The Diagnostic and Statistical Manual of Mental Disorders (DSM) is frequently described by the general public and the mental health profession alike as the "bible of psychiatry." It is not a coincidence that the DSM has come to be known colloquially as a bible for guiding psychiatric diagnosis. I contend that psychiatry functions more or less as a religion in society and that psychiatric treatment, whether with medication or psychotherapy, is a form of spiritual conversion or religious experience. Many of the ideas presented here are not my own and were first introduced by the late psychiatrist Thomas Szasz in the 1960s and 70s. I use the term "psychiatry" to encompass the practices of all mental health professionals working with people called "mentally ill." Likewise, "psychiatric treatment" refers to all forms of interventions by mental health professionals aimed at "treating mental illness."
In order to provide an analysis of psychiatry's function as a religion in modern society, one must first consider the defining features of religion. It has been offered that the single defining characteristic of all religions is a preoccupation with unseen beings or forces. These unseen beings or forces are typically believed to have the ability to control the natural world. Other recognized features of religions include belief in a certain moral code, proselytization (i.e., converting others or attempting to persuade others of the rightness of one's beliefs), and hierarchy. Specific religions also place emphasis on confession and sacraments, and some believe that individuals are subject to possession by some spirit or force. It has become increasingly clear that psychiatry functions essentially as a religious enterprise founded on a belief in the unseen and characterized by the defining features of religion. Like all religions, its aim is social control and the explanation of deviant and socially undesirable human behavior.
If the single defining characteristic of all world religions is a preoccupation with unseen things, how does this relate to psychiatry? The official purview of psychiatry offered by the American Psychiatric Association and other professional organizations is the "diagnosis, treatment, and prevention of mental disorders." These mental disorders are widely believed to be the result of some underlying but yet-to-be-discovered biological disease process affecting the brain and nervous system. It is indeed this belief in mental illness as pathophysiological lesion or disease that holds all of psychiatry together and seemingly justifies its position as a specialty of medicine as opposed to an area of philosophy or as a religion. But herein lies a crucial problem: no one has ever seen a mental disorder under a microscope or on an MRI scan. There are no objective, demonstrable, medical tests used to diagnose mental illness. Indeed, textbooks of pathology--the specialty of medicine dealing with disease--do not list mental disorders. Throughout the history of psychiatry, some conditions once considered to be mental disorders were discovered to be diseases of the brain. These diseases--notably neurosyphilis and Alzheimer's disease--are now treated by neurologists and not psychiatrists. These discoveries say nothing about the existence of a category of disease known as "mental illness." Insofar as there are no objective medical tests for conditions known as mental disorders, psychiatry rests on a belief in the unseen and the unknown. It meets the single most important defining characteristic shared by all known world religions.
Psychiatry as a profession and as a mode of helping people also shares the other features of religion, including belief in a certain moral code, hierarchical organization, and proselytization. In the sense that psychiatry is dealing with moral-existential human problems and not observable medical diseases, it can be said to adhere to and propagandize a certain moral code since the "treatment" of individuals rests on converting their behavior from morally "bad" to morally "good." The so-called treatment of people who take drugs (called "addicts" suffering from a disease called "addiction" or "substance abuse") rests on getting them to stop taking drugs because of the negative consequences their drug-taking is having on themselves, their families, and society. Likewise, a depressed person is told that depression is an illness in need of treatment, despite the fact that melancholy was the normal condition of man for thousands of years--immortalized in some of history's greatest paintings and works of art. When psychiatry is coercive--as is almost always the case--its moral code is readily apparent: patients must follow through with treatment recommendations and behave morally or lose their personal freedoms. The prohibition of suicide rests on the judgment that suicide is always morally wrong and should be forcibly prevented by the mental health professional working in the "interests" of the patient and the state.
The proselytization of psychiatry occurs in the form of "mental health awareness" campaigns, psychiatric "screenings," and the ever-broadening scope of psychiatry in everyday life. It has become common to hear people talk casually about the increasing prevalence of psychiatric disorder in society. Drug advertisements urge people to "talk to their doctor" about depression, anxiety, and mood swings. Professional organizations and academic departments have "mission statements" outlining their goals. They are indeed "on a mission" like religious missionaries to spread their beliefs and ideas about the holy concept of mental illness. Psychiatric training--like religious training--is organized hierarchically. Young psychoanalysts must receive formal training and their own personal analysis before they are admitted to the practice of their chosen profession. Psychiatry residents must prove to their training directors--the high priests--that they are capable of diagnosing and treating the human problems called mental disorders. The founders of various sects of psychiatry are religiously revered and their followers are referred to as their "disciples." Disagreement with established beliefs is considered sacrilegious.
The various elements of psychiatric treatment also mirror religious experiences. In years past, people would confess their sins to priests for "redemption." Today, people go to psychiatrists to tell them about their problems and receive "treatment." In a world that has become vastly more scientific, people have opted to conceive of their problems as being caused by some underlying disease or disorder rather than the result of demonic possession or the will of god. But the roles played by psychiatry and religion are the same: they both attempt to explain human behavior by emphasizing the significance of the unseen object or force. In religion, it is god. In psychiatry, it is mental illness. Both religion and psychiatry attempt to give man a sense of meaning in a sometimes meaningless world. The psychotherapy hour, like Sunday Mass and confession, is a sacred time. The church and the psychotherapy office are sacred places. Psychiatric medication and psychotherapy are Holy Communion. Following the teachings of the Church, like following the treatment of the psychiatrist, is said to bring a person to eternal salvation.
It is only in understanding the broader sociological context of psychiatry that one can truly understand the role psychiatry plays in the amelioration of human suffering. As Szasz said, "Clear thinking requires courage rather than intelligence." History shows us that man has both an interest and a tendency to ascribe deviations in human behavior to supernatural forces beyond the capture of science. Mental illness has proved to be one such endeavor, supported by the Church of Psychiatry.