Pathologization

A new disease? I know not, new or old,
But it may well be called poor mortals’ plague:
For, like a pestilence, it doth infect
The houses of the brain…
Till not a thought, or motion, in the mind,
Be free from the black poison of suspect.  –  Ben Jonson, Every Man in His Humour (II, iii)

One of the problems with trying to get people to recognize the problems in the cultural, political and legal status quo is that they have an amazing capacity for seeing exactly what they want to see, and for ignoring contradictory evidence when it’s right in front of them.  Jacob Sullum of Reason pointed out a fine example of this in the New York Times obituary of the brilliant and crusading psychiatrist Thomas Szasz, who died at the beginning of last month.  Sullum wrote:

The New York Times obituary  for Thomas Szasz…says his critique of psychiatry “had some merit in the 1950s…but not later on, when the field began developing more scientific approaches”…In fact, however, Szasz’s radicalism, which he combined with a sharp wit, a keen eye for obfuscating rhetoric, and an uncompromising dedication to individual freedom and responsibility, was one of his greatest strengths…driven by a “passion against coercion,” [Szasz] zeroed in on the foundational fallacies underlying all manner of medicalized tyranny…

In response to the Times’ claim that Szasz’s criticism of the “mental health” industry lacked “merit” after the 1950s, Sullum points out that:

…it was not until 1973 that the…APA…stopped calling homosexuality a mental disorder.  More often, psychiatry has expanded its domain.  Today it encompasses myriad sins and foibles, including smoking, overeating, gambling, shoplifting, sexual promiscuity, pederasty, rambunctiousness, inattentiveness, social awkwardness, anxiety, sadness, and political extremism…As Marcia Angell, former editor of The New England Journal of Medicine, observed last year…”there are no objective signs or tests for mental illness…and the boundaries between normal and abnormal are often unclear.  That makes it possible to expand diagnostic boundaries or even create new diagnoses in ways that would be impossible, say, in a field like cardiology.”  In other words, mental illnesses are whatever psychiatrists say they are…

Though I don’t often mention it, I actually minored in psychology and could have turned it into a dual major with only about two more semesters of work.  I say this not to grant myself authority, but to explain why I’ve paid such close attention to developments in the field over the past three decades.  During that time I’ve often been dismayed or even alarmed by what I see, especially in the area of fad diagnoses of serious mental disorders made for no reason other than to please parents, cater to legal authorities, make money or (worst of all) go along with the crowd.  Multiple personality disorder was once considered so rare that DSM-II and DSM-III both classed it as a subtype of dissociative disorder, but in the mid-1980s somebody realized that its description in DSM-III was so vague that practically any mode of behavior could be described as a separate personality, and it soon became a hugely popular fad diagnosis.  Until the error was rectified in DSM-IV over 40,000 cases were diagnosed in the US alone, much to the delight of the “repressed memory” crowd, the drivers of the “Satanic Panic” and criminal prosecutors; for example, in 1990 a Wisconsin man was charged with rape for consensual sex with a 26-year-old woman on the grounds that she had multiple personality disorder and the personality of a six-year-old had unexpectedly emerged during intercourse.

In 1994 the APA closed the loophole which allowed over-diagnosis of multiple personalities, but it simultaneously opened (or at least neglected to plug) many others; since then normal behaviors have been increasingly pathologized by quacks, hired guns and those whose professional ethics take a back seat to promoting an agenda.  Much of this involves uncommon or even rare disorders being misapplied to much larger groups, such as claims that sex workers commonly suffer from Post-Traumatic Stress Disorder, or that migrant workers who deny being passively “trafficked” do so because of Stockholm syndrome; fully 10% of American schoolboys are now being drugged daily because of quacks misdiagnosing their normal boyishness as Attention Deficit Hyperactivity Disorder in order to please female teachers and single mothers who subscribe to “social construction of gender” and therefore refuse to accept that normal male behavior is innately different from normal female behavior.  But even beyond that, imaginary “disorders” are created to describe perfectly normal human conduct which politicians find inconvenient or fanatics dislike; for example, the totally understandable resentment young people feel when they’re treated as “children” (or spoiled younger kids’ predictable tantrums when they don’t get their own way) is now pathologized as “Oppositional Defiant Disorder”, and the normal male attraction to adolescent girls is both pathologized by many psychologists and wrongfully conflated with pedophilia in the public mind.  The state, of course, uses this omnipathologization as a tool of increasing state control:

…For more than half a century, Szasz stubbornly highlighted the hazards of joining such a fuzzy, subjective concept with the force of law through involuntary treatment, the insanity defense, and other psychiatrically informed policies.  Consider “sexually violent predators,” who are convicted and imprisoned based on the premise that they could have restrained themselves but failed to do so, then committed to mental hospitals after completing their sentences based on the premise that they suffer from irresistible urges and therefore pose an intolerable threat to public safety.  From a Szaszian perspective, this incoherent theory is a cover for what is really going on:  the retroactive enhancement of duly imposed sentences by politicians who decided certain criminals were getting off too lightly—a policy so plainly contrary to due process and the rule of law that it had to be dressed up in quasi-medical, pseudoscientific justifications…

This is the greatest danger of what Szasz termed “the ‘therapeutic state,’ the unhealthy alliance of medicine and government that blesses all sorts of unjustified limits on liberty, ranging from the mandatory prescription system to laws against suicide.”  Once mercenary or authoritarian physicians and psychologists get in bed with the government, their authority can be added to its own to justify control not only over persons, but also over foods, drugs, sex acts or anything else they can be bribed or commanded to declare “unhealthy”.