I know one of my least popular arguments -- probably even moreso than my arguments for decriminalizing drugs and prostitution, even less popular than my argument for privatizing roads -- is my contention that our current view of mental illness is entirely mistaken. However, I believe it is one of the best examples of a place where our efforts to help others end up doing harm, and thus serves as a good example of so many other bad ideas. Because of that, though I despair of convincing anyone who is not at least a little sympathetic to my views already, I feel the need to keep making this argument, even if few --or none -- of my readers are likely to agree.
To put it simply, my view is that mental illness is not biological, despite current views. Oh, it is biological in the sense that all our thoughts obviously contain a biological element, taking place inside a physical brain. And it is biological in the sense that a few cases dubbed mental illness are actually the result of dementia or brain damage of some sort, or -- thanks to the oddities of government funding -- actually mild mental retardation shuffled into the mental health system to take advantage of available funds1. But beyond those outliers, and the sense in which all thoughts are biological, I deny mental illness is in any conventional sense as illness. Rather, I would argue what we dub mental illness are simply a host of unacceptable behaviors we find ourselves unable to understand. Be it simply unacceptable actions -- such as teen drug users who often get shunted into the mental health system, or the one time practice of doing the same for excessive promiscuity -- or beliefs and behaviors just a bit too far outside of the mainstream, or perhaps it is an example of poor or lacking socialization -- such as an inability to control one's emotions -- or, in some cases, simply a tendency to act on a personal set of connotations, which is unintelligible to an outsider, but perfectly consistent to the individual acting. In short, mental illness is nothing but a blanket term for behaviors which are unintelligible or unacceptable, behaviors we have tried to treat as illnesses, grouping and classifying, but, in the end, not come close to curing because, simply put, they are not a disease2,3.
Some of those are a bit hard to understand, and some may give a mistaken impression of what I believe. For example, when I speak of personal connotations, I do not mean to imply the entirety of mental illness is linguistic, to fall into the errors of General Semantics. Some may well be in that area, people who misinterpret words and react oddly because of it. After all, we have everyday examples of this, people who take certain descriptions badly, groups which charge racism when someone says "niggardly" and so on. So it exists, and some of the behaviors do resemble mental illness, but clearly, that is not the whole of the problem.
As I said above, I think mental illness suffers from a problem I described when discussing "hyperactivity" or "ADD/ADHD", people are taking a symptom, or behavior, and making that description into an ailment. In the realm of more conventional ailments, the same is true of "cancer". There will never be a cure for cancer (see "The Mythical Cure for Cancer") because cancer, the uncontrolled growth of cells, is a symptom, one with multiple causes. It is akin to looking for a cure for fever or cough. Cancer is a symptom, not an illness.
And the same is true, even more so, with "mental illness". Mental illness is not an illness, it is a group of many, many behaviors, the definition of which changes over time -- as we shall see -- and some of which may be deemed normal by some and aberrant by others -- lumped together into a set of supposed ailments. I would contend, that because it is so broad, and the supposed ailments themselves both so broadly defined, and so arbitrary, that even experts often cannot agree on which specific ailment described which behaviors. Thus, I believe, mental illness as such, cannot be ascribed to a single cause, or even groups of causes, as General Semantics tried to do, but rather must be seen as a cultural construct, describing all behaviors, regardless of cause, which fall outside of the socially acceptable. Or, to be precise -- as we do not find all criminals insane4 -- all those behaviors falling outside social acceptability, which the majority of us cannot explain with some understandable motive.
To try to explain the idea of mistaken connotation, as that seems the hardest to grasp, and the one for which my examples provide the least help, I used to offer a thought experiment. For the next hour or day, bear this in mind, and behave as it is absolutely true: Anyone who uses a word starting in "T" is threatening to harm you, while anyone using a word starting with "W" is expressing their love. It is absurd, and something no one would ever believe, but if you were to act as if it were true, your behavior would certainly mimic the mood swings of a number of disorders. And it is my contention that, to some degree, that is at the root of some behaviors. Oh, nothing so absurd, I grant, but we have seen it in real life. The guy in the bar who takes offense at an innocent description because he attaches an extra meaning to one of the words. The person who finds extra significance in something you said because of your choice of words. Even the effort politicians and advertisers put into picking just which words to use. Every day, we accept that connotations, the hidden extra baggage we attach to words, are very real and powerful. Well, if someone were to have come to attach the wrong connotations, to see in words meanings the rest of us did not share, would not the result look a lot like all those bizarre behaviors popularly described as "schizophrenic". I do not want to overstate this, I think such connotations are relatively rare, or arise many times not on their own, but as a consequence of mistaken beliefs5, but it still is a component of mental illness as I see it, and an important one, as it helps explain some of the most inexplicable behaviors. But, to be perfectly clear, I do not think it is the whole explanation, or even the central one; General Semantics was quite wrong in finding linguistic causes to be at the root of most mental disorders.
For the vast majority of what we dub mental disorders, I would instead blame either beliefs well outside the mainstream, or else a lack or absence of socialization -- including socialization to norms not accepted by society at large. For example, in some cultures it would be perfectly acceptable to imagine spirits were speaking to one constantly, it might even be seen as a sign of favor, in ours, imagining you are in constant contact with spirits is seen as an ailment. Unless, that it is, you find a role where it is contextually acceptable, such as working as a medium, where people might still call you "odd'< but would not try to have you institutionalized. Which actually makes a good demonstration of my point. Behaviors are contextual, and what is and is not madness is entirely dependent on societal norms and the context of the behavior. Mourning your spouse the day after he dies is perfectly acceptable; after a year it is acceptable though some may think it excessive; being in mourning a decade after will often be dubbed "depression" and many will claim it has a biological origin. On the other hand, in some societies, or contexts, it would pass unnoticed, since what is and is not appropriate is entirely a social construct, which is a big part of why I doubt mental illness is biological, but rather is a way we try to explain away inappropriate behavior we do not understand6.
Perhaps some of my examples will help to clarify this a bit more.
First, let us look at Truthers, those individuals who believe the events of September 11, 2001 were part of some conspiracy. Now, most of them cannot agree on exactly who was conspiring, or why, or even how, but they all agree something happened and it was not what we were told.
Obviously, when most people hear the theories of one of these Truthers, their reaction is "he's crazy", but not, I must note, "let's put him in an institution". We recognize that, while what someone believe may be far outside the mainstream, and that their belief in such things may even make them hold some irrational beliefs, even act irrationally -- sending FOIA requests to the government, watching Loose Change more than once, etc -- there is a difference between "crazy" and "mentally ill".
But that is where the problem lies. Why is someone just crazy if he thinks the CIA killed Kennedy? Or that Bush blew up the levees in New Orleans? But he is mentally ill if he thinks his roommate is poisoning him? Or Martians are reading his thoughts? Each beliefs has as little or as much proof as the other, each leads to paranoid beliefs, each inspires irrational thoughts and behaviors, yet some we accept as sane -- if outliers -- while others are supposedly suffering some organic disorder. Or, to draw another example, if one were to say "all people are good and helpful" we would call them naive, but not mad. Yet if someone claimed the opposite, that all people were evil and hostile, we would try to medicate them. Or, even more peculiar, if the person saying that others were evil were to do it, as, say, part of a philosophy underlying some self-help program, or lesson in how to win in business, we would accept it as sound, if pessimistic, thought, while in others the very same thought would be a sign of a physical disorder?
That is why I have so much trouble with definitions of mental illness as biological. In many cases, mental illness is nothing more than a more extreme, or less acceptable, expression of a perfectly ordinary --or at least acceptable -- human emotion or belief. We accept some people are happy, some somber, but if the somber individual says being sad is a problem, suddenly it goes from being just another predisposition or understandable mood, and we decide it has a physical origin. Similarly, we accept misfortune can make one despondent, but, if they remain so for longer than society thinks normal, suddenly that sadness is biological in origin. It strikes me as a peculiar way to view the world.
Another example makes this even more plain, as it is an example of a medical miracle. In a period of a few decades, without any medical intervention or medication, without therapy or treatment, we cured millions of the mentally ill. And how we did it shows how troublesome our view of mental illness is.
Recall, in the relatively recent past, homosexuality was either itself a mental illness, or at least so aberrant that it was a sign of an underlying malady. Not so today. Why not? Has human biology changed? Has homosexuality disappeared? Nothing of the kind, what was once madness is no longer because of nothing more than a societal change. As we came to accept homosexuality as acceptable behavior, we magically cured millions of a presumably biological disorder. We made an ailment go away. What previously could only be cured by electro-convulsion, insulin shock, laceration of the frontal lobes, medication or other intervention was magically cured by a change to society. In short, madness was not biological at all, it was merely a social convention. What was claimed to be defined with scientific precision was instantly eliminated by a change in social norms.
Which brings me to the former Soviet Union. It has long been told how the Soviet leadership would use mental institutions as surrogate prisons, claiming those who rejected the Soviet system were mentally ill and locking them away. And, perhaps, in some cases, it was used in an opportunistic way. Then again, there are younger family members in our system have exaggerated how out of touch an elderly aunt or grandfather or other relative is to get early control of an inheritance, so the ability to abuse a system is no indication it is not taken seriously7.
No, I would argue the Soviet system was used, at least by some, as intended. After all, society accepted the Soviet system as the ideal, as the best possible alternative, and to reject it was clearly a sign of a problem. In short, while some may have used it opportunistically, and some may have just gone along, there were doubtless those true believers who saw opposition as a sign of real imbalance, and thus, were using the system as it was meant to be. As we use it. To try to reform those who could not understand their role in society or the benefits society provided. In short, they were curing the mad just as we try to do. I will admit, early on, especially, this was probably less common than later in the life of the Soviet Union, during the Stalin era it was much more likely to find opportunists than true believers, but I doubt even then everyone in the system was corrupt and deceitful. Instead, because we in the west shared the view of the "insane" rather than the society calling them such, we could not see why they were acting, and dubbed it dishonest, but looked at from the inside, doubtless some were acting in what they imagined was good faith8.
Or, to offer another example, why do so many Communist lands bother with reeducation camps? Why not just go the Nazi route and imprison them and work them to death? Why care what they think? Because, to the true believer -- and Communism produces more than we like to believe -- they really are mistaken. They are not enemies or traitors, they are lunatics, maybe just misinformed, and need to be shown the way. You don't bother with reeducation unless you really believe, and I would argue the same is true of Soviet psychiatric institutions. They already had plenty of prisons, even a whole gulag system, for criminals and political rivals. Why bother with institutionalization? Because, at least for some, rejecting the system really was a sign of madness.
All of which shows how much of a social construct madness can be. And argues against any biological origin.
Perhaps one final argument might help. It is hypothetical, but hopefully it will at least let you see how mental illness is tied to social norms, and not biology.
Imagine if you will, an isolated society, maybe a distant island, founded by thoroughgoing atheists, atheists who won't even accept the possibility of religion. Imagine it isolating itself for a few generations, going its own way and developing its own customs and traditions and norms of behavior. Basically, a society much like ours, but with every trace of religion removed. No churches, no prayers, no Christmas or Easter, no "God bless you" when you sneeze, not even goodbye since it is a religious contraction, every hint of anything religious stripped from it, but otherwise much like our own society.
Now, let us imagine they open their doors to the world once more, and foreigners begin to settle in this island. Not many, as if they settled as a large group, any oddities might just be dismissed as "foreign ways". No, let us imagine a single foreigner, renting a home on the island, trying to fit in. And let us look at how he would be viewed by these strangers.
Well, first of all he makes frequent reference to some imaginary being, one he seems to think really exists. He is full of phrases like "God willing" or "I pray it will..." And these don't just seem to be verbal oddities, he really seems to believe in this imaginary entity, so much so he sometimes even speaks to it, telling it his wishes and imaging it can make them come true. Not just that, but he has a lengthy list of rules he must live by, fearing that were he to violate them, this imaginary being might do him harm, though, he also believes, if he does follow them, he will enjoy the being's favor.
I could go on, but you get the picture. The difference between religion and madness is all matter of numbers, or maybe acceptance by society. Militant atheists would use this to argue all religion is nonsense, but I would make a different point. What we accept as ordinary, could easily be madness in a different context. Likewise, were certain beliefs we would dub insane held by enough people, they would probably pass without comment. In short, as I have been arguing over and over, what is mad and what is not is an entirely social matter. It is not biology, it is not organic, it is the outcome of social processes, and those who choose behaviors, or are socialized in such a way, as to violate those social norms, when we cannot find another explanation -- greed, foreign customs, religious minority, strange parents, what have you -- we call them mad.
Which is why I am so strenuous in my objections. I will grant, in cases these mistaken beliefs, improper socialization and the rest can lead to very troubling behaviors, can even make individuals impossible to control. Then again, the same is true of a number of acceptable beliefs. Anyone who had a teenager who wandered off to join the anti-globalization riots knows madness is not required to have a troublesome, uncontrollable family member. I do not mean to minimize how bad behavioral issues can be, I just want to point out that what we dub mental illness is hardly the sole source of such problems.
And that is what troubles me. Because someone hold beliefs too far outside the mainstream, or behaves in a peculiar manner, it troubles me that we believe we have the right, even the obligation, to deprive them of their rights. I know, it is limited to certain specific cases, there are all sorts of reviews, but it still troubles me. Would preventative detention because you were suspected to be planning a crime be acceptable if there were just enough reviews? If it were limited to certain crimes? Of course not. And that is what bothers me about the way we deprive individuals of rights because we dub them mentally ill. I know those doing so mean well, but we also know that cliche about the road to hell. And in this case, I am afraid that may be the most appropriate description.
1. My ex-wife worked in a state mental hospital for a time and the majority of patients seemed to fall into two categories, the mentally retarded sent there because no other money was available and someone managed to convince a social worker they had a "behavioral disorder" and prisoners awaiting trial who were trying to avoid going to jail. They were not the whole of the population, but were definitely the majority.
2. Some will ask why drugs "work" on mental illness if it is not biological. I would respond in two ways. First, it depends on your definition of work. Strong sedatives definitely make violent individuals more tractable, but is that truly a "cure"? In many cases the supposed cures simply amount to reducing the trouble the most difficult patients cause, which could be accomplished by keeping them drunk or doped on opiates, so it is hard to say other drugs "cure" them. In the second case, many drugs "work" in the same way getting drunk "cures" sadness. Patients with mood problems enjoy a brief elevation from psychiatric drugs which mimic stimulants or sedatives, but would probably do as well with more traditional drugs which do the same -- in fact, the tendency to "self-medicate" with drugs and alcohol shows this is true -- so again, it is silly to call a cure the ability to use drugs to make people feel happy for a brief time. (This is not a full answer, obviously, but does explain a number of cases. Anyone who doubts the second explanation needs to explain why so many "mood stabilizing" drugs are both abused by those to whom they are prescribed and sold on the black market. If they did not produce some sort of euphoric effect, that would not happen. Thus, it seems they do little more than what traditional "bad" illegal drugs do. Just legally.)
3. I am ignoring here what was once called malingering, that is play acting and faking. However, I am fairly sure, to some degree play acting is a part of many mental disorders. Not that they are necessarily faking, rather, I would suggest in some cases individuals begin by adopting a persona, or playing at a role, and, over time, find it so comforting they have trouble living without it, or even recognize it is an act any longer. I recall when I was in college one summer, taking some extra classes, I had a break of several hours between classes, and to fill it a friend and I played rummy, hours and hours, eventually racking up running scores of several tens of thousands of points. However, after playing so much rummy, for several weeks, I also recall how I began to always think in threes. When I saw couples or pairs of things, I would begin to ask where the third one was. It convinced me how easily the mind can be trained to patterns, even unintentionally. And it convinced me that it is quite possible for play acting to become pretty real to the actor, provided they do it long enough.
4. I always found it odd that insanity was an argument against imprisonment, as I imagined the inability to tell right from wrong would argue that that person should be locked away for a longer time. Or, as my mother used to say "I would think you would have to be insane to commit any murder." All of which is a round about way of saying, the line between simply criminal and criminally insane seems a terribly artificial one. Someone who is a cold blooded assassin for hire seems to have more trouble telling right from wrong than a man who thinks he is talking to God, at least to my mind, but the former is often held to be sane, while the latter is not. It strikes me as a bit odd.
5. As I am going to discuss Truthers later, look at the odd meanings they ascribe to the word "pull" because of WTC 7. And think about how they often parse discussions and find hidden meanings in certain words. It is not exactly the same as what I am describing, but definitely shows how such mistaken personal connotations could arise.
6. Some may ask where is the harm in trying to help people fit in. Even if it is just a social construct, why is it bad to try to make people happier? To help them adjust to society? And if it were simply people trying to help, I would not object so strenuously. My problem is that we empower unelected individuals to deprive these individuals of various rights. They can lose their right to contract, control of their property, the right to refuse medication, even their freedom, based on medical opinion. That is why I find our present view of mental health not just erroneous but a danger.
7. Not to mention that there have been those who suggested using our commitment system to extend jail terms for rapists and others, which seems little different from the opportunistic use of which we accuse the Soviets. Fortunately, this does not seem to enjoy much widespread support in the US.
8. I am not denying the state used this system for its own advantage, doubtless there were opportunists. However, I am certain, especially after a number of generations had been raised with Soviet beliefs, that there were many who saw an outright rejection of the Soviet system as a sign of madness. (If you doubt this, I have a story from my college Russian professor. He told how, as a child, their local hero was one of the dogs which guarded the border. He told how many times they were told the dog had kept out those seeking to enter the Soviet Union. And he believed it as a child. The fence that kept the Soviet people in was reinvented as a means of keeping others out. And it was accepted unquestioningly, at least by children. And some probably never did question it. If that is true, how hard would it be to find someone who believed anti-Soviet feelings were signs of madness?)