Weekender: Defining mental illness: Is Modern Society Less Tolerant of the “Non-Conformist”?

What defines "normal" behavior in our modern society? How do we perceive those whose actions push the boundaries of accepted stereotypes? Are they regarded merely as eccentric, unusual, original, or a little quirky? Or are those who "dance to a different beat" actually suffering from a form of mental illness?

In today’s so-called permissive society, the full gamut of human conduct appears to exist unfettered as long as no law is broken or crime committed, a far cry from our recent history when, back in the 19th century, a range of workhouses, mental asylums, penitentiaries and other institutions housed a variety of inmates, many of whom were incarcerated on the flimsiest of pretexts. Even unmarried mothers were considered to be neurotic and were confined to homes for the "socially unacceptable" or even in lunatic asylums: there are documented cases of unwed mothers being discovered in such asylums as late as the 1970s, having been imprisoned there since early adulthood.

Our highly developed and civilised culture in the Western hemisphere possesses a much more liberal and broad-minded attitude to the unconventional individual, with "live and let live" being adopted as the mantra of post-war progressive culture. The latest additions to our psychiatrists’ arsenal of symptom clusters may then shock us out of our relaxed, indulgent haze, and prompt us to start scrutinizing our neighbour’s idiosyncratic peccadilloes, for fear that we may be living next to a budding psychotic. The latest edition of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), has identified a new and radical brand of mental illness called “oppositional defiant disorder” otherwise known by the delightfully appropriate and amusing acronym, "ODD".

The acronym would be amusing if it was not so sinister; the condition is defined as an “ongoing pattern of disobedient, hostile and defiant behavior;” symptoms include "questioning authority, negativity, defiance, argumentativeness, and being easily annoyed." So, pretty typical behavior for most of us on a morning when we arise to find that the cat has been sick in our shoes, our shirt or blouse needs ironing and there was a traffic jam on the way to work.

After society has spent years cultivating a free-thinking arena that allows for freedom of expression, it seems that an abrupt U-turn has been made in the field of psychiatry, and any form of extreme behavior is newly termed "unstable." The DSM-IV is apparently becoming thicker with every new edition, as mental health professionals compile and add more and more symptom profiles to the list of mental illnesses. The latest socially unacceptable personality traits detailed in the DSM-IV include "arrogance, narcissism, above-average creativity, cynicism, and antisocial behavior."

"Above average creativity?" As a Washingon Post article sagely observed recently, the use of this yardstick would have identified Wolfgang Amadeus Mozart as "mentally unstable."

As the DSM-IV is not the coffee-table tome of choice for the average U.S citizen, this rash of new psychological "diseases" has not become common knowledge, being read primarily in academic circles; however, even there the latest version has provoked controversy between psychiatrists and psychologists, as critics claim that the additions to the American Psychiatric Association’s manual will result in millions of people being mistakenly diagnosed as mentally ill. Even within the field of psychiatry the trend is causing concern: Allen Frances, a professor of psychiatry and the chair of the DSM-4 committee, used his blog recently to attack the production of the new manual as "secretive, closed and sloppy", claiming that it "includes new diagnoses and reductions in thresholds for old ones that expand the already stretched boundaries of psychiatry, and threaten to turn diagnostic inflation into hyperinflation".

This controversy has begun to spark media attention, and questions are now being asked about a professional handbook that categorises "shyness in children, temper tantrums and depression following the death of a loved one" as medical problems to be treated with drugs. Over the last five decades, the total of psychiatric disorders listed in the DSM-IV has risen from 130 to 357. The book’s authors claim that the amount of conditions listed has increased due to improved diagnostic methods, but critics maintain that symptoms are being over-categorised, and conditions over-medicated.
The very nature of disorders identified by psychiatry is now being called into question, and in an unprecedented move for such a professional body, the Division of Clinical Psychology (DCP), has published a statement asking for psychiatric diagnosis to be abandoned, and instead for alternatives to be considered which do not use the language of "illness" or "disorder".

The statement claims: "Psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias."

The DCP suggests that "diagnoses such as schizophrenia, bipolar disorder, personality disorder, attention deficit hyperactivity disorder, conduct disorders and so on" are of "limited reliability and questionable validity".

Clearly if these floodgates are not closed, the potential for every objectionable mannerism or belief to be classified as a mental illness is becoming a ominous possibility, where psychiatrists will eventually produce a stream-lined race devoid of individual idiosyncrasies, displaying only a limited range of very predictable and manageable personality traits, and living in a culture where any form of extreme behaviour is defined as "unhinged?"? This is not a new concept, as mental illness has previously been used as a weapon to manipulate and control political insurgency in the Soviet Union; those who rebelled against Communism were diagnosed with a new form of schizophrenia where the primary symptom was the "delusion" that the principles behind communism were wrong. These unfortunate citizens were isolated, forcefully medicated, and put through repressive “therapy” to bring them back to conformity, or "sanity." Let us hope that the over-zealous trend in psychiatry is halted here before we become a totalitarian state where everything must be controlled, including every action of every citizens, until we have removed the essence that makes each individual unique.

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