Both as a theoretical construct and a system of classification, the disease model of mental illness leaves much to be desired. Unlike other medical disciplines, there is no proven etiology for specific disorders. Despite millions of dollars in research, there are no detectible viruses, bacterium, neurotransmitter surpluses or deficits, hormonal surpluses or deficits, organ malfunctions, genetic abnormalities, injuries to bone or tissue, nutritional deficits or the like. Instead, mental health providers base their judgments on clusters of phenomena that, to them, seem to go together.
In this regard, the DSM operates far more like your newspaper horoscope than legitimate science. Instead of observing the movements in planets and stars, clinicians are observing clusters of mental and bodily developments. When certain phenomena emerge together, they make predictions about your current status and future needs. (This gives new meaning to the phrase: "I need to look in your chart.")
Just like astrology, the clusters and their associated ramifications have a lot of intuitive appeal that seems to ring true for some people. Unfortunately, the general patterns aren't clear enough on a broad population basis to yield a reliable picture of what is going on underneath the surface. You might as well say, “I’m a libra” as “I’m bipolar.” They both tell you about as much about yourself.
As a result, these categories hinder efforts to develop treatment approaches that provide verifiable, consistently satisfying results. Given the current outcome data, the average person might do about as well consulting the stars as by following the treatment plan developed by a licensed mental health provider.
Adding Insult to Injury
Add in conventional prejudice around the 'mental illness' labels, and it gets even worse. It's like your provider looking only at your horoscope and taking that as the end all and be all of what is happening in your life. Pretty soon, family, friends and everyone else you know are following the provider lead. Next thing you know, all of your complaints are seen and interpreted through the lens of your horoscope. Other issues you're having -very real ones - aren't taken seriously, because hey, "the moon is in the 7th house and Mercury is aligned with Mars, so what do you expect will be happening in your life...?”
The simple fact is a lot of us are grieving real life losses - the loss of jobs, careers, community standing, financial security, family roles, spouses divorce us, courts take our kids, friends abandon us, neighbors look the other way.... These losses all too often follow and directly result from - not just precede and 'cause' - a psychiatric diagnosis. Yet our very real pain is minimized or dismissed. Everyone knows that people with our horoscope [diagnosis] can't expect much. So probably we don't feel much either....
The arbitrariness of the medical model has yet another disturbing dimension. As a practical matter, there are countless non-disease approaches that people use to make sense of the experience and guide their approach to life. Many of these approaches have – or may have - similar reliability, validity and outcomes as conventional mental health. There are personality measures like the Enneagram and Myers-Briggs that describe common themes in human behavior and that many people find helpful in understanding and relating to others. There are practices like acupuncture, naturopathy, reflexology, reiki, cranio-sacral therapy, massage, yoga, meditation, chiropractic, osteopathy, art, coaching.
Practitioners of these and similar modalities can reasonably claim to offer both mental and behavioral benefits to people in distress that – dollar for dollar – would be just as efficacious and far more enjoyable than traditional mental health treatment. Like psychiatry, these alternative modalities all claim skill at:
- identifying the causes of human distress,
- remedying existing problems, and
- preventing potential future catastrophes
Moreover, if vested with the research dollars and sophisticated methods available to the Pharmaceutical industry, quite possibly many alternative approaches could demonstrate efficacy equal to modern psychiatry. This is not an exaggeration. The fact is, armed with the resources, tactics and scope of influence available to Pharma, quite possibly phrenologists (who measure skulls), fortune tellers (who look at the lines in hands), and reflexologists (who track the patterns in feet) would all by FDA approved and Medicare re-imbursed. The 'science' is just that slimy.
Seen in this light, the bias toward medical methods and interpretations is alarming. None of the non-medical alternatives come close to enjoying the public standing granted to medical model providers. They rarely if ever qualify for government research grants, private insurance or public reimbursement. They never get to force their recommendations on unwilling subjects. And they certainly don’t get asked by courts to opine whether someone should lose their freedom based on yesterday’s horoscope or an overly long toe.