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The Politics of Psychiatric Assessments

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Abstract

Definitions of psychopathologies and the diagnostic criteria thereof are formulated primarily by the use of "consensus reality" as a baseline and universal reference point. Consensus reality is dangerously unreliable and unsuited for inclusion in the formulation of any scientific model; in fact, massive collective delusions have been common throughout recorded human history. Furthermore, consensus reality can be manipulated into illusory or delusional configurations in the collective consciousness of large groups, to the benefit of the manipulator(s). As consensus reality becomes part of the large-group behavioral field, large-group behavioral manipulation and control is facilitated in this manner. However objectively measurable many of the self-harming and/or antisocial behaviors documented and defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) may be, and however obvious the suffering of individuals said to be afflicted with "mental illness" is to even the untrained observer, the DSM-IV contains only a pretense of objectivity. With the exception of concrete and observable behavioral manifestations of psychopathology and clearly defined physiological origins of apparent mental disorders, each individual criterion used in the DSM-IV may be, and usually is, interpreted according to the values, beliefs, and prejudices of the diagnostician.

Discussion

The following examines a sampling of diagnostic criteria contained within the definitions of various severe mental illnesses. This author asserts that each of the individual definitions have the potential to reflect the psychopathology of the diagnostician more than that of the patient. I present this not as a philosophical exercise, or a political diatribe, but as an examination of the fact that no two practitioners have been able to agree on the same diagnosis when evaluating my own case. After having had the opportunity to review my own records, after much dispute and legal posturing, I was able to determine that such factors as "incoherence," "unusual thought content," "inappropriate affect," and a "delusional system" had been used in adding the diagnosis of paranoid schizophrenia to my file. In the first section I will look at specific elements of various severe illnesses, and demonstrate how nearly every element of a diagnosis is defined on the basis of assumed norms, consensus reality, and perception. Subsequently, I will provide a few actual examples taken from my own medical records.

The Politics of Assessment

David Icke (pronounced "Ike"), a controversial conspiracy researcher and spiritual visionary, defines the political dimensions of assessment as follows:

"Most people have no idea how easy the law makes it for you to be imprisoned in a mental institution....If we are not vigilant, the excuse of "mental illness" will be used to intern those who say they can communicate with other frequencies ['schizophrenia'] and those who claim there is a global conspiracy ['paranoia']. Someone like me who talks about both becomes a 'paranoid schizophrenic,' which is exactly how they imprisoned dissenters in the psychiatric hospitals of the Soviet Union." (Icke, 1995, p. 408)

As an amateur conspiracy researcher, Icke's above statement hits quite close to home for me. The themes of irrational speech, behavior, and incoherence permeate the DSM-IV section on Schizophrenia and Other Psychotic Disorders. On page 275, the DSM-IV states "Although bizarre delusions are considered to be especially characteristic of schizophrenia, 'bizarreness' may be difficult to judge, especially across different cultures." On page 285, the term "nonbizarre" is used to define an essential difference between Schizophrenia and Delusional Disorder. On page 301, some definitions of the "nonbizarre" are given, based on prevailing notions of what is and is not possible, and consensus reality constructions of life norms, e.g. "...situations that occur in real life such as being followed, poisoned, infected, loved at a distance, deceived by a spouse or lover, or having a disease..."; one can only infer what is excluded from the pre-defined realm of the "non-bizarre."(see Szasz) Therefore, the responsibility of defining the "nonbizarre," itself not a condition but the absence of a subjective condition, reverts solely to the subjective opinion of the diagnostician. I am reminded of Homer Simpson being awarded a certificate stating that he is "Not Insane" upon his discharge from a mental hospital. The detection of a somatic delusion often depends on whether a psychologist or a psychiatrist believes it is necessary to carefully review a patient's medical file. After stating to a clinical psychologist at the Fremont Correctional Facility "I think I'm slowly dying from Hepatitis C I feel tired all the time," (and I do have chronic, active Hep-C, with long episodes of chronic fatigue present), I was promptly diagnosed with somatic delusions among other things. This interview eventually resulted in my transfer to the San Carlos Correctional Facility, a psychiatric prison. Once again, my medical file was not deemed immediately relevant to my treatment; upon my arrival at San Carlos the psychiatrist who did my intake evaluation tried to prescribe an antipsychotic drug that has been known to cause liver failure in persons with chronic liver disease. The DSM-IV has placed life or death medical decision in the hands of individuals who have no intrinsic interest in the survival of their patients apparently.

Intellectuals who don't handle stress all that well and are involved in obscure and disreputable fields of research (such as conspiracy theories and paranormal phenomena) can easily be labeled "Schizotypal." One of the most basic courses of action with which the self defines its existence is resistance and rebellion (Camus) which translates into "maladaptive" and "oppositional behaviors" in the DSM-IV. "Incoherent Speech" denotes nothing more in real terms than the interviewer's inability (or unwillingness) to find the meaning of the plate of "word salad" served up by the patient. Granted there are some cases of speech that are completely indecipherable to all except the speaker, but in my own experience, it is rarely the case. Someone accustomed to interpreting free-verse poetry, rock lyrics, abstract expressionist paintings, and listening to free jazz can usually find the meaning of even the "craziest" speech.

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Normal Madness

At this point it is necessary to re-state that the often painful and destructive variations in human behavior, speech and consciousness listed in the DSM-IV are real and problematic phenomena, and that dangers to self and others are in fact present in mentally ill populations as much as in any other group of people. Here, consensus reality forms a baseline standard as to where intervention may or may not be warranted. Individual delusions of the powerful and collective delusions of the masses give legtimacy to behaviors and value systems and perceptions that would be grounds for confinement and possibly forced drugging,
when observed or uncovered in isolated and powerless individuals.

War, torture, prisons, rape, sexual repression, drug prohibition and forced drugging are means by which authoritarian systems sustain their ability to control, kill, and ravage the earth. Some may claim to oppose rape, while endorsing war and prisons, conveniently ignoring the reality that rape is inherent to both of these seemingly sacred institutions. Others may favor drug prohibition while simultaneously supporting psychiatry's prerogative of forcibly drugging patients with some of the most toxic and debilitating psychoactive substances in existence. Sexual repression vilifies and commercializes sex, while propping up the fear-and-guilt based control systems of fundamentalist interpretations of the patriarchal monotheistic religions(see Wilhelm Reich, The Mass Psychology of Fascism). These in turn are used to justify war, prisons, and rape. Drug prohibition supports the use of prohibited substances as a de facto universal, global "hard currency," used most often in the purchase of the tools of war. The integration of these control systems connects each one of them to the rest. The "normal," conformity-and-obedience based psychotherapies teach the toleration and support of these systems.

When crimes and madness enjoy widespread acceptance and support, they become "norms" and "sanity." Here in America, the overused historical examples of Hitler and Stalin distract the masses from the crimes of our own leaders; and the relative comfort, wealth, and personal liberty that many Americans enjoy somehow are believed to exist separately from the wars and tortures perpetrated in their name.

"Self-Quarantine"

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An effective therapeutic approach would first establish a universal baseline of harm to self and others. I propose that impact on the ecosystem, human beings included, would be included in this standard, as a physical interdependence with the planetary ecosystem is universal to humanity, without regard to cultural, national, racial, or religious norms. Intervention at this time to preserve public's safety from the most dangerous of the criminally insane, who incidentally have exclusive control of the most dangerous weapons, is not something I choose to speak or think much of at this point in history. The truly afflicted among the powerful, regardless of how apparently strong their sense of self is, do not seem to be open to any process of reason, compassion or healing, theoretically warranting entirely physical intervention. My main objection to this course of action is that it's impossible. However, those who care to do so could be assisted in the process of quarantining themselves from the norm of dysfunction and disease. As physical separation from these areas condition exists only as an option available to more the privileged social classes in many cases, the psychic separation and inoculation of the self is the most practical option. To the extent that the authoritarian norms assault, depersonalize, degrade, and ultimately dehumanize those who have no choice other than survival through subservience to the social order, a program of defining self, self interest, and the boundaries that may be established by the self even under the worst of circumstances could serve as an inoculation against the disease/norm. All of this is spoken in the metaphorical language of "mental illness" and "mental health" but, in truth, it is a planetary systems crisis from which no one person is exempt.

Conclusions

Assessment of mental disorders using a biocentric and humanistic standard of reference would require a gradual weaning of psychotherapeutic practice off of the conveniently concrete pseudoscientific criteria found within the DSM-IV. Whether mental healing especially in its existential, transpersonal, and integral modalities can be practiced as a true science at all is questionable; yet these branches of psychology seem to offer the most hope and the most realism simultaneously, as the very idea of mental health is a problem falling within the realm of psycho-epistemology. The fact that both the myth of Prometheus and the myth of Lucifer involve the defiance of patriarchal authority (-Ayn Rand) seems as significant as or more so than Freud's meditations on the myth of Oedipus. At the heart of the idea of insanity is the notion of heresy and defiance (Szasz). Heresy is sought out and punished even among the ranks of the learned. In her Preface to the Second Edition of Manufacturing Victims: What The Psychology Industry is Doing to People, Dr. Tana Dineen defines the essence of the problem quite clearly:

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http://www.freneticmemetics.org

I was born in NYC in 1959. I grew up in the DC area, the product of suburbia and liberal parents with doctoral-level educations. I dropped out of the public school system in eighth grade, and from all schooling by the age of 16. My life rapidly (more...)
 

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I happen to have such high regard for David Icke ... by Michael Rose on Tuesday, Feb 28, 2012 at 6:28:29 AM
The aim of the cult of the red-white-blue (or any ... by Ned Lud on Tuesday, Feb 28, 2012 at 7:34:30 AM
In any situation where a group of profit-seeking p... by Joe Vignolo on Tuesday, Feb 28, 2012 at 8:02:58 AM
My understanding of the DSM is that it was origina... by Rosemary Kean on Tuesday, Feb 28, 2012 at 8:53:55 AM
Going on 43 weeks at OEN and this is your first co... by Ned Lud on Tuesday, Feb 28, 2012 at 10:29:32 AM
I think the question of observable behaviors, self... by Dan Mage on Tuesday, Feb 28, 2012 at 11:27:22 AM
Replied to this, but it popped up one down, please... by Dan Mage on Tuesday, Feb 28, 2012 at 11:36:14 AM
I attended the first in a sequence of (free to mem... by GLloyd Rowsey on Tuesday, Feb 28, 2012 at 9:36:36 AM
I'm not much of an organizer, GlLoyd.....but think... by Burl Hall on Monday, Dec 17, 2012 at 2:13:45 AM
Susan Lindauer, here.  I suffered this myself... by Susan Lindauer on Tuesday, Feb 28, 2012 at 10:21:25 AM
Susan, I would give you a dozen, or a hundred, or ... by Ned Lud on Tuesday, Feb 28, 2012 at 10:40:09 AM
Dear Susan, I will be looking for you book and rea... by Dan Mage on Tuesday, Feb 28, 2012 at 11:47:03 AM
Latest on Op Ed News, Check it Out... by Dan Mage on Wednesday, Feb 29, 2012 at 10:58:01 AM
whenever you have a system without any real checks... by Richard Girard on Wednesday, Feb 29, 2012 at 3:41:02 PM
... for a long time now. I've spoken to a few, and... by Ian MacLeod on Thursday, Mar 1, 2012 at 6:10:08 AM
Much talk about government and what should and sho... by Burl Hall on Monday, Dec 17, 2012 at 2:19:25 AM