DSM Editor Says 'Mental Disorders Most Certainly Are Not Diseases'

Last year, I was surprised to see Allen Frances, who headed the panel that produced the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, tell Gary Greenberg: "There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it." This week Frances surprised me again, declaring in his contribution to a Cato Unbound debate about psychiatric coercion that "mental disorders most certainly are not diseases." Rather, he says, they are "constructs" that may justify treating people against their will as "a last resort." Go here for my response. But start with Jeffrey Schaler's opening essay, where he lays out the Szaszian position on mental illness, which Frances, the lead editor of psychiatry's bible, says he basically agrees with, although "Schaler and Szasz go way too far in their total rejection of any need ever for involuntary treatment."

Next week University of Maryland law professor Amanda Pustilnik will contribute an essay, after which there will be a continuing exchange. I am eager to see Schaler respond to Frances and to see Frances elaborate on his position, which contradicts the standard line, promoted by psychiatrists, drug companies, and government officials, that mental illnesses are brain diseases.

More on psychiatry's shaky conceptual and empirical foundation: my 2011 review of three books about psychiatry, including the 50th-anniversary edition of Szasz's classic The Myth of Mental Illness; Brian Doherty's 2007 essay on the insanity defense; my 2005 review of Szasz Under Fire, an essay collection edited by Schaler; and my 2000 Reason interview with Szasz. 

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  • John||

    Jacob,

    Check out this in the LA Review of Books

    http://lareviewofbooks.org/art.....1media;=#

    Psychiatry is just hocus pocus bullshit. We might as well go back to the days of believing in demon possession. It couldn't be any less scientifically valid or effective than modern psychiatry and might be less cruel.

  • Ptah-Hotep||

    SF'd the link.

  • Almanian's Evil Twin||

    The Devil Brain disease made him to it

  • John||

  • nobody||

    Link don't work.

  • John||

    http://www.aldaily.com/

    Go here and click on the top article of note in the top left hand corner.

    I didn't sf the link. The reason spam filter did.

  • Brett L||

    But the drugs are good.

  • anon||

    Drugs are pretty much the only good thing to come from psychiatry.

  • anon||

    Then again, when the entire field came about because of a coke-head... this should be self-evident.

  • o3||

    meanwhile extended-mag devotee jared loughner has been psychiatric-upped enough to be sentenced

    http://blogs.phoenixnewtimes.c.....fied_w.php

  • Heroic Mulatto||

  • Almanian's Evil Twin||

    Don't even need to know that's insane

  • BakedPenguin||

    If the cops hadn't taken away his crops, he'd still have medicine for that.

  • Brutus||

    That song rocks. The old show "Millenium" used it in an episode that made it about as menacing as you can imagine.

  • Agammamon||

    You sure that's not Judge Smails?

  • John||

    Alt Text

    I have sent boys younger than you to the gas chamber. Felt I owed it to them.

  • ||

    Anyone who buys a hat like that should get a free bowl of soup!

  • Loki||

    It looks good on you though.

  • anon||

    Blog post pretty much sums up why I quit school 3.5 years into a psych degree.

  • Loki||

    It took 3.5 years to figure out it was bullshit?

    Like I'm one to talk, I didn't realize Aerospace Engineering sucked until after I had graduated.

  • anon||

    Took 3.5 years to get sick of knowing it's bullshit and doing work for nothing.

    I was a liberal back then. Quitting school was probably the turning point in my life.

  • Invisible Finger||

    Are you trying to tell me Nancy Pelosi and Chuck Shumer dont't have mental disorders?

  • ||

    Are you trying to tell me Nancy Pelosi and Chuck Shumer dont't have mental disorders?

    Yes. They're not crazy, just evil.

  • Whiterun Guard||

    So it IS demons after all? The gay christian kind? Or the awesome DC universe kind?

    I'm basically asking if I should get some crosses or if my normal weaponry will suffice.

  • R C Dean||

    Go dual-use with silver bullets.

  • Caleb Turberville||

    Can psychiatry be reformed into something that's more therapeutic and less coercive? Is it possible?

  • Ptah-Hotep||

    Can psychiatry be reformed into something that's more therapeutic and less coercive? Is it possible?

    Maybe more therapeutic. IIRC there are studies showing "psychotic" issues are related to chemical imbalances in the brain. As we learn more about the brain and how it functions, I think psychiatry will improve and become more therapeutic.

    Less coercive is another problem though.

  • Caleb Turberville||

    Well, everyone strives to be more socially acceptable. We idealize individuality, but there's some point that individuality gives to social expectation.

    The question is whether the government should have a say in what's socially acceptable behavior.

    But, if a medical professional can provide medication to a person who is willfully trying to "fit in", I say let them.

  • Zeb||

    Well, it already has done a lot for psychotic disorders. A lot of schizophrenic people can function in society now who would have been raving lunatics locked up for life in an asylum not too long ago.

  • Ptah-Hotep||

    Yes, and the more we learn the more we will be able to help people. It will be neuroscience, not psychiatry, that will ultimately solve many of these issues.

  • Loki||

    That's assuming the benefits of neuroscience outway the downsides of neuroscientists snapping and shooting up movie theaters.

    Too soon?

  • Jerry on the road||

  • johnl||

  • anon||

    Can psychiatry be reformed into something that's more therapeutic and less coercive? Is it possible?

    We call that "Fishing and drinking beer."

  • Loki||

    There's also "the Scotch Treatment". First developed by Scottish psychiatrist Phil McCracken, it consists of sitting around drinking scotch until you're piss drunk.

  • anon||

    I really like that one; Almost as much as I like hanging out with my friend Jack. Jack always gets me in trouble though, so we can only hang out when I really really need him.

  • Entropy Void||

    You neglect to mention his partner, Ben Dover ...

  • ||

    My father always stressed that psychiatry was nothing more than a futile attempt to make everyone think and act the same way. One man's crazy was another man's normal and there should be no shame in that. As to what to do about those who are prone to violent outburst, that's what guns are for.

  • Tman||

    Your point in funny exam form-

    http://funnyexam.com/answers/5.....nds-totall

  • ||

    A+

  • Brutus||

    That's all we need is the medicalization of good study habits.

  • tarran||

    The problem here is that we are applying binary categories for what is a conintuum of conditions.

    When does a bad back stop being healthy and start being a condition? Most people use the idea that if something intereferes with the activities of normal life, it is a condition, and if it doesn't it's healthy.

    When it comes to the operation of the mind, this is all we got, because we can't point to an underlying physical cause, even though there are definite modes of mentation, some of which are cripling.

    I just ended a 13 year marriage with someone who has a personality disorder. And it was a disorder. I watched a nice woman surrender herself to madness and rush down a path of self destruction, destroying her career, her reputation, her family, the lives of total strangers who had the misfortune to know secrets she wished would be kept hidden. I don't buy the notion that these disorders are bullshit. We see the same destructive patterns crop up time and time again, often with the people who are experiencing them fighting a seemingly hopeless battle to overcome them.

    Calling it demonic possession or a personality disorder are just ways of naming these unwanted patterns. You don't have to believe in forcing people to accept treatment to see that. Just talk to the people who desperately want to stop destroying their own lives and relationships.

  • anon||

    I just ended a 13 year marriage with someone who has a personality disorder. And it was a disorder.

    I don't think anyone here is saying that "people don't go crazy," I think it's more just "people go nuts, but we still don't know jack shit about why." I agree that we've got to start somewhere, but until we recognize that we don't actually know jack shit, we can't begin finding answers.

  • Todd||

    As someone married to someone with a personality disorder, I think it's more of a case of (literal) brain damage. The same way we recognize that a kid beat all the time will have long-term injuries, or a molestation victim can end up with physical injuries, personalities are much the same.

    With mental illness in general, I think bipolar disorder and schizophrenia treatment are going to become more neuroscience and less psychiatry VERY soon, and I mean within 10 years. While there is a lot we don't know about neuroscience, we know a lot of the neuroscience of the two big-time. We know that they have strong genetic inheritability, have common neurological bases (with some differences between the two), and there are meds in the pipeline that work to function similar to Alzheimer's meds.

    Past that, we get really murky really fast. Personality disorders are being seen more as a bi-product of abuse, with some genetics involved as well (which shows why not all abuse victims have personality disorders). Anxiety and depression though? Yeah. A lot of those cases are bullshit, and the ones that aren't have ties to either personality disorders, schizophrenia and bipolar disorder.

    I'm not fully Szaszian by any stretch, but the man has a point.

  • wef||

    This is good news.

    What might be the servile reaction to Allen Frances's declarations?

    Wonder what George Will thinks.

    (Not really.)

  • Tman||

    The last few girls I've dated were all on some kind of psychiatric medication, some of them on more than one. Of course you don't find out about this until some pillow talk happens as it's not usually part of normal conversation. But all of them fully admitted that the drugs were essential in keeping them from having panic attacks/depression/anxiety etc. It seems these days that women who aren't on medication are a rarity.

    Maybe it's the age group (late 30's), but I don't understand why these things are so prevalent. I wonder how much of these folks really do need these drugs and how many take them just because the therapist/doctor thinks it's an easier solution than solving the problem at the core.

  • anon||

    Duh. All women are crazy. No exceptions. Well, ok, maybe banjo.

    Second thought, no exceptions.

  • tarran||

    OR you might be attracting them....

    I've had a couple of girls express interest in me since the divorce. They both had borderline personality disorder, which is what I think my ex has. Having read up on it, it's pretty clear that I'm giving off a vibe indicating that I'll not run away screaming but will stick around and help them mediate their emotions.

  • Pip||

    "OR you might be attracting them...."

    ^^THIS^^

    I only lasted 12 years with my wife, whose story went pretty much like your wife's. After splitting up, I seemed to only attract crazy women too. Wife beaters easily find masochists. Crazy bitches easily find stable guys. It’s like they figure, “my life is a shitstorm of crazy and Pip is so stable, I just know he’ll make things better”, but of course one can’t, because it’s just not possible.

  • Pip||

    This post is in part to Tman and in part to tarran.

  • o3||

    true tman, seems as tho many (most?) datable women from mid-30's to 40's are on some psychtropic meds.

    a friend in the ohio epa told me when they analyse contaminates in streams, those in higher income areas are loaded with psychotropics, 2d only to caffine

  • Tman||

    Yeah, again I hope I'm wrong about this. I'm certainly not TRYING to find the ones that are crazier than normal.

    Your Ohio EPA story makes sense as well. I bet there's a significant amount of people who would be on psychotropics if they could afford to see therapists regularly who would prescribe them.

  • Brett L||

    Stable, happy, reasonably attractive people who don't make a series of bad decisions tend to partner up in long-term relationships by their late 20s. Sure there are outliers who get out of said relationships for good reasons in their 30s, but for the most part, we're (mid 30s and later singles) the set of people who aren't totally stable or have made decisions against our interest on several important occasions.

    Men just tend to view episodes of depression/anxiety/etc as a shortcoming of character rather than biochemistry and are less likely to seek meds for it, in general.

  • Tman||

    I agree with this to a point, but considering the divorce rate is above 50% the "stable happy couple in their 20's" usually join the singles club more often than not after a few years.

    I do agree about the male/female analysis of depression/anxiety/etc. I barely know any guys on such meds, but there are tons of women I know -both friends and lovers- who are.

  • ||

    the divorce rate is over 50% due to serial divorcers.
    a first time marriage does not face a 50% probability of divorce

    this is the logical issue that most people don't realize when quoting the divorce stats

    there are many many people with 2, 3, 4 etc. divorces who skew the stats

  • Brett L||

    Triumphs of hope over experience.

  • $park¥||

    Men just tend to view episodes of depression/anxiety/etc as a shortcoming of character rather than biochemistry and are less likely to seek meds for it, in general.

    This is a reasonable statement. I started taking medication because of migraines and even though it also kills the depression I don't take them when that hits. That being said, both cases for me aren't as crippling as I know they can be in others.

  • R C Dean||

    Uh, Tman, roofies are not a psychiatric medication.

  • Tman||

    So THAT'S why I was so sleepy.

  • Todd||


    I don't understand why these things are so prevalent. I wonder how much of these folks really do need these drugs and how many take them just because the therapist/doctor thinks it's an easier solution than solving the problem at the core.


    Also, insurance reimbursements are MUCH better for just handing out drugs then talk therapy. There's a major bias against it, when that's all a LOT of people need, because of the financial aspect. Also, you can't make people talk about their issues if they don't want to, so it's easier to get people drugs even if you can get the therapy paid for.

  • ||

    The last few girls I've dated were all on some kind of psychiatric medication, some of them on more than one ... It seems these days that women who aren't on medication are a rarity.

    It seems that women YOU DATE who aren't on medication are a rarity. Try not to project.

  • Tman||

    I only have my own experience to offer in this regards so...not trying to project.

    I hope what I've found isn't normal because it's not like I'm TRYING to find women who are crazier than usual.

  • Christina||

    My brother-in-law has the problem of seeming to attract just the crazies. He's in his late-30s and would love to settle down and have a family. He only goes for women who are quite attractive and high-maintenance. The problem is, those women turn out to be either really stupid or really crazy, or both. Especially in his age bracket, all the good ones are taken, leaving only the nutjobs. I've told him he'd probably be happier with some average-looking chick who has a head on her shoulders, but he can't seem to change who he's attracted to. So he got a dog.

  • Tman||

    So I should get a dog, is what you're saying.

  • $park¥||

    I dunno man, dogs are the first step down the no-knock raid path.

  • Brett L||

    Or a cat if you have problems committing.

  • AlmightyJB||

    Yeah, 'cause cats aren't going to attract more crazy women in that age group. Is it the psychosis or medication that makes them all get multiple cats?

  • Christina||

    Lonliness and desire for kids.

  • Christina||

    If you are willing to put brains before looks, you'll be fine. Find a chubby girl with a high IQ. They need love too!

  • Tman||

    I've been down that road, it doesn't work. I value high IQ and easy going personalities in a partner, and that clearly outweighs the looks column, but if you aren't physically attracted to someone it's impossible to maintain any romantic feelings.

    At least it is for me anyways.

    My last long term girlfriend was a hot lawyer who clerked in town. She had it all-looks, brains, god personality, etc. But crazy as a shit house rat.

    I should've known better.

  • Christina||

    I'll let you in on a secret: no man or woman has it all. Apparently Ms. Law Clerk didn't have all her marbles.

    I'm not telling you to date a dog and supress your gag reflex when you stick it in. I'm just saying that looks fade anyway, so you are better off going for a smart and stable 6-7 than a 9-10 who's looney-tunes.

  • Christina||

    Rereading this I realize that it sounds like my BIL has resorted to bestiality. This is not the case, AFAIK. He says he has no problem finding hot women to have sex with. The problem is not wanting to be around them after the sex is over.

  • Brett L||

    Libertarians don't judge as long as the dog is an adult and consenting.

  • AlmightyJB||

    "he has no problem finding hot women to have sex with"

    yeah, he's got it rough.

  • ||

    The government should force him to redistribute his wealth.

  • Christina||

    He's a chef and a surfer and very flirtatious. So sex is easy to come by. But what he wants is a wife.

  • $park¥||

    I was lucky enough to have inherited from my father a condition which causes migraines and, at times, depression. I'd hesitate to say that all people with mental "disorders" are just looking for a way to pop some pills. I'll agree with what anon says above that there haven't been sufficient enough studies into the working of the brain to successfully treat many things. However, there are times when telling a depressed person to "get over it" is like telling a person with a broken leg to stop having a broken leg.

  • Whiterun Guard||

    The best way to tell is to shut them alone in a room for a day with just a gun, a towel and 24 hours of porn.

    If they shoot themselves, they were indeed depressed.

    If they don't, they're a witch and you should burn them.

  • $park¥||

    How did you know my home remedy? Have you been spying on me?

  • anon||

    I get the feeling that you may not have had a serious relationship in a long time.

  • Mr Whipple||

    "There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it."

    Well, if you want to get technical, you can't define what a "thought" is, either, can you?

  • AlmightyJB||

    Yeah, these semantic arguments are boring.

  • Hyperion||

    Sure they are. Just like alcoholism is a disease. Because billions in crony bucks have been made off of it.

    Also, you know how scientists are in pursuit of that 'theory of everything'? Liberals are in pursuit of the 'excuse for everything'.

  • Mr Whipple||

    AA was formed independently by Bill Wilson and Dr Bob Smith. They classified alcoholism as a disease, and formed a non-profit fellowship to treat themselves and others. They did not profit from it.

    0If you want to refute the idea that alcoholism is a disease, you are going to have to do better than "Teh Prefetz".

  • ||

    i find these posts ironic since i had to invol two women yesterday
    (actually , i assisted on one)

    and they were both on psychiatric meds and in their 30's

    and single

    the above posters re the self selecting group of single, mental ill, psychiatric drug using women in their 30's are spot on based on my experience

    granted, i also had a male blow his head off last week. men COMMIT suicide far more often than women, but women "attempt" it for candy-ass definition of "attempt" (three flinstone chewables and a wine cooler OD because they want to "die")

  • GILMORE||

    "There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it."

    Semantic bullshit.

    My little brother is a severe schizophrenic. Most people who get similarly diagnosed are somewhere along a 'schizo-affective disorder spectrum'-line, which is arguably a fuzzy, poor definition. But of these 1% of 'mentally ill' who get labeled 'schizo-affective', there is a further 1% *of those* who are the Grade AAA, Doctor's-seal-of-approval, 'i hear voices telling me X Y and to kill Z', true-blue, screaming naked, thinking-they're Jesus, A+ Schizophrenic. The Black Swan, as it were.

    When he had his 'break' (early 20s), I met with a clinical psychiatrist who said my bro was a "textbook" case. He then SHOWED ME THE TEXTBOOK. bro met every single symptom/pre-condition/epidemiology/'typical behavioral affects'/yadda yadda yadda, to a T. Down to how much weight he'd lost in the weeks leading up to the break, and other symptoms *predicting* a possible major episode.

    I admit, the 'definition' is still just a cluster of many disparate details of which the causes are really only partially understood. but if the 'science' is good enough to isolate these details so distinctly that it can distinguish this genetic condition from other types of causes... that's good enough.

    But if you don't think the kid has a 'disease', well, then I'll be glad to lock you in a room with him without his meds for a few days, and see if you change your mind.

  • ZengaFooo||

    Sounds pretty smooth to me dude.

    www.in-privacy.tk

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