A couple articles have recently drawn my attention to the field of psychology, and particularly to the upcoming edition of the Diagnostic and Statistical Manual and Mental Disorders (DSM). This book provides the definition of what is and isn’t a mental disorder in the United States. As such, it has great power, because it makes essentially arbitrary decisions about what sort of behavior is and isn’t normal.
Arbitrary? Yes. This is what many people don’t understand about psychology. It’s most obvious when we compare the concept of mental illness to physical illness. (There’s a great Chesterton quote on this topic which I’ll post later this week.) The human body has parts with functions: eyes to see, lungs to bring in oxygen, a heart to pump blood, and so forth. When one of these parts stops working, or doesn’t work as well as it should, we call that a physical illness. Since everyone agrees on what the purpose of these parts of the human body are, we also agree on what is an illness and what isn’t. While there may be a few gray areas, there’s nothing arbitrary about the definition of physical illness.
To define mental illness, we first need a definition a what the function of the human mind is. And here’s the thing. In our modern society, we do not have such a definition. Indeed the debate predates American society by quite a bit. In ancient Greece, the philosophers raged about the question of what states and tasks are indicative of a properly functioning mind. Nowadays, most folks don’t devote much thought to the topic. But, even though we have no clue what a mind should do, we’ve no shortage of things that we know it shouldn’t do.
The first article, from Salon, documents how the number of mental illnesses in the fifth edition of the DSM (DSM V for short) is exploding, and also how the boundaries of disorders such as depression are expanding. In other words, once the DSM V becomes the source of authority, a lot more people will be diagnosed with psychiatric disorders than are currently, even if there’s no change in anyone’s mental state. The second article, in Slate, tells us that the DSM V may include a disorder known as “Complicated Grief”. Of course “grief” is not a disorder, but rather a normal human reaction to the death of a loved one or some other sad event. The exact reason why we need to classify “complicated grief” as a mental illness is unclear.
This facts should give us pause for many reasons, not the least of which is what they tell us about power in modern American society. If such an important book is changing in such big ways, we should ask why it’s changing and who’s benefiting from it. One group that obviously stands to benefit is the pharmaceutical companies. If more people get diagnosed as mentally ill and are prescribed pills for their “illnesses”, sales of pills will go up. You might suspect that drug companies have been behind the pushes to change definitions of mental illness. You would be correct, as this article demonstrates.
But there are other forces at play here beyond merely the profit-hungry pharmaceutical companies. The precise definition of mental illness has always told us something about a society, who holds the power in that society, and what the powerful want to do with the powerless. Sixty years ago, sexual tastes including homosexuality and sadomasochism were mental illnesses both in the USA and other countries. Today they are not; that was changed around 1970. On the flip side, many things that weren’t mental illnesses now are. Ordinary shyness has become “social phobia”, and now grieving is no the list as well. What does this tell us about power in modern American society?
Well, it tells us that the powerful are much more insistent about emotional conformity than they once were. Grief, as I said, is a normal process. The Bible mentions mourners on many occasions. In ancient China, grieving for one’s father lasted three years. Even in early America, grief was a ritual. Close relatives of the deceased would wear black and otherwise indicate that they were withdrawing from mainstream society for a time to focus on their loss. This website has some fascinating information on mourning clothes and rituals during the Victorian period. Here’s an example of a mourning dress:
Nowadays we just don’t tolerate that sort of thing. Anyone who wore black for years–much less the rest of their life–would be viewed as quite odd, and now mentally ill to boot. The definition of mental illness is thus all about punishing people who want their own private space and respect from others for a certain type of emotion. The DSM V says clearly: “You can’t have it.”