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Unlike pathologists, who determine diseases of the body by way of signs, i.e., externally observable, objective phenomena (elevated body temperature, elevated blood pressure, rashes, etc.), psychiatrists identify diseases of the mind on the basis of symptoms, which are the purely subjective experiences (like intrusive thoughts, dread, paranoia, obsessions and compulsions) that their patients convey to them.
Pathologists seek to explain diseases of the body in terms of underlying biological causes. Psychiatrists, in contrast, do nothing more or less than describe diseases of the mind, and do so with respect to the very subjective experiences, the psychological states and behaviors, reported by their patients that the American Psychiatric Association (APA) has decided comprise these mental diseases.
For example, something that the APA refers to as “Generalized Anxiety Disorder” does not cause the agitation, queasiness, chest aches, and other symptoms typically associated with it.
It is those symptoms.
Generalized Anxiety Disorder is not some underlying entity separate from the symptoms.
As Jonathan Shedler, Clinical Professor in the Department of Psychiatry and Behavioral Sciences at the University of California, notes, a diagnosis of Generalized Anxiety Disorder “means [that] a person has been anxious or worried for six months or longer and it’s bad enough to cause problems—nothing else.” Since the diagnosis “is description, not explanation,” to claim that a person’s “anxiety is caused by generalized anxiety disorder makes as much sense as saying that anxiety is caused by anxiety” (italics original).
The disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), “the bible” of psychiatry, “do not cause anything,” Shedler informs us. “They are not things. They are agreed-upon labels—a kind of shorthand—for describing symptoms” (italics original).
That any of this needs to be spelled out, that it’s even remotely controversial, is due to the fact that psychiatry employs a vocabulary patterned after that of the biological sciences. But a medical diagnosis by a pathologist references the etiology, the physical entities causing disease. Psychiatrists, in conspicuous contrast, don’t deal in etiology at all. Their “diagnoses” do nothing more or less than give a name to the symptoms that their patients relay to them.
The implication is unequivocal: “It’s not that we don’t know” the “causes” of mental disorders “yet. It’s that DSM diagnoses cannot speak to causes, now or ever. The DSM was not designed to speak to causes, only describe effects” (italics original).
Shedler cites a tweet from no less a figure than Allen Frances, the Chair of the DSM-IV, confirming that, essentially, the diagnosis of a “mental disorder” is not a literal diagnosis at all:
“Mental disorders are constructs, not diseases. Descriptive, not explanatory. Helpful in communication/treatment planning, but no claims re causality/homogeneity/clear boundaries. We wrote this in DSM-IV Intro—no one read it.”
Mental disorders are not literal illnesses. They do not, then, exist in any literal sense of that term.
Some within the field are even more blunt, referring to mental illness as a “myth,” a “hoax,” a “fiction” intended to advance economic and political interests. Thomas Szasz, a psychiatrist by training, made an immeasurable impact upon the field of psychiatry 65 years ago with the publication of his seminal work, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Love him or hate him, Szasz’s influence remains to this day impossible to elude. “Psychiatry,” Szasz insists, is “not science. It’s politics and economics…Behavior control, it is not science, it is not medicine.”
Psychiatrists, Szasz says, “represent the officially ‘correct’ views and practices.” In doing so, “they have the ears of our lawyers and legislators, journalists and judges [.]” It’s for these reasons that many refuse to recognize the threat of “psychiatric coercion” for what it is.
Eric Maesel, a psychotherapist, refers to the DSM as “a disease-mongering naming game where collections of disparate painful thoughts and feelings and unwanted or distressing behaviors are given profit-seeking labels.” Actually, he continues, it’s even worse than this, as the DSM’s labels are designed to imply that its disorders have underlying “biological causes,” causes “for which there is no evidence.” Psychiatrists “want us to believe that biological abnormality is at play, so that they can prescribe drugs, without having to frankly say that there are biological abnormalities at play, which might require that they prove their assertions.”
Gary Greenberg is a psychotherapist of several decades who has chronicled the history of abuses that have occurred as the consequence of medicalizing, for economic and ideological purposes, human suffering. In his The Book of Woe: The DSM and the Unmaking of Psychiatry, Greenberg alludes to Samuel Cartwright, a physician who, in 1850, introduced in the pages of a prestigious medical journal a new disease: “drapetomania.”
“Drapes” is the Greek term for “runaway slave.” Drapetomania, then, is the disease, Cartwright asserted, that caused black slaves to run away from their masters. Its main symptom is “absconding from service,” but it could be accompanied by other symptoms like “sulkiness and dissatisfaction just prior to flight.”
Greenberg has no doubts that had the DSM existed in the middle of the 19th century, drapetomania would have been listed among “the charade of diagnostic disorders” of which it’s currently comprised.
He reminds us that from the time that the DSM first made its appearance, in 1952, to as recently as 1973, homosexuality was listed as a “sociopathic personality disorder.” Consequently, gays “underwent countless therapies including electric shocks, years on the couch, behavior modification and surrogate sex.”
Nor was homosexuality dropped from the DSM as a mental disorder because of any new scientific findings but, rather, because of the pressure brought to bear upon the APA by gay rights activists. And, in 1973, at its convention, 5,854 psychiatrists voted to remove it, while 3,810 voted to retain it.
“Mental illness” is not an existent. It is a contrivance, a term of convenience, a label assigned to a menu of behaviors and psychological states that an association of psychiatrists decides is best characterized in the idiom of pathology. While there are undoubtedly scores of well-meaning psychiatrists and others in the mental health field, and while mental health itself is of vital importance, it’s also clear that the concept of “mental illness” can and has served financial and political interests.
Given the proliferation of “mental disorders” listed in the DSM, it is imperative that all people of good faith be aware of all of this.
