The Issue of Mental Health (II)
Further thoughts on what we lose by diagnosing others’ eccentricities and instances of human variation as mental illnesses.
When I worked in China in the 1980s, a Chinese coworker with whom I’d developed a good rapport nodded his head at my bare arm one day and announced, “I can recommend some medicine to cure that, if you’re interested.”
It took several moments for me to realize that he was referring to my freckles. To him, I had a skin disease! Or at least, a disfigurement. Along with my blue eyes and fair skin, I freckle when exposed to sunshine. To me, a sprinkling of brown dots all over was a cherished inheritance from my father, who’d had red hair as a kid.
No one in the US had ever indicated anything negative to me about freckles. But in China my natural skin type was not only extremely unusual, but also considered abnormal, ugly and something I should turn to science to deal with. I explained to my coworker that in the West, freckles were not only common, they were considered normal and in many instances even cute. I’m not sure I convinced him.
In this light, let’s look at how close introversion has come to being labeled as a mental illness.
In 2010, several introvert advocates, including Nancy Ancowitz, author of Self-Promotion for Introverts, and Laurie Helgoe, author of Introvert Power, raised an alarm that the forthcoming fifth edition of the American Psychiatric Association’s bible of mental disorders, the Diagnostic and Statistical Manual (DSM), might include being introverted as a diagnostic factor for some personality disorders. According to Ancowitz, 30 years previously those compiling the DSM were considering adding “introverted personality disorder” as a full-blown diagnosis. This would have made introversion itself pathological. At that time, a letter-writing campaign convinced the APA to scotch the idea. For the 2010 edition of DSM, an advocacy campaign similarly turned back the new plan to stigmatize introverts.
Are you surprised that whether being introverted is psychiatrically normal or abnormal could stand or fall according to the strength of a pressure campaign, instead of according to scientific evidence? Most people don’t realize that the DSM, touted by the American Psychiatric Association as the world’s “authoritative guide to the diagnosis of mental disorders,” is actually no more factual or objective than whether freckles call for medical treatment. The DSM is a set of diagnostic categories and criteria that mental health clinicians, pharmaceutical researchers and insurance companies have agreed to use. Its categories are not grounded in rigorous research and are not precise enough to enable different professionals to arrive at the same diagnosis from the same symptoms.
Nevertheless, mental illness labels have spread in Western cultures to the extent that the US Centers for Disease Control and Prevention states that more than half of people will receive a mental illness or disorder diagnosis during their lifetime, and in any given year, around 20 percent of the population will be experiencing mental illness.
One explanation for this situation is that psychiatry’s diagnoses have identified rampant abnormalities and dysfunctions. Illnesses are just objectively out there. A cynic would add that once diagnosed, sufferers become eligible for treatments, which benefit many entities besides the purported sufferers. Alternatively, psychiatric labels have overreached to the point that they are labeling as diseases natural psychological variations among people. In this opposing view, sadness, anxiety, anger, distractibility and even hearing voices are all part and parcel of the human condition.
Susanne Antonetta, a sharp critic of mental illness labels, points out that many more people than you’d probably imagine hear voices yet manage to function well in society as well as in their personal life. Surveys show that internationally, around one in every eight people experiences auditory hallucinations – hears voices – at least once in their life. Ditto for many other supposedly abnormal conditions. “I wonder how much ‘eccentric’ now translates into ‘sick,’” remarks Antonetta.
Where introverts are concerned, people who seldom speak, who greatly prefer their own company much of the time or who would rather relax with a solitary nature walk than have a beer in a crowded bar are statistically unusual. But apart from the displeasure mainstream society has for those tendencies, are such individuals experiencing any distress or harm that calls for psychiatric help? Not necessarily. Remember that unusual does not entail abnormal. As with my freckles, unusual also does not in itself signify suffering or harm.
Labeling unusual human characteristics a “mental illness” or a “mental disorder” has several unfortunate consequences. First, it generates a problem that appears to require a remedy – such as therapy, medication or forced change. Second, it activates stigma. Someone described as “unusually solitary” isn’t thereby tainted, but someone who “suffers from introverted personality disorder” would be.
Third, it downplays the person’s agency, portraying them as subject to elements apart from their identity and out of their control. If someone who is viewed as having a mental disorder says they like themselves just the way they are, thank you very much, that can even be taken as another symptom of disease rather than an assertion of autonomy and self-determination.
Recommended Books Related to This Topic
Madness and Civilization by Michel Foucault
Originally published in French in 1961, this is an eye-opening and influential history of how Western societies conceived of and treated mental illness from around 1500 to 1800.
Pathological: The True Story of Six Diagnoses by Sarah Fay
Interspersed with this woman’s unfortunate history of getting diagnosed with schizophrenia, narcissistic personality disorder, post-traumatic stress disorder, obsessive-compulsive disorder and more are data and arguments showing the subjective and utterly unscientific nature of contemporary psychiatry.
A Mind Apart: Travels in a Neurodiverse World by Susanne Antonetta
This contemplative memoir shows how beautifully accepting our world might be if non-conforming people weren’t confined and disrespected with mental illness labels.