me” to “But we are just a nonprofit,” as well as other indicators of wearing the proverbial hair shirt. The first—working on the side of angels—suggests that incompetence, under performance, unethical behavior, personality flaws should all be forgiven because the cause for which the person “works” is a good one.
The second—only I can do it—generally is found in a control freak, coupled with feelings of self-importance though never admitted and the ingenuous wish to not have to be the only one who can do things right.
The last, and the most distasteful to me, is the self-debasing “we are just a nonprofit,” as if one needed to apologize for being a nonprofit, or for working for one. In all of these scenarios, the individual or organization is looking for pity, sympathy and forgiveness for whatever it was that wasn’t done well, right, enough, etc.
Why should we have to prove that we are making a difference; that we are doing good work. I didn’t get to that grant because I am the only one who can do our books correctly. We have had three years of deficits because we are just a nonprofit. Regardless of the impetus for the condition, the Pity Complex leads to the same end result: a less than stellar product or organization that looks to be excused for that performance because it is, after all, “just a nonprofit.” And the eventual consequence can be the big one: an organization is so busy pitying itself that it fails to pay attention to the important things and it goes out of business.
What strikes me about all of these diagnoses is that they are all excuses for not addressing the issue at the heart of the matter. Szasz once wrote, “No further evidence is needed to show that ‘mental illness’ is not the name of a biological condition whose nature awaits to be elucidated, but is the name of a concept whose purpose is to obscure the obvious.” In the case of nonprofits, the obvious is “something needs to be done.” But these conditions, and others, allow us to obfuscate the obvious.