Great piece. Two of my favorite substantive critiques:
1. "DSM-5 seems to have no definition of happiness other than the absence of suffering. The normal individual in this book is tranquilized and bovine-eyed..."
The DSM does turn mental disease into an entirely negative subject: you're mentally healthy only if you lack any of the listed disorders. The name "Diagnostic and Statistical Manual" does limit the enterprise contained within, but practically speaking, the DSM is the Bible for mental health professionals. It's the document that describes a substantial portion of how to give care to the mentally sick, and no other document has the same stature.
And yet their Bible contains nothing at all about mental hygiene or positive practices. Consider how odd that is, how it distorts the mental health professions. In the realm of "physical" health, medical doctors speak with unanimity on every medium imaginable about how you should exercise regularly, eat more fruits and vegetables, etc., to stave off cancer, diabetes, heart disease, and an array of other ailments. How often do you hear psychiatrists talk about the importance of working on your empathy and forgiveness skills? N.B.: doing so will make you happier.
Again, cataloguing symptoms is important, but not all-important. DSM sucks all the air out of the room and leads those who study the mind to focus excessively on the neat categorization of symptoms rather than means of staving off mental illness in the first place or of developing admirable virtues like courage, self-discipline, and justice.
2. "On some level we’re to imagine that the American Psychiatric Association is a body with real powers, that the Diagnostic and Statistical Manual is something that might actually be used, and that its caricature of our inner lives could have serious consequences."
We know that the caricatures have serious consequences for millions of people, which ought to horrify us. I've seen the consequences of this kind of over-pathologization up close. I've had several criminal clients who've been seriously affected by faulty prison diagnoses of schizophrenia and bipolar disorder. These faulty diagnoses led to the prescription of the powerfully soporific antipsychotic Risperdal, which turned my clients into physically weak zombies, and, for that reason, into victims of sexual assault. Admittedly this is an extreme example, but it amply demonstrates the power of the DSM.
In the cases I'm thinking of, the patients were labeled paranoid - and ultimately schizophrenic - chiefly because they were angry and believed others were out to harm them. (They did not have hallucinations.)
Their "paranoia" may have had something to do with:
a. being watched 24 hours a day,
b. being chased around by some sociopathic fellow inmates,
c. being subject to the rule of arbitrary and capricious guards,
or perhaps some combination of the 3.
Also, from the prison's perspective, prison is not a nice place, and psychiatric labels and medications are useful for keeping inmates in line.
Comments
Great piece. Two of my favorite substantive critiques:
1. "DSM-5 seems to have no definition of happiness other than the absence of suffering. The normal individual in this book is tranquilized and bovine-eyed..."
The DSM does turn mental disease into an entirely negative subject: you're mentally healthy only if you lack any of the listed disorders. The name "Diagnostic and Statistical Manual" does limit the enterprise contained within, but practically speaking, the DSM is the Bible for mental health professionals. It's the document that describes a substantial portion of how to give care to the mentally sick, and no other document has the same stature.
And yet their Bible contains nothing at all about mental hygiene or positive practices. Consider how odd that is, how it distorts the mental health professions. In the realm of "physical" health, medical doctors speak with unanimity on every medium imaginable about how you should exercise regularly, eat more fruits and vegetables, etc., to stave off cancer, diabetes, heart disease, and an array of other ailments. How often do you hear psychiatrists talk about the importance of working on your empathy and forgiveness skills? N.B.: doing so will make you happier.
Again, cataloguing symptoms is important, but not all-important. DSM sucks all the air out of the room and leads those who study the mind to focus excessively on the neat categorization of symptoms rather than means of staving off mental illness in the first place or of developing admirable virtues like courage, self-discipline, and justice.
2. "On some level we’re to imagine that the American Psychiatric Association is a body with real powers, that the Diagnostic and Statistical Manual is something that might actually be used, and that its caricature of our inner lives could have serious consequences."
We know that the caricatures have serious consequences for millions of people, which ought to horrify us. I've seen the consequences of this kind of over-pathologization up close. I've had several criminal clients who've been seriously affected by faulty prison diagnoses of schizophrenia and bipolar disorder. These faulty diagnoses led to the prescription of the powerfully soporific antipsychotic Risperdal, which turned my clients into physically weak zombies, and, for that reason, into victims of sexual assault. Admittedly this is an extreme example, but it amply demonstrates the power of the DSM.
I understand misdiagnosis of many things, but how do you get misdiagnosed as schizophrenic?
In the cases I'm thinking of, the patients were labeled paranoid - and ultimately schizophrenic - chiefly because they were angry and believed others were out to harm them. (They did not have hallucinations.)
Their "paranoia" may have had something to do with: a. being watched 24 hours a day, b. being chased around by some sociopathic fellow inmates, c. being subject to the rule of arbitrary and capricious guards, or perhaps some combination of the 3.
Also, from the prison's perspective, prison is not a nice place, and psychiatric labels and medications are useful for keeping inmates in line.
I should note that blacks in the general population are disproportionately diagnosed with schizophrenia, and it's probably from overdiagnosis due to race-based misunderstandings. Check out http://www.medscape.com/viewarticle/768391 and this study http://archpsyc.jamanetwork.com/article.aspx?articleid=11510..., which confirms on a small scale what I've seen anecdotally in the prison context