Tuesday, May 4, 2010


May is Mental Health Month. The usual advocates are out in full force. An omnipresent message is typified by a recent NAMI-Massachusetts statement on Twitter: "Mental disorders can strike anyone regarless of age, economic status, race, creed or color." I never have understood the point of this.

I responded to NAMIMass this morning with a tweet along the lines of, "Mental disorders (and lightening!) can strike anyone regardless of age, economic status, race, creed or color. So ... what?" Very quickly, I got a reply, "That's precisely the point!"

Well, I still don't really get it. It seems like the critical idea is that nobody should ever be blamed for mental illness, it just not their fault, because it's a disease you catch like a cold or cancer.

If this revelation were true or useful there would be some kind of positive results from it by now, but there are none. In the five or six decades since we all resolved that mental illness is really, definitely, brain disease, there have been no cures, no discovery of actual causes or etiology. Mental illness has grown and grown as a problem, there's just a whole hell of a lot more of it now than ever before.

When we talk about mental illness, we're talking about behavior, and that's all. There is not a single diagnosis in any edition of the DSM which is discussed, defined or accomplished in any other terms. And the forthcoming DSM-V does not list one objective medical test for any mental disorder whatsoever.

The people who are so insistent upon not being blamed for mental illness should just be asked whether they can be responsible for their behavior. If they can, society has no vested interest in what words are used. But if they cannot, society will continue to blame them despite their very best linguistic arguments. And it probably should.

NAMI might say a person's responsibility for his or her mental health includes taking meds when meds will help, when the benefits outweigh the risks. But this presumes that treatment is all voluntary and patients are adequately informed. Certainly while we have civil commitment, Kendra's Law and the insanity defense, treatment is inextricably intertwined with justice and the police. Psychiatry is a coercive arm of the state. Individual responsibility must vary inversely with coercion and ignorance.

I think this mysterious fixation on, "It's not your fault when you're mentally ill..." evidences nothing much better than some fear of being discovered (e.g., as a fraud or a criminal). "Stigma" is a smokescreen, it's not the correct project.

The real project of "mental health" should be improving human behavior, and it's not medical.

1 comment:

  1. I abhor the term "mental health." It presumes that behavior can be empirically quantified by science and medicine. I see no evidence of this. Science still has not been able to conclusively answer the question that has bedeviled the human race since time immemorial, What is this peculiar creature called man?

    In my few run-ins with psychiatrists and psychotherapists, I felt absolutely no responsibility for the drugs and do-gooder horse crap they tried to peddle. Ironically, they refused to take responsibility for what they were selling as well. I found them to be very unhelpful and I don't feel that it was my fault.