We are not going to pick on mental health professionals, at least not more than we indict the professionals in other American institutions. Unconscious people cannot create highly functioning or healthy institutions. In this essay we join a dialogue among three psychiatrists, a philosopher and a layperson evaluating the effectiveness of modern mental health practices.
Controversy is often generated before and after each revision of “psychiatry’s bible,” the Diagnostic and Statistical Manual of Mental Disorders (DSM). The harshest critics say such things as diagnoses are merely “myths” or “socially constructed labels.” Controversy is not a bad thing but getting at the truth, if such a thing is possible, would be good news for a beleaguered humanity. Let’s try to do that.
Certainly over the years, understanding of abnormal human behavior has become more sophisticated. Philosopher of science and historian Patrick Singy gives us some historical perspective. “In the 19th century the diagnosis of “drepetomania” was suggested to describe slaves who flee from their masters, and until the 1970s “homosexuality” was in the DSM.” Today we have the diagnosis of “‘Post Traumatic Slave Syndrome,’ which has its origins in the systematic dehumanization of African slaves that has been passed through generations of their descendents.”
Simple Reality provides yet another perspective which sees virtually all of humanity as suffering from insanity in the sense that “normal” people do not choose self-destructive behavior en masse. This is more like the behavior of lemmings, if indeed lemmings do behave this way. The apt metaphor which has people in the global village heading for the Cliffs of Dover and jumping into the icy-cold waters of the English Channel suggests the need for more therapists than we will ever be able to provide.
All of this begs the question: Do therapists do any good? A related question would be: Are human beings becoming more or less mentally healthy what with all of our new medications and health professionals? All mental health professionals reading this take a deep breath before proceeding.
First, we should look at exactly what the goal of the mental health professional is and then we can make our own judgments about whether they are successful or not. For that we turn to Ronald Pies, professor of psychiatry at SUNY Upstate Medical University and Tufts University. “Indeed, diagnosis remains the gateway to psychiatry’s pre-eminent goal of relieving the patient’s suffering.”
What is the dimension of the problem in America today and how many people suffer from mental illness? Allen Frances, professor emeritus of psychiatry at Duke University helps answer that question. “Diagnosis and the use of psychotropic drugs have both gotten out of hand; 20 percent of the adult population qualifies for a mental disorder, and 20 percent take medicine. The boundary of psychiatry keeps expanding; the realm of normal is shrinking.” So there is some evidence that in the U.S. at least our suffering is increasing, which is driving more of us crazy and hence we are turning in increasing numbers to the use of drugs to assuage our existential anxiety.
That observation would corroborate the prediction associated with Simple Reality but with different reasons of course. As false-self behaviors express increasing levels of fear, for the reasons we are all familiar with, then the DSM-5 would identify new alarming behaviors and create a label for them. Then the drug companies (never missing an opportunity to please stockholders by increasing profits) capitalize on these new behaviors by providing “suitable” medications.
Again, Allen Francis: “As chairman of the DSM-IV Task Force, I must take partial responsibility for diagnostic inflation. Decisions that seemed to make sense were exploited by the drug companies in aggressive and misleading marketing campaigns. They sold the idea that problems of everyday living are really mental disorders, caused by a chemical imbalance and cured with a pill.”
Things are obviously getting more complicated concerning the dysfunctional aspects of the human body, mind and emotions. One thing is becoming undeniably clear, however, and that is we are not getting any healthier in America and we can speculate that as America goes, so goes the rest of the global village. That is because the human false self is universally the same and with globalization even the details of the false-self survival strategy are homogenizing.
What are we going to do about this alarming situation? Allen Francis has his opinion. “The soon to be published DMS-5 will worsen this absurd misallocation of resources by recklessly introducing new and untested diagnoses and reducing the thresholds for existing ones. We badly need a conversation about a diagnostic system that is far too loose, a drug industry that is far too unregulated and a mental health system that is badly broken. But the pages of The New York Times are not enough; it is time for a Congressional investigation.” Pardon our snickering.
If Dr. Francis thinks politicians are going to fix a broken system he probably needs a psychiatrist. Congress was complicit in “breaking” the system. As a Congressman still on the Hill said two years ago (we won’t mention his name to avoid embarrassing him) “They own this place.” Who are they? The corporations including Big Pharma are “they.” There is little point going to the American Association of Hungry Foxes (Congress) to reduce raids on hen houses in America.
How about hearing from a person who had a long-term experience with the mental health care system? “Had I resigned myself to the psychiatric labels I was given in my teens and 20s and followed the recommended course of treatment (hospitalizations, therapy and medication), I would not now be director, mother, wife and homeowner. Those are the labels that I find humanizing. The others I have shed.” Sera Davidow refused to accept the identity that was associated with the labels undoubtedly originating in the DSM-IV.
In Simple Reality we have learned that identity determines behavior and therefore for Americans to reduce their suffering we dare not rely on either Congress or the mental health profession any more than we have to.
It has probably become obvious that we are headed for a catastrophe with more pills for more types of craziness, for the deluded and depressed, terrified and tormented. The details will continue to multiply in an ever thickening DSM; the diagnoses, the pseudo-remedies, and the illusionary sources of fear will color our future until we have no future.
The authors of DSM-6 will look at the seemingly infinite number of manifestations of human neuroses and label them. Big Pharma will create a drug for each and pay psychiatrists handsome fees to speak at conferences lauding the effectiveness of these medications. Or, we could all recognize that there is only one cause of unsustainable human self-destructive behavior and focus on bringing that into consciousness. Then we could apply the proven practices that empower people to transcend the beliefs, attitudes and values that provide the foundation for our toxic P-B narrative.
We wouldn’t be writing about mental illness in America if there were no pragmatic and short-term solutions possible. What would be the point?
Human suffering and most of what we label mental illness takes root in the story we come to believe about ourselves which also determines our all important attitudes and values. All of these determine our identity and as Sera Davidow learned, we dare not let others dictate our story and the resulting identity. Our identity drives most of our behaviors. Hence, story, identity and behavior are interconnected, interdependent and interrelated. That is the fundamental structure of human consciousness. Humanity chooses the direction it will take collectively and individually but we are virtually clueless as to how and why we make those decisions. All of humanity is contained in the same P-B story and in that story we are all suffering from mental illness. So, the answer to the question posed in the title, Who’s Crazy? is EVERYBODY!
We don’t need a Congressional investigation, but we do need a profound conversation structured around profound questions. Simple Reality is the manual describing the work we have to do. Our guidance will ultimately come from our own hearts, the repository of all the wisdom we will need to transcend our suffering.
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References and notes are available for this essay.
Find a much more in-depth discussion in books by Roy Charles Henry:
Who Am I? The Second Great Question Concerning the Nature of Reality
Where Am I? The First Great Question Concerning the Nature of Reality
Simple Reality: The Key to Serenity and Survival
