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.