Why America’s attitude to mental illness is dangerously deluded

A friend who works in social care speaks to me earnestly about a troubled young colleague: ‘Of course, she’s got a borderline personality disorder…’ I check her there: ‘What do you mean by that?’ She thinks for a moment and continues: ‘Well, she’s very emotional, she can’t maintain relationships, and she’s very defiant…’ I wait for a moment to see if there’s anything else before I say my bit: ‘Perhaps she just has a bad character — because fundamentally that’s all a personality disorder is: epithetic psychiatry. There’s no defined organic basis for these so-called disorders, no psycho-dynamic aetiology either, no progression — and, of course, no cure.’

My friend doesn’t really absorb this information. Indeed, it’s as if she can’t hear it at all; she continues talking about the young woman in the same vein, before casually affixing another label to her troubled psyche: ‘She’s bipolar as well.’ There’s no point in repeating what I’ve already said. My friend — a compassionate, intelligent woman — needs these diagnoses, as so many people do, to make sense of a world that has become increasingly defined by an entire ideology of mental illness (and health) that bears as much relation to the psychic reality of human beings as the Harry Potter novels. Arguably less.

If I could’ve prevailed upon my friend to read Allan Horwitz’s exemplary account of the Diagnostic and Statistical Manual of Mental Disorders (DSM) which since 1952 has been published in five distinct iterations (with two substantive revisions) by the American Psychiatric Association, then perhaps her delusional view of the delusional could have been dispelled. Horwitz subtitles his study ‘A History of Psychiatry’s Bible’; but while this captures the significance of the DSM, it does a grave disservice to the Bible, which has far more in the way of succour for the mentally ill and advice for those who would help them than it does.