THE MYTH OF MENTAL ILLNESS

What are we to do when under threat of being found out as unworthy? Believing ourselves to be unworthy, our only choice is between exile, suicide, or madness, since none of us will admit to companions that we are unworthy. After all, those who admit that they are unworthy are certain to be abandoned –an unacceptable fate. Some choose exile, some choose suicide, some choose madness.

But how can we convince others that we are mad? There’s only one way to do this — act-as-if we have lost control of our senses or muscles. By pretending to be out of control we convince our companions that we are helpless, believing, as we do, that the helpless are supported while the unworthy are abandoned. It has ever been so that those who cannot support themselves are supported by others, if, that is, they are worthwhile. If not, they are abandoned.

But acting-as-if-mad in a convincing manner is not easily accomplished. The smarter, more knowledgeable, and more capable a person is, the more convincing the pretense. Acting-as-if-mad takes a lot of practice. Not only that, but the more we understand the social context in which we act-as-if-mad, the more convincing is our action. Madness, of whatever kind, is always embedded in an actual social context. Both the kind of madness displayed, and the degree in which it is displayed, are entirely dependent on the actual social context in which it occurs. Let us, then, examine the idea of social context.

In the mid-50s an anthropologist, Gregory Bateson, and a communication analyst, Jay Haley, said that madness takes place in a social context. Madness, they advised, is a person’s action that is precisely relevant to the immediate social context in which the action is witnessed. In their view madness entails relationship-defining-tactics employed in double-bind-situations. A powerful pair, this, requiring, as it must, both tactical precision and insightful immediacy. The question of madness, had, at last, come to a turning point, at which point either going forward or going backward was forestalled.

And it was at this turning point that the-then two practices, “clinical psychiatry” and “clinical psychology” took off in opposite directions — psychiatry into physiology, psychology into sociology, clinicians of either kind thenceforth having little to do with academics of either kind. Clinical psychiatrists then advising that certain drugs be taken; clinical psychologists then advising certain actions be taken — some drugging “patients” others counseling “clients” — the twain never to meet again.

Some actions are deemed mad, that is, violate local norms. Elsewhere, however, these same actions do not violate local norms, and so are not deemed mad. Can the same be said of thoughts and feelings? Can a dream, however bizarre it may be, violate norms? Can the words one speaks to oneself, again however bizarre, violate norms? They cannot, this because norms are agreements on conventional, customary, or traditional actions, while there cannot be such thoughts or feelings, fleeting as they are, to agree upon. Only actions can be deemed mad.

The more intelligent the person, the more effective the person’s madness, this idea making madness more understandable and corrective counseling more possible. Prior to this, madness could neither be understood nor corrected. Not, take note, that those undertaking counseling did not believe they understood the sort of madness they counseled; nor that they did not believe that their counseling worked. Indeed, each counselor was probably convinced that he did understand the sort of madness he specialized in counseling, as well as why his method of counseling now and then seemed to get results.

So, in the late 1950s, several counselors, assuming that madness was situational, devised new counseling methods which were quickly latched onto by other counselors, the latter increasingly aware that madness is a social event and that their relationship with their clients is crucial to effective counseling. Thus corrective counseling advanced steadily for the rest of the 20^th century.

The Emperor’s New Clothes

Hans Christian Anderson told of an Emperor who concealed his stupidity beneath the finest clothes he could buy. Hearing of this, two swindlers, claiming to be weavers of the finest cloth, convinced the Emperor to hire them to weave some clothes for him. However, they warned him that the clothes they created were invisible to persons who are stupid. So he hired them and they pretended to weave his new clothes, spending a great deal of the emperor’s money on gold and silk thread with which to weave cloth. When they were finished they draped him in his new finery, exclaiming how beautiful his new clothes were and how grand his appearance. Of course he saw no clothes, but wishing not to reveal his stupidity, also praised his new clothes. His ministers, also failing to see his clothes, did likewise. He and his ministers then went on parade to show his people his beautiful new clothes. All of them, wishing not to reveal their own stupidity while finding out which neighbors were stupid, praised the Emperor’s new clothes. Then a little boy shouted “but he has nothing on!” This was whispered from person to person until all were shouting that the emperor had nothing on.

Thomas Szasz, a professor of psychiatry, like the little boy who said the emperor had no clothing on, said that mental illness is a myth. By mid-century the medics had convinced the public that mental illness was epidemic in the United States and that it should be treated with drugs and surgery. In 1994 The American Psychiatric Association published the fourth edition of The Diagnostic and Statistical Manual of Mental Disorders. Millions of copies of manual (“DSM IV”) were sold, resulting in huge profits for the American Psychiatric Association. The first manual of mental disorders (DSM I), was published in 1952. It classified the many differing reactions to stress, thereby reflecting the views of Adolf Meyer. The second manual (DSM II), published in 1978, though little different from DSM I, dropped the word ‘reaction’ (and thus the influence of Adolf Meyer), leaving the word disorder in place. The third manual (DSM III), published in 1980, differed little from the previous version, though the so-called “mental disorders” were regrouped on differing “axes” along with a myriad of “general medical conditions.” Too bad, but neither “mental disorders” nor “general medical conditions” were defined, leaving the more inquisitive readers wondering what was going on. The attempted definition of both words¾“general-medical-conditions” and “mental-disorders” failed, the writer saying that “these are merely terms of convenience and should not be taken to imply that there is any fundamental distinction between mental disorders and general medical conditions…” (page xxv, DSM IV).

By claiming that mental defect—illness, disease, disorder—was a medical domain, psychiatry identified itself as one of many medical practices. The psychiatric manuals (1952, 1978, 1980, 1994), though starting with a focus on mental reactions, shifted to a focus on mental conditions, referring to them as “general medical conditions,” thus construing mental problems as subject to medical practice.  Psychiatry never recovered from the shift.

But politicians, journalists, lawyers, and judges ingested and (seemingly) digested the whole mess. Unfortunately the mess was indigestible, such that politicians, journalists, lawyers, and judges suffered over half a century of indigestion.

Four men powerfully revealed the deceit—Szasz, Glasser, Siebert, and Rosenahan. Szasz wrote 30 books, while Glasser and Siebert each wrote several books, each about the indigestibility of the APA manual. But Rosenhan, decapitated psychiatry by demonstrating empirically—beyond a shadow of doubt—that persons said to be “insane” cannot be distinguished from others by anybody in an insane asylum.