Dissecting Mental Disorder
For serious scientists, the trouble with “mental disorders” is that the official definition is not operationalized in a way that enables any kind of scientific hypothesis – let alone proof – that any obviously separable “symptoms of mental disorder” either fundamentally are or should reasonably be grouped together into categories that can be logically described as “disorderly”.
I am not writing to convince anyone that “mental disorders” do not exist, or are not real, because those statements, while figuratively accurate in certain limited senses of “existence”, are not literally precise in describing the actual nature of mental disorders. Mental disorders exist as gods and goddesses exist – they exist in our imaginations.
The purpose of this essay is to explain the actual nature of the concept of mental disorders – and, thus, the reality of the disorders, themselves – in terms that may clarify some of the countless problems with the modern mental-disorder mindset of helping humans.
This essay is primarily intended for people who depend upon the Diagnostic and Statistical Manual series for diagnostic criteria and definitions, but the International Classification of Diseases explicitly admits that "mental disorder" is "not an exact term", and thus admits that the charge of being unscientific would be equally applicable to its definition of mental disorder.
For most of us who intelligently reject the mental-disorder mindset, the fundamental issue is simple: no real science has ever even attempted to prove the existence of any disorder, let alone mental disorders. There are two primary reasons for this. The first and most important reason is that it is impossible to prove the conjecture “this is disorder” without first defining “disorder”, and the best meaning of “disorder” is not a scientifically testable question. Second, no such proof has ever been necessary or logically essential to the extremely profitable processes of diagnosis or drug-distribution that currently depend on the belief in mental disorders.
To be clear, in order to emphasize my low opinion of the precision of the phrase “mental disorders”, I will occasionally place that phrase in quotation marks throughout this essay, as I have done in this sentence. My treatment of “mental” and “disorder” will be similar.
So, do “disorders” exist?
The answer to this question depends upon our working definition of “exist”. Are you starting to see a pattern? If this bothers you, you are bothered by real science, because real science requires careful definitions of everything.
The etymology – “dis” + “order” – might lead the astute reader to suspect that “disorder” is relative to a clear definition of “order”. If so, I’m sorry that I must be the bearer of disappointing news, but no such base for the prefix has been defined by our modern medical establishment. Close inspection reveals a tangled web of “doctors” who are currently diagnosing abnormality on the basis of a purely instinctive, intuitive notion of “normality”.
You read that correctly – there is no such thing as a “normal” person in the DSM-5. Only a “mentally-disordered” person is defined. Therefore logic would suggest that “mentally-ordered” people are those who haven’t yet been diagnosed with anything.
Nonetheless, if we use a very specific sense of the concept of “existence”, mental disorders indisputably “exist” – but not as they are commonly understood to exist.
A disorder is simply an abstract concept – an idea conceived and discussed purely on the basis of human reflections. Yes, water is also a concept, but its existence has measurably concrete properties. For example, the substance of water must be consumed as a whole in order to benefit us, and in that context, a special term for the substance known as “water” makes a lot of sense. On the other hand, we need not learn that someone is feeling inattentive-confused-melancholy-anhedonic-misguided-stigmatized-isolated-frustrated-hopeless all at the same time, so it does not make as much sense to reduce that collection of phenomena to “major depressive disorder” for any individual. We can contemplate those conditions one by one, and we learn much better about the details of struggling individuals by doing so.
The fact of the matter is that we use the phrase “mental disorder” as a common noun phrase that refers to a collection of observed phenomena that sometimes cause enough problems to warrant a search for professional assistance. In doing so, we label those diverse phenomena in exactly the same way that a religious zealot identifies a collection of phenomena by the name of their favorite god or goddess.
If you don’t know what I mean, consider this: many Christians might define “God” (you know, “the God”) as something close to an intangible supreme being who has feelings, ideas, a plan for everything, omnipotence, and omniscience; who transcends and enables all love, light, understanding, and forgiveness; and who is generally responsible for all the good that can exist in the world. If you honestly believe this to be an observation of how things really are, then this article is probably not for you. But for the rest of us, who see that tying all of those things together and calling it God is a leap of opinion rather than the kind of undeniable fact that can kill anyone in a fraction of a second, my reason for saying this will become clear soon if it’s not already.
Now – bear with me – is there any indisputably, rigorously scientific obligation that a logical human being believe that love, light, understanding, forgiveness, and everything good are collectively the domains of “God”? No. There is no laboratory test for “Godness” that can avoid a necessary reliance on a prerequisite definition (or, in other words, an unscientifically imaginative opinion) of something tangible that qualifies as a measure of Godness. We have to first agree that something real indicates “Godness” before we can test for the presence of that phenomenon. Unfortunate though it may seem to some readers, our ability to agree on the definition of “Godness” is nowhere near our ability to agree on the definition of “pain”, “sadness”, “fear”, or “joy”.
Does the unscientific nature of this specific belief in God imply that love, light, understanding, forgiveness, and all the good things are nonexistent, and that everyone who defines those things as expressions of God is wrong? No. “God” is simply a word that some-but-not-all people like to use for that set of phenomena. They have elected to use their freedom as human beings to choose to reference that set of phenomena as a collective, and given the collective a term. That’s not wrong – but it’s also fundamentally unscientific. It’s a decision of opinion and human aesthetic sense.
Unlike the fully concrete baseball bat and your equally concrete ability to swing it, God can only be proven to exist as an abstraction, but not as a tangible entity. Humans either use “God” for reasoning, discard it in favor of other strategies, or never hear about it in the first place because they hide deep in the jungle, far away from our crazy “civilization”. Whatever our belief regarding the existence of Christian God, Allah, Saraswati, or any other deity, we suffer no serious consequence as a result of our opinion on that matter (though other behaviors that follow in relation to our beliefs may be an entirely different story).
“Mental disorders” are a lot like gods and goddesses, and nothing like baseball bats or water. Just as you cannot do a favor for an enemy and thus prove the existence of the Christian God, you cannot smack someone in the face with anything and reliably cause the whole range of “symptoms” associated with any of the major “mental disorders” that people today are accused of having, let alone prove that those consequences are justly categorized as “disorderly”, “abnormal”, or any other buzzword that has been enjoyed by the psychiatric-industrial-congressional complex in the past.
Nevertheless, distraction is real; sadness (depression) is real; anxiety is real; fear is real; callousness is real; anger is real; hate is real; anhedonia is real; confusion is real; paranoia is real; hallucination is real; and, sometimes, these real phenomena arise in extraordinary degrees or circumstances. But if you argue that a persistently sad-inattentive-anhedonic-hopeless-confused mindstate is “major depressive disorder”, you’ve made exactly the same kind of leap as someone who says that all of the good in the world is an expression of God (albeit to a lesser degree) – that is, you have asserted a totally unscientific leap of categorization, very different from the undeniable forms of causality associated with baseball bats, water, distraction, sadness, anxiety, fear, callousness, anger, hate, anhedonia, confusion, paranoia, and hallucination.
How many psychiatric patients are fully informed that this is the reality of a mental diagnosis before consenting to treatment? Very few, I suspect.
So, what exactly is a “mental disorder”?
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
This is the definition of “mental disorder” provided by the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders, on the basis of which millions of people have been (and will continue for years to be) labeled with various “mental disorders”.
Now, we can immediately ignore everything after “usually”, because “usually” does not imply “necessarily”, and is therefore not fundamental to the provided definition. This leaves us with just a few more words and relationships that must be defined in order to approach anything scientifically. At the very least, we must define “syndrome”, “clinically significant disturbance”, and “dysfunction”.
The DSM helps with the first of these. A “syndrome” is defined as a “grouping of signs and symptoms, based on their frequent co-occurrence that may suggest a common underlying pathogenesis, course, familial pattern, or treatment selection.” They do not define “frequent” in any scientific way. Also notice that “may” renders everything after that irrelevant to the definition, because “may” implies “may not”, and therefore there is no requirement that a mental “syndrome” must have a common underlying origin (pathogenesis), course, familial pattern, or treatment selection. The only absolutely mandatory element of the definition of a syndrome offered in defining mental disorder is that it is a group of signs and symptoms (objective and subjective manifestations of a “pathological condition“, respectively). Therefore, a “mental disorder” is simply “a group of subjective and objective manifestations of a pathological condition that reflects dysfunction in the psychological, biological, or developmental processes underlying mental functioning.”
“Clinically significant disturbance” also goes undefined, but presumably refers to anything that leads a person to seek psychological or psychiatric assistance.
Alas, “dysfunction” remains undefined, as well, rendering these definitions sufficiently flexible and ambiguous to accommodate a wide range of potential customers – I mean patients.
What does this mean for ordinary people, ultimately?
The fully-clarified, fully-unscientific definition of “mental disorder” means that if any child and their legal guardian can be convinced to subjectively feel that maybe the child is experiencing enough of the collective “abnormalities” (of unspecified degree) commonly known as any of the many mental disorders in the DSM, and if a doctor of sufficient authority can be persuaded to agree that their behaviors are an indicator of that disorder, then that doctor may sell them stimulants to promote ease of concentration, euphoriants to make them feel happier, anxiolytics to relax them, antipsychotics to quiet their imagination, or whatever else the market is allowed to sell that month.
The good news is that serious scientists are already finding many new ways to improve the art of optimizing human happiness.
To many people, the mental-disorder model of psychology feels so well-established and ancient that a new model would be impractical, and perhaps even waste most of our psychological research. This fear is not defensible, however, in light of the simple fact that the vast majority of our best research involves isolated measures of cognitive-behavioral effects related to various not-necessarily-disordered causes, including but not limited to experience, education, inoculation, treatment, medication, feeling, belief, logic, primacy, and incentive. Most of our best research would remain as relevant as it has ever been if the belief in disorders ceased to exist tomorrow. Furthermore, I strongly suspect that better research would become much more relevant when freed from the oppressive and misleading shadow of mental disorders.
Nothing about our knowledge of social pressure or classical conditioning will lose its value if we stop thinking of “major depressive disorder” as a single entity, and instead contemplate the precise nature of an individual’s various upsetting mental states, seeking only research and treatment options with direct relevance to precise operationalizations of an individual’s real symptoms. In fact, historically (and also unsurprisingly), there is a positive correlation between the likelihood of desirable treatment outcomes and the specificity of observation when managing every problem we’ve ever faced. Our ability to survive would surely be improved by a more specific understanding of our psychological challenges.
Similarly, nothing about the biomechanical effects of various drugs would be fundamentally changed by a model of drug distribution in which patients chose drugs based on the strength and likelihood of the known effects of those drugs. A new model of drug distribution could enormously benefit our habits of analysis and thus our understanding of drug effects. Consider this: instead of studying the relationship between drug effects and broad, abstract collections of possibly-but-also-possibly-not-presenting symptoms, we could study the interaction between drugs and individual symptoms, or between drugs and specific groups of actually-present symptoms. That would undoubtedly provide a more accurate estimation of whether a real individual with a unique set of symptoms would be more likely to benefit or suffer from the consumption of any given drug. When we ask more specific questions, we get more specific answers. There is no good scientific reason not to ask questions that are more specific and diverse than the questions about vague disorders that plague so many people daily.
And what about the hundreds of studies establishing that drugs relieve the symptoms of various disorders?
Those studies would be mostly unaffected by reconceptualizing the way we treat groups of symptoms. Studies suggest, for example, that when children have struggled in school, been diagnosed with attention-deficit hyperactivity disorder, and then been given certain stimulants (for example, amphetamines), they have experienced significant gains as measured by scholastic performance and positive self-image. In other words, there is evidence that stimulants improve the academic focus of many people, and that can benefit them more generally. However, it is important to realize that amphetamines are banned performance-enhancing drugs for most professional athletes (without a prescription, of course). Why? Because they are known to provide an “unfair” performance advantage to any athletes who take them – not only those who might be DSM-diagnosable. As a matter of fact, most people will focus more clearly and remember more of what they read (at least in the short term) if they regularly take big enough doses of “speed”.
Amphetamines don’t care whether you’ve been diagnosed with a “clinically significant dysfunction”. They are going to stimulate cognitively-important aspects of your central nervous system, anyway, and that is going to benefit most people in concentration-oriented activities up to the point of overdose.
Because so many drugs are potent enhancers of human performance in the context of various activities, I am not opposed to selling stimulants for concentration, or euphoriants for enthusiasm, or anxiolytics for relaxation, or any other drug for any other difficulty in life. My problem is with the bureaucratic and unscientific requirement that people be arbitrarily stamped “disordered” before being allowed to purchase drugs that would likely improve their lives.
Some people argue that “dysfunction” (among other things) indicates disorder. Others argue that everything in reality is inherently “ordered” and “functional” – that we cannot logically discuss whether something is ordered or functional, but only how it is ordered and functional. There is no scientific study that can settle this disagreement. Therefore we cannot honestly study disorder without first agreeing to operationalize it in a context-dependent manner, while realizing that we are not being and cannot be purely scientific in choosing that operationalization – at best, we can be democratic.
In my view, our model of treating human difficulty should not be based upon arbitrarily-defined “mental disorders”, but upon a truly scientific understanding of the psychoactive stimulation of our complete humanity.
We do not need authoritarian bureaucrats to grant permission to people who seek social or chemical assistance in their lives. We do not need to declare someone “disordered” before we offer them either advice or useful drugs. We do not need to declare any behavior “dysfunctional” to see that it is “harmful”, or to seek ways for teaching “helpful” behaviors. We can do better in acknowledging the extremity of situations that produce extreme personalities via perfectly orderly, functional mechanisms.
The old model is unnecessary and misleading on several fundamental levels.
We can usher in a new era in which individualized analysis and assistance replaces the outdated, misleading, simplistic, and unscientific mental-disorder-based diagnosis and treatment that has come to dominate the minds and markets of the modern world. Any challenge is either a truly organic disease with an identifiable source (and therefore a medical issue), or it’s an ordinary consequence of human development under extraordinary circumstances. A traumatized person is not disordered. A nescient person is not disordered. An extraordinarily active person is not disordered. Someone who doesn’t want to listen to authority figures is not disordered. “Disorder” demands a clear and democratic definition of “order”, or it’s snake oil masquerading as rigorously scientific thought.
Let’s stop treating people as fundamentally abnormal without any concrete proof of fundamental abnormality.
Let’s stop simplistically studying “disorder”, and start studying the tastiest fruits of our scientific research on a deeper level – let’s focus on the intricate web of causal connections that truly direct our lives. Scientific progress is being achieved despite the crushing weight of poorly-conceived “disorders”, and serious scientists are trying to come up with wiser ways to conceptualize mental illness. As long as we remember that our definitions are not the scientific parts of our science, we will make greater progress in seeing the truth of ourselves.
We are not alone. Share this essay if you feel me, friends.
Aiso Ippudu Milele
10 September 2017