|
|
Does
Mental Illness Exist?
by Lawrence Stevens, J.D.
All diagnosis and treatment in psychiatry, especially biological
psychiatry, presupposes the existence of something called mental
illness, also known as mental disease or mental disorder. What
is meant by disease, illness, or disorder? In
a semantic sense
disease means simply dis-ease,
the opposite of ease. But by
disease we don't mean anything that causes a lack of ease,
since
this definition would mean losing one's job or a war or economic
recession or an argument with one's spouse qualifies as
"disease". In his book Is Alcoholism Hereditary?
psychiatrist
Donald W. Goodwin, M.D., discusses the definition of disease and
concludes "Diseases are something people see doctors for.
...
Physicians are consulted about the problem of alcoholism and
therefore alcoholism becomes, by this definition, a disease"
(Ballantine Books, 1988, p. 61). Accepting this definition,
if
for some reason people consulted physicians about how to get the
economy out of recession or how to solve a disagreement with
one's mate or a bordering nation, these problems would also
qualify as disease. But clearly this is not what is meant
by
"disease". In his discussion of the definition
of disease, Dr.
Goodwin acknowledges there is "a narrow definition of disease
that requires the presence of a biological abnormality" (ibid).
In this pamphlet I will show that there are no biological
abnormalities responsible for so-called mental illness, mental
disease, or mental disorder, and that therefore mental illness
has no biological existence. Perhaps more importantly,
however,
I will show that mental illness also has no non-biological exis-
tence - except in the sense that the term is used to indicate
disapproval of some aspect of a person's mentality.
The idea of mental
illness as a biological entity is easy to
refute. In 1988, Seymour S. Kety, M.D., Professor Emeritus
of
Neuroscience in Psychiatry, and Steven Matthysse, Ph.D.,
Associate Professor of Psychobiology, both of Harvard Medical
School, said "an impartial reading of the recent literature
does
not provide the hoped-for clarification of the catecholamine
hypotheses, nor does compelling evidence emerge for other
biological differences that may characterize the brains of
patients with mental disease" (The New Harvard Guide to
Psy-
chiatry, Harvard Univ. Press, p. 148). In 1992 a panel
of
experts assembled by the U.S. Congress Office of Technology
Assessment concluded: "Many questions remain about the biology
of
mental disorders. In fact, research has yet to identify
specific
biological causes for any of these disorders. ... Mental
disorders are classified on the basis of symptoms because there
are as yet no biological markers or laboratory tests for them"
(The Biology of Mental Disorders, U.S. Gov't Printing Office,
1992, pp. 13-14, 46-47). In his book The Essential Guide
to
Psychiatric Drugs, Columbia University psychiatry professor
Jack
M. Gorman, M.D., said "We really do not know what causes
any
psychiatric illness" (St. Martin's Press, 1990, p. 316).
In his
book The New Psychiatry another Columbia University psychiatry
professor, Jerrold S. Maxmen, M.D., said "It is generally
unrecognized that psychiatrists are the only medical specialists
who treat disorders that, by definition, have no definitively
known causes or cures. ... A diagnosis should indicate the cause
of a mental disorder, but as discussed later, since the etiolo-
gies of most mental disorders are unknown, current diagnostic
systems can't reflect them" (Mentor, 1985, pp. 19 & 36
- emphasis
in original). In his book Toxic Psychiatry, psychiatrist
Peter
Breggin, M.D., said "there is no evidence that any of the
common
psychological or psychiatric disorders have a genetic or biolog-
ical component" (St. Martin's Press, 1991, p. 291).
It is sometimes
argued that psychiatric drugs "curing"
(stopping) the thinking, emotions, or behavior that is called
mental illness proves the existence of biological causes of
mental illness. This argument is easily refuted: Suppose
someone
was playing the piano and you didn't like him doing that.
Suppose you forced or persuaded him to take a drug that disabled
him so severely that he couldn't play the piano anymore. Would
this prove his piano playing was caused by a biological
abnormality that was cured by the drug? As senseless as
this
argument is, it is often made. Most if not all psychiatric
drugs
are neurotoxic, producing a greater or lesser degree of
generalized neurological disability. So they do stop
disliked
behavior and may mentally disable a person enough he can no
longer feel angry or unhappy or "depressed". But
calling this a
"cure" is absurd. Extrapolating from this that
the drug must
have cured an underlying biological abnormality that was causing
the disliked emotions or behavior is equally absurd.
When confronted with the lack of evidence for their
belief
in mental illness as a biological entity, some defenders of the
concept of mental illness will assert that mental illness can
exist and can be defined as a "disease" without there
being a
biological abnormality causing it. The idea of mental illness
as
a nonbiological entity requires a more lengthy refutation than
the biological argument.
People are thought
of as mentally ill only when their
thinking, emotions, or behavior is contrary to what is considered
acceptable, that is, when others (or the so-called patients
themselves) dislike something about them. One way to show
the
absurdity of calling something an illness not because it is
caused by a biological abnormality but only because we dislike
it
or disapprove of it is to look at how values differ from one
culture to another and how values change over time.
In his book
The Psychology of Self-Esteem, Nathaniel
Branden, Ph.D., a psychologist, wrote: "One of the prime
tasks of
the science of psychology is to provide definitions of mental
health and mental illness. ...But there is no general agreement
among psychologists and psychiatrists about the nature of mental
health or mental illness - no generally accepted definitions,
no
basic standard by which to gauge one psychological state or
other. Many writers declare that no objective definitions
and
standards can be established - that a basic, universally
applicable concept of mental health is impossible. They
assert
that, since behavior which is regarded as healthy or normal in
one culture may be regarded as neurotic or aberrated in another,
all criteria are a matter of `cultural bias.' The theorists
who
maintain this position usually insist that the closest one can
come to a definition of mental health is: conformity to cultural
norms. Thus, they declare that a man is psychologically
healthy
to the extent that he is `well-adjusted' to his culture. ... The
obvious questions that such a definition raises, are: What if
the
values and norms of a given society are irrational? Can
mental
health consist of being well-adjusted to the irrational? What
about Nazi Germany, for instance? Is a cheerful servant
of the
Nazi state - who feels serenely and happily at home in his social
environment - an exponent of mental health? "(Bantam Books,
1969,
pp. 95-96, emphasis in original). Dr. Branden is doing several
things here: First, he is confusing morality and rationality,
saying that respect for human rights is rational when in fact
it
is not a question of rationality but rather of morality. So
psychologically and emotionally locked into and blinded by his
values is he that Dr. Branden is evidently incapable of seeing
the difference. Additionally, Dr. Branden is stating some
of his
values. Among these values are: Respect for human rights is good;
violation of human rights (like Naziism) is bad. And he
is
saying: Violating these values is "irrationality" or
mental
illness. Although their practitioners won't admit it and
often
are not even aware of it, psychiatry and "clinical"
psychology in
their very essence are about values - values concealed under a
veneer of language that makes it sound like they are not
furthering values but promoting "health". The
answer to the
question Dr. Branden poses is: A person living in Nazi Germany
and well-adjusted to it was "mentally healthy"
judged by the
values of his own society. Judged by the values of a society
which respects human rights he was as sick (metaphorically
speaking) as the rest of his culture. A person like myself
however says that such a person is morally "sick" and
recognizes
that the word sick has not its literal but a metaphorical
meaning. To a person like Dr. Branden who believes in the
myth
of mental illness, such a person is literally sick and
needs a
doctor. The difference is that a person like myself
is recog-
nizing my values for what they are: morality. Typically,
the
believer in mental illness, such as Dr. Branden in this quoted
passage, has the same values as I do but is confusing them with
health.
One of the most
telling examples is homosexuality, which was
officially defined as a mental disease by the American
Psychiatric Association until 1973 but hasn't been since then.
Homosexuality was defined as a mental disorder on page 44 of the
American Psychiatric Association's standard reference book,
DSM-II: Diagnostic and Statistical Manual of Mental Disorders
(the 2nd Edition), published in 1968. In that book,
"Homosexuality" is categorized as one of the "Sexual
deviations"
on page 44. In 1973 the American Psychiatric Association
voted
to remove homosexuality from it's official diagnostic categories
of mental illness. (See "An Instant Cure",
Time magazine, April
1, 1974, p. 45). So when the third edition of this book
was
published in 1980 it said "homosexuality itself is not considered
a mental disorder" (p. 282). The 1987 edition of The
Merck
Manual of Diagnosis and Therapy states: "The American
Psychiatric
Association no longer considers homosexuality a psychiatric
disease" (p. 1495). If mental illness were really an
illness in
the same sense that physical illnesses are illnesses, the idea
of
deleting homosexuality or anything else from the categories of
illness by having a vote would be as absurd as a group of
physicians voting to delete cancer or measles from the concept
of
disease. But mental illness isn't "an illness
like any other
illness." Unlike physical disease where there are physical
facts
to deal with, mental "illness" is entirely a question
of values,
of right and wrong, of appropriate versus inappropriate. At
one
time homosexuality seemed so weird and hard to understand it was
necessary to invoke the concept of mental disease or mental
illness to explain it. After homosexuals made a big enough
spectacle of themselves and showed their "strength in numbers"
and successfully demanded at least a small measure of social
acceptance, it was no longer necessary and no longer seemed
appropriate to explain homosexuality as a disease.
A cross-cultural
example is suicide. In many countries,
such as the United States and Great Britain, a person who commits
suicide or attempts to do so or even thinks about it seriously
is
considered mentally ill. However, this has not always been
true
throughout human history, nor is it true today in all cultures
around the world. In his book Why Suicide?, psychologist
Eustace
Chesser points out that "Neither Hinduism nor Buddhism have
any
intrinsic objections to suicide and in some forms of Buddhism
self-incineration is believed to confer special merit." He
also
points out that "The Celts scorned to wait for old age and
enfeeblement. They believed that those who committed suicide
before their powers waned went to heaven, and those who died of
sickness or became senile went to hell - an interesting reversal
of Christian doctrine" (Arrow Books Ltd., London, England,
1968,
p. 121-122). In his book Fighting Depression, psychiatrist
Harvey M. Ross, M.D., points out that "Some cultures expect
the
wife to throw herself on her husband's funeral pyre" (Larchmont
Books, 1975, p. 20). Probably the best known example of
a
society where suicide is socially acceptable is Japan. Rather
than thinking of suicide or "hara-kiri" as the Japanese
call it
as almost always caused by a mental disease or illness, the
Japanese in some circumstances consider suicide the normal,
socially acceptable thing to do, such as when one "loses
face" or
is humiliated by some sort of failure. Another example showing
suicide is considered normal, not crazy, in Japanese eyes is the
kamikaze pilots Japan used against the U.S. Navy in World War
II.
They were given enough fuel for a one-way trip, a suicide
mission, to where the attacking U.S. Navy forces were located
and
deliberately crashed their airplanes into the enemy ships. There
has never been an American kamikaze pilot, at least, none
officially sponsored by the United States government. The
reason
for this is different attitudes about suicide in Japan and
America. Could suicide be committed only by people with
psychiatric illnesses in America and yet be performed by normal
persons in Japan? Or is acceptance of suicide in Japan a
failure
or refusal to recognize the presence of psychological
abnormalities which necessarily must be present for a person to
voluntarily end his or her own life? Were the kamikaze pilots
mentally ill, or did they and the society they come from simply
have different values than we do? Even in America, aren't
virtually suicidal acts done for the sake of one's fellow
soldiers or for one's country during wartime thought of not as
insanity but as bravery? Why do we think of such persons
as
heros rather than lunatics? It seems we condemn (or "diagnose")
suicidal people as crazy or mentally ill only when they end their
own lives for selfish reasons (the "I can't take it any more"
kind of reasons) rather than for the benefit of other people.
The real issue seems to be selfishness rather than suicide.
What these examples
show is that "mental illness" is simply
deviance from what people want or expect in any particular
society. "Mental illness" is anything in human mentality
greatly
disliked by the person describing it.
The situation
was aptly summed up in an article in the
November 1986 Omni magazine: "Disorders come and go.
Even
Sigmund Freud's concept of neurosis was dropped in the original
DSM-III (1980). And in 1973 APA [American Psychiatric
Association] trustees voted to wipe out almost all references
to
homosexuality as a disorder. Before the vote, being gay
was
considered a psychiatric problem. After the vote the disorder
was relegated to psychiatry's attic. `It's a matter of fashion,'
says Dr. John Spiegel of Brandeis University, who was president
of the APA in 1973, when the debate over homosexuality flared.
`And fashions keep changing'" (p. 30).
What is wrong
with this approach is describing people as
having a psychiatric "disease" or "illness"
only because he or
she doesn't match up with a supposed diagnostician's or with
other people's idea of how a person "should" be in standards
of
dress, behavior, thinking, or opinion. When it involves
violating the rights of others, nonconformity with social norms
or values must be curbed or stopped with various measures,
criminal law being one example. But calling nonconformity
or
disliked behavior a "disease" or assuming it must be
caused by a
disease only because it is unacceptable according to currently
prevailing values makes no sense. What causes us to do this
is
not knowing the real reasons for the thinking, emotions,
or
behavior we dislike. When we don't understand the real reasons,
we create myths to provide an explanation. In prior centuries
people used myths of evil spirit or demon possession to explain
unacceptable thinking or behavior. Today most of us instead
believe in the myth of mental illness. Believing in mythological
entities such as evil spirits or mental illnesses gives an
illusion of understanding, and believing a myth is more comfort-
able than acknowledging ignorance.
Calling disapproved
thinking, emotions, or behavior a mental
illness might be excusable if mental illness was a useful myth,
but it isn't. Rather than helping us deal with troubled
or
troublesome persons, the myth of mental illness distracts us from
the real problems that need to be faced. Rather than being
caused by a "chemical imbalance" or other biological
problem, the
nonconformity, misbehavior, and emotional reactions we call
mental illness are the result of difficulties people have getting
their needs met and the behavior some people have learned
during
their lifetimes. The solutions are teaching people how to
get
their needs met, how to behave, and using whatever powers of
enforcement are needed to force people to respect the rights of
others. These are the tasks of education and law enforcement,
not medicine or therapy.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice
has included representing psychiatric "patients". He
has published
a series of pamphlets about various aspects of psychiatry,
including psychiatric drugs, electroshock, and psychotherapy.
His pamphlets are not copyrighted. You are invited to make
copies
for distribution to those you think will benefit.