DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS
The Diagnostic And Statistical Manual of Mental Disorders (DSM) is published by the American Psychological Association (APA) and is a leading authority on the diagnostic criteria of mental disorders by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers. The enormous influence that this manual has in the structure of our society is almost immanent by now, and perhaps there is no mistake that 1 in every 5 of American adults are being taken care of (and presumably medicated), in the name of “mental illness.”
What does this reflect about our society? Do we simply have better knowledge to identify these mental disorders and treat them? Is our society become a psychological burden on others? Perhaps, we could even be in a government and corporate-bonding bureaucratic mess that is driven by greed, and plays on the minor psychological inadequacies that are inherit in all of humanity?
Or maybe even all of the above. American society and culture is largely hedonist. It could be said that we cover up our psychological inadequacies through our pursuit of pleasure, material things, entertainment, social status, and money. This is especially true in industrialized nations. For those of us that can’t fulfill our craving strictly through indulgence in the pleasant life (not many can, but some are good at hiding or believing they can), than we are subject to the emergence of psychological distress and suffering. Throughout the century, western psychology has rapidly grown and evolved in response to this growing demand to alleviate these distresses.
The DSM-IV-TR is the latest edition of the Diagnostic And Statistical Manual Of Mental Disorders. It is divided into five different categories depending on the nature of the illness. Some biologists, evolutionary psychologists, and philosophers like Leda Cosmides, Stephen Stich, and John Tooby, have argued that there is a “symptomatological bias”, to the DSM because it does not distinguish between genuine cognitive malfunctions (in the brain) and those induced by psychological adaptations (learned behaviors).
There has also been argued to be a reductionist bias in the DSM diagnostic approach towards mental illness, in the sense that diagnosis of mental illnesses sometimes fail to take into consideration the phenomenological, environmental and cultural factors that go into one’s mental health. In response to this, the 2008 American Psychological Association President Stephen Sharfstein released a statement saying psychiatrists had “allowed the biopsychosocial model to become the bio-bio-bio model.”
There is nothing wrong with trying to discover if some mental illnesses have neurological correlates, or even if the mental illness is caused by a biochemical imbalance or abnormality. This kind of knowledge can serve to be incredibly useful in the treatment of mental illnesses. As I understand it, modern day neuroscience is making great progress in the biological underpinnings of mental disorders like schizophrenia, autism, and bipolar disorder. The importance of this research cannot be overstated enough, as the potential findings of these projects can lead to the alleviation of much suffering.
However, with that all being said, psychology cannot succumb to the guise of a strictly materialistic and biochemical approach toward mental disorders. What begins to happen, and is already happening as described in Charles Barber’s book “Comfortably Numb: How Psychiatry Is Medicating a Nation,” is that we begin to believe that mental illnesses are only treatable through pharmaceutical drugs. But what about the mental shortcomings that arise out of strictly psychosocial and non-biological factors? We know a lot about how the mind learns, how come we so often ignore to consider that many mental issues that arise (such as phobias, anxieties, bad habits, low self-esteem) are learned behaviors, not causes of a biological disturbance.
According to the National Institute of Mental Health (NIMH), an estimated 26.2% of Americans 18 and older suffer from a diagnosable mental disorder in a given year. Over the last few years NIMH Director Thomas Insel, MD, has been reported as saying misdiagnosis of bipolar disorder has been a problem in children as well as adults. In this article I will discuss the Diagnostic and Statistical Manual For Mental Disorders (DSM) and its disadvantages when it comes to distinguishing between mental disorders (poor habits of living) from neurological disorders (brain diseases and abnormalities).
THE ANTI-PSYCHIATRY MOVEMENT OF THE 1960s-TODAY
The idea that psychiatrists over diagnose for mental disorders is not such a new idea. An Anti-psychiatry movement emerged in the 1960s, lead by psychiatrists such as R. D. Laing, Thomas Szasz who both denied association with the term but were strong proponents of its theories. The movement began with British Psychiatrist David Cooper who believed that madness and psychosis were a product of dysfunctional societies.
1. The specific definitions of, or criteria for, hundreds of current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards.
2. Prevailing psychiatric treatments are ultimately far more damaging than helpful to patients.
Other key criticisms of psychiatric claims to authority include the:
1. Inappropriate and overuse of medical concepts and tools to understand the mind and society, including the miscategorization of normal reactions to extreme situations as psychiatric disorders;
2. Scientifically and/or clinically ill-founded system of categorical diagnoses (e.g., Diagnostic and Statistical Manual of Mental Disorders or DSM), which stigmatizes patients;
3. Inappropriate (i.e. unvalidated) exclusion of other approaches to mental distress/disorder;
4. Unexamined abuse or misuse of power over patients who are too often treated against their will;
5. Relation of power between patients and psychiatrists, as well as the institutional environment, is too often experienced by patients as demeaning and controlling; and
6. Compromise to medical and ethical integrity because of financial and professional links with pharmaceutical companies and insurance companies in countries where these companies are a force.
The theories of anti-psychiatry can be traced all the way to the Scientology doctrine of today, famously brought into the public eye by American actor and Scientology activist Tom Cruise, and his assertion that there is no such thing as “chemical imbalance” and that psychiatry was a form of pseudoscience. Tom Cruise was of course wrong. Chemical imbalances do exist, just like people are sometimes born naturally with missing limbs and other physical abnormalities. Scientology’s relations to the Anti-psychiatry movement are irrational in the face of science, and a distortion to the actual beliefs held by so-called “Anti-psychiatry” psychiatrists.
Psychiatry is a legitimate medicinal practice. But it is only effective when the physiological pathology of the disease has been clearly demonstrated, and only when the prescribed treatment has been tested under scientific rigor (with placebo and double-blind controls). Otherwise, it is not science. And prescribing medicine based on loose biochemical correlations between brain states and mental states (with no clear pathology demonstrated) is careless and hazardous. At worse, it ignores the psychosocial roots of other mental illnesses.
HOW DOES CULTURE PLAY A FACTOR IN ANXIETY AND DEPRESSION
I think those with even a basic understanding of psychology can look around their world and see how we are constantly being conditioned towards suffering. It is evident in the way we perceive the world through our TVs: the fear mongering we hear in the mass media to the commercialism on every channel and every show. Very few mediums in our American culture exist solely on their mastery of art or meaning. Instead, we have, to some extent, sacrificed the meaningful life for the life of pleasure, luxury and convenience. We are a society that has largely dulled our senses through the overstimulation of mindless pleasure and entertainment. We are motivated by what makes us feel good, in the most hedonistic sense of the word. Many, driven by these desires, live a life of mediocrity and passivity. And if were not motivated by pleasure in one moment, we are motivated by fear in the next. These are the kinds of emotions (or mental defilements) that have us at a never-ending tug of war. It is hard to find inner peace in the industrialized world. It is loud, noisy, and busy, no wonder that so many of us feel so anxious, cold and empty.
Our intelligence as a civilized nation is insurmountable. It has led us to tremendous breakthroughs in material well-being, the treatment of biological illnesses, technology, and entertainment. But then why are so many people not happy with it all? Even those with nice houses and nice families feel overwhelmed by it all. There is no space and time for just peace and me. We find ourselves trapped in a meaningless and destructive worldview driven only by more and more consumption. Many have a false, simple unrealistic and unattainable view on what is true happiness.
HOW DO WE FIND SATISFACTION THAT LASTS
It is easy enough to see that modern society is continuing to grow more and more unsatisfied with life despite the wonderful economic growth we have experienced since our birth as a country (I am speaking for the U.S. here). Many of these individuals who suffer have been born into unfortunate circumstances such as with biological and neurological illnesses that have handicapped these individuals’ capacity to live life fully. But also many of these individuals are unsatisfied due to psychosocial factors. The scientific field of psychology, and especially clinical psychology which is intended to help others who are suffering, cannot ignore the relevance of psychosocial factors in replace of a more “hard science” biological approach. If it did, it would be neglecting others in need of psychological fulfillment.
We simple cannot blame life solely on predetermined biological make-up. The experience of life impacts us too. Acknowledging one’s creative role in life empowers the individual. By find the desire to achieve better habits of living, and not simply be a victim of circumstances, we better equip ourselves to cultivate healthy habits of both mind and body (action/behavior). This means finding a solid and useful value system, finding a sense of morality and meaning in one’s life, and to be guided by these values and beliefs. This does not mean simply valuing the life of pleasure, self-serving, quick fixes and convenience (which do have their rightful place in our life), but to also value the life of engagement, friends and family, meaning and compassion toward others.
Mental health is more than just having the right chemicals in the right parts of the brain. It is about a strong, guiding value system that serves one’s interests and creative potential. It’s about good action, altruistic deeds, provoking reality, being of positive value to one’s society, and pursuing the arts. To this extent, we must all have what I call a “spiritual” aspect to our beings if we want to experience real and lasting happiness.
I would like to see psychology pay greater attention to the life of engagement and meaning. The so called “spirit” of man. We need to also accept that first and foremost psychology is a social science; we need to study humans in the context of their whole environment and being, not just inside their brains. I am hardly the only person advocating a more holistic, even ecological, approach to psychology. By this I am referring to a psychology that recognizes the importance of a meaningful relationship between Self and World, not simply Self with Self, and especially not simply the biological Self with Self – that is what doctors and psychiatrists are for. But for the people who aren’t broken, perhaps we just need a more enlightening worldview, one that is centered around meaning, purpose, creativity, intelligence, good morality, love and compassion.
The study of the mind must also be about personal development and self-actualization. How individuals can create a powerful and real effect on their life and well-being; through the power of thoughts, positive values, strong attention, and good self-monitoring skills. The quest for psychological well-being is more than just those overcoming physical limitations, it is the search for inner peace – an inner satisfaction towards the role one plays in this marvelous theater called life.