Abstract
In 1487, the Malleus Maleficarum was published by members of the Catholic Church in Germany as an authoritative guidebook on how to identify, question, and, ultimately, convict witches. Similarly, the DSM serves as an authoritative manual for identifying and classifying individuals who disturb, who defy social norms, and who are considered to be somehow different. These diagnostic categories, however, lack reliability and validity, result in assumptions and stereotypes that contribute to unhelpful and harmful practices, create an illusion of disease and difference where there is none, and provide a means of social control that may violate human rights for many. Anti-stigma campaigns advocate for decreasing prejudice and discrimination for those suffering emotional distress, yet the very paradigm upon which these campaigns, and the mental health field as a whole, is predicated may be the central culprit for this prejudice in the first place.
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- 1.
See, for example, O’Brien (2016), McDonald (1997), and Pihlajamaki (2000), for analyses and reviews of practices common during the sixteenth and seventeenth centuries. Most reviews of the time view these practices as highly biased, stemming from fear and attempts to control the chaos and suffering in life through the prevailing ideology of the time (i.e., Christianity). These reviews, and many others, highlight how the certainty of the professionals of the time was an illusion and resulted in the torture and death of countless innocent victims. See, specifically, Pihlajamaki, for an analysis of how professionalism and a “scientification” of the procedures involved helped explain why these witchcraft trials and ordeals were so common in countries whose values aligned with science and professional stature.
- 2.
In almost every psychological and/or neurological battery ordered, an IQ test will be included to examine for “cognitive deficits” or “areas of weakness” that are purported to be associated with particular diagnostic categories. The subtest titled “Information” specifically requires individuals to know random facts, for example, “Who is Martin Luther King, Jr.?” or “Who authored Tom Sawyer?” The subtest regarding Comprehension requires individuals to have a particularly narrow view of things like keeping money in a bank or putting envelopes in the mail. While common, these are not universal, nor, certainly, evidence of anything other than someone’s Westernized educated culture and conforming attitude. In addition to this more formal test, if a person speaks in convoluted or confusing ways, they may be said to “have a thought disorder”, which is presumed to be evidence of brain dysfunction or disease rather than, perhaps, confusion due to trauma or prolonged stress, drugs (prescribed or not), or just mere lack of desire to communicate in proscribed ways.
- 3.
See, for example, Kinderman et al. (2017) and Pilgrim (2014) for recent analyses and reviews of the history of the politics controlling the development of and subsequent changes to the DSM, and the uproar in response to the latest version. See also Caplan (1995) and Ross (2008) for critical insiders’ reflections on the development of diagnoses and the DSM. All offer rich information on the details of this process throughout the years, a glimpse behind the scenes of what really goes on, and analyses of how political and financial agendas in accordance with societal needs appear to guide the process rather than true science.
- 4.
There are numerous analyses of the history of many of these drugs, the political and even corrupt practices of pharmaceutical companies and their representative researchers and ghostwriters, and the lack of long-term effectiveness, specificity, and harm associated with psychotropic drugs. For instance, see Healy (2012) for a detailed account of how the pharma-centric system of care has decreased the ability to actually care, and how corruption and greed have resulted in millions taking unnecessary and even harmful drugs that are sold as “life-savers”. See also Moncrieff (2013) for a critical historical analysis of neuroleptic drugs, the story that developed from one of dangerous and largely ineffective drugs to “magic bullets” that are antipsychotics, and the current epidemic of prescribing. Additional evaluative narratives that highlight a broader truth than typically spread regarding these drugs and the medicalization of human suffering include, but certainly is not limited to Kirk, Gomory, and Cohen (2013); Olfman and Robbins (2012); Rapley, Moncrieff, and Dillon (2011); and Whitaker (2010).
- 5.
I myself am a clinical psychologist operating under this paradigm. Most of the people I work with pay through insurance. Insurance companies only reimburse for medical problems—in fact, if they determine that a person’s issues are spiritual, existential, or otherwise non-medical, I will stop getting paid. I, like all of my colleagues, have a vested interest in maintaining this setup seeing as how I cannot pay rent without it. Further, I live in New York City where the population of therapists is rivaled only by that, perhaps, of actors, finance professionals, and rats. One must be able to stand out, and the only way to do this is through having a “specialty”. Without diagnoses, what would we specialize in? I have lost not a few potential clients as a result of my refusal to pretend that I specialize in anything other than supporting people in better understanding and working through their human suffering. See also Whitaker and Cosgrove (2015) for an academic thesis on how these guild interests fuel corruption and promotion of the status quo.
- 6.
In society, in general, women frequently get blamed for putting themselves in a position that enticed a rapist or allowed sexual abuse or rape to occur (e.g., Deming, Covan, Swan, & Billings, 2013). It has also been asserted that prolonged distress after experiences such as sexual abuse is the result of problematic ways of thinking or an innate temperament (e.g., Hankin & Abramson, 2001) rather than this being an understandable result of extraordinary circumstances. What if, instead of words like “personality disorder” or “schizophrenia ” or “dissociative disorder”, we started classifying people as having “sexual abuse reaction syndrome”? How would this change the way we interact with and care for such individuals?
- 7.
See, for instance, Levine (2011), for an exploration of how democracy, economic injustices, and elitism have contributed to the silencing and powerlessness of individuals who either do not or cannot conform. Bruce Levine has written numerous articles, blogs, and books about the pathologizing and diagnosing of anti-authoritarians and non-conformists. He also offers potential solutions for uniting and changing the status quo. See brucelevine.net.
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Hunter, N. (2018). The Illness Inquisition. In: Trauma and Madness in Mental Health Services. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-91752-8_4
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