All diagnosis and treatment in psychiatry, especially
biological psychiatry, presupposes the existence of something
called mental illness, also known as mental disease or mental
disorder. What is meant by disease, illness, or
disorder? In a semantic sense disease means simply
dis-ease, the opposite of ease. But by disease we
don't mean anything that causes a lack of ease, since
this definition would mean losing one's job or a war or
economic recession or an argument with one's spouse qualifies
as "disease". In his book Is Alcoholism Hereditary?
psychiatrist Donald W. Goodwin, M.D., discusses the definition
of disease and concludes "Diseases are something people see
doctors for. ... Physicians are consulted about the problem
of alcoholism and therefore alcoholism becomes, by this
definition, a disease" (Ballantine Books, 1988, p. 61).
Accepting this definition, if for some reason people consulted
physicians about how to get the economy out of recession or
how to solve a disagreement with one's mate or a bordering
nation, these problems would also qualify as disease. But
clearly this is not what is meant by "disease". In his
discussion of the definition of disease, Dr. Goodwin
acknowledges there is "a narrow definition of disease that
requires the presence of a biological abnormality" (ibid). In
this pamphlet I will show that there are no biological
abnormalities responsible for so-called mental illness, mental
disease, or mental disorder, and that therefore mental
illness has no biological existence. Perhaps more
importantly, however, I will show that mental illness also has
no non-biological existence - except in the sense that the
term is used to indicate disapproval of some aspect of
a person's mentality.
The idea of mental illness as a biological entity
is easy to refute. In 1988, Seymour S. Kety, M.D., Professor
Emeritus of Neuroscience in Psychiatry, and Steven Matthysse,
Ph.D., Associate Professor of Psychobiology, both of Harvard
Medical School, said "an impartial reading of the recent
literature does not provide the hoped-for clarification of the
catecholamine hypotheses, nor does compelling evidence emerge
for other biological differences that may characterize the
brains of patients with mental disease" (The New Harvard
Guide to Psychiatry, Harvard Univ. Press, p. 148). In
1992 a panel of experts assembled by the U.S. Congress Office
of Technology Assessment concluded: "Many questions
remain about the biology of mental disorders. In fact,
research has yet to identify specific biological causes for
any of these disorders. ... Mental disorders are classified
on the basis of symptoms because there are as yet no
biological markers or laboratory tests for them" (The
Biology of Mental Disorders, U.S. Gov't Printing Office,
1992, pp. 13-14, 46-47). In his book, The Essential Guide
to Psychiatric Drugs, Columbia University psychiatry
professor Jack M. Gorman, M.D., said "We really do not know
what causes any psychiatric illness" (St. Martin's Press,
1990, p. 316). In his book, The New Psychiatry,
another Columbia University psychiatry professor, Jerrold S.
Maxmen, M.D., said "It is generally unrecognized that
psychiatrists are the only medical specialists who
treat disorders that, by definition, have no definitively
known causes or cures. ... A diagnosis should indicate the
cause of a mental disorder, but as discussed later, since the
etiologies of most mental disorders are unknown, current
diagnostic systems can't reflect them" (Mentor, 1985, pp. 19 &
36 - emphasis in original). In his book, Toxic Psychiatry,
psychiatrist Peter Breggin, M.D., said "there is no evidence
that any of the common psychological or psychiatric disorders
have a genetic or biological component" (St. Martin's Press,
1991, p. 291).
It is sometimes argued that psychiatric drugs
"curing" (stopping) the thinking, emotions, or behavior that
is called mental illness proves the existence of biological
causes of mental illness. This argument is easily refuted:
Suppose someone was playing the piano and you didn't like him
doing that. Suppose you forced or persuaded him to take a
drug that disabled him so severely that he couldn't play the
piano anymore. Would this prove his piano playing was caused
by a biological abnormality that was cured by the drug? As
senseless as this argument is, it is often made. Most if not
all psychiatric drugs are neurotoxic, producing a greater or
lesser degree of generalized neurological disability. So they
do stop disliked behavior and may mentally disable a
person enough he can no longer feel angry or unhappy or
"depressed". But calling this a "cure" is absurd.
Extrapolating from this that the drug must have cured an
underlying biological abnormality that was causing the
disliked emotions or behavior is equally absurd.
When confronted with the lack of evidence for
their belief in mental illness as a biological entity, some
defenders of the concept of mental illness will assert that
mental illness can exist and can be defined as a "disease"
without there being a biological abnormality causing it.
The idea of mental illness as a nonbiological entity requires
a more lengthy refutation than the biological argument.
People are thought of as mentally ill only when
their thinking, emotions, or behavior is contrary to what is
considered acceptable, that is, when others (or the so-called
patients themselves) dislike something about them. One way to
show the absurdity of calling something an illness not because
it is caused by a biological abnormality but only because we
dislike it or disapprove of it is to look at how values differ
from one culture to another and how values change over time.
In his book The Psychology of Self-Esteem,
Nathaniel Branden, Ph.D., a psychologist, wrote: "One
of the prime tasks of the science of psychology is to provide
definitions of mental health and mental illness. ...But there
is no general agreement among psychologists and psychiatrists
about the nature of mental health or mental illness - no
generally accepted definitions, no basic standard by which to
gauge one psychological state or other. Many writers declare
that no objective definitions and standards can be established
- that a basic, universally applicable concept of mental
health is impossible. They assert that, since behavior which
is regarded as healthy or normal in one culture may be
regarded as neurotic or aberrated in another, all criteria are
a matter of 'cultural bias.' The theorists who maintain this
position usually insist that the closest one can come to a
definition of mental health is: conformity to cultural
norms. Thus, they declare that a man is psychologically
healthy to the extent that he is 'well-adjusted' to his
culture. ... The obvious questions that such a definition
raises, are: What if the values and norms of a given
society are irrational? Can mental health consist of
being well-adjusted to the irrational? What about Nazi
Germany, for instance? Is a cheerful servant of the Nazi
state - who feels serenely and happily at home in his social
environment - an exponent of mental health?" (Bantam Books,
1969, pp. 95-96, emphasis in original). Dr. Branden is doing
several things here: First, he is confusing morality
and rationality, saying that respect for human rights is
rational when in fact it is not a question of rationality but
rather of morality. So psychologically and emotionally locked
into and blinded by his values is he that Dr. Branden is
evidently incapable of seeing the difference. Additionally,
Dr. Branden is stating some of his values. Among these values
are: Respect for human rights is good; violation of
human rights (like Naziism) is bad. And he is saying:
Violating these values is "irrationality" or mental illness.
Although their practitioners won't admit it and often are not
even aware of it, psychiatry and "clinical" psychology in
their very essence are about values - values concealed under a
veneer of language that makes it sound like they are not
furthering values but promoting "health". The answer to the
question Dr. Branden poses is: A person living in Nazi
Germany and well-adjusted to it was "mentally healthy"
judged by the values of his own society. Judged by the values
of a society which respects human rights he was as sick
(metaphorically speaking) as the rest of his culture. A
person like myself however says that such a person is morally
"sick" and recognizes that the word sick has not its
literal but a metaphorical meaning. To a person like Dr.
Branden who believes in the myth of mental illness, such a
person is literally sick and needs a doctor.
The difference is that a person like myself is recognizing my
values for what they are: morality. Typically, the
believer in mental illness, such as Dr. Branden in this quoted
passage, has the same values as I do but is confusing them
with health.
One of the most telling examples is
homosexuality, which was officially defined as a mental
disease by the American Psychiatric Association until 1973 but
hasn't been since then. Homosexuality was defined as a mental
disorder on page 44 of the American Psychiatric Association's
standard reference book, DSM-II: Diagnostic and
Statistical Manual of Mental Disorders (the 2nd Edition),
published in 1968. In that book, "Homosexuality" is
categorized as one of the "Sexual deviations" on page 44. In
1973 the American Psychiatric Association voted to remove
homosexuality from it's official diagnostic categories of
mental illness. (See "An Instant Cure", Time magazine,
April 1, 1974, p. 45). So when the third edition of this book
was published in 1980 it said "homosexuality itself is not
considered a mental disorder" (p. 282). The 1987 edition of
The Merck Manual of Diagnosis and Therapy states:
"The American Psychiatric Association no longer considers
homosexuality a psychiatric disease" (p. 1495). If mental
illness were really an illness in the same sense that physical
illnesses are illnesses, the idea of deleting homosexuality or
anything else from the categories of illness by having a vote
would be as absurd as a group of physicians voting to delete
cancer or measles from the concept of disease. But mental
illness isn't "an illness like any other illness."
Unlike physical disease where there are physical facts to deal
with, mental "illness" is entirely a question of values, of
right and wrong, of appropriate versus inappropriate. At one
time homosexuality seemed so weird and hard to understand it
was necessary to invoke the concept of mental disease or
mental illness to explain it. After homosexuals made a big
enough spectacle of themselves and showed their "strength in
numbers" and successfully demanded at least a small measure of
social acceptance, it was no longer necessary and no longer
seemed appropriate to explain homosexuality as a disease.
A cross-cultural example is suicide. In many
countries, such as the United States and Great Britain, a
person who commits suicide or attempts to do so or even thinks
about it seriously is considered mentally ill. However, this
has not always been true throughout human history, nor is it
true today in all cultures around the world. In his book,
Why Suicide?, psychologist Eustace Chesser points out that
"Neither Hinduism nor Buddhism have any intrinsic objections
to suicide and in some forms of Buddhism self-incineration is
believed to confer special merit." He also points out that
"The Celts scorned to wait for old age and enfeeblement. They
believed that those who committed suicide before their powers
waned went to heaven, and those who died of sickness or became
senile went to hell - an interesting reversal of Christian
doctrine" (Arrow Books Ltd., London, England, 1968, p.
121-122). In his book, Fighting Depression,
psychiatrist Harvey M. Ross, M.D., points out that "Some
cultures expect the wife to throw herself on her husband's
funeral pyre" (Larchmont Books, 1975, p. 20). Probably the
best-known example of a society where suicide is socially
acceptable is Japan. Rather than thinking of suicide-- or
"hara-kiri", as the Japanese call it-- as almost always caused
by a mental disease or illness, the Japanese in some
circumstances consider suicide the normal, socially acceptable
thing to do, such as when one "loses face" or is humiliated by
some sort of failure. Another example showing suicide is
considered normal, not crazy, in Japanese eyes is the kamikaze
pilots Japan used against the U.S. Navy in World War II. They
were given enough fuel for a one-way trip, a suicide mission,
to where the attacking U.S. Navy forces were located and
deliberately crashed their airplanes into the enemy ships.
There has never been an American kamikaze pilot, at least,
none officially sponsored by the United States government.
The reason for this is different attitudes about suicide in
Japan and America. Could suicide be committed only by people
with psychiatric illnesses in America and yet be performed by
normal persons in Japan? Or is acceptance of suicide in Japan
a failure or refusal to recognize the presence of
psychological abnormalities which necessarily must be present
for a person to voluntarily end his or her own life? Were the
kamikaze pilots mentally ill, or did they and the society they
come from simply have different values than we do? Even in
America, aren't virtually suicidal acts done for the sake of
one's fellow soldiers or for one's country during wartime
thought of not as insanity but as bravery? Why do we think of
such persons as heroes rather than lunatics? It seems we
condemn (or "diagnose") suicidal people as crazy or mentally
ill only when they end their own lives for selfish reasons
(the "I can't take it any more" kind of reasons) rather than
for the benefit of other people. The real issue seems to be
selfishness rather than suicide.
What these examples show is that "mental illness"
is simply deviance from what people want or expect in any
particular society. "Mental illness" is anything in human
mentality greatly disliked by the person describing it.
The situation was aptly summed up in an
article in the November 1986 Omni magazine:
"Disorders come and go. Even Sigmund Freud's concept of
neurosis was dropped in the original DSM-III (1980). And in
1973 APA [American Psychiatric Association] trustees voted to
wipe out almost all references to homosexuality as a
disorder. Before the vote, being gay was considered a
psychiatric problem. After the vote the disorder was
relegated to psychiatry's attic. 'It's a matter of fashion,'
says Dr. John Spiegel of Brandeis University, who was
president of the APA in 1973, when the debate over
homosexuality flared. 'And fashions keep changing'" (p. 30).
What is wrong with this approach is describing
people as having a psychiatric "disease" or "illness" only
because he or she doesn't match up with a supposed
diagnostician's or with other people's idea of how a person
"should" be in standards of dress, behavior, thinking, or
opinion. When it involves violating the rights of others,
nonconformity with social norms or values must be curbed or
stopped with various measures, criminal law being one
example. But calling nonconformity or disliked behavior a
"disease" or assuming it must be caused by a disease only
because it is unacceptable according to currently prevailing
values makes no sense. What causes us to do this is not
knowing the real reasons for the thinking, emotions, or
behavior we dislike. When we don't understand the real
reasons, we create myths to provide an explanation. In prior
centuries people used myths of evil spirit or demon possession
to explain unacceptable thinking or behavior. Today most of
us instead believe in the myth of mental illness. Believing
in mythological entities such as evil spirits or mental
illnesses gives an illusion of understanding, and believing a
myth is more comfortable than acknowledging ignorance.
Calling disapproved thinking, emotions, or
behavior a mental illness might be excusable if mental illness
was a useful myth, but it isn't. Rather than helping us deal
with troubled or troublesome persons, the myth of mental
illness distracts us from the real problems that need to be
faced. Rather than being caused by a "chemical imbalance" or
other biological problems, the nonconformity, misbehavior, and
emotional reactions we call mental illness are the result of
difficulties people have getting their needs met and the
behavior some people have learned during their
lifetimes. The solutions are teaching people how to get their
needs met, how to behave, and using whatever powers of
enforcement are needed to force people to respect the rights
of others. These are the tasks of education and law
enforcement, not medicine or therapy.
THE AUTHOR, Lawrence
Stevens, is a lawyer whose practice has included representing
psychiatric "patients". He has published a series of
pamphlets about various aspects of psychiatry, including
psychiatric drugs, electroshock, and psychotherapy. His
pamphlets are not copyrighted. You are invited to make copies
for distribution to those you think will benefit.
1996 UPDATE:
"... modern psychiatry has yet to convincingly prove the
genetic/biologic cause of any single mental illness." David
Kaiser, M.D.,
Commentary: Against Biologic
Psychiatry, December
1996 Psychiatric Times.
1997
UPDATE:
"We really do not know what causes any psychiatric illness."
Jack M. Gorman, M.D., Professor of Psychiatry at Columbia
University, in his book The Essential Guide to Psychiatric
Drugs - Third Edition (St. Martin's Press, New York,
1997), p. 314. The same statement in the 1990 edition was
quoted above in Mr. Stevens's article, "Does Mental Illness
Exist?"
1998
UPDATES:
"Contrary to what is often claimed, no biochemical,
anatomical, or functional signs have been found that reliably
distinguish the brains of mental patients." Elliot S.
Valenstien, Ph.D., Professor Emeritus of Psychology and
Neuroscience at the University of Michigan, in his book
Blaming the Brain: The Truth About Drugs and Mental
Health (The Free Press, New York, 1998), p. 125.
"...there are no external validating criteria for
psychiatric diagnoses. There is neither a blood test nor
specific anatomic lesions for any major psychiatric disorder."
From a
letter
dated December 4, 1998 by Loren R. Mosher, M.D., a
psychiatrist, resigning from the American Psychiatric
Association.
1999
UPDATES:
"... all 5 million to 6 million children on these drugs [for
hyperactivity] are normal. The country's been led to believe
that all painful emotions are a mental illness and the
leadership of the APA [American Psychiatric Association] knows
very well that they are representing it as a disease when
there is no scientific data to confirm any mental illness."
Neurologist
Fred Baughman,
quoted in Insight magazine, June 28, 1999, p. 13
(underline added).
"...there is no evidence that these mental illnesses, such as
ADHD, exist." Psychiatrist Peter Breggin, quoted in
Insight magazine, June 28, 1999, p. 13. ADHD is attention
deficit hyperactivity disorder.
2000
UPDATES:
"In medicine, strict criteria exist for calling a condition a
disease. In addition to a predictable cluster of symptoms,
the cause of the symptoms or some understanding of their
physiology must be established. ... Psychiatry is unique
among medical specialties in that... We do not yet have proof
either of the cause or the physiology for any psychiatric
diagnosis. ... In recent decades, we have had no shortage of
alleged biochemical imbalances for psychiatric conditions.
Diligent though these attempts have been, not one has been
proven. Quite the contrary. In every instance where such an
imbalance was thought to have been found, it was later proven
false. ... No claim of a gene for a psychiatric condition
has stood the test of time, in spite of popular
misinformation."
Joseph Glenmullen, M.D.,
clinical instructor in psychiatry at Harvard Medical School,
in his book Prozac Backlash (Simon & Schuster, New
York, 2000), pages 192-193, page 196, and page 198.
"A disease is a condition that has a known cause and can be
identified by one or another set of laboratory tests." Miryam
Ehrlich Williamson, Fibromyalgia: A Comprehensive Approach,
2000,
Chapter 1.
"There is no evidence that any psychiatric or psychologial
disorder is caused by a biochemical imbalance." Peter R.
Breggin, M.D., in his book
Reclaiming Our Children
(Persues Books, Cambridge, Mass., 2000), page 139.
"First, no biological etiology has been proven for any
psychiatric disorder (except Alzheimer's disease, which has a
genetic component) in spite of decades of research. ... So
don't accept the myth that we can make an 'accurate
diagnosis.' ... Neither should you believe that your
problems are due solely to a 'chemical imbalance.'" Edward
Drummond, M.D., Associate Medical Director at Seacoast Mental
Health Center in Portsmouth, New Hampshire, in his book The
Complete Guide to Psychiatric Drugs (John Wiley & Sons,
Inc., New York, 2000), pages 15-16. Dr. Drummond graduated
from Tufts University School of Medicine and was trained in
psychiatry at Harvard University.
2001 UPDATE:
"Remember that no
biochemical, neurological, or genetic markers have been found
for attention deficit disorder, oppositional defiant disorder,
depression, schizophrenia, anxiety, compulsive alcohol and
drug abuse, overeating, gambling, or any other so-called
mental illness, disease, or disorder." Bruce Levine, Ph.D.
(psychologist), Commonsense Rebellion: Debunking
Psychiatry, Confronting Society (Continuum, New York
2001), p. 277.