Affluenza: How to be sick without being sick

The four pedestrians never saw it coming.

Around 11:45 p.m on June 15, 2013 on a road in Burleson, Texas (a suburb of Fort Worth), the driver of a stranded SUV and three people who had stopped to help her change a flat tire were killed when 16-year-old Ethan Couch smashed into them with his red pickup truck. Seven other teens were in the truck with him. Drunk, and driving 70 mph in a 40 mph zone, Couch then plowed into the parked Silverado pickup that belonged to one of the victims, who was — in a cruel twist of fate — a youth pastor. Nine other people — seven passengers in Couch’s vehicle, and two in the pastor’s — were also injured, two seriously. At the time of the crash Couch’s blood-alcohol level was found to be 0.24, three times the legal limit.

On September 11th Couch was charged in juvenile court with four counts of intoxication manslaughter, and pleaded guilty. At the conclusion of his trial on December 10, 2013 Judge Jean Boyd sentenced him to 10 years probation. The prosecution had argued for a 20-year prison term. Adding anguish to the prosecution, as part of the sentence the judge ordered that Couch spend time in a Southern California rehabilitation facility, a posh establishment for which his wealthy father would pay $450,000 a year.

The judge’s ruling provoked outrage among authorities, the victims’ families, citizens in Texas and other States, and even observers abroad. In her ruling the judge accepted the defense’s argument, based on the testimony of Dr. G. Dick Miller, a clinical psychologist who testified on Couch’s behalf, that Ethan was not responsible for his actions. The boy suffered from “affluenza, ” Dr. Miller argued. Couch, he said, had been brought up in wealth and privilege, and had never learned to face adverse consequences for bad behavior. His parents had instilled in him a sense of entitlement, along with the conviction that wealth would cushion him.

Affluenza is not recognized as a diagnostic category by the American Psychiatric Association (DSM-5). Not having seen the trial transcript, I don’t know whether the prosecution challenged Dr. Miller’s use of the word. However, it seems everyone else did after the verdict came down.  Dr. Christopher J. Ferguson, a psychologist, said, “As a clinical psychologist, I’ve never before seen a mental health practitioner try to diagnose someone with affluenza. And there is practically nothing in the research literature about it.” Writing for the British Guardian, journalist Jessica Luther called affluenza “the latest excuse for the wealthy to do whatever they want.” Paul Callan, a former New York homicide prosecutor seethed, “In a system where rich and poor are supposed to be treated equally, affluenza as a defense is an insult to us all.”

Dr. Miller was nearly on the ropes. After the trial he appeared in a long interview with CNN correspondent Anderson Cooper, on CNN’s AC360o. During one segment (13 December 2013), Dr. Miller said, “We used to call these people spoiled brats. I wish I hadn’t used that term [affluenza]. Everyone seems to have hooked on to it.” He was distressed over the flak he received, which overshadowed his victory in court.

So why did he use “affluenza,” which he probably knew wasn’t a recognized psychiatric diagnosis? Or — since we can’t read his mind — what effect did he expect this word (rather than, say, “spoiled brat,”) to have on the judge, the prosecution, the victims’ families, other observers in the courtroom, and finally us? He probably used the term because he expected everyone to accept it as a legitimate diagnosis. But only Judge Boyd accepted it.

“Affluenza” is a blend of “affluence” and “influenza.” In a blend the first part of one word is attached to the second part of another. Although “affluenza” might have been in minimal use as early as the 1950s, the Oxford English Dictionary (OED) enters first documented use as 1973.  The OED indicates that affluenza usually affects young wealthy people, with symptoms that include “a lack of motivation, feelings of guilt, and a sense of isolation.” Since the 1970s the word has gained traction. Its main current meanings are social: It attaches to modern Western nations, particularly the U.S., and denotes consumerism, materialism, and a desire to “keep up with the Joneses.” John deGraaf, co-producer of the 1997 PBS documentary “Affluenza”, highlighted the show as an exploration of “the high social and environmental costs of materialism and overconsumption.” Nevertheless, when social critics use the term “affluenza” to describe these social problems, they attach to the problems a clinical connotation, suggesting that consumerism and materialism are diseases.

Now, a real diagnosed disease is something that happens to us. We’re sufferers, patients, even if some of our behavior might have led to a disease (e.g. smoking leading to lung cancer). And we’re treated for a disease by medical practitioners. “Affluenza” implies that Ethan Couch was not responsible for killing four people and injuring nine. He was sick. And true to its clinical spin, the defense argued—and Judge Boyd agreed—that Ethan needed treatment (for a disease), not punishment (for a crime).

The flak Dr. Miller received for his “affluenza” defense surprised him. Yet he would have been justified in believing that the term would not cause offense. After all, we live in an era in which many expected behaviors (good and bad), as well as the normal processes of maturity and aging, are now medicalized, given a clinical spin. Researchers, among them anthropologists, physicians, and social critics deplore what they call this “medicalization of society”, which has pathologized shyness, menopause, aging, wrinkles, inattentiveness, pregnancy, male pattern baldness, perceived physical defects (e.g. shape of one’s nose), rudeness, and other conditions—even in the absence of clearly diagnosed disease.

One of the most popular clinical terms attached to non-disease conditions is “syndrome.” It’s not only used to describe political events (e.g. the Iraq syndrome, meaning the erosion of public support for wars in which American casualties increase), but also social and personal events. A person who envies another’s good fortune suffers from “tall poppy syndrome”, an expression familiar in Australia and New Zealand. Parents whose children grow up and move out suffer from the “empty nest syndrome.”

Not surprisingly, wealth and entitlement have also generated syndromes. “Sudden wealth syndrome” affects those who suddenly come into money; for instance, through winning the lottery. They may feel undeserving of it and fear that they’ll suddenly lose it. “Rich kid syndrome” affects children born to privilege and wealth. They lead self-centered lives, exercising little responsibility and suffering few consequences for bad behavior. Author Jennifer Senior lamented, “America’s burgeoning money culture is producing a record number of heirs—but handing down values is harder than handing down wealth.” In 1989 Bruce J. McIntosh, a pediatrician, coined the term “spoiled child syndrome” which, he argued, resulted from the failure of parents to discipline their children consistently and age-appropriately. These wealth-related syndromes dovetail with “affluenza.”

If affluenza is indeed a sickness, it can be treated. Paul Callan, the former New York homicide prosecutor, proposed for Ethan Couch “a solid dose of state-inflicted poverty in a prison cell.”

Janet Byron Anderson is medical linguist and medical editor, and author of Sick English: Medicalization in the English Language. She can be reached at MedLinguistics.

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