The Myth of ‘Mental Illness’

Bench near harbor

A new Diagnostic and Statistical Manual of Mental Disorders is due out next year, and there is renewed discussion about what constitutes “mental illness.” One of the world’s leading psychiatrists, Dr. Z, questioned the very concept: “In nonpsychiatric circles, mental illness all too often is considered to be whatever psychiatrists say it is. The need to reexamine the problem of mental illness is both timely and pressing. There is confusion, dissatisfaction, and tension in our society concerning psychiatric, psychological, and social issues. Mental illness is said to be the nation’s No. 1 health problem, and more than 17 million people were diagnosed as suffering from some form of mental illness last year.”

These quotes could be from today, but they are not. They were voiced by one of my teachers when I was getting my master’s degree in social work in 1965. At the time I knew him, Dr. Z (Thomas S. Szasz) was a fellow of the American Psychiatric Association. He caused quite a stir when his book, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, was published in 1961.

Dr. Z acknowledged that people were suffering and they needed our help. He just questioned whether calling their experience a “mental illness” was helpful. “Although I consider the concept of mental illness to be unserviceable, I believe that psychiatry could be a science,” he said. “I also believe that psychotherapy is an effective method of helping people—not to recover from an ‘illness,’ it is true, but rather to learn about themselves, others, and life.”

Although many believe that psychotherapy is helpful to individuals, it doesn’t help solve the major problems we face in the world today. Psychologist James Hillman and author Michael Ventura, who together published the book, We’ve Had a Hundred Years of Psychotherapy and the World’s Getting Worse, in 1992, sat on a bench overlooking the ocean in 1990 and pondered this.

“We’ve had a hundred years of analysis, and people are getting more and more sensitive,” Hillman said. “And the world is getting worse and worse. Maybe it’s time to look at that. We still locate the psyche inside the skin. You go inside to locate the psyche, you examine your feelings and your dreams. They belong to you.” He went on to say: “We’re working on our relationships constantly, and our feelings and reflections, but look what’s left out of that.”

Hillman made a wide gesture that encompassed the oil tanker on the horizon, the gang graffiti on a park sign, and the homeless woman with swollen ankles and cracked skin asleep on the grass about 15 yards away.

“What’s left out is a deteriorating world,” Hillman said. “So why hasn’t therapy noticed that? Because psychotherapy is only working on that ‘inside’ soul. By removing the soul from the world and not recognizing that the soul is also in the world, psychotherapy can’t do its job anymore. The buildings are sick, the institutions are sick, the banking system’s sick, the schools, the streets—the sickness is out there.”

Confessions of a recovering mental health professional 
When I was in graduate school, Dr. Z was seen as a radical psychiatrist, outside the mainstream, and we were taught that “mental illness” was real and we needed to learn to diagnose it properly. I went along because I wanted to help people and figured this was the way to do it. But I had a few problems from the beginning:

  1. Giving the right diagnosis never seemed to translate into offering a different kind of treatment.
  2. The more I learned to be a good therapist, the less I was convinced that people were “sick.”
  3. It was clear that big money was being made in “treating the sick” and it seemed that diagnosing more people as having a mental illness was a way to get more customers rather than to help more people who were suffering.
  4. Real mental health had to go beyond our personal psyches and include the wider world.

Like many professionals, I followed the rules and gave people an official diagnosis, but I never took it seriously as a way to help me or my clients to better understand issues. I did it mostly so I could get insurance reimbursement or so my client could get paid. But times are changing, and more people are suggesting a better way ahead.

Natural psychology and ecological medicine: the wave of the future? 
When Dr. Szasz was sounding the alarm of our increasing labeling of so many life problems as “mental illness,” he noted that 17 million people were thought to have it. Now the National Institute of Mental Health estimates that 60 million people need “mental health” services, and the number increases every year.

Dr. Eric Maisel is a licensed family therapist and author of 40 books on topics ranging from creativity to new understandings of “mental illness.” In his recent book, Rethinking Depression: How to Shed Mental Health Labels and Create Personal Meaning, he wrote: “With the rise of four powerful constituencies—the pharmaceutical industry, the psychotherapy industry, the social work industry, and the pastoral counseling industry—and their handmaidens—advertising, the media, and the political establishment—it has become increasingly difficult for people to consider that unhappiness might be a normal reaction to unpleasant facts and circumstances. Cultural forces have transformed almost all sadness into the mental disorder of depression.”

Maisel believes that the health field needs a new psychology for understanding and helping people. He called it “natural psychology” and said it is “a new addition to the ranks of the many existing psychologies. It looks at the human experience with a fresh eye, takes as its starting point a naturalistic world view, focuses on the nature of meaning, and offers a vision of how a person with meaning needs might want to live.”

Ecological medicine is a new field of inquiry and action to reconcile the care and health of ecosystems, populations, communities, and individuals. In the foreword to the book Ecological Medicine: Healing the Earth, Healing Ourselves by Kenny Ausubel, Bioneers founder Dr. Andrew Weil said: “Ecological medicine shifts the emphasis from the individual to public health; from nutrition to the food web and farming system; from human-centered viewpoint to one of biodiversity and all the other ecosystem services that are the foundations of health and healthy economics.”

Clearly, health care as we have known it is changing. A system that sees humans as separate from nature and the mental as separate from the physical just doesn’t work. As a health care provider for more than 40 years, I’m happy that we can finally let go of the “myth of mental illness” and work together to help ourselves, our clients, and the fragile planet we all share to find a better way.

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Jed Diamond, PhD, LCSW, therapist in Willits, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • steven

    steven

    October 24th, 2012 at 11:36 AM

    Myth?!

    had they grown up in my world they would have known this was no myth, it’s the real deal.

  • Fran

    Fran

    October 24th, 2012 at 3:49 PM

    mY concern is that if you don’t give it a name, then not only will insurance not cover help that the patients need to receive, but it will leave even more patients with questions and confusions, and they will feel like there is possibly no hope for a solution to their problems. People like to have aname for things, it gives them something with which they can fight and research. If we are not even willing to allow them this that I fear that even fewer will seek help even when they know that it is needed because they will have the sense that no one out there really wants to help them anymore.

  • Jed Diamond

    Jed Diamond

    October 24th, 2012 at 5:01 PM

    Steven and Fran, I’m not questioning the reality of mental illness. I’m concerned about the labeling and finding more and more things we can call mental illness, that might be better understood as normal human experiences. I’m also concerned that we not close the door to other ways of understanding the suffering that so many of us experience and other ways of treating it beyond those recommended within a medical model.

  • Mae

    Mae

    October 25th, 2012 at 4:05 AM

    I agree with you, Jed. I don’t think that this is the time to close the door to the realization that there are clearly those people who suffer from some sort of imbalance in their lives that we have always pigeonholed as mental illness, and that could be the case or maybe this imbalance is instead brought on by something physical. I have noticed that when one is given the notice that they have mental illness, that’s where the buck stops and no other solution or treatment is ever sought or given. I too think that we have to begin to step out of that prescribed medical model that we have been so accustomed to working within and offering everyone real solutions that may or may not fit that treatment as usual model which has been used for so many years, but often with very little success. I see this as merely a different approach and one that actually looks to treat more people rather than leaving those out who know that they need help of some kind.

  • Jed Diamond

    Jed Diamond

    October 25th, 2012 at 7:13 AM

    I think its good that mental illness has been brought into the mainstream instead of being stigmatized. We all need to be treated with respect and have our pain and suffering effectively addressed. But we also have to recognize that the “mainstream” isn’t the only stream and there are methods of healing, some old, some new, that are as effective or more effective than those advocated by the psychiatric establishment.

  • Sandra.K

    Sandra.K

    October 25th, 2012 at 8:01 AM

    Life is a mystery.There is always ups and downs,hills and plateaus.Nobody always has good times or bad times,it is always a combination of the two.And although there is suffering in many of these downs,it is not really easy to name or classify the things.I certainly think the labeling should not be that rigid as to call everything mental illness.That is because we are complex beings and need to understand life even better.We are just not there yet,I feel.

  • kirby

    kirby

    October 25th, 2012 at 4:26 PM

    love this whole concept of ecological medicine
    healing is not always about healing just an illness but looking for the environmental factors which could be contributing and searching for ways to start the healing process there
    will take a long time for the majority of the world to get on board, but we have to start somewhere right?

  • Jed Diamond

    Jed Diamond

    October 26th, 2012 at 7:49 AM

    Kirby, Thanks for the note. After practicing psychotherapy for more than 40 years, I’ve come to see that healing must occur at all levels: Mental, emotional, physical, relational, spiritual, and ecological. Healing ourselves and healing the planet.

  • kirby

    kirby

    October 26th, 2012 at 11:24 AM

    don’t know if we are evolving toward this realization or if we are simply re-discovering something that our forefathers knew before us, but i think that it is vital to all of our survival and that of geenrations to come to lead cleaner and healthier lives, for our selves and for the planet

  • Myra b

    Myra b

    October 28th, 2012 at 12:28 PM

    All too often we are so busy looking inward at what is wrong with us and putting too much on us that we forget that hey, alot of this is being done TO us. You were so right by pointing out all of the things that are wrong, and so then we internalize all of that and it becomes what makes us ill ourselves. Yeah, we need to take care of ourselves but we have to remember to not be so hard on ourselves all the time either because there is a lot that is beyond our control.

  • Jed Diamond

    Jed Diamond

    October 28th, 2012 at 9:09 PM

    Myra, excellent advice. We all need to be gentler with ourselves. Thanks for the reminder.

  • gregg

    gregg

    October 29th, 2012 at 4:02 AM

    Hate to even have to say this but I think that the perception of saying that mental illness may not really be wil turn a lot of people off. I think that most of us have to come to the point where we recognize that mentall illness is real and that it is something that can have toms of adverse effects on someone. To try to backtrack now and say that this is not the case, well I think that there are those people who so strongly believe in this that you will face a lot of backlash as a result of espousing those beliefs. I do think that it is important to find the source for the illness, be it environmental, genetic or any combination of those. But for someone to say that it is not reality and that this is about something else, then I think that is taking mental health care back down the wrong path again.

  • Jed Diamond

    Jed Diamond

    October 29th, 2012 at 6:38 AM

    Gregg, your point is well taken. I don’t believe that what we have come to call mental illness doesn’t exist. I just question the purpose of our increasingly expanding labeling which often ties to a narrow medical model that focuses on giving medications. I think its good to step back and question our assumptions and see whether are models are helping or interfering with those of us who have dedicated our lives to helping others.

  • Jennifer Bullock

    Jennifer Bullock

    December 9th, 2012 at 12:41 PM

    Excellent article – thank you for writing. We are kin as I too have been practicing a non-diagnostic group therapy approach called Social Therapy for many years which is more interested in helping people be in the world in new ways versus in their heads. Helping humans grow and develop has nothing to do with the adaptive individualistic medical model which with its traditional lenses of diagnoses and deficits. Developing has everything to do with creating new methods for living- like collective learning, creativity and focusing on the social-ness or relational-ness of our existence.

  • Jed Diamond

    Jed Diamond

    December 10th, 2012 at 6:49 AM

    Jennifer,

    Thanks for your note. Nice to have kindred spirits out there. Feel free to contact me through my website MenAlive.com and share your ideas and work more fully (be sure and respond to my Spamarrest challenge so you get through my spam blocker if you haven’t emailed me before.

  • Ron

    Ron

    December 11th, 2012 at 9:21 AM

    I think the labels are important. As a physician, I know that an accurate diagnostic definition is key to understanding the illness and the proper treatment.

    What I think Psychiatry lacks are definitions of what a normal or optimal response should be to pathogenic conditions.

    Given a traumatic event, or a broken environment, what is the optimal (normal) response and what is the best expected (normal) outcome (prognosis) from that situation? Normal may not be what is desirable, it might only be the best that can be expected.

    So when is it good enough? You can’t fix perfect. What is perfect given one history and set of circumstances, may look very dysfunctional from the perspective of someone with a different history and different circumstances. How do you know? By what criteria do you judge?

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