Perspectives - Vol. 5, No. 4 - Mental Illness, A Powerful And Dangerous Idea

Editors note: The ideas discussed in the following article, are the author's and are not necessarily shared by .

The idea of mental illness is dangerous primarily because its the only idea allowed on the playing field. There are other ideas that can explain and guide the treatment of our emotional pain, other ideas that can help us solve our moral dilemmas and resolve our interpersonal conflicts, but the idea of mental illness is so embedded in our society at all levels of its functioning that these other ideas have been rendered impotent, shut out....not allowed.

The problem with psychiatry is not so much that psychiatrists have too much power - although they do: it is rather that the idea of mental illness as defined by psychiatrists has too much power; power assigned to it by the people who believe in it, by the people who stand to gain economic profit from it, and by those who comply with the idea and the service delivery system that has been structured to support it out of greed or self preservation.

I do not propose that the medical model of mental illness be obliterated from the face of the earth. Like any other belief, like any other idea, or religion it has its place, and its right to exist. It should not however, be allowed to smother all other ideas. It should not be the only idea to which adherence is mandated by our government, validated and supported by our health care providers, our social institutions, and our courts of law.

Case in point, two boys go on a shooting rampage at their school and we immediately assume these boys were sick, not bad. A husband is repeatedly unfaithful to his wife and he claims to have a sexual addiction. Again, illness, not moral depletion is the villain. A physical therapist takes liberties with a patient. The therapist claims the patient seduced him because she is a borderline. Mental illness is an easy target to blame for every immoral, illegal, and simply malicious act a human being can commit.

Diagnoses of mental illness are used to excuse criminal behaviors in our court system and treatment, not punishment is ordered. Mental illness gives us the liberty to commit adultery and abuse. Mental illness excuses us from quilt when we kill someone in a car accident while driving under the influence of alcohol. A diagnosis of mental illness can be used to avoid doing an honest days work for an honest days pay if the diagnosis qualifies us for a social security disability.

Traditional justice is based on concepts of right and wrong; modern justice however, is based on mental health and illness. Consider the following quote from The Untamed Tongue by a Syracuse psychiatrist, Dr. Thomas Szasz. (1) Faced with two women both of whom claimed to be the mother of the same child, Solomon talked to them, listened to them, and awarded the child to the woman who he inferred from the information he obtained was the real mother.

A modern American judge would proceed quite differently. Faced with two such women, he would conclude that one of them must be deluded. Then, he would order both to be examined by psychiatrists, who would duly discover that one of the women is a fanatic, insisting that she wants the whole child or nothing, whereas the other is reasonable, willing to compromise and accept half a child. Accordingly, the psychiatrist would declare the real mother to be suffering from schizophrenia, and recommend awarding the child to the impostor - a recommendation the judge, respectful of the findings of medical experts, would rubber stamp.

What is mental illness? Who decides who is sick and how is the diagnosis made? Does everyone have a brain? I do. I know where it is too; its in my head. Im not crazy, I know my brain can have an illness. Im not sure what a mental is, where in my body it resides or how it could have a tumor; a lesion, a virus, a disorder or a chemical imbalance. The American Psychiatric Association (APA) wants us to believe that what they call mental illness is really bonafide brain illness.

Weve witnessed the rush to publicize new findings about the genetics of alcoholism, schizophrenia, and manic depression, many of which were later retracted. In spite of repeated renunciations of earlier reports and findings, the belief is growing that each of these so-called mental disorders has been found to have a genetic or biologic source, and if it hasnt yet, it soon will. Were constantly on the brink of new scientific discoveries that will finally show proof positive that mental illness is really brain illness.

Ironically however, if and when a genetic or biologic source is found, it wont be called mental illness, and it wont be treated by psychiatrists. Neurology is the medical specialty devoted to the study, diagnosis, and treatment of the diseases of the nervous system, the brain, the spinal cord, and the peripheral nerves. Its not psychiatry that Insurance will pay. Its neurologists that will be paid for the treatment of brain illnesses.

Its an interesting shell game were playing here. Its in the best interest of the APA to keep the illusion of scientific findings alive. The hype about new scientific findings is loud and clearly printed as front-page news. Retractions appear obscurely and quietly on the last page of the newspaper. Just tell the jury to ignore the evidence and the game goes on.

Scott Miller and Barry Duncan on their web site, Institute for the Study of Therapeutic Change (ISTC) have done our homework for us. They have painstakingly scoured the literature and diligently reported flaws in research designs making conclusions frankly erroneous, and they have identified findings that have been blatantly skewed to support the claims of whomever pays for the research. Check it out at wwwtalkingcure.com. (2)

So far weve established that scientific methods can identify the existence of brain illness, but how is the existence of mental illness determined? As it turns out, if your behavior is listed as one of the behaviors the APA has decided to list in this book, the Diagnostic and Statistical Manual of Mental Disorders IV, (3) you qualify for the diagnosis of mental illness.

Someone once told me that mental illness is contagious, but only by word of mouth. More accurately he should have said only by word of book. According to this book, were all mentally ill. Many learned and scholarly people have written brilliant exposes of this book. Joe Sharkey, Youre Not Bad, Youre Sick. Its in the Book The New York Times, September 28, 1997. (4) Check it out.

L. J. Davis refers to the DSM IV as The Encyclopedia of Insanity. This psychological handbook lists a madness for everyone. He writes,

Dr. Thomas Szasz postulates that psychiatry is based on pseudo science not on science, that virtually all psychiatric diagnoses are economic and political claims, serving the interests of psychiatry as a state protected monopoly for the manufacture of pseudo medical euphemisms, and that the diagnostic categories in the DSM are based on politics not on science. So, its politics that makes us sick. I might even agree with that.

An example of the political considerations to which he refers is the deletion of homosexuality from the list of mental disorders in the 1980 version of DSM. Gay rights activists lobbied and rallied against including their sexual orientation as a mental disorder, and the APA caved in to the political pressure by omitting it. Dissension among their own ranks mediated in favor of eliminating the diagnosis. Homosexual psychiatrists quietly fought from behind the scenes to rid themselves of a mental disorder. Szasz, Dr. Thomas (6)

Wouldnt it be nice if we could rally and lobby to get the medical profession to take a vote and eliminate cancer as a deadly disease.

Kutchins and Kirk, Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders, devote a whole chapter in their scholarly book to describing the process through which diagnoses are added to and deleted from the DSM. Were not talking about the one diagnosis of homosexuality here, were talking about a process, an ongoing standardized political procedure for determining what goes, what stays, and what gets added. Kutchins and Kirk (7) So, brain illness is determined by scientific methods, mental illness by vote.

Today, the diagnosis of mental illness is being applied to more people than ever before. How do we count the numbers? In the 1980s the National Institute of Mental Health sponsored an expensive epidemiological study. Its purpose was to estimate the number of mentally ill in the United States. Five university-affiliated research teams interviewed in person almost 2000 randomly selected adults. All the research teams used an interview protocol that probed for the presence or absence of specific mental disorders by following very closely the diagnostic criteria listed in the DSM. According to this study, 24.1 percent of the population or 48.2 million Americans have some kind of mental disorder within a 12-month period.

Whats wrong with this picture? The interviews were based on criteria in the 1980 version of DSM. In 1987, a new version was published altering the criteria for the major disorders. The 1994 version of the DSM made the criteria for the survey two generations out of date. Even if we accept the DSM as the definitive word on what constitutes mental illness, the survey gives a false picture of the numbers. The DSM has grown from identifying about 100 illnesses or disorders eighteen years ago to over 300 certified mental disorders in its fourth edition. It currently has 886 pages describing mental illness and mental disorders. If we used the criteria of the current version of the DSM, the number of people who have some kind of mental disorder within a 12-month period could be a LOT higher. They could be triple the number, or 72.3 percent of our population. See Kutchens and Kirk (7)

Why do we count the numbers? The answer to that one should be easy. Its money. Funding money. Its the old supply and demand scam. Create the illusion of a problem and get real money to solve a fake problem. Today, just about everybody who is having a normal problem of living qualifies for the label of mental illness. John Leo states, The DSM is converting nearly all lifes stresses and bad habits into mental disorders in his article Doing the Disorder Rag, U.S. News and World Report. October 17, 1997.

In their book, Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders Herb Kutchins and Stuart A. Kirk, state the DSM is a handbook that medicalizes problems that are not medical and gives formal diagnostic labels and code numbers to behaviors that are better described as eccentric, irresponsible, foolish, or sinful. See Kutchins and Kirk (7) The test of the validity of DSMs definition of mental disorder is whether it allows us to separate disorders from non-disorders. So much for validity.

Lets look at reliability; the extent to which clinicians can agree on diagnosis from the DSM for their patients. Most of the clinicians I know consider the book to be a joke, unfortunately a very dangerous joke. However, even within the psychiatric community, it is highly likely that the same patient will get a different diagnosis from two different psychiatrists. So much for reliability.

The diagnoses in this book are not based on scientific findings, they not only fail the tests of reliability and validity, and they are dangerous. Each and every diagnosis in this book fails to take into consideration the context within which the behaviors it pathologizes occur. By severing cause from effect, the psychiatric profession has privatized the entire field of mental illness, removed it from the marketplace of ideas, abandoned the rigorous proofs of the scientific method, and adopted circular thinking as its central discipline. In the absence of cause and effect, a mental illness is anything the psychiatric profession chooses to call a mental illness. L.J. Davis Encyclopedia of Insanity (5)

It situates all problems of living squarely in the mental whatever that is of the patient. It blames the victims of poverty, war, abuse, and neglect, and it penalizes people of minority groups by situating their problems inside of them, thus blaming them for not adjusting to circumstances a sane person should not accept.

Check this one out: Reactive Attachment Disorder in Infancy or Early Childhood (313.89) The child shows a pattern of excessively inhibited, hypervigilant, or highly ambivalent responses. Sounds to me like this might be a child who may have good reason not to trust his caregivers; an infant or child who is not getting his basic emotional needs for comfort, stimulation, and affection met. Thirty-five thousand years of human history says that the kid is reacting logically to an intolerable situation. The DSM IV says that the kid, the infant, is not playing with a full deck. (Paraphrased from: L.J.Davis,) (5)

Thus, the disorders listed in this book are based on politics, not science, and it cannot claim validity or reliability. It blames the people it benevolently proports to help for their own problems and challenges them to do some hocus pocus on their mentals, thus; making them crazy. The book doesnt even give a good definition of its premise. Disorder is defined in a convoluted circular manner that makes no sense to anyone with a brain. Check it out, its in the book.

There can however, be no doubt that the DSM and its idea of mental illness are a smashing success. It has been reported that in its first ten months this book brought in eighteen million dollars for the APA.

Why is this book and its one idea so dangerous? Its just a book. It has a right to exist. Its dangerous because its approach and definitions of mental illness are required for those seeking research funding from the National Institute of Mental Health or writing textbooks about abnormal behavior. It is used by attorneys in various matters bearing on competence and culpability. It is used in schools, prisons, welfare offices, and other social agencies grasping for labels and rationales. And, of course, it is on the desks of almost all mental health clinicians.

Its not just insurance Companies that require we use DSM exclusively. The state of Wisconsin requires its use. It may be called a Bible by its critics, but its the only Bible our state acknowledges as the one true Bible. Its use is mandated.

In Wisconsin, the law mandates that all mental health providers who work in the context of a state certified mental health clinic use the DSM to diagnose everyone for whom they provide services, regardless of the theoretical orientation of the provider. Its use is mandated even when people seeking services pay for those services out of their own pockets. Records containing these diagnoses must be kept available for state officials to observe when site checks are done.

It appears the state wants to protect the public. It would be against the law for a therapist to take money for helping a client solve a problem of living if that problem was not defined as a bonafide mental illness according to the states official Bible. (DSM IV) I wonder how many of us would fight if our state required us all to practice the same religion; the one the state decided to call the true and only word of God!

How can this one book with its one idea have so much control over our lives?
Just how powerful is the APA and its idea of mental illness, you might ask. Consider this. In early 1996 the United States House of Representatives and the Senate had unanimously passed a Health Insurance Reform Act that would have allowed workers to change jobs without jeopardizing continuing health insurance coverage. However, at the last minute, senators Domenici and Wellstone added an amendment to the bill jeopardizing the House Senate conference committees ability to reach a compromise on their different versions of the legislation. The amendment proposed that mental health care have parity with physical health care coverage. Result...were still fighting for health care reform. See Kutchins and Kirk (7)

Treatment for brain illness has always been covered by health insurance. Perhaps if we had a reasonable definition for mental illness there wouldnt be so much resistance to parity. If the diagnoses used to identify mental illnesses were at least reasonable, it wouldnt matter so much that theyre not based on scientific methods. If the APA and the drug companies werent so greedy, so anxious to capture the whole market share with their one idea, they could probably get insurance to pay for the treatment of some on a par with physical illness. But, we simply cant all be mentally ill. Who benefits from all this pathologizing?

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