We Have Issues: Decontextualizing and Dehumanizing Mental Illness with the Diagnostic and Statistical Manual of Mental Disorders

Few texts are frequently likened to holy texts, for fear of overstatement or offense, and for good reason. This has stopped seemingly few, however, from lauding a series of technical manuals, or criticizing those plaudits, with exactly that comparison. The “bible of psychiatry” may have become ultimately more influential than any version of the Christian bible in our nation, as a recent Harvard review showed that antidepressant prescriptions had increased 400% between 1988 and 2008(1), and 11% of American children under 18 now take drugs to combat attention deficit hyperactivity disorder(2). Twenty-three percent of American women between ages 40 and 50 take antidepressant drugs, and these drugs are taken daily(1). Meanwhile, the number of Americans that attend church once per week has declined over that same period of time, with many of the most recent estimates putting the average at roughly 10%, as compared to estimates of 49% in 1991(3). The top four selling items under “international medicine” are versions and addendums to the fifth addition of the DSM-V, the diagnostic and systemic manual of mental conditions. In the religion section, the top four have to do with Buddhism, a neurosurgeon's thoughts on the afterlife, and a memoir entitled “Hippie Girl”. Even under “Christian Books and Bibles”, none of the top 15 selling items reference the bible in their title, with Richard Dawkin's “The God Delusion” appearing at number 41, above the top-selling version of the bible, the New Revised Edition, which ranked at 50.(4) This text approaches humanity in much the same way as the bible. Seemingly unexplainable things, the very things that make each person who they are, why they do the things they do and love the things they love, are defined, categorized and even treated. The newest edition of the DSM, the fifth version, has received tremendous criticism for defining grief itself as a mental condition, with suggestions for treatment. In this, we are given a new form of original sin, a list of reasons to repent and all the pills that can bring one penance, reprieve or a temporary sense of peace. Divine truth is indicative of schizophrenia or some psychotic condition: the solution to all the suffering of the human condition can, of course, only be reached by a committee, specifically the American Psychiatric Association. It is claimed by some that the answer to any problem can be reached by opening up a holy book to a certain random page, and it must be with this same sense of biblical inerrancy that saw the diagnosis of bipolar disorder in adolescents in the mid-1990s surge an astounding 4,000%.(5) The authors paint themselves as the prophets of psychological health, envisioning the real problems and solutions in revelations somehow missed by earlier thinkers. They took the work of William James and others, who had identified the issues of their nagging wives and mothers as “hysteria”, and indeed sometimes proscribed hysterectomies as solutions. They took the work of others, such as Freud, who found some individuals to simply be neurotic, inherently unstable, or at least had gotten into his cocaine stash when he wasn't looking. Though the organization of the American Psychological Association dates itself back to 1944, well before dysaesthesia aethiopica was used to diagnose slaves described as “lazy”, and to advise treatment to the skin lesions that came with the condition through whipping. The work of these individuals and others was advanced, as in the wake of “One Flew Over a Cuckoo's Nest”, along with attacks on psychiatry as a peudo-science, the American Psychiatric Association reacted. Marcia Angell, senior lecturer on social medicine at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine, describes the psychiatric profession's backlash against a developing perception in the 1960s and 1970s that the practice was a "soft" almost pseudo science:
'In the late 1970s, the psychiatric profession struck back--hard. As Robert Whitaker tells it in Anatomy of an Epidemic, the medical director of the American Psychiatric Association Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported.”' This offered a unique opportunity. Psychiatrists already were M.D.s, allowing them to write prescriptions and subjugate other mental health professionals, to seem to bring professionalism and scientific scrutiny to the field. This gave them something even more valuable: a relationship with the pharmaceutical industry. While legally, there is some obligation for them to reveal their pharmaceutical backers, they seem to have successfully achieved a status of some academic standing. They attempt to hide themselves as authors of their work of fiction using frank, objective language and lists, but in so doing are revealed as much the same as their intended audience. When individuals need answers so desperately that they open a book to a random page, hoping to find a solution, when the chaos and confusion of the world and one's relationship with the people and persistent problems that come with simply being a human being, they apparently will also accept a wide variety of side-effects and great expense. According to Forbes, in 2012, the five largest U.S. charities took in a combined 16.4 billion dollars in revenue(6). One pharmaceutical company, Pfizer, took in 15 billion dollars in just the fourth quarter of 2012. (7) It may be a mental illness to grieve, as disagreeing with official state policy was a condition known as “political intoxication” in the Soviet Union, and the desire of a slave to have freedom in our own country was diagnosed as “drapetomania”. Indeed, even our own government issued a report with the 1840 census that stated that mental illnesses were significantly more common among freed blacks than among slaves, and though the study was quickly found to be flawed, it was still influential in the debates of John Quincy Adams and other anti-abolitionists. (8) In 2005, at a meeting of the American and Canadian Academies of Child and Adolescent Society, findings were presented showing that African American and Latino children and adolescents were 3.3 and 2.9 times more likely to be diagnosed with schizophrenia in an emergency room as compared to their white counterparts.(9) These diagnoses are made using the DSM, and this shows we have not come very far from a time when African Americans were popularly believed to be the cursed descendents of Cain, a burden for the white man to care for through careful direction of their labors. In a time when seven out of eight federal prison inmates are African Americans, we must take seriously the points made by individuals such as Senator John Nutting of Leeds, Maine, who put forth a bill to make his state like 42 others in allowing those deemed mentally ill to be forced to take prescribed medications.(10) He and others argue that in most communities, the institution tasked with caring for most of the mentally ill are jails and prisons, and that the inmates in these institutions are frequently there for lack of treatment. As he argues for laws to be put on the books forcing individuals to take drugs, possibly adding to the million-plus drug offenders already incarcerated, it isn't the bible upon which he swore his oath of office on which he bases his arguments. It is the DSM, and he is exactly the implied audience. Insightful on the implied audience of such a book, recent presidential hopeful John Edwards used the DSM recently as Reagan and George W. Bush used the bible. On August 8th, 2008, Edwards, a presidential candidate at the time, explained a series of political scandals with a single word. “Narcissism”, itself explained as the price of power, an unfortunate side-effect of his noble intentions and natural gifts, was the diagnosis he offered of himself to the American public. In explaining his behavioral transgressions using medical terminology, he aimed for our sympathy, and apologized for nothing.(11) While the best minds of Ginsberg's generation may have been destroyed by madness, mine has been destroyed by overmedication. I have survived an epidemic of ADD, ADHD, bipolar disorders, an onslaught of personality disorders that should be insulting to children and parents and people entirely unrelated, and as my peers come back from war with wounds unseen, we are urged to fight with them against the dreadful menace of PTSD, and celebrate their courage post-trauma, post-disorder, after the diagnosis. Where children experience sub-standard standardized education while surrounded by wealth inequality that only thousands of years of human ingenuity could form into our modern insecurities, the president-elect of the American Psychiatric Association has reported holding millions of dollars in stock with drug development companies, and of the 170 contributors to the DSM-IV, 95 were found to have financial ties to the pharmaceutical industry, including all of the contributors on sections such as mood disorders and schizophrenia.(12) Who are these people who invent diseases for money, peddle addictive drugs illegal to the general public to children, and to whom are they writing? They seek to lead us into a Brave New World of Soma, to cure us of the drapetomania and political intoxication that led Aldous Huxley to wonder in the first place if we even have the right to be unhappy. They are like the prophets of the past, seeing people sacrificing bulls to idols and writing scripts for amphetamines, suggesting that some place their sons on the chopping block; that if a world of visually-stimulating yet transient plastic, at least in terms of cultural relevancy, can't keep their interest, prescriptions are easier than parenting, and may just cost the co-pay. They are people who devote large amounts of their time and energy wondering, “What is wrong with people?” and write at length on narcissism without a hint of irony, for people who read at length on hypochondriasis, reflecting upon themselves, also sensing no irony. They write for people who sense the irony, and wonder, “What is wrong with me?” as well, for those who drink and smoke and gamble and show their remorse by tithing to their shrink's malpractice insurance, so they can resolve the same sufferings in the same ways in the future, knowing at least for a while, during the period that one edition of the DSM was in print, they had an answer, a disease to blame and combat like something outside of themselves and outside of a reference book people went to school for years to be able to use properly, or at least some pills that seemed to help.

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http://www.treatmentadvocacycenter.org/resources/mental-health-law/more-on-mental-health-laws/282-news-bill-would-force-severely-mentally-ill-to-take-meds

http://www.dailymail.co.uk/news/article-2152997/John-Edwards-escaped-30-year-prison-sentence-lost-trust-American-people-forever.html

http://www.minyanville.com/mvpremium/2011/07/25/harvard-expert-links-our-mental/?refresh=1