To think of Dr Freud as that guy who wrote about dicks is to think about Bruce Springsteen as that guy who helped Courteney Cox out with her career. If you care to listen to The Boss or Freud, you’ll find they both told us with great intelligence how we’re just dancing in the dark. Although, of course, many people think we’re dancing in the sun of reason. We should all be made to listen to Springsteen and read Freud to remind us that this age, in many respects, is as dark an age as any and, in fact, quite a bit darker than most. Mostly because we think it is so illuminated.
This is a feature of every age. Generally, we tend to presume that this time is the most enlightened time and even if we romanticise the past—and I fully intend to glorify Freud or at least redeem his reputation as That Penis Guy—we do so through the enlightened filter of the present. We know that nostalgia is never a longing for a real thing lost; it’s more of a romantic way of avoiding the present. It is probably worth mentioning that in the Good Old Days, nostalgia was actually a mental disorder.
Nostalgia. It ain’t what it used to be. What it first was, in fact, was a medical disorder recognised in soldiers deeply troubled by their longing for the past. During the Thirty Years’ War, some men were discharged from the Spanish Army of Flanders with the condition that was first described in a 1688 medical text. Up until the American Civil War, this illness was treated.
Of course, now we are so much more enlightened and we know that soldiers were just suffering the effects of war. They had post-traumatic stress disorder, silly! Thank goodness we know that.
And thank goodness we can now recognise depression. Did you know that Willy Loman from Death of a Salesman was depressed? Well, Arthur Miller, who wrote the play, didn’t and he was a bit, um, depressed by the news that for a 1999 Broadway revival, director Robert Falls gave the script to two psychiatrists. Willy was diagnosed as depressed.
‘Willy Loman is not a depressive,’ Mr Miller said to the New York Times. ‘He is weighed down by life. There are social reasons for why he is where he is.’
Willy Loman was weighed down by life. Soldiers were weighed down by death. Diagnosing any of these men, either in the terms of their own era or by ours, just seems silly. External forces impacted on them and it would be, surely, as Stupid to get Willy some Prozac as it would be to take men forced to kill other men into family counselling. Or Lady Macbeth into a treatment program for obsessive-compulsive disorder.
But. We are very enlightened. To remove Willy Loman from his broad social context and to give him a narrow psychological diagnosis is the work of our age. But it wasn’t Freud’s work, now discredited and darkened by the false memory of a big penis. Psychiatry as it is now—organised and immense and as detached from the world that produced it as Willy is from life—is very often very Stupid. And not only is this iffy branch of medicine itself Stupid, but it has begun to endorse our individual Stupid in a way that extends well beyond patient care. It is, after all, the science of the self. Psychiatry has not only itself become a Stupid science decried by some of its own most respected practitioners; it is now very useful in enhancing our everyday Stupid.
It seems stupid to say that a soldier is suffering the internal illness of ‘nostalgia’ and not the external impacts of war. But, what we say about Loman, or what we might say about ourselves is just as stupid. This is an era that makes its influence felt. Which is to say, there has never before been an instant where we have been so intimate with the institutions of the state and the market. Opting out is not a realistic option in a time that demands our participation in and consumption of social and electronic media, goods, organised labour and all of those exchanges that create a ‘normal’ and socially viable person.
We tend to think of our time as one that celebrates the uniqueness of the individual. And, in some ways, there are greater freedoms to behave in ways that are not orthodox; for example, living in a homosexual relationship will not make you a pariah. Neither will failing to show up on every Sabbath to your temple. But what will mark you indelibly is, for example, a refusal to engage in social media. In 2012, both Forbes Magazine and Time ran articles proposing that an individual without a searchable social media history was far less likely to gain employment in white collar industries. Drawing on the experiences of a former Facebook employee, Katherine Losse, who left the company and cashed in her options, the articles concluded that non-participation in the profit-seeking social media sector not only made life difficult, it was almost impossible. In a piece in the Washington Post that same year, Losse, who deactivated all her own social media profiles for a time, explained how Facebook kept ‘dark’ profiles of those who had not yet joined the big blue giant. ‘The moment we’re in now is about trying to deal with all this technology rather than rejecting it, because obviously we can’t reject it entirely’, Losse told the Post.
The internet knows that you are absent. And the realms of work and of consumption and health could be said to develop something very like a ‘dark profile’ if you ‘choose’ not to participate in their conventions.
One cannot simply not participate in a range of institutions. Not, at least, without a superhuman effort. To describe one’s involvement in the world as ‘social pressure’ doesn’t really begin to describe the demands of life which is formed in large part by institutions. Not only our self-esteem but our livelihood is contingent on participation in and some adherence to a dizzying set of norms in the workplace, in the way we look and in our physical health.
In short, there’s a lot of stuff we are supposed to do. And it is pretty easy to fail a lot more in the face of so many daily tests. Yet, we naturalise all of these standardised tests and we naturally believe it is our shortcoming when we screw them up. When we fail at life as it is so broadly and meticulously prescribed, we call it mental illness. We have failed life. We are not permitted to think it is the conventions of life that have failed us.
Of course, mental illness can be a useful category. There are those who seem beset by what we would have once called demons. There are certainly people in urgent need of patient care. Even if we have trouble with the sort of extreme medicalisation that leads us to diagnose Willy with depressive disorder and not a bad case of life, we can still agree that it might have been nice if he could have talked through his issues with a professional; maybe even taken some drugs. But it is unlikely that Willy would get much more than drugs even if he did seek help today. Medicalisation, a process that characterises and treats some problems or conditions in medical terms, doesn’t have much time for the kind of talk that Freud proposed.
In a complex era that produces complex problems, we are forced to rational solutions. Instrumental medicine might not be ideal in the way it treats the results of life experience as illness, but it’s what we’ve got. Perhaps treating, as we do, things like libido or alcoholism or a lack of socially sanctioned beauty is not the best approach. Perhaps it would be better to reform the world, or to reform the patient’s understanding, as Freud suggested, of her place within it. But sometimes it’s just more efficient to recognise and treat a problem as a disease. Get your nose fixed. Dry out in a hospital. Take Viagra as prescribed. These may not be ideal solutions to problems we can argue only exist because of social forces and could be fixed by drug-free years in the therapist’s suites. But, they are, sometimes, solutions.
But I don’t know if we can be quite so permissive when it comes to the medicalisation of Willy Loman. That people are improved by a one-size-fits-most treatment of the ‘symptoms’ described as anxiety and depression is quite uncertain. The pharmaceutical solution, which is so overwhelmingly and easily offered—in the 2004–2005 financial year, more than twelve million prescriptions for antidepressants were written for Australians—is no solution. In fact, it comes from Stupid. (Actually, I personally found that it produced Stupid. I have never been more Stupid than when I was taking one of the SNRI class of drugs.)
Again, it would just be foolish to reject medicine in its treatment of psychiatric disorders. And this is in no way an account of the Evils of Big Pharma. (Although, like a lot of large institutions, the pharmaceutical industry may fall into patterns of evil.) What I want to do is to take, like Freud would, a patient history of psychiatry itself. Perhaps we can talk out its problems when it comes to treating ‘everyday’ illnesses such as the anxiety and depression of Willy Loman.
There have been moments in history where we were almost admiring of mental illness; according to one of psychiatry’s best-known critics, Michel Foucault, seventeenth-century Europe was ‘hospitable’ towards the mad. In Madness and Civilisation, he takes us on a tour of those moments when the mad have been identified romantically or worshipped as prophets, through those where they have been confined and tortured as devils, to a time (now) where they are medicated and known as ‘mentally ill’. Foucault’s big book of mad is long and difficult and one I can only recommend to the studiously insane. But its central idea that madness as we now know it is in fact a product of the Age of Reason is a really good one.
Even if you have no time for Foucault—and, man, he is an effort—you probably know about history’s idealised madman. Even now, some hopeless romantics think of the mentally ill as seers; as people whose view is not so much impaired as it is enhanced. But this view has all but disappeared. Today, depression—the most common form of recognised madness—is typically seen as limited vision and not at all as something that can give anyone any particular insight. Every now and then, some nutty scientist will tell us that depression has an upside; that there is a benefit to depression in that it seems to create the conditions for deep thought. Certainly, Aristotle thought of it as a useful pest. In The Problems, he notes that ‘all men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease’. In 2009, a paper in US journal The Psychological Review called ‘The bright side of being blue: Depression as an adaptation for analyzing complex problems’ (Andrews, Thomson and Anderson) caused a fuss when the authors advanced the possibility that depression has some cognitive benefits.
Mostly, though, the view of depression is that it is bad thinking that needs to be fixed. If you have had an experience of the collection of symptoms psychiatry calls depression, you will agree that it is something that needs to be fixed. But perhaps you might also agree—if not now, then a little further along—that if it does need to be fixed, then we are certainly going about fixing it in a Stupid way. There is an argument to be made that depression, and mood disorders in general, aren’t getting a whole lot better. Which is to say, maybe this is one of the things that our enlightened age has not illuminated but darkened.
Even if we are not ourselves told by our doctor that we are mentally unwell, there is a very good chance someone in our lives will be afflicted by what we call ‘mental illness’. And in the very rare case that you do not have the experience of knowing someone with a diagnosis of mental illness, you will have certainly heard a statistic like ‘one in three Australians’ or the World Health Organization’s declaration that mental illness will be a major health concern in coming decades.
Now, there are many good practitioners who will critique this view of mental health and remind us that what we often have when we are diagnosed with ‘mental illness’ is a perfectly logical reaction to life. Psychiatry has long been Stupid. Well, to be fair, it has been Stupid on and off. It wasn’t Stupid where Freud was concerned. This is the guy who gives us the useful idea of the unconscious mind. Before Freud, we heard preludes to the idea that we have a big numb beast inside us. Jesus is thought to have said, ‘They know not what they do.’ Marx, who half described the unconscious mind as ‘ideology’, said, ‘They don’t know what they are doing, but they are doing it.’ Nietzsche saw something very close to Freud’s idea of the unconscious mind. He called it the ‘will to power’. These accounts of how and why we are so often so fucked up and out of our own control appear throughout history. There’s stuff inside us that we are very good at keeping in the dark.
Let’s just pause to shine a little light on Freud, the Prince of Psychiatric Darkness. Freud talked about the conscious mind being like a stronghold in a great city. This ‘ego’ is the thing we need, and the thing that develops in most human children, to make us social. If we were solitary creatures, we’d have no need of ego (nor super-ego, the semi-conscious part of us that stores away morality and ‘conscience’); we would just need our id, or our unconscious. Our unconscious, of course, is the city. The big messy ancient city that stores unexamined memory in the darkness. At another point, Freud describes the unconscious mind like a horse and the ego, or the conscious mind, as its puny rider.
We don’t know what we do but we are doing it. The biggest part of us is always in the dark. Actually, I think the city describes it best. If we think of the dark city, we can begin to see how this development of consciousness is reflected in history.
The city of the self is in darkness at childhood, so let’s say that the Dark Ages are something we remember as our intellectual infancy. We build the garrison at the Enlightenment. And from this little stronghold of conscious thought, we form the ability to engage in all kinds of complex social interaction. It is here, in this tiny space, that conscious miracles are made. We learn to describe and govern ourselves and others. Our capacity to think and to organise and to reason evolves at speed. We have grown into and built a conscious social adult world that gives us powerful principles like science, reason and liberal democracy. We no longer need God to assuage the dark fears felt by the barely conscious child and we feel that our world is bathed in light.
But what we consciously forget while we’re in this small garrison full of light is that the city full of darkness sustains it. The process of psychoanalysis is one that acknowledges the darkness. Freud may not have succeeded in finding a way into the dark unconscious, but he certainly knew it was there. What our modern age did, however, was grow to suppose that everything was bathed in the light of reason. The great fault of the Enlightenment was to make us believe that we were entirely enlightened. In our eagerness to believe we could shine a light on everything, we committed a fundamental act of adult Stupid. We repressed the unconscious darkness in which every conscious life begins.
If we are to entertain this Freudian view of Enlightenment history, we can see how what was once just seen as the darkness of uncontrolled human emotion now becomes the opposite of reason. You are no longer emotional or mad or a prophet or a demon. You are just unreasonable. And the way we treat unreason is with reason.
Freud wanted to treat patients with some crazy techniques. Dream interpretation; word association; an analysis of ‘slips’ or mistakes. Psychoanalysis doesn’t believe that mental illness is the opposite of reason. Rather, it’s the thing that reason leaves behind and fails to acknowledge. Of course, you might still think this idea of the unconscious as an actual thing is a crock. But you might acknowledge that it is also a very powerful crock in terms of explaining mental illness. There are few of us who can say we understand our own behaviour fully. There are fewer still who can say they understand the behaviour of the world. Unless we actually stop believing that we are all completely rational enlightened beings in full command of all our actions and nations, there really is no hope for our journey out of Stupid. And perhaps there is no hope for treating the large numbers of people who feel real and keen pain. If there is no moment where we say that psychiatry simply does not know, then the suffering we call ‘anxiety’ and ‘depressive’ disorders are bound to continue.
We can do better as an organised species that acknowledges its own Stupid and so can psychiatry. It is the perverse hope that we will think more ably in the future than we do right now that prompts me—and other more qualified people—to ask questions of the branch of medicine that defines reasonable and unreasonable behaviour in the present. As we’ve said about a thousand times elsewhere in this book, it is crucial for us to examine the idea of ‘progress’ if we want to stop being so stupid. We tend to assume that things are just getting better. Come on. Lots of things are absolute shit and one of them is the fact that a large number of people having, like Willy Loman, perfectly logical reactions to life are being treated with drugs.
Psychiatry won’t admit it, but the psychiatric view of science is actually mystic and dark. A great deal of science is not at all mystic. A great deal of science happens entirely in that well-lit garrison. But psychiatry is not science. There are no blood tests for psychiatric disorders. There are no brain scans. No pathology has yet been found. All we have is a checklist of symptoms as evidence for depression, ADHD or binge eating disorder. We have a checklist of symptoms and some drugs littering the streets of an unconscious city now growing more uniformly fucked thanks to the idea it knows how to organise itself.
Concern about job loss, the death of one’s child or physical dismemberment can all be diagnosed as depression. Actually, grief can now be diagnosed as depression, too. I remember reading that in the news and wondering to myself if, perhaps, love would also one day become a mental illness.
This will almost certainly be the case. There is ‘an involuntary interpersonal state that involves intrusive, obsessive, and compulsive thoughts, feelings, and behaviours that are contingent on perceived emotional reciprocation from the object of interest’ identified by psychiatry (Albert Wakin & Duyen B. Vo, 2011 The Wakin–Vo I.D.R. Model of Limerence). One is no longer ‘love sick’. One has come down with something called ‘Limerence’. This involuntary and frequent affection is pretty much what I feel for my partner.
One can easily suppose in such a rational and illuminated century where even talk shows shed ‘light’ on the darkest corners of the psyche that psychiatry has progressed. I began to suspect that this may not be the case when, in 2008, my ninety-seven-year-old grandmother, who was widowed, in pain and about to die, was prescribed an antidepressant. A young doctor called her ‘depressed’. As if death wasn’t already sufficiently medicalised.
I’m hardly the only one shocked by psychiatry’s irrationally rational authority. Some of the twentieth century’s most respected voices in psychiatric medicine have denounced a system that can no longer make room for the sadness of death. There are guys who, quite literally, wrote the book on madness who now find it mad; we’ll meet them in a minute. First, let’s look at that book; it’s one where normal sadness is rewritten to become depression.
The most influential document in psychiatry today was not written by Freud; a difficult voice muffled for its insistence that the world had something to do with the darkness of individuals and that an unconscious mind governs so much of this individual will. It is The Diagnostic and Statistical Manual of Mental Disorders, or the DSM, a book that turns much non-normative behaviour into a series of symptoms that come together to give us diseases. The DSM, first published in 1952 and currently in its fifth revision, is both the major funding source and the raison d’être of the American Psychiatric Association. In it, you’ll find all the mental and mood disorders for which we can be treated and a few for which we cannot. There are some diseases-by-committee so dumb and made up that even psychiatry can’t be bothered to invent a way to fix them. Honestly, read it. Some of the diseases look like they were put in there for kicks or on a dare. Among my favourites in the new edition of the DSM is binge eating disorder (BED). It is basically like very mild bulimia without the throwing up and it has, like so many of the disorders in the book do, pretty generous criteria. To wit: eat to excess more than twelve times in three months and feel a bit bad about it. So if, like me, you have eaten a pizza on your own once a week, possibly in your underwear, and felt a bit crap about how fast you rammed it into your greedy pie-hole, congratulations: you’re not just a lazy pig who has fallen into a bad habit because things have been shitty lately and/or you like pizza; you’re mentally ill.
Actually, in researching this chapter—surely a ‘rational’ act—I have shown symptoms consistent with BED. I ate an imperial pound of Cadbury Dairy Milk Marvellous Creations Jelly Popping Candy Beanies when I was trying to understand Foucault’s account of madness and I ate a whole barbecued chicken while I was reading just one chapter of Freud’s Civilisation and its Discontents. When Freud compared my conscious mind to a garrison in the city of the id, I thought I felt bad because I knew that most of humanity represses most of itself most of the time. Now I know it was because I ate an entire bird while I was alone in my underpants. I also ate the parson’s nose. I am not even going to tell you what I ate when I was reading the newest revisions to the DSM. Let’s just say that I should probably be in sectioned care for greedy lunatics.
Thanks, psychiatry. Thanks for turning my erratic eating habits into unreason. Thanks for BED, which turns ‘eating even when feeling full’ into something that can be medicated with Topmirate, an appetite suppressant, or with antidepressant drugs. Let’s not think about talking it through. Let’s not say that overeating is a normal response to a culture that encourages it or, worst of all, just fun.
We should make brief mention of the influence of pharmaceutical companies on DSM revisions. Certainly, this topic is widely discussed by psychiatrists. There are a few blockbusters on the subject, including David Healy’s Let Them Eat Prozac: The unhealthy relationship between the pharmaceutical industry and depression. There is a wealth of study on economic rationalism and how it plays its part in creating ‘mental illness’ that is, in fact, just a reaction to life. You can read many compelling arguments against the business of a psychiatry that would create a ‘disorder’ like BED in order to medicate it. But my argument is more about how the idea of reason is used to make us ill.
There are many reasons why one might overeat, not the least of which is that consumption itself is seen by so many of us as an antidote to the despair of the everyday. I mean, this despair is produced and then milked as surely as psychiatric illnesses are invented and then medicated. Listen, for example, to the music played at any major supermarket chain. It will be Coldplay, U2, Snow Patrol, REM. Mournful music played in the key of minor consumption. Even if psychiatry has dispensed with the idea of the unconscious mind, marketers still know how to work it.
It strikes me that if one is overeating, one is behaving in accordance with the temptations and frustrations of our era. And no, I am not saying that people have no choice. If I said that, Bernard, a real free-will guy, would demand a creative divorce. But I do believe our choices are limited by the diminishing size of our conscious minds and the encroaching size of our BED appetites. Every day, this rational world makes our big, dumb ids just a little bit bigger and dumber.
The era is mad and it is not unreason to act in accordance with its demands. If one is overeating and feeling bad about it, one is probably driven by unconscious desires. The correct way to illuminate these unconscious desires might be, say, a Freudian approach. That is, we would set about illuminating the unconscious and actually shining a light on the individual experiences that led us to repeatedly enact this unwanted behaviour. Psychoanalysis is the process of giving light to individual darkness. We are mostly made of chocolate-eater, says Freud. The chocolate-eater is the city and the conscious mind is the tiny dieter in the garrison. The city stores all of the history and is, in fact, the foundation for this tiny little room to which the city is hostile. The conscious us can be seen as an unwelcome soldier in the city of the self.
In Civilisation and its Discontents, Freud described how this internal conflict plays out in the social. And he talks about how the psychoanalytic approach is a long, and quite unreasonable, process of illumination. From the garrison, we learn to view and even command some of the city. This remains a powerful idea. And it is one that stays with us in a very contradictory form. We absolutely agree with Freud that ‘repression’ is a bad thing and that we MUST talk about our problem; we must shine a light on all the dark. And we do this on talk shows and in newspapers and on our deathbed. But really, in thinking we have conquered the chocolate-eating city, the chocolate-eating city conquers us. Freud would be ‘depressed’ to know that he gave us Oprah, and Stupid people who think that ‘mental illness’ is an explanation and a cure for unwanted behaviour. Mine is a whole generation of twits with a psychiatric industry to support them in the belief that we know about the ugliness of the unconscious city because we see it on TV.
What is that thing Keyser Söze says about the devil in The Usual Suspects? The greatest trick the devil ever pulled was convincing us all he didn’t exist. We believe ourselves, in this age of psychiatric reason, to be emptied of the devil and filled with rational light. But the city is now even darker and our idea of the devil remains. It’s a wasteland filled with chocolate wrappers and electronic memories of suffering. The unconscious is devouring us with a melancholy soundtrack and the delusion it has disappeared.
Psychoanalysis is the attempt to throw light, to take us carefully through the rubble and make sense of it. Whether we have suicidal thoughts or a chocolate problem, it is an approach with value on both a philosophic and individual level. But there is so little demand for it in a world that sees itself as so enlightened.
Now, there are still a handful of psychiatrists who will embark on this individual exploration of the unconscious with a patient. But mostly, there are psychiatrists and general practitioners who will prescribe a one-size-fits-most cognitive or drug approach. And what this supposes is not, as Freud posited, that the individual unconscious needs illuminating but, in the process started by men like Descartes and mutated by an increasingly rational Oprah Age that feels it has absolute knowledge, that we have already illuminated everything.
If I happened to have a serious problem with binge eating—and I know this can be a serious problem; I live in the world’s most obese nation—I think I would benefit more long term from a discussion of the factors that led me to cram things into my face. If I can genuinely see the problem truly illuminated, as Freud would have recommended, and not just falsely illuminated by a GP going through a list of symptoms and prescribing me a factory-made solution, then I think my chances of overcoming the bad behaviour would be much improved.
Here is a case where real enlightenment might work; where really tackling that Stupid that lives in your big, dumb, pleasure-craving, death-loving id and exposing it to light could change your behaviour. Instead, the more common end is to take a mass-produced solution. And for the patient, this is almost as much a faith-based cure as any snake oil. We trust that the professional knows what he is doing and has a fine understanding of the very complex research and theorising that led him to give us a Selective serotonin reuptake inhibitor (or SSRI, such as Prozac or Zoloft). But what we emerge with is no real understanding of the darkness inside us and no way to really illuminate it.
Accepting a standard cure, in which I have no understanding, just doesn’t strike me as a good way to bounce back from an undesirable mental state. This is not to say the new drugs have no place. I was prescribed medication to recover from the ongoing attentions of a stalker. I was also instructed in Thought Field Therapy, an idiot-fringe treatment that required me to tap my ‘meridian points’. My understanding of meridians is about the same as my understanding of how serotonin inhabits the neural cleft; which is to say, hazy-to-none. But I underwent this therapy, which I had no choice but to trust, for a year and I just wish, given that I still feel the effects a decade later of the conditions that the psychiatrist called post-traumatic stress disorder and major depression and generalised anxiety, that I had walked into the office of a good Freudian.
I think what I got was some urgent care that stopped me killing myself. But what came after that was false enlightenment. The diagnosis did no good to anyone but my insurance providers. I got a false cure just as easily as I might get a false diagnosis of BED if I chose to explain my recent eating habits to a doctor.
Just why the DSM-5 felt the need to add a regular feature of my Friday nights to its taxonomy of unreason is uncertain. And not illuminated much by its own explanation. ‘A primary goal is for more people experiencing eating disorders to have a diagnosis that accurately describes their symptoms and behaviors,’ they offer as a justification for BED.
The chief function of psychiatry’s pseudo-science is diagnosis based on symptoms. Diagnosis based on symptoms, usually described by the patient, is all that psychiatry has. It is an improper science behaving like a proper science. It is totally full of shit.
But we buy this idea of the illuminated self and we accept that ‘mental illness’ is itself a rationale for much of our unwanted behaviour.
The editor of the third revision of the DSM is Robert Spitzer. Described by The New Yorker as ‘one of the most influential psychiatrists of the 20th century’, the man diagnosed the DSM itself with delusions of progress. In the foreword to an excellent book on the history of depression, The Loss of Sadness (Horwitz and Wakefield, 2008), he said he had been ‘forced to rethink [his] own position’ on the habits of a medicine that made ordinary sadness a medical concern.
The editor of the fourth revision of the DSM was even more broadly critical of the publication of which he had once been chief architect. Allen Frances called the defence by the American Psychiatric Association of its book a ‘meaningless mantra’ in the Huffington Post. In the journal Annals of Internal Medicine he described an urgent ‘crisis of confidence’ and advised that the revised DSM be used ‘cautiously, if at all’.
There are men and women of science pleading for the DSM to be remade.
If one shows evidence of distress upon a fatal diagnosis and those ‘symptoms’ extend to a period longer than two weeks, one will be diagnosed with depressive disorder. Yes, you can and most likely will be diagnosed with depression along with certain death. These are the plain instructions in psychiatry’s most influential handbook.
Psychiatry may not be rational, but it is certainly rationalised. It may not be medical, but the conditions it purports to treat are certainly medicalised.
There is a widespread belief that there is a stigma associated with mental illness. I have found that the reverse is true. There is a stigma in saying: ‘Hey, maybe something else is going on here that has nothing to do with “mental illness”. Maybe I am not mentally ill but just responding to a life that pumps waste into my brain and does not permit its outlet.’
I believe in reason. But I don’t know if I believe that if the psychiatric version of reason is much good at treating ‘mental illness’. A great deal of the time—and again I want to be clear that there are obviously people beset by terrible pain who require meaningful therapy—‘mental illness’ is unconsciously defined by psychiatry as the opposite of reason. So if we think about Freud’s city of the unconscious as being a good idea, then psychiatry itself is a rejection of this territory. Psychiatry wants to make us live entirely in the reasonable garrison of the conscious mind. In other words, the reason of the Enlightenment has begun to believe in itself so completely, it does not allow for anything outside it. If psychiatry continues to see unreason as something to treat rather than something that can be explained or even accepted, then it will continue its program of widespread Stupid.
Psychiatry has a great history of imposing its irrational diagnostic reason on people who really didn’t need it: Willy Loman. My grandmother. Nostalgic soldiers. Homosexuals—a disease category that was removed from the DSM in the seventies not thanks to scientific evidence but because of political pressure. In other words, homosexuality ceased to be a disease for exactly the same reasons it was classified as one in the first instance. Scientistic, moralising, half-arsed Stupid.
Occupied for so long with the unambitious and harmful work of normalising people who are not ill and of making illness normal, psychiatry has fallen into darkness. It has abandoned even the pretence of science in its mania for finding a disease to fit a cure rather than finding a cure to fit a disease.
‘Mental illness does not discriminate,’ say the organisations that support the view that nearly everyone is mentally ill and not just, perhaps, in need of a talking cure or a better life. Mental illness does not discriminate and neither does psychiatry. It provides a narrow range of drug therapies for an ever-increasing range of made-up diseases. And in its mania to treat Willy Loman-itis or the sadness of death and other inevitable human states of confusion, it has much less than it should to offer those suffering disorders that might truly have an identifiably medical basis. In other words, how about a little bit less looking for drugs to treat binge eating disorder and a bit more research into suffering that cannot be socially explained?
Practitioners and patients must become more cynical about the false light of psychiatry. There is no branch of medicine which gets away with so much profitable mischief with so few biomarkers. But what it lacks in laboratory evidence or any account of its underlying scientific principles, it makes up for in profit and a broad public enthusiasm for diagnosis. To claim that mental illness may not be as widespread as routinely suggested is not unkind. Nor does it discredit the very real agony people feel or the very real need for its remediation. This is not a moralising claim. It’s just a simple conclusion that even a basic understanding of what is meant by scientific method allows. Psychiatry’s method, by the admission of some of its most notable practitioners, is not scientific. It is a pseudo-science that got lucky with the development of some drugs that changed moods. The hypothesis that low serotonin levels cause depression is losing traction. No one has a good idea of how these drugs work. In 2011, Marcia Angell, a former editor of The New England Journal of Medicine, wrote of psychiatry’s vague ideas of chemical imbalances that ‘researchers have still come up empty-handed’.
This is a science without theories and without any real shifts in its theorising. This is a medical practice that, unlike cardiology, does not have a uniform set of guidelines on what life practices a sick person might embrace or avoid. Of course, a good shrink might dare you to consider that changing your life is a more effective route out of a depression that, meta-studies suggest, in a mild form is resistant to drug treatment. But a profession working to sustain itself in the half-light of reason is too preoccupied to produce that many good shrinks.
Freud may have been dancing in the dark with ideas that bore more relation to philosophy and art than they did to reason and science. But perhaps this approach is what psychiatry needs to save itself and the many, regardless of their ‘diagnosis’, who need it. As much as psychiatric diagnosis might provide some short-lived comfort to desperate people, it has been shown to be an impotent practice. It is not moralising to say that our idea of mental anguish as a disease needs redress. What is moralising is a system of hunches masquerading as theory that can transform non-normative behaviour into a problem.
Depression and anxiety are not beautiful. ‘Mad’ people are not prophets. People in pain need relief. But they’re not going to get it from mysticism in scientific drag. The belief that we are enlightened and not benighted is a poison. It is not a remedy.
The Stupid of failing to acknowledge our ignorance will get us every time.
Pass the fucking chocolate.
HR