L and ethical justification for physicians to diagnose and treat, judges
L and ethical justification for physicians to diagnose and treat, judges to incarcerate and excuse, insurance companies to pay, and a myriad other social exchanges to be transacted. Implicitly, if not explicitly, the debaters’s task is to improve the “accuracy” of the DSM as a “diagnostic instrument” and increase its power as a document of legitimation. Long ago, having become convinced of the fictitious character of mental disorders, the immorality of psychiatric coercions and excuses, and the frequent injuriousness of psychiatric treatments, I set myself a very different task: namely, to delegitimize the legitimating authorities and agencies and their vast powers, enforced by psychiatrists and other mental health professionals, mental health laws, mental health courts, and mental health sentences. In Psychiatry: The Science of Lies, I cite the warning of John Selden, the celebrated seventeenth-century English jurist and scholar: “The reason of a thing is not to be inquired after, till you are sure the thing itself be so. We commonly are at, what’s the reason for it? before we are sure of the thing.” In psychiatry it is usually impossible to be sure of “‘what a thing itself really is,” because “the thing itself” is prejudged by social convention couched in ordinary language and then translated into pseudomedical jargon. Seventy-five years ago, in my teens, I suspected that mental illness was a bogus entity and kept my mouth shut. Twenty-five years later, more secure in my identity, I said so in print. Fifty years later, in the tenth decade of my life, I am pleased to read Dr. Allen Frances candidly acknowledging: “Alas, I have read dozens of definitions of mental disorder (and helped to write one) and I can’t say that any have the slightest value whatever. Historically, conditions have become mental disorders by accretion and practical necessity, not because they met some independent set of operationalized definitional criteria. Indeed, the LY294002 molecular weight concept of mental disorder is so amorphous, protean, and heterogeneous that it inherently defies definition. This is a hole at the center of psychiatric classification.” This is as good as saying, “Mental illness, there ain’t no such thing,” and still remain loyal to one’s profession. The fallacy intrinsic to the concept of mental illness call it mistake, mendacity, metaphor, myth, oxymoron, or what you will – constitutes a vastly larger “problem” than the phrase “a hole at the center of psychiatricclassification” suggests. The “hole” – “mental illness” as medical problem – affects medicine, law, education, economics, politics, psychiatry, the mental health professions, everyday language – indeed the very fabric of contemporary Western, especially American, society. The concept of “psychiatric diagnosis,” enshrined in the DSM and treated by the discussants as a “problem,” is challenging because it is also a solution, albeit a false one. Medicalization, epitomized by psychiatry, is the foundation stone of our modern, secular-statist ideology, manifested by the Therapeutic State. The DSM, though patently absurd, has become an utterly indispensable legal-social tool. Ideologies – supported by common PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28388412 consent, church, state, and tradition – are social facts/”truths.” As such, they are virtually impervious to criticism and possess very long lives. The DSM is here to stay and so is the intellectual and moral morass in which psychiatry has entwined itself and the modern mind.Commentary: On Inviting the Gori.
