Stigma and Psychiatry

jessicakellyJessica Kelly, Psychogendered, asked, “Is psychopathy a mental illness, or is it – as some would say – merely a defect in personality or character?” The way this question was posed indicates something important in our culture’s approach to psychology. Before psychology, before science, there was morality. There were good people and bad people. Some people were even evil. The reasons people were the way they were wasn’t important. We had free will. What we were was our responsibility. Psychotic people were probably possessed by the devil. They were kept in asylums where they wouldn’t interfere with the lives of “decent folks.” The conditions in which they were held were cruel in the extreme but that didn’t seem to matter in those days. Life improved tremendously for these inmates when their condition became recognized as an illness rather than a sign of evil.

The concept of mental illness was a major turning point in the way people with conditions such as schizophrenia were treated. Instead of being possessed or evil, they were seen as sick, victims of a disease. Over time, the concept of mental illness expanded to include snakepitmore kinds of behavior that society didn’t quite accept as right and proper. People who were “difficult” now found themselves vindicated as they were increasingly considered sick the way people with diabetes or appendicitis are sick. Nobody blames sick people and now victims of mental illness wouldn’t be blamed either. At first, people were either neurotic or psychotic. Later on, more forms of “mental illness” were “discovered.” Today, we hardly ever hear the word “neurosis.” We hear a lot about personality disorders, developmental disorders and mood disorders.

While we have tried our damnedest to separate science from morality, psychiatric antistigmaconditions have never managed to free themselves from moral stigma. People are still people and, as such, tend to judge. Conditions that are now considered to be disorders are those that cause some problem for society or, at least, clash with accepted social values. Advocates of people with stigmatized conditions can talk forever but society clings to it’s original judgmental view of people who don’t fit the idealized mold.

addictiondiseaseAddiction is now called a “disease.” So are problematic personalities and even learning difficulties. While it’s nice that alcoholics and addicts are not condemned as often and as harshly as they used to be, the “cure” for addiction still involves free will and discipline on the part of the “recovering” addict. S/he must accept certain dogmas which started in the 12-Step movement and have been adopted and developed further by professional organizations such as Hazelden. While considered victims of a disease, addicts are still expected to play an active role in their recovery.

Let us examine the concept of disease as a model for rehabilitating the image of people’s whose behavior isn’t quite acceptable. It is much easier to define physical health and it’s opposite. We all know what a healthy body looks and acts like. Behavior is dependent on our “values” which is a philosophical question.

laingWhile the medical establishment has built up an elaborate edifice of dogma, there have always been the mavericks who challenge those dogmas. Even schizophrenia has come under the scrutiny of Dr. R.D. Laing. More radical critique have come from Dr. Thomas Szasz, whose book, The Myth of Mental Illness, attacked the very concept of psychiatry. There is a movement behind these intellectual critiques. The Ex-Patients’ Movement: Where We Have Been and Where We are Going is but one of various groups that have taken issue with establishment thinking (and institutions).

People with “personality disorders” and conditions such as ADHD are less likely to find personalitythemselves in institutions where they lose their civil rights. Perhaps that’s why there is less organized resistance to psychiatry. Far from forcing “treatment” on people with personality disorders, psychiatrists are prone to avoid even treating such “patients.” That is especially true for people with Cluster B, the so-called “dramatic cluster” of personality disorders. Of this group, people with Histrionic, Narcissistic and Antisocial Disorders are usually happy to ignore psychiatry. Only people with Borderline Disorder usually seek treatment because they suffer the most. But psychiatrists are usually averse to treating Borderlines. They, in turn, are actively fighting their plight with movements such as Make BPD Stigma Free.

antisocialMost psychopaths, which psychiatrists call people with ASPD, Anti-Social Personality Disorder, are probably the most adverse to “treatment.” Most of us do not believe there is anything wrong with  us. An exception is Jessica Kelly, mentioned in my opening paragraph. She hearkens back to when “mental illness” was the alternative to being a bad person. Psychopaths are all-too-often considered bad or evil. Even psychiatrists who supposedly have moved beyond that kind of moralism psychiatry was supposed to eradicate often judge us in moralistic terms. I suspect one reason so many people can’t let go of their judgments is that we are, as Robert Hare puts it, Without Conscience. At the same time, we are hyper-rational which makes us calm and matter-of-fact even when discussing subject matter most people find volatile. Whatever the reason, the magic blanket which so successfully shields other “mentally ill” from judgment doesn’t seem to cover us. There are even books like People of the Lie by Dr. M. Scott Peck who unabashedly mixes Christianity with science.

psychopathtestThomas Sheridan, one of the most active haters of psychopaths has expressed fear that psychopaths would soon get away with crime on the grounds that we are mentally ill. Nobody really gets away with crime on that basis. Read The Psychopath Test by Jon Ronson. England has hospital/prisons for criminals with mental illness diagnoses. These places are prison. But you can’t always get out after serving your term.

Let’s face it. Moralism has never been superseded by science. Calling something “mental illness” doesn’t remove the moral stigma. Instead, the mental illness labels become stigmatized. No label is more stigmatized than psychopathy or ASPD. Whether we call it “mental illness” or a “personality disorder,” the label will be toxic. What is a personality disorder anyway. What is a disorder? It’s something wrong, something that shouldn’t be. Something that doesn’t work properly. In psychiatry, a “disorder” is something society doesn’t like. Robert Hare, who has called us “social predators,” has more recently said, “Psychopaths are not disordered. They don’t suffer from a deficit, but they’re simply different.”

stupidityWe are going to have to live with stigma. Correcting the judgments of psychiatry won’t do it. The DSM no longer called homosexuality a disorder. But homophobia lives on. Blacks are equal by law in the United States but are still discriminated against. “Jews need not apply” no longer graces want ads. But antisemitism is a lot harder to eradicate than such overt signs of it. Stigma will last as long as human stupidity which I expect to last as long as we live.

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