"You can know the name of a bird in all the languages of the world, but when you're finished, you'll know really nothing whatever about the bird... So let's look at the bird and see what it's doing - that's what counts. I learned very early the difference between knowing the name of something and knowing something."
Richard Feynman, Physicist and 1965 Nobel Prize laureate (1918-1988)
Kaiser Medical
"You have all I dare say heard of the animal spirits and how they are transfused from father to son etcetera etcetera - well you may take my word that nine parts in ten of a man's sense or his nonsense, his successes and miscarriages in this world depend on their motions and activities, and the separate tracks and trains you put them into, so that when they are once set a-going, whether right or wrong, away they go cluttering like hey-go-mad."
Lawrence Sterne (1713-1758), "The Life and Opinions of Tristram Shandy, Gentleman" (1759)
I. Overview
Someone is carefully mentally "ill" if:
His show the way rigidly and consistently deviates from the typical, mean behaviour of all other citizen in his culture and community that fit his profile (whether this accepted behaviour is moral or rational is immaterial), or
His judgment and grasp of objective, corporal reality is impaired, and
His show the way is not a matter of choice but is innate and irresistible, and
His behavior causes him or others discomfort, and is
Dysfunctional, self-defeating, and self-destructive even by his own yardsticks.
Descriptive criteria aside, what is the essence of reasoning disorders? Are they merely physiological disorders of the brain, or, more really of its chemistry? If so, can they be cured by restoring the equilibrium of substances and secretions in that mysterious organ? And, once equilibrium is reinstated - is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) - or brought on by abusive or wrong nurturance?
These questions are the domain of the "medical" school of reasoning health.
Others cling to the spiritual view of the human psyche. They believe that reasoning ailments estimate to the metaphysical discomposure of an unknown medium - the soul. Theirs is a holistic approach, taking in the sick person in his or her entirety, as well as his milieu.
The members of the functional school regard reasoning condition disorders as perturbations in the proper, statistically "normal", behaviours and manifestations of "healthy" individuals, or as dysfunctions. The "sick" individual - ill at ease with himself (ego-dystonic) or development others unhappy (deviant) - is "mended" when rendered functional again by the prevailing standards of his collective and cultural frame of reference.
In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter - but, to a counter intuitively large degree, a faulty methodology.
As the paramount anti-psychiatrist, Thomas Szasz, of the State University of New York, notes in his narrative "The Lying Truths of Psychiatry", reasoning condition scholars, regardless of academic predilection, infer the etiology of reasoning disorders from the success or failure of treatment modalities.
This form of "reverse engineering" of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological "theories" - even the "medical" ones (the role of serotonin and dopamine in mood disorders, for instance) - are regularly none of these things.
The outcome is a bewildering array of ever-shifting reasoning condition "diagnoses" expressly centred nearby Western civilisation and its standards (example: the ethical objection to suicide). Neurosis, a historically fundamental "condition" vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a analysis prior to 1973. Seven years later, narcissism was declared a "personality disorder", approximately seven decades after it was first described by Freud.
Ii. Personality Disorders
Indeed, personality disorders are an exquisite example of the kaleidoscopic landscape of "objective" psychiatry.
The classification of Axis Ii personality disorders - deeply ingrained, maladaptive, lifelong behavior patterns - in the Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. Dsm-Iv-Tr, Washington, 2000] - or the Dsm-Iv-Tr for short - has come under sustained and serious comment from its inception in 1952, in the first edition of the Dsm.
The Dsm Iv-Tr adopts a categorical approach, postulating that personality disorders are "qualitatively clear clinical syndromes" (p. 689). This is widely doubted. Even the difference made between "normal" and "disordered" personalities is increasingly being rejected. The "diagnostic thresholds" between normal and abnormal are whether absent or weakly supported.
The polythetic form of the Dsm's Diagnostic Criteria - only a subset of the criteria is adequate grounds for a analysis - generates unacceptable diagnostic heterogeneity. In other words, citizen diagnosed with the same personality disorder may share only one criterion or none.
The Dsm fails to expound the exact association between Axis Ii and Axis I disorders and the way persisting childhood and developmental problems interact with personality disorders.
The differential diagnoses are vague and the personality disorders are insufficiently demarcated. The succeed is immoderate co-morbidity (multiple Axis Ii diagnoses).
The Dsm contains little consulation of what distinguishes normal character (personality), personality traits, or personality style (Millon) - from personality disorders.
A dearth of documented clinical experience about both the disorders themselves and the utility of discrete treatment modalities.
Numerous personality disorders are "not otherwise specified" - a catchall, basket "category".
Cultural bias is evident in clear disorders (such as the Antisocial and the Schizotypal).
The emergence of dimensional alternatives to the categorical coming is acknowledged in the Dsm-Iv-Tr itself:
"An alternative to the categorical coming is the dimensional perspective that Personality Disorders describe maladaptive variants of personality traits that merge imperceptibly into normality and into one another" (p.689)
The following issues - long neglected in the Dsm - are likely to be tackled in future editions as well as in current research. But their omission from official discourse hitherto is both unbelievable and telling:
The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;
The genetic and biological underpinnings of personality disorder(s);
The improvement of personality psychopathology during childhood and its emergence in adolescence;
The interactions between corporal condition and disease and personality disorders;
The effectiveness of discrete treatments - talk therapies as well as psychopharmacology.
Iii. The Biochemistry and Genetics of reasoning Health
Certain reasoning condition afflictions are whether correlated with a statistically abnormal biochemical action in the brain - or are ameliorated with medication. Yet the two facts are not ineludibly facets of the same fundamental phenomenon. In other words, that a given treatment reduces or abolishes clear symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.
To designate a pattern of behaviour as a reasoning condition disorder is a value judgment, or at best a statistical observation. Such designation is effected regardless of the facts of brain science. Moreover, correlation is not causation. Deviant brain or body biochemistry (once called "polluted animal spirits") do exist - but are they truly the roots of reasoning perversion? Nor is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause reasoning illness - or the other way around?
That psychoactive medication alters behaviour and mood is indisputable. So do illicit and legal drugs, clear foods, and all interpersonal interactions. That the changes brought about by designate are desirable - is debatable and involves tautological thinking. If a clear pattern of behaviour is described as (socially) "dysfunctional" or (psychologically) "sick" - clearly, every convert would be welcomed as "healing" and every agent of transformation would be called a "cure".
The same applies to the alleged heredity of reasoning illness. Particular genes or gene complexes are oftentimes "associated" with reasoning condition diagnoses, personality traits, or behaviour patterns. But too little is known to produce irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.
Nor is the difference between psychotropic substances and talk therapy that clear-cut. Words and the interaction with the therapist also influence the brain, its processes and chemistry - albeit more moderately and, perhaps, more profoundly and irreversibly. Medicines - as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume Xiii, Issue 12, December 1996) - treat symptoms, not the fundamental processes that yield them.
Iv. The Variance of reasoning Disease
If reasoning illnesses are corporal and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed, the case. Psychological diseases are not context dependent - but the pathologizing of clear behaviours is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are carefully sick by some cultures - and utterly normative or advantageous in others.
This was to be expected. The human mind and its dysfunctions are alike nearby the world. But values differ from time to time and from one place to another. Hence, disagreements about the propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.
As long as the pseudo-medical definitions of reasoning condition disorders continue to rely exclusively on signs and symptoms - i.e., mostly on observed or reported behaviours - they remain vulnerable to such discord and devoid of much-sought universality and rigor.
V. reasoning Disorders and the collective Order
The mentally sick receive the same treatment as carriers of Aids or Sars or the Ebola virus or smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done in the name of the greater good, largely as a preventive policy.
Conspiracy theories notwithstanding, it is impossible to ignore the large interests vested in psychiatry and psychopharmacology. The multibillion dollar industries absorbing drug companies, hospitals, managed healthcare, private clinics, academic departments, and law compulsion agencies rely, for their prolonged and exponential growth, on the propagation of the concept of "mental illness" and its corollaries: treatment and research.
Vi. reasoning Ailment as a beneficial Metaphor
Abstract concepts form the core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visited the unconscious. These are beneficial metaphors, theoretical entities with explanatory or illustrated power.
"Mental condition disorders" are no different. They are shorthand for capturing the unsettling quiddity of "the Other". beneficial as taxonomies, they are also tools of collective coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating both the hazardous and the idiosyncratic to the collective fringes is a vital technique of collective engineering.
The aim is progress straight through collective cohesion and the regulation of innovation and creative destruction. Psychiatry, therefore, is reifies society's preference of evolution to revolution, or, worse still, to mayhem. As is often the case with human endeavour, it is a noble cause, unscrupulously and dogmatically pursued.
recommended you read The Myth of mental Illness
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