An Article by:

by Susan Rosenthal

(Susan Rosenthal, MD, is a veteran American physician - Justice Lover)

When you are sick or injured, you want to know what’s wrong and what can be done. You want a diagnosis. A correct diagnosis reveals what is wrong, what is the preferred treatment and what is the likely outcome. For example, a diagnosis of pneumonia indicates a serious lung infection that can usually be cured with antibiotics.

While medical diagnoses are based on science, psychiatric “diagnoses” are not at all scientific. They do not reveal what is wrong, what is the preferred treatment, and what is the likely outcome. Nor are they reliable. Different psychiatrists who examine the same patient typically offer different “diagnoses.” Moreover, psychiatric “diagnoses” move in and out of favor, depending on a variety of social factors.

Psychiatric “diagnosis” is actually a labeling process, where the patient’s symptoms are matched with a grouping of symptoms listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Psychiatric Disorders (DSM). As we shall see, this psychiatric “bible” was developed and is maintained by financial and political interests.¹

Sigmund Freud

Who decides what is normal or healthy and what is deviant or sick?
Before the 20th century, life stresses were generally seen as spiritual problems or physical illnesses, and people turned to religious advisors and physicians for help. Medical doctors treated “hysteria” and “nerves” as physical problems. Psychiatry was restricted to the treatment of severely disturbed people in asylums.² The first classification of psychiatric disorders in the United States appeared in 1918 and contained 22 categories. All but one referred to various forms of insanity.

In 1901, Sigmund Freud revolutionized psychiatry by breaking down the barrier between mental illness and normal behavior. In The Psychopathology of Everyday Life,³ Freud argued that commonplace behaviors — slips of the tongue, what people find humorous, what they forget and the mistakes they make — indicate repressed sexual feelings that lurk beneath the surface of normal behavior.

By linking everyday behavior with mental illness, Freud and his followers released psychiatry from the asylum. Between 1917 and 1970, as psychiatrists cultivated clients with a broad range of problems, the number of psychiatrists practicing outside institutions swelled from eight percent to 66 percent.⁴

The social movements of the 1960’s opposed psychiatry’s focus on inner conflict and emphasized the social sources of sickness instead. Dr. Alvin Poussaint recalls the 1969 convention of the American Psychiatric Association (APA).

“After multiple racist killings during the civil rights movement, a group of black psychiatrists sought to have murderous bigotry based on race classified as a mental disorder. The APA’s officials rejected that recommendation, arguing that since so many Americans are racist, racism in this country is normative.”⁵

Growing the industry

In 1980, the APA overhauled the DSM. The Task Force established to create the new manual declared that any disorder could be included,
“If there is general agreement among clinicians, who would be expected to encounter the condition, that there are significant number of patients who have it and that its identification is important in the clinical work it is included in the classification.”⁶

In other words, the new DSM was not based on science, but on the need to maintain existing patients and include new ones who might seek help for any number of problems. A profitable and self-perpetuating industry was born. The more people could be encouraged to seek treatment, the more conditions could be entered into the DSM, and the more people could be encouraged to seek treatment for these new conditions.

By 1994, the DSM listed 400 distinct mental disorders covering a wide variety of behaviors in adults and children. Significantly, racism, homophobia (fear of homosexuality) and misogyny (hatred of women) have never been listed as mental disorders. In 1999, the chairperson of the APA’s Council on Psychiatry and the Law confirmed that racism “is not something that is designated as an illness that can be treated by mental health professionals.”⁷ Homosexuality was listed as a mental disorder until activists campaigned to have it removed.⁸

The women’s liberation movement condemned labeling symptoms of oppression as mental illnesses. In They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, Paula Caplan explains,

“In a culture that scorns and demeans lesbians and gay men, it is hard to be completely comfortable with one’s homosexuality, and so the DSM-III authors were treating as a mental disorder what was often simply a perfectly comprehensible reaction to being mocked and oppressed.”⁹

Caplan describes efforts to prevent “Masochistic Personality Disorder” from being included in the DSM. This disorder assumes that women stay with abusive spouses because like to suffer, not because they lack the resources to leave. Despite protest, “Masochistic Personality Disorder” was added to the 1987 edition of the DSM, although it was later dropped.

The inclusion of “Pre-Menstrual Dysphoric Disorder” (PMDD) in the DSM also raised a protest. According to Caplan,

“The problem with PMDD is not the women who report premenstrual mood problems but the diagnosis of PMDD itself. Excellent research shows that these women are significantly more likely than other women to be in upsetting life situations, such as being battered or being mistreated at work. To label them mentally disordered — to send the message that their problems are individual, psychological ones — hides the real, external sources of their trouble.”¹⁰

As soon as PMDD was listed in the DSM, Eli Lilly repackaged its best-selling drug, Prozac, in a pink-pill format, renamed it Serafem, and promoted it as a treatment for PMDD. By creating Serafem, Lilly was able to extend its patent on the Prozac formula for another seven years.

A marketing gold mine

The DSM is a marketing gold mine for the drug industry. The FDA will approve a drug to treat a mental disorder only if that disorder is listed in the DSM. Therefore, each new listing is worth millions in potential drug sales. Most of the experts who construct the DSM have financial ties to pharmaceutical companies, and every new edition of the DSM contains more conditions than the previous one.

Once the DSM lists a new mental disorder, drugs for that disorder are heavily marketed for everyone who might fit the symptom checklist. (Doctors are also encouraged to prescribe these drugs for “off-label use,” which means to anyone they think might benefit.) Not surprisingly, the numbers of people “diagnosed” with a mental condition rise rapidly after a drug is approved to treat that condition.

In 2005, a major study announced that “About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life…”¹¹ How is this possible? Has it become normal to be mentally ill, or has the definition of mental illness expanded beyond reason? Both could be true.

Capitalism damages people in many ways. It’s also true that the more people can be labeled as sick, the more profits can be made from selling them treatments. In Creating Mental Illness, Alan Horowitz warns,

“…a large proportion of behaviors that are currently regarded as mental illnesses are normal consequences of stressful social arrangements or forms of social deviance. Contrary to its general definition of mental disorder, the DSM and much research that follows from it considers all symptoms, whether internal or not, expected or not, deviant or not, as signs of disorder.”¹²

Most people know the difference between normal behavior (such as grief over the death of a loved one) and abnormal behavior that could indicate an internal disorder (such as prolonged grief for no apparent reason). However, the DSM does not consider what happens in people’s lives. With one exception (Post-Traumatic Stress Disorder), the DSM lists and categorizes symptoms outside of any social context. As a result, DSM-based surveys artificially increase the numbers of people suffering from mental disorders and, therefore, the market for drug treatments.

DSM-inflated rates of mental illness are typically accompanied by the warning that not enough people are getting treatment.¹³ The question of whether or not they are actually sick is never raised.

Social control

Psychiatry has a long history of medicating the oppressed, including children, for social control.¹⁴

Using DSM criteria, at least six million American children have been diagnosed with serious mental disorders, triple the number in the early 1990’s. The rate of boys aged 7 to 12 diagnosed with Bipolar Disorder more than doubled between 1995 and 2000 and continues to rise.

A 2007 survey of 8- to 15-year-olds discovered that nine percent met the DSM criteria for attention deficit/hyperactivity disorder (ADHD). The survey found that fewer than half of these children had been diagnosed or treated, “suggesting that some children with clinically significant inattention and hyperactivity may not be receiving optimal attention.” Noting that poor children were least likely to receive medication, the authors of the study recommend “further investigation and possible intervention.”¹⁵

Instead of addressing the stressful social conditions that agitate children, psychiatry imposes conformity through medication. To force compliance with this oppressive system, access to insurance benefits, medical care and social services depends on “having a diagnosis.”

The psychiatric-pharmaceutical industry treats illness as strictly individual and internal — the result of faulty genes or chemical imbalances. In reality, human problems exist in a social context.

Most of the symptoms listed in the DSM describe human responses to deprivation and oppression (anxiety, agitation, aggression, depression) and the many ways that people try to manage unbearable pain (obsessions, compulsions, rage, addictions). Depression is strongly linked with poverty,¹⁶ and alleviating poverty can lift depression.¹⁷

Under capitalism, addressing the social causes of misery is politically risky and unprofitable. So psychiatry extracts the individual from society, splits the brain from the body, severs the mind from the brain and drugs the brain.¹⁸

A sick society

Capitalism is a system that requires the majority to have no control over their lives and to believe that this condition is normal. Therefore, all reactions to inequality and deprivation must be viewed as signs of personal inadequacy, biological defect, mental illness — anything other than reasonable responses to unreasonable conditions.

During slavery days, experts argued that Black people were psychologically suited for a life of slavery, so there must be something wrong with those who rebelled.¹⁹ In 1851, the diagnosis of “drapetomania”(runaway fever) was developed to explain why slaves try to escape.²⁰ Not much has changed. Today, exploitation and oppression are considered normal, and those who rebel in any way are considered to be sick or deviant and in need of medication or incarceration.

What’s the diagnosis for a sick society? We know what’s wrong. Most people are kept in sick social conditions so that a few can maintain their wealth and power. What is the treatment? Putting human needs first would eliminate most human misery. Who will deliver the medicine? The majority must organize to take collective control of society.

I don’t expect this diagnosis to appear in the DSM anytime soon.

(Emphasis by Justice Lover)

1. Kirk, S.S. & Kutchins, H. (1992). The selling of DSM: The rhetoric of science in psychiatry. New York: Aldine De Gruyter. #
2. Horowitz, A.V. (2002). Creating mental illness. Chicago: University of Chicago Press. #
3. Freud, S. (1901/1991). The psychopathology of everyday life. New York: Penguin #
4. Shorter, E. (1997). A history of psychiatry: From the era of the asylum to the age of Prozac. New York: John Wiley & Sons. #
5. Poussaint, A.F. & Alexander, A. (2000). Lay my burden down: Suicide and the mental health crisis among African-Americans. Boston: Beacon Press, p.125. #
6. Spitzer, R.L., Sheeney, M. & Endicott, J. (1977). DSM III: Guiding principles. In Psychiatric diagnosis, (Eds). Rakoff, V., Stancer, H. & Kedward, H. New York: Brunner Mazel. #
7. Egan, T. (1999). Racist shootings test limits of health system and laws. New York Times, August 14, p.1. #
8. “DSM and homosexuality: A cautionary tale.” in Kirk, S.A., Kutchins, H. (1992). The selling of DSM: The rhetoric of science in psychiatry. New York: Aldine De Gruyter p 81-90 #
9. Caplan, P. (1995). They say you’re crazy: How the world’s most powerful psychiatrists decide who’s normal. New York: Addison-Wesley, pp.180-181. #
10. Caplan, P.J. (2002). Expert decries diagnosis for pathologizing women. Journal of Addiction and Mental Health. September/October 2001, p.16. #
11. Kessler, R.C., Berglund, P., Demler, O., Jin, R. & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. Vol.62, No.6, pp.593-602. #
12. Horowitz, A.V. (2002). Creating Mental Illness. Chicago: University of Chicago Press. p.37. #
13. Talen, J. (2005). Survey says nearly half of all Americans will be affected by a mental illness, some before adulthood. Newsday, June 7. #
14. Breggin, P.R. & Breggin, G. R. (1994). The war against children: How the drugs, programs, and theories of the psychiatric establishment are threatening America’s children with a medical ‘cure’ for violence. New York: St. Martin’s Press. #
15. Froehlich TE, et.al. (2007). Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med. Vol.161, pp.857-864. #
16. Duenwald, M. (2003). “More Americans Seeking Help for Depression.” New York Times, June 18. #
17. Costello EJ, Compton SN, Keeler G, Angold A.(2003). Relationships between poverty and psychopathology: a natural experiment. JAMA. Oct 15, Vol.290, No. 15, pp.2023-9. #
18. Ross, C.A., & Pam, A., (1995). Pseudoscience in biological psychiatry: Blaming the body. New York: Wiley. #
19. Poussaint, A.F. & Alexander, A. (2000). Lay my burden down: Suicide and the mental health crisis among African Americans. Boston: Beacon Press. #
20. Cartwright, S. (1851). Report on the diseases and physical peculiarities of the Negro race. New Orleans Medical and Surgical Journal. May, p. 707. #

Tags: mental health, politics, psychology, religion
Categories: Commentary, Politics, Religion, mental health
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The crux of the thesis developed in this essay is extensible to most aspects of the behavioral sciences and the research practices they implement in order to generate their generalizations and specifications regarding human behavior and how it can be manipulated. Essentially, what is argued here comes down to the following: Every time we answer a survey or participate in qualitative interviews where we assume the role of a subject, from whom information is extracted during the course of the ensuing dialogue, we are contributing to the development of techniques, qualifying as social engineering technologies; or, as Foucault would have it, Biopower. In other words, we are aiding the very people who are involved - although, in most occasions, unwittingly- in fostering the technologies required to regulate the existing social structure by forging interdictive techniques utilized for purposes of restoring behaviors that are in sycn with the way things stand currently; a state of affairs that relatively few of us have a stake in preserving. With that said, the following essay is, for all practical purposes, a summation of some of the insights offered by Foucualt’s geneology and the understanding of power he develops in opposition to its preemptive understanding, as it has assumed form in the more conventional sociological ideology introduced by Weber.

I believe the best way of revolting against the sexual identities that have been implanted into our bodies, such as homosexual, heterosexual and so forth, by the various medical community disciplines, such as psychiatrists, psychologists, demographers, and sociologists of the family, is to stop talking about sex as if it is a behavior serving as an indicator of some underlying psychic condition that, in turn, marks some deep and character defining identity; subsequently, coming to dominate the way we think about ourselves as well as the way - and these two dynamics are, of course, related to one another - others perceive us. All of this creates the context in which our actions; our abilities and penchants; our propensities; are interpreted. Consequentially, the ongoing undergoing of disciplinary treatment results in a condition where we come to defined ourselves in a modality that reflects the dispositions deposited in the discourse of disciplinarian institutions, which span through out all spheres of Modern society.

Essentially, what we can learn from Foucault - and what might be the most significant insight provided by Foucault - is the discourse we engage in regarding sex and the behaviors that we attempt to come to terms with by emitting descriptions of ourselves - consisting mostly of our private urges - and the associated behaviors and experiences that we have been taught to consider relevant to our sexual demeanors are not contributing to our sexual liberation; rather, the act of divulging intimacies of our selves, serves merely to proliferate the knowledge of disciplinarians who devise technologies - usually guised in the form of health-care - used to classify us and define us, as well as, to identify what courses of intervention enacted upon us can be used to normalize our conduct in society, so our existences conform to the established behavioral protocol, dictating the appropriate way for us to act.

If we attempt to reduce the ideology of which the preponderance of practitioners embody when correcting the social behaviors of those deemed to possess pathological perversions, we can probably use the following characterization quite felicitously: Individuals should be productive members of society, which entails working; sometimes having a family, according to the definition of a healthy family life developed by disciplinarians; we should avoid circumstances where we become dependencies of the state, such as welfare recipients; we should be prone to avoid criminal conduct; ect.; all of which can be understood - within the context of disciplinarian praxes - as the production of productive citizens.

However, such an existential transformation of our Selves into the standardized forms endorsed and implemented by disciplinarians, is by no means constitutive of a promotion of our own interests. Instead, we are simply re-tailored to conform with the expectations that have been developed and naturalized - into the realm of social knowledge that is taken-for-granted and rarely questioned - concerning the proper comportment of individuals belonging to society, which does not necessarily account for our own exploitations within the systemization of social relations comprising the society to which we contribute through our labors, (a term that expands to include most every aspect of our material beings; even child rearing and raising).

By means of our externalized expressions pertaining to, as subject matter, own behaviors and fetishes within the contours of the probing procedures that have been developed by practitioners of the behavioral sciences, we - inadvertently - contribute to our own regulation; a condition fostered by our own cooperation in the disciplinarian knowledge construction practices of those who make it their business to modify and, ‘correct,’ as well as appropriate the way we conduct our own businesses. In short, this compulsion to reveal the intimacies our of the private lives - a propensity that is undoubtedly, according to Foucault, a vestige of our Christian confessional tradition - is by no means an expression of a liberationist ideology; instead, it is symptomatic of our own cultural conditioning, which render us amenable to our own training by others; disciplinarians who seek to produce productive citizens.

Let us, after decades of subjugation by disciplinarian regimes such as psychology, acknowledge that sex is not the manifestation of a drive emanating from the invisible posit referred to as the psyche; rather, let us accept that the uses of our bodies to incite pleasures reflective of purely hedonistic calculations. There is no hidden logic to our sexual activities that needs to be teased out of us and rendered a spectacle for the appropriate quasi-health-care, behavioral specialists, who might treat us in order to correct what deviates from the established and entrenched normativity, which is associated in almost all respects to the Modern advent of Sexuality. How we should act as mothers and fathers - how we should conduct our sexual activities; not asking for compensation; nor providing compensation - the appropriate age we should be prior to inciting certain pleasures of the body through our own device or the devices of others - what sex should symbolically represent; and what it should not - and how much of our interests and pursuits should be driven by our sexual appetites - are all matters we can answer for ourselves without the interdiction of behavioral scientists, who implicitly premise all of their conclusions upon normative assumptions that represent values belonging to a social order to which they attempt to integrate the human objects of their practices.

However, to conclude that our indoctrination into the preemptive order of things is in our own interests speaks more of the interests that are vested in the way things stand now: An order that exploits some for the profit of others; an order that thrives off of the replication of the values with which we have been implanted - in order to be disposed toward a deferential posture in relation to the extant social structure - and those we are expected to instill in our children, in order to ensure progeny that will assume the same deferential attitude toward the complex of stratifications that organize our labors into a system of material production that benefit some while depriving others. Further this is a social structure that systematically identifies those who deviate from its prescriptions defining, ‘healthy behaviors;’ subsequently, labeling non-conformists with the encumbering baggage of social identities that are negatively interpreted and valued, according to the cultural codes that guide disciplinarians as they strive to identify social pathologies worthy of interdiction. This social intervention occurs in manifold forms, of which some salient examples come to mind: The dosing of children with Ritalin in order to adjust their modify and control their behaviors; The incursions made by social workers into the family affairs to private individuals, enforcing protocols for appropriate family interactions that the social workers deem as the, ‘Right,’ way to act. The positioning of these disciplinarian institutions in civil society makes them all the more deleterious to our personal sovereignty, because they fall outside the scope of our avenues for participating in policy formation; even though the activities conducted by the tribes of disciplinarians certainly have political consequences.

Therefore, there is nothing Authentic - a term meant to entail the connotative properties with which Heidegger endowed it - resulting from our introspective examinations of Self, in order to supply the data that become the property of behavioral scientists; to those who correct us and makes us conforming and docile; to those who make us deferential to the exploitation of our very selves.

Russell Cole

Tags: foucault, higher consciousness, labor, Modernity, psychology, sexaulity, workplace
Categories: Commentary
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For the last year and a half or so, I have been researching the sociological dimensions of Web 2.0, from which I could apply some of the conclusions I have formed from my observations of the Plebeian social democratic knowledge-production communities to the administration of education.  I think that this would be a refreshing change since educational theory – undoubtedly to its detriment – has primarily borrowed from the field of psychology.  This leads to approaches that are so latent with implicit moralistic baggage that we tend to lose sight of the possibility that education should be a vehicle for individuals to actively shape and form their own modality of existentiality, rather than simply being indoctrinated into forms of practice that serve the vested interests of economic elites who need access to a docile, a skilled, and a confirmative mass of technocratic minions.  I am primarily concerned with the revitalization of a democratic culture in America, so I might offer in opposition to the standards based assessments of educational success – which, of course, simply extend the reach of the hegemonic culture in America - which instantiates the one-dimensional mind that can only evaluate human worth according to the metric of perfomativity - a conceptualization of the appropriate teleology for education, giving form to our educational praxis that is rooted in the promotion of an egalitarian, deliberative, social democracy. After reading what I just wrote, I do not expect a reply, but I will send this off anyway,

Tags: culture, education, psychology, society, web 2.0
Categories: Commentary, Society, Russell Cole's Blog, Web 2.0, Education
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