Welcome to From Insults To Respect.
In our society, many assume psychiatrist can accurately diagnose mental illness, also referred to as mental disorder or psychopathology. Why do they?
Sometimes we respect what a group of people do because of their association with something we highly value. 
Thus, in a commercial, we might see people purchasing a particular brand of car with a highly respected athlete, such as Derek Jeter, sitting in the driver’s seat.
Similarly, in our society many people respect the ability of psychiatrists to make a diagnosis of mental illness because psychiatrists have highly valued medical degrees. 
Those with this degree often save lives, a pretty amazing accomplishment certainly worthy of respect. However, the association between saving lives in situations that involve broken bones, tissue tears, heart disease, and cancer, might be irrelevant when it comes to their involvement in offering, for a fee, help for people who present with psychological concerns. 
In fact many view the psychiatrists’ approach to diagnosing and treating psychological concerns with drugs as causing far more harm than good (see, for example, HERE). Moreover, the type of “diagnoses” psychiatrists make is stigmatizing while lacking reliability and validity (see HERE).
Most publications on this topic present the relevant research. This leads many untrained folks to feel this type of information is way over their head, so they leave the necessary mental processing that can lead to a more thorough rational understanding of the issues to the experts. 
But when people cut short their reasoning in this way, it leaves them at the mercy of people who have an enormous financial interest in misleading patients and themselves. Consider the chemical imbalance theory that didn’t pan out, and yet I still hear it being promoted. Therefore, today I want to try my hand at providing readers a more accessible, common sense understanding of the type of labels psychiatrists use when describing the various concerns people present to them.
Mental Illness and Common Sense
To begin to understand, in a common sense manner, this notion of mental illness, we first have to come to understand that it is chiefly made up of three ideas–distress, abnormality, and dysfunction. By looking at these three ideas seperately we arrive at a place where our common sense can better understand why a psychiatrist’s “diagnosis” makes no sense for patients while being enormously valuable to the profession and the pharmaceutical industry.
Distress
The latest version of what is viewed by psychiatrists as the most authoritative American text on mental illness is the DSM-5. It tells us that mental disorders “are usually associated with significant distress in social, occupational, or other important activities.” 
Internationally, the most authoritative text according to psychiatrists is the International Classification of Diseases (ICD). It tells us that mental disorder “is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress…”
The phrase “significant distress,” as you can see, appears in both definitions. But notice that although this distress component in the definition is “usually” associated with mental disorder, it is not really a requirement.
I
n case this vague definition does not provide enough wiggle room for clinicians to label all people seeking their services as having a mental disorder and to prescribe a drug for it, the ICD tells the clinician, “When the requirements are only partially fulfilled, it is nevertheless useful to record a diagnosis for most purposes.” This type of double talk is one of the reasons why many people view the mental illness construct as super useful for a financially rewarding business model, but too vague and misleading for scientific purposes.
Let’s consider a patient who comes to a psychiatrist and asks for help because each day he becomes a mass of quivering fear. This patient sure sounds like he is experiencing distress. But so too do many woman who are giving birth, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.
When writers receive rejections from publishers, or a loved one dies, distress often accompanies these experiences. Yet, we do not typically describe them with pathological terms, but if you went to a psychiatrist expressing any such concerns there’s a pretty good chance you will leave the office labelled as having a mental disorder and a prescription for pills.
As mentioned, not all psychological concerns need to have the “symptom” of distress to be labeled a mental disorder by psychiatrists, e.g., attention deficit/hyperactivity disorder, conduct disorder, intellectual disability, and schizophrenia. Thus, by using the psychiatrists’ classification system, we find that people who are experiencing distress may or may not be classified as having a mental disorder, and people who are not experiencing distress may or may not be classified as having a mental disorder.
Meanwhile, according to a variety of wisdom traditions, distress is viewed as useful. According to many Christian philosophers, distress is something to make us think. It is a tool to get our attention and to accomplish a valued purpose in a way that would never occur without the trial. In Judaism, the Talmud teaches that the righteous suffer in this world in order to increase their reward in the Eternal World. Rabbi Eliezer, in the Talmud, welcomed his suffering, calling his emotional distresses ”my friends.”
Add to all of this the problems one encounters when one tries to decide objectively how much distress, beyond the “normal” amount that one experiences during life’s parade of disappointments, is required for a diagnosis, and the reader begins to get a sense of how problematic it is to decide from the descriptor distress if a disorder is or is not present. But, in less than an hour, often as little as fifteen minutes, a doctor can transform your distress experience into a mental illness diagnosis, prescribe drugs with many significant side effects, and consequently have a financially rewarding relationship with you for years.
Abnormality
Now, sometimes people come to believe that it is not merely distress that leads to a mental illness diagnosis; it has to be an abnormal amount of distress for that to occur. Abnormal means deviating from average. So, let’s think about this.
According to Buddhist philosophy, the first Noble Truth is that suffering is a normal part of life. The average soldier in Ukraine is currently experiencing significant distress. Are all of these soldiers mentally ill? At what point does it become abnormal. Is someone with a medical degree who has a financial interest in diagnosing as many people as he or she can get away with best suited to make this decision?
Perhaps you are thinking that under conditions of war it is normal to be distressed, and therefore these soldiers are not mentally ill. But people find themselves in various situations that they experience as significantly distressful. Deciding on what situations are legitimately worthy to experience significant distress is really a value judgment and psychiatric terminology is masquerading as a scientific decision.
Dysfunction
Having indicated some of the problems of unambiguously applying the descriptors of distress and abnormality to the concept of mental disorder, we now turn our attention to the descriptor, dysfunction.
There are reliable, valid assessments for determining a person’s level of functioning. If instead of a classification system that labels people as having mental disorders, we had one that classifies a person’s expressed concerns regarding their areas of functioning this would be clearer and easier to understand than the vague notion of mental illness (see HERE). Various domains of functioning are sleep, eating, exercise, interpersonal relationships, work/school, and household responsibilities.
Although functioning is mentioned as part of the diagnosis process used by psychiatrists, the mental disorder label fails to clearly indicate what specific function has fallen below average. The psychiatrists’ determination of a mental disorder seldom use any of the reliable and valid ways to assess a person’s level of functioning. Moreover, there is an assumption in the mental disorder classification system that a person having a below average level of functioning is bad.
What do I I mean by this? Consider the case of William James, the eminent psychologist and philosopher. He described his experience of dropping out of medical school as a symptom of a mental disorder. I suppose if we believe that one function of the body is to learn and be educated, James’s medical school interruption might be viewed as a dysfunction. Yet, from another perspective, this interruption might be viewed as part of the normal search for understanding.
When an individual’s functioning diminishes in one domain, functioning in another domain oftentimes increases. By going to Europe, James, instead of continuing on with his studies, had more time during this period for contemplation and was exposed to fresh new experiences that he later used productively. This may seem a pathological waste of time to some, but to others it is greatly valued.
Philosopher Aldous Huxley, for example, stated that “there is no form of contemplation, even the most quietistic, which is without its ethical values.” Those who practice it, Huxley goes on to say, “may bring back enlightening reports of another, a transcendent country of the mind.” And sometimes “they will become conduits through which some beneficent influence can flow out of that other country into a world of darkened selves, chronically dying for lack of it.”
Thus, from one perspective, it is possible to view James’s interruption of his medical education as one criterion for diagnosing a mental disorder, and from another perspective, to view it as a potentially beneficial response to some difficult problems that had chronically darkened his soul. Can a person, simply because he has a medical degree, be trusted to have the wisdom to make this determination? Does the fact that such medical professionals have a great financial interest in saying people who come to them have an abnormal, pathological amount of dysfunction be relevant when thinking about this?
A few years after James dropped out of medical school, he returned to his studies, graduated, and became a Harvard professor. During his tenure there, he came to view the mental disorder language of doctors as “superficial medical talk,” and he wrote,
The trouble is that such writers . . . use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with. . . . The only sort of being, in fact, who can remain as the typical normal man after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity . . . Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all? A certain tolerance, a certain sympathy, a certain respect, and above all a certain lack of fear, seem to be the best attitude we can carry in our dealing with these regions of human nature.
Regular readers of this blog know that from time to time I discussed some famous person’s experience with periods of severe distress. In each example, they found it clearly interfered with their functioning. Each one of them would likely have been “diagnosed” as having a mental illness if they went to a psychiatrist. 
The experiences of Abraham Lincoln (see HERE), Joni Mitchell (see HERE), U.S. Grant (see HERE), and Leo Tolstoy (see HERE) are some examples. All of them, despite their mighty struggles, still managed to earn the respect of millions.
As Joni Mitchell beautifully expresses this,
Depression can be the sand that makes the pearl…. Most of my best work came out of it. If you get rid of the demons and the disturbing things, then the angels fly off, too. There is the possibility, in the mire, of an epiphany.
Alternatives for Getting Professional Help During Distressful Periods
Today, the pharmaceutical companies have an impressive well funded program of convincing people that they have to go to a psychiatrist for treatment. Psychiatrists have a financial interest in supporting this promotional business model. That said, I don’t mean to suggest that all psychiatrists are purely in their profession for the money. I have moderated several debates on this subject and on the panel were several leading psychiatrists. I came away fairly convinced each of them genuinely convinced themselves their approach leads to more help than harm.
What alternative to the psychiatric pathologizing pill prescribing approach exists for people dealing with deeply challenging concerns? If someone can not find sufficient support from a family member or friend, counseling is often helpful. However, some counselors are just as pathologizing as psychiatrists, and encourage their clients confer with a psychiatrist in addition to receiving counseling services.
One example of a non-pathologizing, non stigmatizing way of providing counseling is the humanistic Power Threat Meaning Framework (PTMF). Dr Lucy Johnstone, one of its lead authors explains:
The Power Threat Meaning Framework can be used as a way of helping people to create more hopeful narratives or stories about their lives and the difficulties they have faced or are still facing, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’.
It highlights and clarifies the links between wider social factors such as poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress or troubled behaviour, whether it is confusion, fear, despair or troubled or troubling behaviour.
It also shows why those of us who do not have an obvious history of trauma or adversity can still struggle to find a sense of self-worth, meaning and identity.
Threat responses are not called “symptoms.” Instead, it looks at how we make sense of these experiences. It recognizes messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt.
At the top of each of my posts is a heading that says, “Counseling Services.” By clicking on it, you might find some help identifying humanistic, non-pathologizing counseling through Zoom. I get no kickback if you choose to work with them.
Okay, then, those are some thoughts to ponder for this week. Thanks for stopping by, and I hope you’ll soon join us again right back here at From Insults to Respect.
My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
Today, if your behavior, thoughts, or feelings begin to concern you or a family member, for a fee many doctors will translate your experiences into mental illness terminology. Synonyms for mental illness, are mental disease, mental sickness, mental disorder, and psychopathology. These terms, as metaphors for experiences someone doesn’t like, have been with us for centuries. When used in this way, it can communicate something about an experience that others relate to. However, when we move from using these types of concepts as metaphors to believing wholeheartedly that they are proper scientific terms, we begin to lose the respect of those well grounded in the principles of science.
Let’s consider The Tragedy of Hamlet, Prince of Denmark, which William Shakespeare wrote in about 1604. This play offers its audience a magnificent tale of adultery, fratricide, revenge, and feigned madness by a protagonist. When reading Hamlet, we see how Shakespeare uses metaphors to vividly evoke in us the experiences of his characters. Thus, when Hamlet becomes dissatisfied that his mind keeps identifying flaws in his plans for action, he describes these plans as becoming “all sicklied o’er with pale cast of thought.” By extension, the reader senses that when Hamlet’s plans become “all sicklied o’er,” he, too, becomes in a sense, “sicklied o’er” with feelings of frustration, anguish, and helplessness.
Literature regularly uses this type of metaphor. Ralph Waldo Emerson, to take another example, once wrote:
I actually like Emerson’s disease terminology here because the context in which he uses it so obviously reveals that he is using it metaphorically. Notice how he cleverly uses diseases associated with childhood to evoke the feeling that individuals who worry themselves over problems of original sin and so on are acting, in his view, childishly. In this context, disease, to Emerson, was a metaphor for immaturity. If he were a man of science, in contrast to a literary personality, we would expect that he would use terms with clearly defined, objective meaning, that avoid value judgements.
At the time, medical writers were already heavily pathologizing a great number of experiences. Thus, James cited W. Griesinger, the author of The Pathology and Therapy of Psychological Illnesses, and T. S. Clouston, author of Clinical Lectures on Mental Diseases. As James delved further and further into the experiences being pathologized in this way, he came to believe such terminology was “simple minded” and “superficial medical talk.”
Does it make sense to say that when people are suffering, they have a “mental disorder?” Well, consider the experience of giving birth. It is typically accompanied by suffering, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.
When writers receive rejections from publishers, or a loved one dies, suffering often accompanies these experiences. Yet, we do not typically describe them with pathological terms.
For example, cortisol levels in saliva and heart rate variability has some connection with a person’s self-reports of how much stress they have experienced in recent days, while hair cortisol levels have some connection with longer term exposure to stressful experience. Other measures of stress utilize a list of stressors, such as the recent death of a loved one, living in poverty, etc. The person being assessed places a check mark next to each of the stressors on the list that applies to him or her. These check marks are then used to calculate how much stress the person has been experiencing.
Having indicated some of the problems of unambiguously, and non-subjectively applying the descriptors of suffering to the concept of mental disorder, we now turn our attention to the descriptor, “dysfunction.” As with the notion of suffering, the pathologizers almost never use the various scientifically validated measures of functioning to determine if someone has a mental disorder. A pretty good such measure is the Scales of Independent Behavior-Revised. It has norms for functioning in such areas as social interaction (communication skills, language comprehension, language expression), personal living skills (eating and meal preparation, toileting, dressing, personal self-care, domestic skills), community living skills (time and punctuality, money and value, work skills), and gross and fine motor skills. Rather than using measures of this type, pathologizers rely on their professional privilege to make a subjective estimate of dysfunction.
In the most current edition of the DSM, someone who is experiencing abnormal levels of distress might be considered to have a mental disorder. But the issue of the boundary between normal and abnormal experiences lies at the heart of the most contentious disputes in the field of psychopathology today. A major problem with using the term abnormal as one of the defining attributes of mental illness is that it leads us to forget the fact that natural to all organisms is substantial variability across individuals and within individuals. Having above average or below average functioning in various areas of our many areas of functioning is normal. Displaying rare behavior patterns that are highly valued, such as the great altruism of Mother Teresa, are not viewed as mental disorders. Psychopathology is applied when someone does not like a particular experience. Thus, a term that masquerades as a scientific term is really a value judgment masquerading as a scientific term.
Although there are some fairly well developed scientific measures of the three major factors (suffering, functioning, and abnormality) that the psychopatholgizers tend to claim are usually part of the mental illness experience, these measures are almost never used in their “diagnostic” determination. Instead, subjective indicators of these three factors are combined into an even more subjective abstraction called “mental illness.” This process is not scientific despite claims to the contrary.
Rather than a scientific concept, the mental illness concept has been very useful as part of a highly lucrative business plan for the pharmaceutical industry and medical doctors, which includes psychiatrists. This plan has doctors first convincing people that the experiences referred to as mental illnesses are scientifically real illnesses just like physiological pathologies. It then provides license for doctors, in as little as fifteen minutes, to declare that they have provided their patients a diagnosis, and to send them on their way with a prescription for pills. With this plan, billions of dollars flow their way.