The Chief Peril Is Not a Diagnosis, but the Polarized Mind

New article on the broader problems with mental health in the U.S. and world.

Posted Jul 19, 2018

Author note: The following is a draft excerpt of an article that has been published by the Journal of Humanistic Psychology, all rights reserved, Sage Publishing Co., July, 2018. For the published version of this article, click here, or for the full draft text click here. The article is also a significantly revised version of an earlier Psychology Today blog post called "The Peril is Not Mental Illness but the Polarized Mind"

Preface and Call for Future Research

Babies being wrenched from parents, disquieting authoritarian alliances, alarming levels of civil and political discord—this is our country and world in the summer of 2018. To be sure, there are also positive developments but are they reliable, enduring?

I believe this article goes to the heart of our troubled times both individually and collectively, and especially challenges us as therapeutic agents to find creative ways to integrate polarizing systemic and environmental factors into the context of our guidelines for so called mental disorders. This could entail some kind of narrative discussion of the evidence for psychosocial polarization (or what I call the "polarized mind" or fixation on a single view to the utter exclusion of competing views) as a context—where relevant—for individual "disorders," such as depression, anxiety, substance abuse, obsessive-compulsiveness, post-traumatic stress and even autism spectrum, bipolar and schizophrenic spectrum syndromes. I call for urgent research to expand the present DSM to include contextual-systemic supplementation such as above. Short of this, we will perpetually fall short of a fuller understanding of troubled lives.

Summary

This article calls on organized psychiatry and psychology to wake up and address a major under-appreciated discrepancy. This is the discrepancy between diagnostic nomenclature for therapy clients, and the nonpathologizing or even glorifying nomenclature for many throughout history who are abusive, degrading, and massively destructive. While the former, typically clinical population, may be referred to as the “diagnosed” and the latter, typically nonclinical population, as the “undiagnosed,” I show how the compartmentalization of our current psychiatric diagnostic system prevents us from seeing the larger problems with mental health in our country and beyond, and that these problems require an alternative framework. Such a framework would address both that which we conventionally term “mental disorder” as well as the disorder of cultures, which so often forms the basis for that which we term mental disorders. I propose that the phenomenologically based framework that I call “the polarized mind” is one such alternative that might help us more equitably treat suffering, whether individual or collective.* 

Introduction

There is a reason that many of the most “twisted” and destructive people on this planet are not seen as “mental patients.” They tend to be ordinary or even celebrated individuals—and their brains are considered to be as “normal” as the rest of us. Does this not tell us something glaring about the inadequacy of our current psychiatric diagnostic system, as well as the culture out of which it arises (e.g., see Fromm, 1955)? We have no language for the malady that both supersedes and in many cases fuels the diagnostic categories we conventionally term psychiatric illnesses, and our reduction of these categories to brain abnormalities almost entirely blinds us to their deeper cause. This cause is overridingly environmental and the product not of sickness but of unaddressed, unacknowledged fear—which leads individuals—as well as societies—to become rigid, narrow, and destructive (Schneider, 2013).  

Time for a Broader Perspective

In light of humanity’s persistent destructiveness (Pilisuk & Rountree, 2015)—and in the spirit of Laing (1967), Foucault (1961/1988), and Szasz (1961/1974)—it is time to revisit what we mean by “mental illness” and “mental disorder.” Although these terms are popularly understood as various forms of psychological suffering, increasingly, they are being defined in terms of biologically based brain correlates (Insel, 2013). From the standpoint of the disease model of psychiatry for example, mental illness implies the presence of detectable tissue pathology and mental disorder implies a discrete deviation from normal functioning as defined by the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM [APA, 2013]); yet neither concept holds up well under close scrutiny. 

Mental illness, for example, is rarely corroborated by the clear presence of tissue pathology, and when it is, it tends to be dispositional rather than determinative (Read & Bentall, 2012).  The second category, mental disorder, is typically confined to those who are 1) socially isolated; 2) professionally referred; or 3) socially powerless. The problem, however, is that the category is much broader than is generally conceived. There are legions of people who fit many aspects of what is conventionally termed mentally disordered (as well as mentally ill), and they are rarely considered as such either by authorities or by the authority-adhering public. Consider, for example, the relevance of the following set of traits, drawn from the DSM, to many of the world’s most notorious political leaders, business and religious leaders and everyday bullies, bigots, and nationalists. (Let’s not forget that 76 short years ago eight out of the fifteen leaders assembled at the ill-famed Wansee conference in Nazi Germany, which instigated the “Final Solution,” were doctors!). Consider how problematic it is to restrict diagnoses to a relatively small and powerless constituency of mental patients (the so-called mentally disordered) while forgetting that the most egregious possessors of such qualities often reside casually next door, or worse, in the most lavish chambers of national capitols.

The traits to which I refer are first, the diagnostic criteria for antisocial personality disorder, as adapted from the DSM V.  These traits include: 

1  A callous unconcern for the feelings of others

2  The incapacity to maintain consistent, responsible relationships 

3  The reckless disregard for the safety of others

4  Deceitfulness: the repeated lying to and conning of others for profit

5  The incapacity to experience remorse and

6  The failure to conform to social norms with respect to lawful behaviors

I would also add the diagnostic criteria for narcissistic personality disorder, which include:

1 A grandiose sense of self importance

2 A preoccupation with fantasies of unlimited success or power

3  A sense of entitlement, a lack of empathy, and an unwillingness to recognize the needs of others and finally,

4  Arrogance

Now it is abundantly clear—or should be with even a cursory knowledge of history, as well as our own times—that these above “disorders” are major disturbances of humanity and not merely the pathologies of marginalized groups. They are also major disturbances of personal and cultural conditioning and not merely the byproducts of defective brains or genes (Fromm, 1955; Laing, 1967; Pilisuk & Rountree, 2015). 

References

Schneider, K. J. (2018). The Chief Peril Is Not a DSM Diagnosis but the Polarized Mind

Journal of Humanistic Psychology http://journals.sagepub.com/doi/10.1177/0022167818789274

Kirk J. Schneider