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The Myth of Mental Illness
"You can know the name of a bird in all the languages of the world, but when you are finished, you'll know absolutely nothing whatever about the bird? So let's look at the bird and see what it's doing that's what counts. I learned very early the difference between knowing the name of something and knowing something." Richard Feynman, Physicist and 1965 Nobel Prize laureate (1918-1988) "You have all I dare say heard of the animal spirits and how they are transfused from father to son etcetera etcetera well you may take my word that nine parts in ten of a man's sense or his nonsense, his successes and miscarriages in this world depend on their motions and activities, and the different tracks and trains you put them into, so that when they are once set a-going, whether right or wrong, away they go cluttering like hey-go-mad." Lawrence Sterne (1713-1758), "The Life and Opinions of Tristram Shandy, Gentleman" (1759) 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, self-defeating, and self-destructive 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 (ego-dystonic) 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 anti-psychiatrist, 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 all-inclusive (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 ever-shifting 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. DSM-IV-TR, Washington, 2000] or the DSM-IV-TR for short has come under sustained and serious criticism from its inception in 1952, in the first edition of the DSM. The DSM IV-TR 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 DSM's 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 co-morbidity (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 DSM-IV-TR 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 disorder(s) and their temporal stability from early childhood onwards; The genetic and biological underpinnings of personality disorder(s); 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 drugs, 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 causes-and-effects. 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 clear-cut. 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 symptom-based diagnostic system. As long as the pseudo-medical 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 much-sought 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 society's 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. About The Author Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He is a columnist for Central Europe Review, PopMatters, and eBookWeb , a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory Bellaonline, and Suite101 . Until recently, he served as the Economic Advisor to the Government of Macedonia. Visit Sam's Web site at http://samvak.tripod.com; palma@unet.com.mk
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Alternative Medicine I?m Sorry! Blame-Game or Accountability? A powerful tool for health as we approach the new year can be to focus on giving and/or receiving only real apologies when we want to heal a rift with a family member, friend, or co-worker. We hear apologies all the time, but I don't think many of them are sincere. An apology has to be real to heal. Dogs Use Psycho-Cybernetics To Accomplish Goals Dogs picture in their minds an event of an activity they wish to perform whether it hunting a rodent, greeting their human companions at the door or retrieving a stick. This helps them set goals similar to psycho-cybernetic human intent goal oriented human endeavors. We know dogs do this for two reasons. One, when they sleep their paws move as if they are running. Some might say that this is nervous system reactions, but fRMI scans show these are simultaneously happening with motor areas of the brain. Secondly the memory of motions for dogs is evident in the way they approach problem solving while moving toward an object such as a bone or Frisbee. If the Frisbee is thrown in a standard fashion the dog jumps and takes it the same every time and commits the action to muscle memory, which is an indication of that reflex of motion being done over and over again in its mind. The Joan of Arc Complex Sometimes I think that I have a mental health problem and that at any minute the pharmaceutical companies are going to develop a cute little green star-shaped pill to cure me of my ailment. I call it my Joan of Arc Complex. You see, I hear voices that I'm pretty sure aren't mine and they tell me to go out and do these stupid save the world projects. I call them THEY or THEM because they refuse to give me a more accurate name to call them. So, I must be crazy. Solution Focus Process: Solution Talk vs. Problem Talk Pt I Solution Talk vs. Problem Talk Are All Dementias Alzheimer's ? I'm surprised when some patients and caregivers confuse dementia and Alzheimer's as one and the same. Each time a family member is suffering from memory loss, the conclusion is always Alzheimer's. Is it reasonable to label all dementias as Alzheimer's? Establishing Trust in Grief Management Groups Trust is the basis of all human relationships. Trust can be thought of as a tool that can measure the positive and negative nature of a relationship. The more positive one feels about others in the group, the more likely they are to share feelings, thoughts, ideas and suggestions. Those persons who cannot trust others in the group at even a basis level will have great difficulty functioning in the group. How Big of a Problem is Attention Deficit Hyperactivity Disorder? Attention Deficit Hyperactivity Disorder - "ADD" or "ADHD" - affects between five to ten percent (5% - 10%) of all children in the United States, and three to six percent (3% - 6%) of adults. About 35% of all children referred to mental health clinics are referred for Attention Deficit Hyperactivity Disorder, making it one of the most prevalent of all childhood psychiatric disorders. Do You Love Your Body? Through out the course of one's life one is faced with and accumulates a history of emotional trauma that becomes stored in ones's energy field. Such trauma poses many problems. These include such things as emotional and physical pain, chronic stress, a drain in one's vital life energy and the tendency for the individual to take flight from the physical body. In this article I hope to address the latter, its consequences and a new modality that may be able to reverse this tendency. Birds in the Room Alter Sleep Patterns of Humans Birds have always been considered good pets of modern day humans. It seems our living in close proximity may have given us a closer bond than we know. There are many reports, which have been collected of birds having a psychic connection with their owners. Others poo poo the idea as utter non-sense, but the studies done scientifically seem to prove that there are connections between humans and birds with regards to the normal and natural telepathy abilities of both species. Biometrics ABSTRACT Human Psychological Issues in the Recruitment of Suicide Bombers Swedish Scientists did a study and found that young men with low intelligence scores were more likely to commit suicide. Narcissistic Personality Disorder Tips FIVE DON'T DO'S Fairies and Mental Health Schizophrenics hallucinate alternate realities. People who claim to have been abducted by aliens are accused of having Fantasy Prone Personalities. So what about those of us who claim to be conversing with angels, fairies, and spirit guides? Are we nuts? Absolutely yes! If we weren't crazy before we started chatting with the divine, we soon will be. Just the constant questioning of one's sanity can drive a person insane. How do you know if you are really talking to spirits or if you are losing your mind? Time Out of Mind Let us first consider the role of time in our lives, then let us consider that role in terms of mental illness. Buddhists and Hindus, among others, propose that time does not actually exist. The Western world, however, with its dependence on clocks and deadlines, scoffs at such a notion, relying upon sayings such as "Time is money" and "Time is of the essence." Narcissism, Substance Abuse, and Reckless Behaviours Pathological narcissism is an addiction to Narcissistic Supply, the narcissist's drug of choice. It is, therefore, not surprising that other addictive and reckless behaviours workaholism, alcoholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving piggyback on this primary dependence. No Picnic In Sight Upon being diagnosed with Obsessive-Compulsive Disorder, I saw the reality behind the greatest myth of mental illness, the myth that The Victim Is Unaware of His or Her Own Condition. A childhood flooded with media depictions of the mentally ill had lead me to believe that the afflicted had somehow been robbed of their objectivity, thrown into a dark hall-of-mirrors beyond the realm of rational perspective. The Essence of Being Human What does it mean to be Human? Well if you reflect on your thoughts and behaviors and those of the individuals around you on this planet since the beginning of our existence here I think you will likely come to the conclusion that to wear the label Human is not exactly endearing or desirable. The Psychology of Torture There is one place in which one's privacy, intimacy, integrity and inviolability are guaranteed - one's body, a unique temple and a familiar territory of sensa and personal history. The torturer invades, defiles and desecrates this shrine. He does so publicly, deliberately, repeatedly and, often, sadistically and sexually, with undisguised pleasure. Hence the all-pervasive, long-lasting, and, frequently, irreversible effects and outcomes of torture. Is China Testing Bio Weapons on Its Own People? Well the conspiracy theorists are out in full force I see. I had an interesting meeting the other day at a coffee shop and talked with a highly paranoid chap, who claimed to have some real insider information. He said that the Chinese were experimenting with their own populations with new vaccines for bird flu. He later said that an experiment with the N5H1 strain in a South Eastern province yielded better than expected results and they were forced to quarantine the area and kill thousands of birds and nearly 200 humans. He also said that they made mandatory the vaccination of all families in the vicinity to test their newest vaccine on the N5H1 Bird Flu strain. Mind Over Matter - Proven THE ACTS OF CREATION:
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