Cars

I Overview

Someone is considered mentally ill if

His conduct rigidly and consistently deviates from the typical average behaviour of all other people in his culture and society that fit his profile whether this conventional behaviour is moral or r
I Overview

Someone is considered mentally ill if

His conduct rigidly and consistently deviates from the typical average behaviour of all other people in his culture and society that fit his profile whether this conventional behaviour is moral or rational is immaterial or

His judgment and grasp of objective physical reality is impaired and

His conduct is not a matter of choice but is innate and irresistible and

His behavior causes him or others discomfort and is

Dysfunctional selfdefeating and selfdestructive even by his own yardsticks

Descriptive criteria aside what is the essence of mental disorders Are they merely physiological disorders of the brain or more precisely of its chemistry If so can they be cured by restoring the balance of substances and secretions in that mysterious organ And once equilibrium is reinstated is the illness gone or is it still lurking there under wraps waiting to erupt Are psychiatric problems inherited rooted in faulty genes though amplified by environmental factors or brought on by abusive or wrong nurturance

These questions are the domain of the medical school of mental health

Others cling to the spiritual view of the human psyche They believe that mental ailments amount to the metaphysical discomposure of an unknown medium the soul Theirs is a holistic approach taking in the patient in his or her entirety as well as his milieu

The members of the functional school regard mental health disorders as perturbations in the proper statistically normal behaviours and manifestations of healthy individuals or as dysfunctions The sick individual ill at ease with himself egodystonic or making others unhappy deviant is mended when rendered functional again by the prevailing standards of his social and cultural frame of reference

In a way the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant Still they share not only their subject matter but to a counter intuitively large degree a faulty methodology

As the renowned antipsychiatrist Thomas Szasz of the State University of New York notes in his article The Lying Truths of Psychiatry mental health scholars regardless of academic predilection infer the etiology of mental disorders from the success or failure of treatment modalities

This form of reverse engineering of scientific models is not unknown in other fields of science nor is it unacceptable if the experiments meet the criteria of the scientific method The theory must be allinclusive anamnetic consistent falsifiable logically compatible monovalent and parsimonious Psychological theories even the medical ones the role of serotonin and dopamine in mood disorders for instance are usually none of these things

The outcome is a bewildering array of evershifting mental health diagnoses expressly centred around Western civilisation and its standards example the ethical objection to suicide Neurosis a historically fundamental condition vanished after 1980 Homosexuality according to the American Psychiatric Association was a pathology prior to 1973 Seven years later narcissism was declared a personality disorder almost seven decades after it was first described by Freud

II Personality Disorders

Indeed personality disorders are an excellent example of the kaleidoscopic landscape of objective psychiatry

The classification of Axis II personality disorders deeply ingrained maladaptive lifelong behavior patterns in the Diagnostic and Statistical Manual fourth edition text revision American Psychiatric Association DSMIVTR Washington 2000 or the DSMIVTR for short has come under sustained and serious criticism from its inception in 1952 in the first edition of the DSM

The DSM IVTR adopts a categorical approach postulating that personality disorders are qualitatively distinct clinical syndromes p 689 This is widely doubted Even the distinction made between normal and disordered personalities is increasingly being rejected The diagnostic thresholds between normal and abnormal are either absent or weakly supported

The polythetic form of the DSMs Diagnostic Criteria only a subset of the criteria is adequate grounds for a diagnosis generates unacceptable diagnostic heterogeneity In other words people diagnosed with the same personality disorder may share only one criterion or none
The DSM fails to clarify the exact relationship between Axis II and Axis I disorders and the way chronic childhood and developmental problems interact with personality disorders

The differential diagnoses are vague and the personality disorders are insufficiently demarcated The result is excessive comorbidity multiple Axis II diagnoses
The DSM contains little discussion of what distinguishes normal character personality personality traits or personality style Millon from personality disorders

A dearth of documented clinical experience regarding both the disorders themselves and the utility of various treatment modalities
Numerous personality disorders are not otherwise specified a catchall basket category

Cultural bias is evident in certain disorders such as the Antisocial and the Schizotypal
The emergence of dimensional alternatives to the categorical approach is acknowledged in the DSMIVTR itself

An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another p689

The following issues long neglected in the DSM are likely to be tackled in future editions as well as in current research But their omission from official discourse hitherto is both startling and telling

The longitudinal course of the disorders and their temporal stability from early childhood onwards

The genetic and biological underpinnings of personality disorders

The development of personality psychopathology during childhood and its emergence in adolescence

The interactions between physical health and disease and personality disorders

The effectiveness of various treatments talk therapies as well as psychopharmacology

III The Biochemistry and Genetics of Mental Health

Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain or are ameliorated with medication Yet the two facts are not ineludibly facets of the same underlying phenomenon In other words that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered Causation is only one of many possible connections and chains of events

To designate a pattern of behaviour as a mental health disorder is a value judgment or at best a statistical observation Such designation is effected regardless of the facts of brain science Moreover correlation is not causation Deviant brain or body biochemistry once called polluted animal spirits do exist but are they truly the roots of mental perversion Nor is it clear which triggers what do the aberrant neurochemistry or biochemistry cause mental illness or the other way around

That psychoactive medication alters behaviour and mood is indisputable So do illicit and legal drugs certain foods and all interpersonal interactions That the changes brought about by prescription are desirable is debatable and involves tautological thinking If a certain pattern of behaviour is described as socially dysfunctional or psychologically sick clearly every change would be welcomed as healing and every agent of transformation would be called a cure

The same applies to the alleged heredity of mental illness Single genes or gene complexes are frequently associated with mental health diagnoses personality traits or behaviour patterns But too little is known to establish irrefutable sequences of causesandeffects Even less is proven about the interaction of nature and nurture genotype and phenotype the plasticity of the brain and the psychological impact of trauma abuse upbringing role models peers and other environmental elements

Nor is the distinction between psychotropic substances and talk therapy that clearcut Words and the interaction with the therapist also affect the brain its processes and chemistry albeit more slowly and perhaps more profoundly and irreversibly Medicines as David Kaiser reminds us in Against Biologic Psychiatry Psychiatric Times Volume XIII Issue 12 December 1996 treat symptoms not the underlying processes that yield them

IV The Variance of Mental Disease

If mental illnesses are bodily and empirical they should be invariant both temporally and spatially across cultures and societies This to some degree is indeed the case Psychological diseases are not context dependent but the pathologizing of certain behaviours is Suicide substance abuse narcissism eating disorders antisocial ways schizotypal symptoms depression even psychosis are considered sick by some cultures and utterly normative or advantageous in others

This was to be expected The human mind and its dysfunctions are alike around the world But values differ from time to time and from one place to another Hence disagreements about the propriety and desirability of human actions and inaction are bound to arise in a symptombased diagnostic system

As long as the pseudomedical definitions of mental health disorders continue to rely exclusively on signs and symptoms ie mostly on observed or reported behaviours they remain vulnerable to such discord and devoid of muchsought universality and rigor

V Mental Disorders and the Social Order

The mentally sick receive the same treatment as carriers of AIDS or SARS or the Ebola virus or smallpox They are sometimes quarantined against their will and coerced into involuntary treatment by medication psychosurgery or electroconvulsive therapy This is done in the