The results of a just-published, government-sponsored survey of the nation’s mental health said more than half of Americans will develop a mental disorder in their lifetimes. The good news is that at the moment only one quarter of all Americans is suffering from a mental illness. How did we get so many sick people? It has something to do with how we define mental illness.
The American Psychiatric Association first printed a diagnostic manual in the 1950’s that defined mental illnesses, and it included 60 disorders. In the last 40 years, there have been four editions. The current DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) is the definitive arbiter of what constitutes a mental illness, and it now includes about 300 disorders. It includes everything from sexual arousal disorder to hypersomnia (excessive sleep). The DSM-IV lists dozens of shades of depression and bipolar disorders, what it means to be borderline, and even shyness can qualify as a disease.
Psychiatrists developed the DSM in the hope of refining our understanding of what mental illness is. What instead happened was we defined problematic feelings and behaviors as diseases. In so doing, we also implied that because these manifestations now had a name, it meant we knew how to treat the problem. Instead, what we have done is psychopathologized the ordinariness of the human condition and turned the vagaries of life into a drug-taking experience.
In most parts of the world, if you feel anxious, sad, can’t sleep, or lose your appetite for food or sex, you are not defined as mentally ill, not medicated, and generally get better. Families gather, healing rituals are performed, the community mobilizes support, and with time, people are reintegrated. What’s happening in America is we’re defining lots of people as mentally ill for a disease they probably don’t have, and we’re prescribing far too many drugs for them.
The interesting paradox is that we let an assortment of deviants run around who need to be treated, but who are never diagnosed. We don’t need the DSM-IV to tell us that a 46-year-old man who: invites a succession of kids for sleepovers, gives them white wine disguised in soda cans, pays a multimillion dollar settlement for accusations of child molestation, and dangles his son over a high-rise balcony railing, is bizarre.
Let’s stop defining the ordinary ups and downs in our lives as diseases. Let’s start holding people responsible for behaviors we all know are unacceptable. We are seriously confused when lawyers in courtrooms define what behaviors are tolerable or acceptable. No wonder we are #1 in the world for mental illness.