Psychiatry's sick compulsion: turning weaknesses into diseases - Los Angeles Times

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HOW WE LIVE

Psychiatry's sick compulsion: turning weaknesses into diseases

By Irwin Savodnik

Irwin Savodnik is a psychiatrist and philosopher who teaches at UCLA.

January 1, 2006

IT'S JAN. 1. Past time to get your inoculation against seasonal affective

disorder, or SAD — at least according to the American Psychiatric Assn. As

Americans rush to return Christmas junk, bumping into each other in Macy's

and Best Buy, the psychiatric association ponders its latest iteration of

feeling bad for the holidays. And what is the association selling? Mental

illness. With its panoply of major depression, dysthymic disorder, bipolar

disorder and generalized anxiety disorder, the association is waving its

Calvinist flag to remind everyone that amid all the celebration, all the

festivities, all the exuberance, many people will " come down with " or

" contract " or " develop " some variation of depressive illness.

The association specializes in turning ordinary human frailty into disease.

In the last year, ads have been appearing in psychiatric journals about

possible treatments for shyness, a " syndrome " not yet officially recognized

as a disease. You can bet it will be in the next edition of the Diagnostic

and Statistical Manual of Mental Disorders, or DSM-IV, published by the

association. As it turns out, the association has been inventing mental

illnesses for the last 50 years or so. The original diagnostic manual

appeared in 1952 and contained 107 diagnoses and 132 pages, by my count.

The second edition burst forth in 1968 with 180 diagnoses and 119 pages. In

1980, the association produced a 494-page tome with 226 conditions. Then,

in 1994, the manual exploded to 886 pages and 365 conditions, representing

a 340% increase in the number of diseases over 42 years.

Nowhere in the rest of medicine has such a proliferation of categories

occurred. The reason for this difference between psychiatry and other

medical specialties has more to do with ideology than with science. A brief

peek at both areas makes this point clear. All medicine rests on the

premise that disease is a manifestation of diseased tissue. Hepatitis comes

down to an inflamed liver, while lung tissue infiltrated with pneumococcus

causes pneumonia. Every medical student learns this principle. Where,

though, is the diseased tissue in psychopathological conditions?

Unlike the rest of medicine, psychiatry diagnoses behavior that society

doesn't like. Yesterday it was homosexuality. Tomorrow it will be

homophobia. Someone who declares himself the messiah, who insists that

fluorescent lights talk to him or declares that she's the Virgin , is

an example of such behavior. Such people are deemed — labeled, really —

sick by psychiatrists, and often they are taken off to hospitals against

their will. The " diagnosis " of such " pathological behavior " is based on

social, political or aesthetic values.

This is confusing. Behavior cannot be pathological (or healthy, for that

matter). It can simply comport with, or not comport with, our nonmedical

expectations of how people should behave. Analogously, brains that produce

weird or obnoxious behaviors are not diseased. They are brains that produce

atypical behaviors (which could include such eccentricities as dyed hair or

multiple piercings or tattoos that nobody in their right mind could find

attractive).

Lest one think that such a view is the rant of a Scientologist, it is no

such thing. Scientology offers polemic to lull the faithful into belief.

Doctors and philosophers offer argument to provoke debate.

It's a natural step from using social and political standards to create a

psychiatric diagnosis to using them to influence public policy.

Historically, that influence has appeared most dramatically in the insanity

defense. Remember Dan White, the man who murdered San Francisco Mayor

Moscone and Supervisor Harvey Milk in 1978? Or Hinckley, who

shot President Reagan in 1981? Or Mark Chapman, who killed

Lennon? White, whose psychiatrist came up with the " Twinkie defense " — the

high sugar content of White's favorite junk food may have fueled his

murderous impulses — was convicted and paroled after serving five years,

only to commit suicide a year later.

The erosion of personal responsibility is, arguably, the most pernicious

effect of the expansive role psychiatry has come to play in American life.

It has successfully replaced huge chunks of individual accountability with

diagnoses, clinical histories and what turn out to be pseudoscientific

explanations for deviant behavior.

Pathology has replaced morality. Treatment has supplanted punishment.

Imprisonment is now hospitalization. From the moral self-castigation we

find in the writings of , we have been drawn to Woody -style

neuroses. Were the psychiatric association to scrutinize itself more deeply

and reconsider its expansionist diagnostic programs, it would, hopefully,

make a positive contribution to our culture by not turning the good and bad

into the healthy and the sick.

The last thing the United States needs is more self-indulgent,

pseudo-insightful, overly self-conscious babble about people who can't help

themselves. Better, as Voltaire would put it, to cultivate our gardens and

be accountable for who and what we are.

--------------------------------------------------------

Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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" Just look at us. Everything is backwards; everything is upside down.

Doctors destroy health, lawyers destroy justice, universities destroy

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and religions destroy spirituality " .... Ellner