In an earlier post I objected to the medicalization of bias, because I see this as leading towards classfying dissent as disease.
However, some of the top minds in the psychiatric community not only continue to insist that bias is a mental illness, but they do so in language revealing such contempt for the distinction between the sanity and insanity that I wonder whether they believe everyone is insane (or want them to be). Fortunately, there are still mental health practitioners with enough common sense to object:
Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.
If it succeeds, it could have huge ramifications on clinical practice, employment disputes, and the criminal justice system. Perpetrators of hate crimes could become candidates for treatment, and physicians would become arbiters of how to distinguish "ordinary prejudice" from pathological bias.
Several experts say they are unsure whether bias can be pathological. Solomon, for instance, is uncomfortable with the idea. But they agree that psychiatry has been inattentive to the effects of prejudice on mental health and illness.
"Has anyone done a word search for 'racism' " in psychiatry's manual of mental disorders, asked Carl C. Bell, a Chicago psychiatrist. "It doesn't exist. Has anyone asked, 'If you have paranoia, do you project your hostility toward other groups?' The answer is 'Hell, no!' "
The proposed guidelines that California psychologist Edward Dunbar created describe people whose daily functioning is paralyzed by persistent fears and worries about other groups. The guidelines have not been endorsed by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM); advocates are mostly seeking support for systematic study.
Darrel A. Regier, director of research at the psychiatric association, said he supported research into whether pathological bias is a disorder. But he said the jury was out on whether a diagnostic classification would add anything useful, given that clinicians already know about disorders in which people rigidly hold onto false beliefs.
"If you are going to put racism into the next edition of DSM, you would have enormous criticism," Regier said. Critics would ask, " 'Are you pathologizing all of life?' You better be prepared to defend that classification."
The problem with pathologizing all of life is that if everyone is sick, then no one is sick. There are people who are really suffering and unable to perceive reality amidst hallucinations. When the great egalitarian state lumps them in with people who are shy at cocktail parties and children who don't pay attention in school, or simple bigots, then how are they to get the help they so desperately need?
Might as well just diagnose them as "homeless" and tell them they're victims of capitalism while they run around yelling at people who aren't there.
But never mind that. It all comes down to social, um "context":
Psychiatrists who advocate a new diagnosis, such as Gary Belkin, deputy chief of psychiatry at New York's Bellevue Hospital, said social norms play a central role in how all psychiatric disorders are defined. Pedophilia is considered a disorder by psychiatrists, Belkin noted, but that does not keep child molesters from being prosecuted.
"Psychiatrists who are uneasy with including something like this in the Diagnostic and Statistical Manual need to get used to the fact that the whole manual reflects social context," said Belkin, who is planning to launch a study on pathological bias among patients at his hospital. "That is true of depression on down. Pathological bias is no more or less scientific than major depression."
Pathological bias is no more or less scientific than major depression?
I don't even know how to begin to analyze a statement like that. I'd almost swear the man believes science stands in opposition to common sense.
(Perhaps common sense itself will soon be declared a delusion, and therefore worthy of DSM inclusion as a disease.)
posted by Eric on 12.26.05 at 09:07 AM
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So reality is whatever societal norms say it is?
Does that mean that the feelings of Nazi Germany towards Jews reflected the reality of Jewry?
In our current society, since far more people believe in God than don't, does that mean atheists are crazy?
And if the Republicans further their gains in the next couple of elections, will that make being a Democrat a pathology? ;)
DSmith · December 26, 2005 12:35 PM
Getting hung up on language. "Disease" is not a technical term - we use it loosely for any significant degree of pain, disability, or abnormality. An example: In Germany, high blood pressure is called "strong blood" and they don't treat it.
So it is not only in psychiatry that the word is used loosely. However, psychiatry is sensitive to the abuses of diagnosis in totalitarian states, so are extremely careful not to extend diagnoses into normal variants.
Plus there is the sujbect of Evil - see our re-post this AM.
"Pathological bias is no more or less scientific than major depression?
I don't even know how to begin to analyze a statement like that."
I do. The important bit is the 'pathological' part, not the 'bias' part. I agree that bias in itself is not a good criteria for a disease model, however.
They are correct that pathological bias is a feature within mental illnesses, and they are equally correct that pathological bias can interfere with normative functioning. The problem, as I see it, is that pathological bias is contained very readily under other illness headings, such as social phobias, anxieties, etc.
You are also correct that classifying dissenting thought, speech, or action as disease, no matter how offensive, is an extremely bad idea. It takes us closer to Soviet 'political psychiatry' than I would be willing to tolerate.
BTW, IMPO the mental health fields are just beginning to bifurcate along medical vs. therapeutic lines in a serious way, eg. the therapeutic community is beginning to strongly reject medical modelling, partly in an effort to preserve their own professional ground. Should be an interesting battle over the next few years.
Have to argue slightly with Bird Dog - "disease" is a technical term within psychology, at least. It refers to the modeling for treatment of discrete pathological entities. So schizoid personality is a disorder of normative personality development and may be treated with therapy, but a pervasive chemical imbalance is more appropriately labeled 'disease' and is treated medically.
The model is the important part. A disorder may be more a 'problem with living' that needs coping skills while a disease is something to be cured & rid of.
If memory serves, the soviets did quite a bit of classifying as insane and institutionalizing those who bucked the party line but could not for one reason or another be executed or sent to camps.
charlie · December 26, 2005 07:06 PM
The Soviets actually assigned persons determined to be 'ill' to various neighborhoods, so if you were schizophrenic you went to live in a schizophrenic area, depressives to another bleak housing project zone, and I suppose if you were pathologically bigoted you'd go to another.
It was a way to control that population easily, especially for medications enforcement, law enforcement and experiments.
Interestingly, they reported schizophrenia to be somewhat 'catching' in that patients in adjacent areas started to exhibit schizophrenic behaviors. I still wonder if it was all just a ruse to get better meds.
So yes, not camps exactly [they weren't 'criminals'] but they did herd them off just the same.
"Sane" and "insane" shouldn't be looked at as absolutes, but rather as opposite ends of a continuum. To cop the psychiatric jargon: 'we're all nuts, but some moreso than others'.
Between the psychiatrists and the legislatures, we will all be certifiably "criminally insane", so anyone who is an irritant or a challenge can be locked away one way or the other (or both).
The Anti-Idiotarian Rottweiler
Don?t bang your head!
So reality is whatever societal norms say it is?
Does that mean that the feelings of Nazi Germany towards Jews reflected the reality of Jewry?
In our current society, since far more people believe in God than don't, does that mean atheists are crazy?
And if the Republicans further their gains in the next couple of elections, will that make being a Democrat a pathology? ;)