The logic is cogent and the research is rigorous. Read the book and decide for yourself.

Dr. Kirsch argues in favor of psychotherapy as a substitute for pills. And certainly talking is usually helpful. However, as long as depression is conceptualized as an illness, I don’t believe we will see real progress in this field.

Depression is not an illness. Depression is not an instance of something going wrong in an organism, but rather something going right. It is an adaptive response – a warning system (analogous to pain), alerting us to a need to make some changes in lifestyle.

The fact is that each person has within him or herself the resources needed to generate and maintain positive feelings. This is the essential point of the placebo research. It wasn’t the sugar pills (or the antidepressants) that generated the positive feelings. It was the individuals themselves starting to take appropriate corrective action in their lives.

The six natural antidepressants are:

- good nutrition

- fresh air

- sunshine

- physical activity, with frequent successes

- purposeful activity

- at least one good, open, honest relationship

When these factors are present in our lives to a significant degree, we feel generally positive; when one or more is largely absent, we feel down. These ideas are developed more fully in my post of July 28, 2009: Depression is not an Illness.

If you’re taking antidepressants, you owe it to yourself to read Dr. Kirsch’s book.

Irving Kirsch, Ph.D, The Bodley Head, 2009

This is not to say that the behaviors in question are not problems. They certainly are. Frotteurism is a case in point. A man who uses the crowd cover of trains and buses to press his genitals against non-consenting females clearly has a problem. The question is: how can we explain this behavior? Why does he do it?

Socialization is the process by which we acquire the skills necessary to function in society. The newborn has no sense of the needs/rights of others. He is a bundle of pure and utter selfishness. During childhood his parents and other significant adult figures instill in him an appropriate measure of regard for other people’s rights and needs. They also help him acquire an appropriate level of personal control. During his formative years he acquires the ability to control his immediate needs, to respect the rights of others, and to pursue the attainment of long-term goals. This is a complex process, but it is generally achieved through the long-established practices of consistently applying appropriate rewards and punishments and through the process of good example (role modeling).

Now it’s a fairly obvious fact of life that this socialization process isn’t always entirely successful. We have all encountered adults who are “spoilt brats” or who routinely afford more priority to short-term than to long-term goals, or who blatantly disregard the rights of others.

The reasons for these failures in socialization are as varied as the population. Sometimes the parents simply didn’t know what they should have been doing. Other times they were drinking and drugging and just didn’t care. Other times there was conflict and tension between the parents, and the child “slipped through the cracks.” Other times the parents themselves weren’t adequately socialized and so the role modeling was inadequate. And so on.

In order to understand why an individual is deficient in these areas, one needs to examine the individual case closely. So in the case of frotteurism, we have an individual who routinely disregards the rights of females (i.e. the right to be free from molestation) and who probably lacks the social skills necessary for normal heterosexual interactions.

The explanation of his behavior is:

1. Like almost all men he has an internal drive to make genital contact with women.

2. He has not acquired the skill/habit of controlling and channeling this drive in socially appropriate ways.

Note that this is not a complete explanation of the behavior in question. If we wish to understand why an individual behaves in a certain way, we must devote a good deal of time and energy to studying and examining the individual case. There are no shortcuts in behavioral analysis.

This is in marked contrast to the APA’s implied position, i.e., that he engages in this behavior because he has a mental illness called frotteurism. The facile nature of this explanation is seldom articulated, but this kind of simplistic thinking underlies the response of the mental health system (and frequently of the judicial authorities) to these individuals.

Next Post: More on sexual disorders.

Imagine the case of an attractive well-dressed young land who boards a crowded bus or train. It’s standing room only, and after a few minutes she becomes aware of the fact that the gentleman standing behind her is pressing his groin against her buttocks. At first she thinks that it is just because the train is crowded. So she inches away from him, but he follows and the pressing continues. She becomes angry. She may confront him, but often does not for fear of causing a scene. Frequently she just exits at the next stop, seething with anger and a sense of helplessness. Perhaps later she recounts the incident to her husband, boyfriend, co-worker, etc… Her response to the incident remains one of anger, but this usually dissipates in time as she writes the perpetrator off as a “dirty little pervert” or some such.

What she doesn’t’ realize, however, is that the perpetrator is in reality “suffering from” a “mental illness” called frotteurism. This is an “official” DSM diagnosis. Let me quote:

The paraphilic focus of frotteurism involves touching and rubbing against a nonconsenting person. The behavior usually occurs in crowded places from which the individual can more easily escape arrest (e.g., on busy sidewalks or in public transportation vehicles). He rubs his genitals against the victim’s thighs and buttocks or fondles her genitalia or breasts with his hands. (DSM IV TR, p 570)

I am not making this up. Over the years, the APA has learned that they can get away with almost anything, and the diagnostic categories expand and expand and expand. And the psychiatrists’ and pharmaceutical companies’ cash registers go kerchung, kerchung, kerchung.

As far as the psychiatrists are concerned, every human problem is a mental illness and should be “treated” with drugs.

Next post: More on the so-called sexual disorders.

Stay tuned.  I still have lots to say concerning the spurious nature of DSM’s so-called mental illnesses.

The central tenet of the mental health system is that unusual, bizarre, and disturbing behaviors are caused by mental disorders (or illnesses). But their definition of a mental disorder is: a serious behavioral problem. So problem behavior is caused by problem behavior. This is the facile logic behind the widespread peddling of drugs in which psychiatry and the mental health system engage.

Within the mental health system a personality disorder is conceptualized as a specific kind of mental illness and is defined as follows:

“an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” (DSM-IV-TR, p. 685)

DSM lists eleven different kinds of personality disorder. These are: paranoid; schizoid; schizotypal; antisocial; borderline; histrionic; narcissistic; avoidant; dependent; obsessive-compulsive; and of course, personality disorder not otherwise specified.

Let us examine schizoid personality disorder. The APA lists the following criteria:

A. A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings, beginning by early adulthood and
present in a variety of contexts, as indicated by four (or more) of the following:

(1) neither desires nor enjoys close relationships, including being part of a family
(2) almost always chooses solitary activities
(3) has little if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others
(7) shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder
With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental
Disorder and is not due to the direct physiological effects of a general medical
condition. (DSM-IV-TR, p 697)

It is clear from even a cursory examination of these criteria that what’s involved here are the qualities of solitariness, introspection, and stoicism. Note in particular that the criteria do not require that the individual be troubled by these qualities. Even if a person is perfectly contented with his habitual state of quiet isolation, he nevertheless has a mental illness and swells the ranks of the “untreated sufferers.” The so-called schizoid personality disorder is one of the more blatant examples of the APA’s pathologizing of normal human differences. Even their selection of the word “schizoid” serves to impart connotations of danger and hidden pathology.

The fact is that each of the criterion qualities listed above is present in the human population to a varied degree. And it is indeed the case that some individuals are introspective and isolative to an extreme degree. Assuming, however, that this necessarily constitutes a problem is unwarranted and dangerous. Most of the introspective individuals I have known are contented productive people who would be truly appalled to learn that in reality they are suffering from a mental illness and that they need treatment (i.e. drugs). The drugs, of course, will be prescribed by a psychiatrist and manufactured by a pharmaceutical company. It is little wonder that a former surgeon general could state that one fifth of the US population is suffering from a mental disorder in any given year. As has been stressed many times in this blog, the primary purpose of DSM is not to advance our knowledge of ourselves as a species, or help us become more resilient and adaptive, but rather to generate income for psychiatrists and pharmaceutical companies.

The reader who is not particularly isolative or introspective might be thinking “Oh, well – but it doesn’t apply to me.” Read on.

Here are the DSM criteria for dependent personality disorder:

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
(2) needs others to assume responsibility for most major areas of his or her life
(3) has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution.
(4) has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)
(5) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
(6) feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
(7) urgently seeks another relationship as a source of care and support when a close relationship ends
(8) is unrealistically preoccupied with fears of being left to take care of himself or herself

Two generations ago probably half the women in our culture would have met these criteria. (Note that only five of the items have to be met.) Even today a substantial percentage of the women in our society are raised to think of themselves as essentially dependent and as having little or no personal identity until they have become “hitched” to a man. By calling this a mental disorder, the APA is pathologizing what for many individuals is a normal state. It is also critical to note that the only reason that this particular lifestyle is a mental disorder is that the APA say so. The APA attempts to promote the idea that their so-called diagnoses are based on science. This is simply not the case, and is certainly not true of the so-called personality disorders. The APA and its various committees have simply decided that certain lifestyles and mindsets are to be considered pathological. They pretend that this reflects some kind of reality, i.e. that in fact these individuals are truly damaged in some way. But in fact the determination that certain mindsets constitute disorders while others do not is entirely arbitrary.

Why, for instance, is there not an independent personality disorder? After all, if people who are extremely dependent are to be considered pathologized, why not the individuals at the other end of the continuum? Individuals who never ask for help; who conceptualize asking for help as shameful; who are driven to succeed by their own efforts; who never see themselves as part of a team, etc., etc.. One could easily draft eight or ten criteria, arbitrarily require that 3 or 4 or 5 of these be met, and voila! A new diagnosis. Frighteningly, there are probably individuals within the APA who would take this suggestion seriously. The APA’s objective is to pathologize as much normal behavior as possible, and this has been demonstrated clearly by each successive revision of the DSM.

Next Post: Sexual Disorders Are Not Illnesses

It is certainly true that people display various problems in their daily lives and particularly in their interpersonal relationships.  The American Psychiatric Association claims that all such problems are caused by mental illness and their list of these so-called illnesses is so long that virtually anybody can be embraced within their coils.

It is also true that problem behavior can be the direct result of an illness.  The paradigm example of this is general paresis.  This illness, which is in fact an advanced stage of syphilis, often generates psychotic symptoms and at one time accounted for 10-20% of mental hospital admissions.  But psychotic behavior and other behavioral problems can and do occur in the absence of any underlying illness.  Indeed it is my main task in these posts to show how these kinds of behaviors can be explained in terms of the ordinary constraints of daily living.

The vast majority of mental health workers subscribe to the APA’s philosophy.  There have been voices of dissent, however.  The late George Albee, PhD, wrote this in 1999:

“Most mental/emotional problems are learned patterns of maladaptive behavior resulting from the stresses of poverty, anxiety, exploitation and abuse or neglect!”  (Sarasota Herald-Tribune June 27, 1999)

William Glasser, MD, a renowned psychiatrist, was the top speaker at the 2006 national conference of the American Psychotherapy Association.  The National Psychologist (Nov-Dec 2006) quotes him as follows:

“I’ve never identified anyone as having a DSM disorder.  …All of these are phony diagnostic categories.  The DSM was not written to help people; it was developed to help psychiatrists – to help them make money.”

The point is this:  mental illness is an explanatory concept.  It purports to explain unusual, aberrant, or troublesome behavior. So that if a person were to ask:  Why does my mother say these crazy things?  Why doesn’t she take care of herself and let us help her?”  The answer from the mental health establishment is:  ”Because she has a mental illness called schizophrenia.”  We’ve discussed the circular nature of this so-called explanation in an earlier post.   And the fact is that it’s not an explanation at all.  It’s a soothing form of words – a mantra, if you will – that legitimizes medical involvement in the “treatment” of people who are experiencing problems with living.  The history of medical involvement in these kinds of problems is not edifying, and the present-day exploitation of these individuals by pharmaceutical and medical drug pushers is no exception.

Three books I’ve come across recently on these topics are well worth the read:

Shyness: How Normal Behavior Became a Sickness

Christopher Lane, PhD, Yale University Press, 2007

Mad In America

Robert Whitaker, Perseus Publishing, 2002

The Myth of the Chemical Cure (Revised Edition)

Joanna Moncrieff, MD, palgrave macmillan, 2008

Next Post: More on Personality Disorders