The recent debates and protests against the DSM-V sheds light on a major problem facing the fields of psychology and social work: how is mental illness defined? Classifying and labeling has a tendency to give the subject some empirical reality that it does not possess. The mind references the concept so often that, in essence, it becomes an entity in and of itself, if only in that mind’s subjective context. All the while it is easy to forget that words are simply a way of expressing some sort of regularity in this world, and that their accuracy largely depends on context. Like a Limit in mathematics, the expression points toward a value, but can never quite reach it.
This seems to be the case with mental illness, and might be the cause of the problems that professionals are having with the DSM-V. The further removed we are from the point in time when the researchers and practitioners divided behavior in to specific categories, the harder it is to gain a feel for the context of their original intention. This includes the idea that there is some fixed set of behaviors that can be clearly defined as “mental illness”. The most damaging aspect of this classification system is that it divides people, albeit unintentionally, into two groups: normal and abnormal. Standards for such determinations are being made in an arbitrary manner within the context of a current set of cultural values and regularities and are often made by those very people who have been granted “normal” status.
Society likes conformity, it is the glue that holds together complex systems. In the case of mental illness, normal behavior is defined by actions that help keep that fragile balance. Normality is the range of behaviors that lead to productivity and efficiency. How many of the DSM criteria are met by a person having a problem functioning in work, school or socially? A person who operates well within these settings is passing the conformity test as their behaviors do little to disturb the arbitrary way in which Western society is structured; such a person can be influenced and the community knows what to expect from them in a danger sense. Creating a safe society is important, but there is always a cost; in this case it is being shouldered by those who are pushed into the system and labeled as outcasts.
Here is what Forbes has to say about mental illness and our most successful citizens, CEO’s:
“…the incidence of psychopathy among CEOs is about 4 percent, four times what it is in the population at large.”
This lends creedence to the premise that what matters most is not the behaviors, but the results of those behaviors. If pyschopathy leads to great wealth, that person is celebrated; if it leads to a claim on a DSS line, the person is shunned. The rich parade around reality T.V. shows such as the “Real Housewives…” of this or that exhibiting severe problems with reality testings, relationship management and over all stability, but they are celebrated and are even rewarded for the same behaviors that often lead lower class people into institutions or prison.
If your not convinced think of the way that the mentally ill are treated in the media and pop culture in general, always unstable, always dangerous. Even as statistics show that the mentally ill are not more dangerous than the rest of society.
Operating within a fixed reality of labels that divides people in simplistic ways such as normal and abnormal, society forgets to reevaluate its initial premises about behavior. Reevaluation itself upsets social balance and is unconsciously ignored by those “normal” folks who do want to be found out to be abnormal. Enter the stigma of mental illness, a label that a person will go to great lengths to not be diagnosed with and will do just about anything to avoid. They will do so at great cost, and with great suffering, all to uphold a fictitious label or position.
The foundation of the stigma of mental illness is built upon a convenient house of delusion that the concepts and terms we use are in some way more than regularities and enter into the realm of truth. Yet, we find that behaviors that classify mental illness are the normal spectrum of emotions and actions that any other person experiences. From a diagnosis standpoint, attention gets paid to those behaviors when they begin to interfere with the personal and societal social stability. In other words, there really is no difference between those who have been stigmatized and the rest of society. There is no such thing as a separate group of people that is abnormal. Even those who would fight for the rights of the “mentally ill” could inadvertently oppress the people labeled such if the really believed that they were fundamentally different in some manner.
The job of a helping professional is to help a person connect their behavior to the rest of humanity in ways that allows them to understand that: 1) they are normal, because 2) there is no such thing as a permanent normality. There have been times and cultures that celebrated those who had hallucinations yet we label them schizophrenic and mentally ill. It all depends on the context and who the gate keepers are.
In that vein, this is the most important thing I have to say on this subject: all in all we are the gate keepers. As such, we have a moral responsibility to keep this lesson well in mind less we alienate a portion of the population that is not quite as small as we once thought. By doing so we can open up treatment as an option for so many different demographics that might not seek treatment. Helping professionals are not special and they are not the definition of normal, but for taking on the burdens that so many others do not want, we are certainly brave. Hopefully we are brave enough to admit that much of how we practice is built on a flawed understanding of what it means to be human.
By Matthew Cohen, MSW
SJS Staff Writer