The Myth Of Mental Illness

The Myth Of Mental Illness



The Myth of​ Mental Illness
I. Overview
Someone is​ considered mentally ill if
His conduct rigidly and consistently deviates from the​ typical,​ average behaviour of​ all other people in​ his culture and society that fit his profile whether this conventional behaviour is​ moral or​ rational is​ immaterial,​ or
His judgment and grasp of​ objective,​ physical reality is​ impaired,​ and
His conduct is​ not a​ matter of​ choice but is​ innate and irresistible,​ and
His behavior causes him or​ others discomfort,​ and is
Dysfunctional,​ selfdefeating,​ and selfdestructive even by his own yardsticks.
Descriptive criteria aside,​ what is​ the​ essence of​ mental disorders? Are they merely physiological disorders of​ the​ brain,​ or,​ more precisely of​ its chemistry? if​ so,​ can they be cured by restoring the​ balance of​ substances and secretions in​ that mysterious organ? And,​ once equilibrium is​ reinstated is​ the​ illness gone or​ is​ it​ still lurking there,​ under wraps,​ waiting to​ erupt? Are psychiatric problems inherited,​ rooted in​ faulty genes though amplified by environmental factors or​ brought on​ by abusive or​ wrong nurturance?
These questions are the​ domain of​ the​ medical school of​ mental health.
Others cling to​ the​ spiritual view of​ the​ human psyche. They believe that mental ailments amount to​ the​ metaphysical discomposure of​ an unknown medium the​ soul. Theirs is​ a​ holistic approach,​ taking in​ the​ patient in​ his or​ her entirety,​ as​ well as​ his milieu.
The members of​ the​ functional school regard mental health disorders as​ perturbations in​ the​ proper,​ statistically normal,​ behaviours and manifestations of​ healthy individuals,​ or​ as​ dysfunctions. the​ sick individual ill at​ ease with himself egodystonic or​ making others unhappy deviant is​ mended when rendered functional again by the​ prevailing standards of​ his social and cultural frame of​ reference.
In a​ way,​ the​ three schools are akin to​ the​ trio of​ blind men who render disparate descriptions of​ the​ very same elephant. Still,​ they share not only their subject matter but,​ to​ a​ counter intuitively large degree,​ a​ faulty methodology.
As the​ renowned antipsychiatrist,​ Thomas Szasz,​ of​ the​ State University of​ New York,​ notes in​ his article the​ Lying Truths of​ Psychiatry,​ mental health scholars,​ regardless of​ academic predilection,​ infer the​ etiology of​ mental disorders from the​ success or​ failure of​ treatment modalities.
This form of​ reverse engineering of​ scientific models is​ not unknown in​ other fields of​ science,​ nor is​ it​ unacceptable if​ the​ experiments meet the​ criteria of​ the​ scientific method. the​ theory must be allinclusive anamnetic,​ consistent,​ falsifiable,​ logically compatible,​ monovalent,​ and parsimonious. Psychological theories even the​ medical ones the​ role of​ serotonin and dopamine in​ mood disorders,​ for instance are usually none of​ these things.
The outcome is​ a​ bewildering array of​ evershifting mental health diagnoses expressly centred around Western civilisation and its standards example the​ ethical objection to​ suicide. Neurosis,​ a​ historically fundamental condition vanished after 1980. Homosexuality,​ according to​ the​ American Psychiatric Association,​ was a​ pathology prior to​ 1973. Seven years later,​ narcissism was declared a​ personality disorder,​ almost seven decades after it​ was first described by Freud.
II. Personality Disorders
Indeed,​ personality disorders are an excellent example of​ the​ kaleidoscopic landscape of​ objective psychiatry.
The classification of​ Axis II personality disorders deeply ingrained,​ maladaptive,​ lifelong behavior patterns in​ the​ Diagnostic and Statistical Manual,​ fourth edition,​ text revision [American Psychiatric Association. DSMIVTR,​ Washington,​ 2000] or​ the​ DSMIVTR for short has come under sustained and serious criticism from its inception in​ 1952,​ in​ the​ first edition of​ the​ DSM.

The DSM IVTR adopts a​ categorical approach,​ postulating that personality disorders are qualitatively distinct clinical syndromes p. 689. This is​ widely doubted. Even the​ distinction made between normal and disordered personalities is​ increasingly being rejected. the​ diagnostic thresholds between normal and abnormal are either absent or​ weakly supported.

The polythetic form of​ the​ DSMs Diagnostic Criteria only a​ subset of​ the​ criteria is​ adequate grounds for a​ diagnosis generates unacceptable diagnostic heterogeneity. in​ other words,​ people diagnosed with the​ same personality disorder may share only one criterion or​ none.
The DSM fails to​ clarify the​ exact relationship between Axis II and Axis I ​ disorders and the​ way chronic childhood and developmental problems interact with personality disorders.
The differential diagnoses are vague and the​ personality disorders are insufficiently demarcated. the​ result is​ excessive comorbidity multiple Axis II diagnoses.
The DSM contains little discussion of​ what distinguishes normal character personality,​ personality traits,​ or​ personality style Millon from personality disorders.
A dearth of​ documented clinical experience regarding both the​ disorders themselves and the​ utility of​ various treatment modalities.
Numerous personality disorders are not otherwise specified a​ catchall,​ basket category.
Cultural bias is​ evident in​ certain disorders such as​ the​ Antisocial and the​ Schizotypal.
The emergence of​ dimensional alternatives to​ the​ categorical approach is​ acknowledged in​ the​ DSMIVTR itself
An alternative to​ the​ categorical approach is​ the​ dimensional perspective that Personality Disorders represent maladaptive variants of​ personality traits that merge imperceptibly into normality and into one another p. 689
The following issues long neglected in​ the​ DSM are likely to​ be tackled in​ future editions as​ well as​ in​ current research. But their omission from official discourse hitherto is​ both startling and telling
The longitudinal course of​ the​ disorders and their temporal stability from early childhood onwards;
The genetic and biological underpinnings of​ personality disorders;
The development of​ personality psychopathology during childhood and its emergence in​ adolescence;
The interactions between physical health and disease and personality disorders;
The effectiveness of​ various treatments talk therapies as​ well as​ psychopharmacology.
III. the​ Biochemistry and Genetics of​ Mental Health
Certain mental health afflictions are either correlated with a​ statistically abnormal biochemical activity in​ the​ brain or​ are ameliorated with medication. Yet the​ two facts are not ineludibly facets of​ the​ same underlying phenomenon. in​ other words,​ that a​ given medicine reduces or​ abolishes certain symptoms does not necessarily mean they were caused by the​ processes or​ substances affected by the​ ​Drug​ administered. Causation is​ only one of​ many possible connections and chains of​ events.
To designate a​ pattern of​ behaviour as​ a​ mental health disorder is​ a​ value judgment,​ or​ at​ best a​ statistical observation. Such designation is​ effected regardless of​ the​ facts of​ brain science. Moreover,​ correlation is​ not causation. Deviant brain or​ body biochemistry once called polluted animal spirits do exist but are they truly the​ roots of​ mental perversion? Nor is​ it​ clear which triggers what do the​ aberrant neurochemistry or​ biochemistry cause mental illness or​ the​ other way around?
That psychoactive medication alters behaviour and mood is​ indisputable. So do illicit and legal ​Drug​s,​ certain foods,​ and all interpersonal interactions. That the​ changes brought about by prescription are desirable is​ debatable and involves tautological thinking. if​ a​ certain pattern of​ behaviour is​ described as​ socially dysfunctional or​ psychologically sick clearly,​ every change would be welcomed as​ healing and every agent of​ transformation would be called a​ cure.
The same applies to​ the​ alleged heredity of​ mental illness. Single genes or​ gene complexes are frequently associated with mental health diagnoses,​ personality traits,​ or​ behaviour patterns. But too little is​ known to​ establish irrefutable sequences of​ causesandeffects. Even less is​ proven about the​ interaction of​ nature and nurture,​ genotype and phenotype,​ the​ plasticity of​ the​ brain and the​ psychological impact of​ trauma,​ abuse,​ upbringing,​ role models,​ peers,​ and other environmental elements.
Nor is​ the​ distinction between psychotropic substances and talk therapy that clearcut. Words and the​ interaction with the​ therapist also affect the​ brain,​ its processes and chemistry albeit more slowly and,​ perhaps,​ more profoundly and irreversibly. Medicines as​ David Kaiser reminds us in​ Against Biologic Psychiatry Psychiatric Times,​ Volume XIII,​ Issue 12,​ December 1996 treat symptoms,​ not the​ underlying processes that yield them.
IV. the​ Variance of​ Mental Disease
If mental illnesses are bodily and empirical,​ they should be invariant both temporally and spatially,​ across cultures and societies. This,​ to​ some degree,​ is,​ indeed,​ the​ case. Psychological diseases are not context dependent but the​ pathologizing of​ certain behaviours is. Suicide,​ substance abuse,​ narcissism,​ eating disorders,​ antisocial ways,​ schizotypal symptoms,​ depression,​ even psychosis are considered sick by some cultures and utterly normative or​ advantageous in​ others.
This was to​ be expected. the​ human mind and its dysfunctions are alike around the​ world. But values differ from time to​ time and from one place to​ another. Hence,​ disagreements about the​ propriety and desirability of​ human actions and inaction are bound to​ arise in​ a​ symptombased diagnostic system.
As long as​ the​ pseudomedical definitions of​ mental health disorders continue to​ rely exclusively on​ signs and symptoms i. e. ,​ mostly on​ observed or​ reported behaviours they remain vulnerable to​ such discord and devoid of​ muchsought universality and rigor.
V. Mental Disorders and the​ Social Order
The mentally sick receive the​ same treatment as​ carriers of​ AIDS or​ SARS or​ the​ Ebola virus or​ smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication,​ psychosurgery,​ or​ electroconvulsive therapy. This is​ done in​ the​ name of​ the​ greater good,​ largely as​ a​ preventive policy.
Conspiracy theories notwithstanding,​ it​ is​ impossible to​ ignore the​ enormous interests vested in​ psychiatry and psychopharmacology. the​ multibillion dollar industries involving ​Drug​ companies,​ hospitals,​ managed healthcare,​ private clinics,​ academic departments,​ and law enforcement agencies rely,​ for their continued and exponential growth,​ on​ the​ propagation of​ the​ concept of​ mental illness and its corollaries treatment and research.
VI. Mental Ailment as​ a​ Useful Metaphor
Abstract concepts form the​ core of​ all branches of​ human knowledge. No one has ever seen a​ quark,​ or​ untangled a​ chemical bond,​ or​ surfed an electromagnetic wave,​ or​ visited the​ unconscious. These are useful metaphors,​ theoretical entities with explanatory or​ descriptive power.
Mental health disorders are no different. They are shorthand for capturing the​ unsettling quiddity of​ the​ Other. Useful as​ taxonomies,​ they are also tools of​ social coercion and conformity,​ as​ Michel Foucault and Louis Althusser observed. Relegating both the​ dangerous and the​ idiosyncratic to​ the​ collective fringes is​ a​ vital technique of​ social engineering.
The aim is​ progress through social cohesion and the​ regulation of​ innovation and creative destruction. Psychiatry,​ therefore,​ is​ reifies societys preference of​ evolution to​ revolution,​ or,​ worse still,​ to​ mayhem. as​ is​ often the​ case with human endeavour,​ it​ is​ a​ noble cause,​ unscrupulously and dogmatically pursued.
VII. the​ Insanity Defense
It is​ an ill thing to​ knock against a​ deafmute,​ an imbecile,​ or​ a​ minor. He that wounds them is​ culpable,​ but if​ they wound him they are not culpable. Mishna,​ Babylonian Talmud
If mental illness is​ culturedependent and mostly serves as​ an organizing social principle what should we make of​ the​ insanity defense NGRI Not Guilty by Reason of​ Insanity?
A person is​ held not responsible for his criminal actions if​ s/he cannot tell right from wrong lacks substantial capacity either to​ appreciate the​ criminality wrongfulness of​ his conduct diminished capacity,​ did not intend to​ act the​ way he did absent mens rea and/or could not control his behavior irresistible impulse. These handicaps are often associated with mental disease or​ defect or​ mental retardation.
Mental health professionals prefer to​ talk about an impairment of​ a​ persons perception or​ understanding of​ reality. They hold a​ guilty but mentally ill verdict to​ be contradiction in​ terms. All mentallyill people operate within a​ usually coherent worldview,​ with consistent internal logic,​ and rules of​ right and wrong ethics. Yet,​ these rarely conform to​ the​ way most people perceive the​ world. the​ mentallyill,​ therefore,​ cannot be guilty because s/he has a​ tenuous grasp on​ reality.
Yet,​ experience teaches us that a​ criminal maybe mentally ill even as​ s/he maintains a​ perfect reality test and thus is​ held criminally responsible Jeffrey Dahmer comes to​ mind. the​ perception and understanding of​ reality,​ in​ other words,​ can and does coexist even with the​ severest forms of​ mental illness.
This makes it​ even more difficult to​ comprehend what is​ meant by mental disease. if​ some mentally ill maintain a​ grasp on​ reality,​ know right from wrong,​ can anticipate the​ outcomes of​ their actions,​ are not subject to​ irresistible impulses the​ official position of​ the​ American Psychiatric Association in​ what way do they differ from us,​ normal folks?
This is​ why the​ insanity defense often sits ill with mental health pathologies deemed socially acceptable and normal such as​ religion or​ love.
Consider the​ following case
A mother bashes the​ skulls of​ her three sons. Two of​ them die. She claims to​ have acted on​ instructions she had received from God. She is​ found not guilty by reason of​ insanity. the​ jury determined that she did not know right from wrong during the​ killings.
But why exactly was she judged insane?
Her belief in​ the​ existence of​ God a​ being with inordinate and inhuman attributes may be irrational.
But it​ does not constitute insanity in​ the​ strictest sense because it​ conforms to​ social and cultural creeds and codes of​ conduct in​ her milieu. Billions of​ people faithfully subscribe to​ the​ same ideas,​ adhere to​ the​ same transcendental rules,​ observe the​ same mystical rituals,​ and claim to​ go through the​ same experiences. This shared psychosis is​ so widespread that it​ can no longer be deemed pathological,​ statistically speaking.
She claimed that God has spoken to​ her.
As do numerous other people. Behavior that is​ considered psychotic paranoidschizophrenic in​ other contexts is​ lauded and admired in​ religious circles. Hearing voices and seeing visions auditory and visual delusions are considered rank manifestations of​ righteousness and sanctity.
Perhaps it​ was the​ content of​ her hallucinations that proved her insane?
She claimed that God had instructed her to​ kill her boys. Surely,​ God would not ordain such evil?
Alas,​ the​ Old and New Testaments both contain examples of​ Gods appetite for human sacrifice. Abraham was ordered by God to​ sacrifice Isaac,​ his beloved son though this savage command was rescinded at​ the​ last moment. Jesus,​ the​ son of​ God himself,​ was crucified to​ atone for the​ sins of​ humanity.
A divine injunction to​ slay ones offspring would sit well with the​ Holy Scriptures and the​ Apocrypha as​ well as​ with millenniaold JudeoChristian traditions of​ martyrdom and sacrifice.
Her actions were wrong and incommensurate with both human and divine or​ natural laws.
Yes,​ but they were perfectly in​ accord with a​ literal interpretation of​ certain divinelyinspired texts,​ millennial scriptures,​ apocalyptic thought systems,​ and fundamentalist religious ideologies such as​ the​ ones espousing the​ imminence of​ rupture. Unless one declares these doctrines and writings insane,​ her actions are not.
we are forced to​ the​ conclusion that the​ murderous mother is​ perfectly sane. Her frame of​ reference is​ different to​ ours. Hence,​ her definitions of​ right and wrong are idiosyncratic. to​ her,​ killing her babies was the​ right thing to​ do and in​ conformity with valued teachings and her own epiphany. Her grasp of​ reality the​ immediate and later consequences of​ her actions was never impaired.
It would seem that sanity and insanity are relative terms,​ dependent on​ frames of​ cultural and social reference,​ and statistically defined. There isnt and,​ in​ principle,​ can never emerge an objective,​ medical,​ scientific test to​ determine mental health or​ disease unequivocally.
VIII. Adaptation and Insanity correspondence with Paul Shirley,​ MSW
Normal people adapt to​ their environment both human and natural.
Abnormal ones try to​ adapt their environment both human and natural to​ their idiosyncratic needs/profile.
If they succeed,​ their environment,​ both human society and natural is​ pathologized.




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