The Political Dimensions of Mental Illness

16 March 2010

Tuesday


An older edition of the DSM.

Yesterday I found an interesting article in the Psychiatric Times, Opening Pandora’s Box: The 19 Worst Suggestions For DSM5, by Allen Frances, MD. The author was in charge of the fourth revision of the DSM, and the New York Times called him, “perhaps the most powerful psychiatrist in America” in an article titled, “SCIENTIST AT WORK: Allen J. Frances; Revamping Psychiatrists’ Bible.”

In so far as the DSM — i.e., the Diagnostic and Statistical Manual of Mental Disorders — is understood to be the “psychiatrist’s bible” it is easy to understand the controversy that surrounds each revision and edition. I can recall articles in the popular press when each subsequent edition has been published, either hailing it as a comprehensive marvel or criticizing its pretensions to having defined the parameters of psychological normalcy.

Dr. Frances’ above mentioned article comes with the special authority of one who has edited an earlier edition. I searched on his name and found quite a few articles available on the internet about his criticisms of the most recent edition in preparation. Dr. Frances focuses in particular on two primary concerns with the new edition: “1. New diagnoses that would be extremely common in the general population (especially after marketing by an ever alert pharmaceutical industry) [and] 2. Lowered diagnostic thresholds for many of the existing disorders.” These themes appear throughout the detailed nineteen criticisms of the DSM5. If Dr. Frances is correct in the thrust of his criticisms, this newest edition of the DSM would seem to be, in large measure, a gift to the pharmaceutical and medical industries, and further evidence of the extent to which elite professions have become captives to vested interests.

The DSM has a quasi-official status in terms of defining mental illness, and thus, by way of the via negativa, mental health. Whether or not an insurance company will pay the bill for the treatment of a mental illness, or pay for prescription drugs to treat a mental illness, depends upon whether the condition appears in the DSM, and the diagnostic criteria detailed in the DSM by which said condition can be identified in an individual. Thus the two primary concerns of Dr. Frances — new diagnoses that would be common in the general population and lower thresholds for diagnoses — make it that much easier to identify a mental health condition and to be remunerated for its treatment.

All are complicit in this transaction; it is the medical equivalent of grade inflation through lowered standards. Doctors and clinics who want to increase their business, publishers who want the latest edition of a standard text to be adopted rapidly, patients and families of patients who demand treatment and demand that insurance companies pay for it, insurance companies who want professional “cover” for continuing to do business as usual, and regulators and politicians who hold insurance companies accountable and who in turn are held accountable both by patients and the industry. No one has clean hands here.

In the short term, what suffers is our intellectual honesty. In the long term, society suffers on the whole by tolerating both a culture of phoniness and a pervasively medicated society in which there is a psychotropic drug for everyone and everyone has been medicated with a psychotropic drug.

It would be difficult to imagine a more perfect illustration of the Marxist doctrine of ideological superstructure being determined by economic infrastructure. We have an enormous medical-industrial complex that takes in billions of dollars each year, employing millions and treating millions. If proposed health care legislation passes even more money may be funneled into the medical-industrial complex, perhaps under threat of compulsion. An economic entity of such size and power is self-perpetuating, generating its own supply and demand, and indeed generating its own political realities to which smaller entities (not to mention mere individuals) must conform or be cast into outer darkness.

As I wrote above, no one’s hands are clean in this business. The vested interests extend from top to bottom throughout the social and economic system. Because no one wants to be left out, everyone wants to get on board. But getting on board the medical-industrial complex in this instance means admitting that almost everyone is mentally ill, possessing one treatable condition or another.

Also in this instance, the ideological superstructure that is being slowly and steadily, albeit obliquely created by this vast, untouchable economic infrastructure is a doctrine of the mind. At present, in other words, the theory of the mind is being driven by economic interests. I find this deeply disturbing. The dignity of man is in the dignity of the mind of man. What makes us distinctly human is our uniquely intellectual accomplishments cultivated against all odds through millions of years of evolution. Darwin concluded the Origin of Species famously writing that, “There is grandeur in this view of life,” the view of life in question being that of the antiquity of life of earth having wrested itself out of the seas and out of the swamps and ultimately having colonized the world entire. As Darwin writes:

There is grandeur in this view of life, with its several powers, having been originally breathed by the Creator into a few forms or into one; and that, whilst this planet has gone circling on according to the fixed law of gravity, from so simple a beginning endless forms most beautiful and most wonderful have been, and are being evolved.

Or, in the words of the first edition, before the passage was softened to placate sacrosanct pieties, and which I prefer:

There is grandeur in this view of life, with its several powers, having been originally breathed into a few forms or into one; and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endless forms most beautiful and most wonderful have been, and are being, evolved.

Implicit in the Darwinian view of life is a Darwinian view of mind, and I would add that there is a similar grandeur in this view of the mind, which we might put thus:

There is grandeur in this view of mind, with its several faculties, having originally emerged within a few conscious beings or within one; and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endless ideas most beautiful and most wonderful have been, and are being, evolved.

That something as magnificent as the mind should not only be subject to petty politicking, but that the mind and its faculties should be defined by such a process is not only bad science and bad medicine, but it is also a humiliation and a degradation to the hard-won achievements of our species.

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Grand Strategy Annex

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