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September 01, 2004

Unbelievable Psychiatric "Illnesses"

I'm sure everyone remembers that homosexuality used to be considered a mental disorder. That's thankfully not the case anymore.

While doing a little catch-up reading in preparation for two of my WorldCon panels about psychology, I ran across something that just blew my mind. In my opinion, quite a bit of psychology is really about the people with power regulating the behavior of the people they wish to control. Witness junk science like false memory syndrome and parental alienation syndrome. Think back to when being homosexual meant that you were mentally ill.

Have you ever heard of drapetomania?

This one is a doozy.

It was a mental illness ascribed to black slaves who would flee their masters. Drapetomania was obviously created to appease the slave-owners, who would claim that their slaves who ran away must be crazy for doing so because they have it so good under their master's thumbs. "Treatment" included whipping and cutting off their toes.

Un-fucking-believable.

I tell you, nothing surprises me anymore.

Posted on September 1, 2004 at 10:59 AM | Permalink

Comments

THIS is why I'm skeptical of psychology, especially of the drug-peddling variety. "Mental illness" is a social construct--a useful one and oft-times based in reality, but NOT always.

-Linnet

Posted by: Linnet at Sep 1, 2004 1:17:16 PM

Thanks to modern science, the twin scourges of small pox and drapetomania have been eradicated.

Posted by: lucia at Sep 2, 2004 1:17:56 PM

"Witness junk science like false memory syndrome and parental alienation syndrome..."

Prove that PAS doesn't exist. What do you call it when a parent convinces a child the other parent is no good? Tell me it doesnt't exist, and I'll call you a flat out liar. Wouldn't it be nice, Trish, if everyone believed your lies and half-truths? Then you wouldn't have to deal with trolls like me.

Sounds like a case of false memory syndrome.

Posted by: TonySprout at Sep 5, 2004 1:08:37 PM

Hey back off Tony Twisto. The p-docs got me on lithium, epival and clonazepam for bi-polr, subtle brain injury with a twist of psychotic mainia. Between my employers insurance,government benefits and what I can earn as a binner. My net take home is 1700$ per month. Crazy? Why not when they have made the diagnosis signed, sealed and delivered. I have gym privileges, network of group therapy friends, and we even have our own Kookaburra nightclub just for idiots like me. A pampered life. No 12 hour work days. Might get sick the p-docs say. Hell, i hope they never find a cure for mental illness, least with me anyway and if they do maybe "I" can invent another one just to stay stupid. Afterall, I keep seeing all those rich folks from Hollywood and them business people going to the finest nuthouses money can buy. Lots of politicians and their family member go their too. For a host of mental disorders from alcholism, drug addiction, sexual problems, depression, and maybe just being an asshole may the 'force be with you'. Prove it doesn't exist is like saying the Mendez brothers were not fond of their equally sick parents and Jeffery Dahmer was told that one of his parents was the Devil.

Posted by: jigger8 at Sep 6, 2004 2:42:10 AM

Thanks, Trish, for a great post. Not everyone agrees, of course; thus Troll Tony:

"Prove that PAS doesn't exist. What do you call it when a parent convinces a child the other parent is no good?"

I can't speak for Trish, but as for myself, I call it "a parent convincing a child the other parent is no good". Of course, what the child is convinced of may be *true* or it may be *false* (some parents *really are* no good; others are not). The methods used to convince the child may be *rational* or *irrational*. But then why not discuss the issue in those terms, rather than inventing a psychiatric disorder out of whole cloth? If you have a serious issue here, isn't it worth addressing on its own terms rather than making up pseudo-medical mumbo-jumbo in order to short-circuit argument?

Trish, have you read anything by Thomas Szasz? I think he makes a really important argument (in, e.g., THE MYTH OF MENTAL ILLNESS and THE MANUFACTURE OF MADNESS) that the whole way we traditionally talk about "mental illness" is systematically skewed in such a way that it enables the powerful (who, as you point out, control instruments like the DSM) to write off the powerless, by creating whole categories of people who (they claim) ought to be manipulated and coerced rather than addressed as rational human beings. (You don't have to think about issues like whether it's *reasonable* to think that your dad is no good if you write the whole thing off as a disorder of the brain rather than a thought process.) "Drapetomania" and pathologized "Homosexuality" are classic cases in point, but it's no less true today: note that as soon as "Homosexuality" went out of the DSM-III it was replaced by "Gender Identity Disorder". And, as it has for decades, the diagnosis of "hysteria" lives on (in "Borderline Personality Disorder" and "Histrionic Personality Disorder"...)

Anyway, thanks for the great post. I'm interested in hearing what you think about cases like these and how they relate to psychiatry today--that is, whether they were (are) unfortunate cases that can be peeled away from psychiatry while leaving most of what we know in place, or whether psychiatry *as a whole* needs a serious shake-up in the way that it thinks or talks about people to keep it from remaining a pseudo-medical means of command and control?

Posted by: Rad Geek at Sep 7, 2004 9:58:42 AM

Hey, Rad Geek, glad you liked my post. Tony Troll is only one of my trolls. I have a collection. LOL. I have a happy tendency to attract loonies because of the way I counter crap put out by the fathers' rights movement.. The loony trolls get quite miffed, as you've noticed. ;)

Bad behavior is just bad behavior, as you pointed out. It's not a mental illness and quite often it's not illegal. There's a great article written by one of my colleagues called "But I've Seen PAS - No You Haven't" that I'd like to link to for you but she's caught in the hurricane clean-up so I don't think it'll be up for awhile. There are lots of mothers who would like to use PAS against their abusive ex's without understanding how (1) that's not how it works, and (2) it'll backfire on them. The article goes into exactly what you are talking about, and how garbage like PAS pathologizes people's behavior in cases where it's really a subjective interpretation of behavior or persons the one placing the label does not like. On the other hand, those women dealing with abusers should call it what it is - abuse, not PAS. Even if he isn't abusive, boorish behavior is just that. It's not a mental illness. People have to deal with boors all the time and they don't think for a second that they have a mental illness. They just think they're jerks. The difference here is that some psychologists have figured out how to make a living by "diagnosing" people with junk medical "syndromes" - based strictly on a personal interpretation and dislike of another's behavior. Those kinds of cases happen only in the context of a court setting. You don't just walk into a psychiatrist's office feeling blue and get a "diagnosis" of Parental Alienation Syndrome. It's about controlling people's behavior and controlling people you don't like, as you've written.

I read Szasz's "The Manufacture of Madness" a long time ago. One trend I see now is the use of forensic psychologists in custody cases. That's been going on for some time but it's on the rise because psychologists are seeing their businesses suffer due to the rise of HMOs and lack of mental health coverage in insurance policies. It's a conflict of interest in my opinion to take these kinds of custody cases because these people make money as long as the conflict is kept alive. I wrote an earlier post on this subject in which a survey was done of psychologists who are in therapy themselves. A very high number of them have family problems, suffer from depression, are divorced themselves, and are having problems with their children. These people with serious problems in their own lives are telling other parents how they should raise their children and live their lives. These people are affecting judge's decisions regarding custody cases. Not a good thing.

I'm not sure if the entire field of psychology needs a serious shake-up, but I know this trend towards forensic psychology in custody cases needs some serious airing out. I have a feeling that those people aren't as good as psychiatrists who have a regular, thriving practice. There are just too many conflicts of interest, too much bias against mothers (the "diagnoses" and legal trends such as "friendly" parent provisions are very biased against mothers), and too much focus on making money from people's misery for my taste.

Posted by: Trish Wilson at Sep 7, 2004 1:56:10 PM

Excellent discussion. I posted in the thread below stating my beliefs regarding mental illness/health and won't rehash it here. But you're definitely onto something when picking the tangled threads of money, political interest, the mental health industry, the insurance industry, and hysterics of both genders looking for anything that will give them power in their conflicts.

I think there will soon be a revolution in how we see "borderline/histrionic" personality disorders. It will follow our adjustment as a society to the breakdown of gender roles. Specifically the "virtue of selfishness" and how it presents in women and men, and how we react to it.

On the neuroscience side, we must acknowledge that there are real, biological differences in men's and women's general behavior. We must also acknowledge that the brain's wonderful sophistication complicates that general behavior by imposing stoopid concepts like "personality," "situation," and "free will." Darn those big brains!

We could go a ways by getting rid of the concept of mind/body dualism, but then what would we do with all our religions and crystals and stuff? And the funeral industry would go right in the crapper. But the organ donations might go up. How much of a utilitarian are you, family of the recently "brain dead?" But I digress.

There are tons of fake syndromes, conditions, diagnoses, and treatments that not only ignore established knowledge of how bodies and behavior work, but actually do harm by trying to contradict established knowledge. "Syndromes" like PAS (both kinds), Recovered Memory, Sensory Integration Disorder, and all their attendant "therapies" have two broad categories of harm. On the individual level, patients and their families waste emotional and economic resources by malingering, exacerbating and creating conflict, alienating people who are blameless, and clinging to people who are harmful (this includes bad therapists). On the larger societal level, people lose productivity through time and job loss and waste resources on quacks when they could be getting reliable help from credible therapies.

Having said that, it's not that hard to tell the difference between assholery and actual brain problems. Actual brain problems create aberrations in brain behavior. The more sophisticated we get at mapping the brain and spying on it while it's engaged in tasks/behaviors, the easier it will be to pinpoint these aberrations and treat them.

My best advice to Tony and others suffering problems like his: Don't marry and reproduce with assholes. Get your picker fixed. And examine your own personality and behavior to see what you're contributing to the problem. Embrace transparency. Pull in all the objective experts you can to monitor interactions. Control your temper. Don't try to "win."

For those who wonder if it's a real problem or not: Consult a behavioral neurologist or licensed psychiatrist, or, ideally, a neuropsych. If you consult a psychologist or "Licensed Therapist (which can be anyone with a shingle)," run his/her recommendations through a free site like "Quackwatch" before committing much time and money to a therapeutic relationship with him/her.

Posted by: Kathy at Sep 7, 2004 3:32:58 PM

Written very quickly, so its kind of choppy- sorry if it's a pain to read:

There are certainly some fairly dubious syndromes, but the majority of them are not unreasonable. It's a little bizarre to attack the margins of psychiatry by coming down heavily on things like PAS, whilst ignoring the real and dramatic impact of diseases like depression or schizophrenia which form the core of psychiatric practice. Also I think you need to draw distinctions between the various domains of mental health treatment- for example, recovered memory therapies were largely a product of therapeutic counsellors, nor psychiatrists. The power dynamics operating between patients and the different spheres of mental health practicioners are very different. Psychiatry is like pretty much any field in that the standard of care or service you receive depends on who's treating you- BPD is a good example here; actual BPD is really really hard to deal with, and very clearly needs treatment, yet too many doctors tend to see a self-injurer and immediately throw out a BPD diagnosis inappropriately. The problem isn't with the categorisation per se (although that can sometimes be an issue) but is connected to the way those categories get implemented and used\abused. Incidentally, I wouldn't rely much on Szasz; his criticisms of the psych industry were great and fairly relevant when they were written, but hold much much less value now. Psych people are still often authoritarian or uncaring, but they are a lot better than they were, particularly as psych diagnoses have become better understood as illnesses and not moral failings. Take a look at the difference in treatment between Rosenhan's 'On being sane in insane places' and the repeat of that experiment by Slater in 'Opening Skinner's box.'
In summary, yes there are problems with the psych industry, as with everything, but it's hardly the malign agent of social control some people seem to think it is, and for a lot of people modern psychiatry is an absolute godsend.

Also re. homosexuality and gender identity disorder: GID in adults is a fairly useful diagnosis given trans folk tend to want significant medical interventions, the problem is GID of children and adolescents. GID applied to young people is almost always applied to boys who are too feminine, and it's also the diagnosis that most clearly replaced homosexuality, as a large % of children diagnosed with GID grow up to be gay men (I believe a majority but I can't remember the precise numbers, but see Green, R 'The Sissy Boy Phenomenon' for details.) The question then becomes why if adult homosexuality isn't a problem is its childhood manifestation pathologised?

Posted by: Tcharn at Sep 8, 2004 10:53:06 AM

Kathy raises some excellent points, but I'm a bit puzzled by this claim:

Having said that, it's not that hard to tell the difference between assholery and actual brain problems. Actual brain problems create aberrations in brain behavior. The more sophisticated we get at mapping the brain and spying on it while it's engaged in tasks/behaviors, the easier it will be to pinpoint these aberrations and treat them.

But unless one accepts some form of mind-body dualism, isn't it the case that all mental phenomena are realized in some brain state or another? If so, then the fact that you can pick out some distinctive feature(s) of the brain activity of a group of people doing something bad does not necessarily mean that what those people have is a "mental illness." (Being furious has certain very distinct physiological features that go along with it. But being furious is not, in and of itself, a mental disorder; and neither, for that matter, is being furious without any good reason.)

Another approach to the same point: if ordinary assholery didn't map to aberrant brain activity, what would it map to? Aberrant liver activity?

One of the upshots of this is, I think, that the talk of a lot of psychiatric disorders purely as "brain disorders", to be treated by fiddling with neurotransmitter levels and the like, may be fundamentally wrong-headed in a lot of important ways. Feminist therapists have rightly pointed out the ways in which talking about emotional states as issues of a pathological "brain chemistry"--without addressing such minor questions as whether or not it's rational for many women in a patriarchal society to be depressed--is both dehumanizing and systematically corrupting to the forms of treatment recommended. (If it is perfectly rational for women in today's world to be depressed, at times, then it seems that an important part of treatment ought to be working to change today's world--rather than fiddling with "brain chemistry" until she stops complaining about her predicament...)

Posted by: Rad Geek at Sep 8, 2004 10:34:11 PM

Hmm. As the wife of a man subject to depression, I think "brain chemistry" sometimes is a large part of the problem. Joel slips into depression far more readily than I do when faced with similar situations, he has a family history of depression, and he functions better with antidepressants than without (and it's not like medication stops him complaining about what's wrong in life - what it does is stop him from spiralling down for long periods of time and giving up).

That doesn't mean I believe you begin and end with medication. For some people, like my husband, or, for another example, a friend of mine with bipolar disorder, medication can be part of what improves their lives. After all, it's hard even to be empowered enough to try to change anything for the better when you're really down in the pit of depression. That doesn't mean you don't also want to look at whether there are things you can change in your life to make yourself happier, and whether there are changes in the way you frame the situation which would help you better see what you can change. In fact, cognitive therapy has a good success rate with depression (and that's not about talking yourself into believing that everything is OK - it's about understanding when something's situational, and not about you being a bad person, that sort of thing).

I do agree that some aspects of psychology are dodgy. I'm more skeptical of forensic psychology, in general, than clinical psychiatry. I also question some disorders (I agree with Tcharn about GID in children, and I wonder about some other things like the provisional really bad PMS disorder). And Kathy makes good points as well, particularly about the way anyone with a shingle can set up as some sort of therapist. I just think that medication does have its place.

Posted by: Lynn Gazis-Sax at Sep 9, 2004 12:53:09 AM