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Our definitions of mental health are entirely behavioural - i.e. the ability to hold down a job (if there is one), have relationships, and not say odd things about mind probes and TV aliens from the sofa.
The fact that one of the diagnostic criteria for "disorders" is "suffering distress" lends credence to the view that many "mental disorders" are social. That is, if the social environment is such that the "subject" doesn't experience distress, it's not a "disorder". Then, whose problem is it, the "subject" or society's for not being accommodating?


Autism Spectrum Quotient - Wikipedia, the free encyclopedia

although the test is popularly used for self-diagnosis of Asperger syndrome, the authors caution that it is not intended to be diagnostic, and advise that anyone who obtains a high score and is suffering some distress should seek professional medical advice before jumping to any conclusions.


Of the students who scored 32 or more on the test, eleven agreed to be interviewed and seven of these were reported to meet the DSM-IV criteria for Asperger syndrome, although no formal diagnosis was made as they were not suffering any distress.

(My emphasis)

So mental illness is to a lerge extent social. In the social environment of his mother, Sven's friend will suffer distress and cause it on others. You can call it mental illness or not, but the fact remains that a different social environment would go a long way towards removing the distress.

Keynesianism is intellectually hard, as evidenced by the inability of many trained economists to get it - Paul Krugman

by Migeru (migeru at eurotrib dot com) on Thu Jan 27th, 2011 at 09:54:54 AM EST
[ Parent ]
There's a scale with behaviour that's obviously dangerous and psychotic at one extreme - shooting random politicians, believing you're the CIA Jesus of the lizard people - at one extreme, and various unpleasant but relatively trivial social anxieties at the other.

The problem is that psychology is individual, and there's no political or economic equivalent of DSM criteria for cultures as a whole.

Nazi Germany was clearly psychotic as a culture. So was Mao's China. So was Bush's America. So is Wall St.

But without some formal benchmarks for cultural behaviour, patterns of cultural dysfunction become lost in thousands or millions of individual cases, and various forms of acting out that are - bizarrely - considered normal politics.

by ThatBritGuy (thatbritguy (at) googlemail.com) on Thu Jan 27th, 2011 at 10:12:36 AM EST
[ Parent ]
I suppose the prevalence of psychological "disorders" diagnosed on the basis of "distress" might be such a benchmark. How many "maladapted" "malcontents" or "misfits" does the society create?

Not so long ago, when Western culture was a lot more misogynistic than it is today, women would be diagnosed with "Female hysteria", and one of the symptoms was

... "a tendency to cause trouble".


A physician in 1859 claimed that a quarter of all women suffered from hysteria. One physician cataloged 75 pages of possible symptoms of hysteria and called the list incomplete;[2] almost any ailment could fit the diagnosis. Physicians thought that the stresses associated with modern life caused civilized women to be both more susceptible to nervous disorders and to develop faulty reproductive tracts.[3] In America, such disorders in women reaffirmed that the United States was on par with Europe; one American physician expressed pleasure that the country was "catching up" to Europe in the prevalence of hysteria.[2]

(my emphasis)

Was the 1960's counterculture, evidence of systemic cultural dysfunction?

Keynesianism is intellectually hard, as evidenced by the inability of many trained economists to get it - Paul Krugman

by Migeru (migeru at eurotrib dot com) on Thu Jan 27th, 2011 at 11:52:27 AM EST
[ Parent ]
Or worse.

Walter Jackson Freeman.

Freeman performed nearly 2500 lobotomies in 23 states[3], mostly based on scanty and flimsy evidence for its scientific basis[4][5], but more significantly he popularized the lobotomy. A neurologist without surgical training, he initially worked with several surgeons, including James W. Watts. In 1936, he and Watts became the first American doctors to perform prefrontal lobotomy (by craniotomy in an operating room).

Seeking a faster and less invasive way to perform the procedure, Freeman adopted Amarro Fiamberti's transorbital lobotomy and began to perfect it, initially by using ice picks hammered into each frontal lobe through the back of each eye socket ("ice pick lobotomy"). Freeman was able to perform these very quickly, outside of an operating room, and without a surgeon. For his first transorbital lobotomies, Freeman used an actual icepick from his kitchen. Later, he utilized an instrument created specifically for the operation called a leucotome. In 1948 Freeman developed a new technique which involved wrenching the leucotome in an upstroke after the initial insertion. This procedure placed great strain on the instrument and in one case resulted in the leucotome breaking off in the patient's skull. As a result, Freeman designed a new, stronger instrument, the orbitoclast.

Freeman embarked on a national campaign in his van which he called his "lobotomobile" to demonstrate the procedure to doctors working at state-run institutions; Freeman would show off by icepicking both of a patient's eyesockets at one time - one with each hand.[5] According to some, institutional care was hampered by lack of effective treatments and extreme overcrowding, and Freeman saw the transorbital lobotomy as an expedient tool to get large populations out of treatment and back into private life.

The "ice pick lobotomy" was, according to Ole Enersen, performed by Freeman "with a recklessness bordering on lunacy, touring the country like a travelling evangelist. In most cases," Enersen continued, "this procedure was nothing more than a gross and unwarranted mutilation carried out by a self righteous zealot."[6]

Freeman's most notorious operation was on the ill-fated Rosemary Kennedy, who was permanently incapacitated by a lobotomy at age 23. Another of his patients, Howard Dully, has now written a book called My Lobotomy about his experiences with Freeman and his long recovery after the surgery he underwent at 12 years old.[7]

Who's bonkers now? But then:


Laing, Cooper, Theodore Lidz, Silvano Arieti and others went on to argue that schizophrenia could be understood as an injury to the inner self inflicted by psychologically invasive "schizophrenogenic" parents, or as a healthy attempt to cope with a sick society. Psychiatrist Thomas Szasz argues that "mental illness" is an inherently incoherent combination of a medical and a psychological concept, but popular because it legitimizes the use of psychiatric force to control and limit deviance from societal norms.

Adherents of this view referred to "the myth of mental illness" after Szasz's controversial book of that name. (Even though the movement originally described as anti-psychiatry became associated with the general counter-culture movement of the 1960s, Szasz, Lidz and Arieti never became involved in that movement.) Michel Foucault, Erving Goffman, Deleuze and Guattari, and others criticized the power and role of psychiatry in society, including the use of "total institutions", "labeling" and stigmatizing.[25]

I think it's a little glib to say that all mental illness is social. But it's equally simplistic to pretend that you can take individuals out of their personal contexts, and assume that any "distress" is remote from their circumstances.

I'll just repeat what I said earlier - we have a psychiatry of the individual, and we have the beginnings of a much less developed psychiatry of the family. But we don't have a psychiatry of corporations, of social institutions, of belief systems, or of policy.

by ThatBritGuy (thatbritguy (at) googlemail.com) on Thu Jan 27th, 2011 at 12:25:50 PM EST
[ Parent ]
This is particularly bad:

Uxbridge father pleads for autistic son to be set free from care - Communities - Uxbridge

"As he does not like being there, he gets agitated and anxious, and has reported aggressive behaviour.

"Being forced into a situation he does not like, finds difficult to understand and gets upset about means he can react to the situation and this gets used as evidence against him.

"Prior to going to the treatment unit Steven had quite a good life, content with his routines and daily activities. Of course he gets anxious at times- that's autism."


Brian Doughty, interim director of adult social care health and housing said: "Our Positive Behavioural Support Unit is a residential setting for people who need assistance in managing their own behaviour.

"Although we cannot comment on individual cases, the council takes the decision to refer people to these units very seriously and people are only referred if they are displaying behaviour which is believed to be detrimental to themselves or others.

"We appreciate that these decisions can be very difficult for families, but in all cases the council works closely with them to discuss what is best for individuals so that we can adapt the services accordingly."

Keynesianism is intellectually hard, as evidenced by the inability of many trained economists to get it - Paul Krugman
by Migeru (migeru at eurotrib dot com) on Thu Jan 27th, 2011 at 12:33:18 PM EST
[ Parent ]
jeez, that gives me the shivers

keep to the Fen Causeway
by Helen (lareinagal at yahoo dot co dot uk) on Thu Jan 27th, 2011 at 01:06:07 PM EST
[ Parent ]
psychological "disorders" diagnosed on the basis of "distress"...

..are a major weakness of the DSM. The institutional need to have an appropriate category for every presentable condition is bad enough. Add to that the fact that a negative diagnosis is a revenue killer and there is clearly room for abuse. Were treatment for "mental illness" remunerated at the same rate as treatment for physical illness the only limit might be the number of psychiatrists. :-)

"It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Thu Jan 27th, 2011 at 01:24:11 PM EST
[ Parent ]
The political sanity of the USA is degenerating rapidly and that encourages the crazies who seem to be a significant proportion of the Republican party.

I fear for the USA right now, it's got serious problems but there's no adult supervision


keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Thu Jan 27th, 2011 at 01:09:25 PM EST
[ Parent ]
Yes. And a circle of real friends capable of discussing any and all issues openly is, imo, an important protection against 'distress'. And still better if these friends are neither everyday work colleagues or family (who may have other agendas).

You can't be me, I'm taken
by Sven Triloqvist on Thu Jan 27th, 2011 at 10:29:26 AM EST
[ Parent ]
You can call it mental illness or not, but the fact remains that a different social environment would go a long way towards removing the distress.

Which is exactly what Sven's friend is advocating. But to one who is the beneficiary of an oppressive social environment, this will seem crazy.

"It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Thu Jan 27th, 2011 at 01:14:31 PM EST
[ Parent ]
It would also be interesting to know whether this is really just about "John's" karma-based society. I assume that the mother just used this to illustrate her own desperation with her son.

I don't think any "sane" person who explores funny ideas will be kept in any facilty without any other elements justifying the space that he's taking. If John needs help because his problem is more serious since he's seriously losing touch of "reality", then it will be good for him to find assistance. He may be even grateful for it. "Assistance" could consist of medication but more importantly of therepeutic sessions adapted to his specific problem, or he may be directed to self-help groups. There's always an interest there to put the patient back in charge of her own life asap, if possible.

To me it appears a bit immature to blame the mother and declare John "not mad".

"Mad" in any case speaks of some psychological imbalance. The world is full of those, true. But we all look for balance even if imbalance is an option and society is fairly tolerant of it.


by Lily (put - lilyalmond - here <a> yahaah.france) on Thu Feb 3rd, 2011 at 12:46:06 PM EST
[ Parent ]


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