Who is Insane?

Tuesday, 22 September 2009

When we remember we are all mad, the mysteries disappear and life stands explained. – Mark Twain

[Picture of a lunatic restrained in a straitjacket in an insane asylum cell]I WILL show here that there are a lot of popular misconceptions and misunderstandings about mental illness, and that we are being seriously manipulated by celebrities, the media and the legal system.

It is a very human trait to attempt to group things together into classes or classifications — from books and music collections to plants and animals. We like to pigeon-hole and categorise everything we encounter.

[Picture of filing system - classification, grouping, sorting]This approach is supposed to simplify matters and reveal patterns that aid understanding.

The trouble is that as we know more, we re-classify, recategorise, revise and review the data, so everything is really in flux.

The investigations into human behaviour, individual and social, have over time produced many theories and have resulted in classifications and reclassifications on a continual basis.

[Picture of a Gollywog ragdoll]If you are reading this, you will no doubt be well aware of the changes in how the perception of certain groups of people has changed over recent years — examples would have to include women, black skinned people, the aristocracy, and homosexuals.

As far as insanity is concerned, there actually does exist an ultimate authority:

  • ‘The Diagnostic and Statistical Manual of Mental Health Disorders‘ (The DSM) is the book that determines what is normal and what is insane.

[Picture of the book]The DSM is the rule book all over the world — not just in the USA where it is published by The American Psychiatric Association (The APA). In the UK, psychiatrists generally would not get their work published if they did not follow The DSM diagnostic guidelines.

This book has been revised four times, and is presently being updated.

Many things that were once classed as insane, are no longer so, and other behaviours that were not included in one edition are included in another.

Probably the most famous (or infamous) example would be that homosexuality had always been classified as a mental disorder by The DSM, and treatments were prescribed.

[Picture of homosexual rights protest parade]In 1973, for the third edition of The DSM, homosexuality was removed from the classification of mental disorders and replaced by the category Sexual Orientation Disturbance. The reason given was that this was a compromise between two views — on the one hand that homosexuality is a treatable mental disorder, and the other — that homosexuality is merely a sexual variant.

This may surprise you, for in this, the 21st century, the dominant ideology is that homosexuality is neither a mental disorder nor a normal sexual variant, but a special and defining aspect — people are born gay and are therefore different in a way that is on a par with race.

Who knows, maybe this will be the new definition in the fifth edition (The DSM-V) when it is published.

I don’t know about you, but I find it interesting — and somewhat alarming — to discover that definitions of insanity are so fluid. The American Psychiatric Association is the group of people who decide what goes into an edition of the DSM.

[picture of tossing a coin to decide if bipolar disorder is recognised]When the publishing deadline is coming up, a committee will reach deadlock on a particular classification.  One eminent psychiatrist will not budge from his opinion, for example on the existence of bipolar disorder, while another — equally eminent psychiatrist will stick to his guns that this exists — so they quickly take a vote, and reach stalemate; it’s 50-50.  Basically the panel of scientists involved are split down the middle, opinion is divided equally — so the committee chairman has the casting vote — and in goes bipolar disorder!

Yes, it is as tenuous as that!

Psychiatrists from the UK are presently voicing concerns about the prospect of bipolar disease in children being added to the next edition – not least because the drugs used to treat the disorder have serious side effects.

This is pretty amazing to me; this book is used in courts of law all over the world to prove diminished responsibility and more besides. It is venerated as a “bible”, yet nothing it contains is absolute — and in fact may range from probable to just plain wrong.

To make matters worse, there has been a lot of concern in the scientific and legal communities with regard to the transparency of the committees/ panels of The APA when compiling a revision of The DSM.

[Picture of cash notes stuffed into manilla envelope]The pharmaceutical industry — the drug companies — who make pills that treat mental disorders may have more influence than previously thought.

We have to ask whether or not traits of human personality are being turned into medical classifications to keep sales of pills high.

This is all of massive importance, in my opinion. People who are a bit off colour visit their GP, who looks up the current edition of The DSM, ticks enough checkboxes and declares the patient to have, for example, bipolar disorder.

[Picture of a manic depressive Patient under restraint]The range of problems that are presently are grouped as bipolar disorder would have been called ‘anxiety’ and treated with tranquillisers in the 1960s and 70s. In the 90s, they would have been reclassified as depression and treated with antidepressants.

In popular culture, Bipolar Disorder is, for some unknown reason, understood as a modern term — a simple name-change from Manic Depression — and that is seriously wrong;  Manic Depression used to hospitalise patients during bouts of depression or mania.

[Picture of patient visiting GP in surgery]This leaves the patient in a mixed-up state; on the one hand he or she feels good that whatever-it-is-that-they-have, it has a name — so when someone asks them why they are off work, they can say ‘Bipolar Disorder’.  It is something they can put on forms.  On the other hand, it is scary to have a very serious mental health problem, it is awful to be treated differently by colleagues, friends and family; they whisper “It’s Manic Depression you know”!

Imagine, just imagine, how they would feel if, in the next edition of The DSM, their mental illness simply vanished!  What happens then?  Do they just put on their CV when they try to get back to work that they were “a bit fed up” because they cannot put “Bipolar”?

That is not even as ridiculous or as far-fetched as you might think.  Apart from children with Bipolar Disorder, there are proposals for Shopping Addiction, Internet Addiction, and even eating snacks too late in the evening. Seriously.

If we turn once again to Bipolar Disorder — the drugs currently prescribed are supposed to be about stabilising mood. It may surprise you to realise that there is NO EVIDENCE for any drug being capable of stabilising mood! There is not even any evidence of the brain having mood centres for the drugs to target! Many psychiatrists and GPs believe that bipolar drugs might be useful just by being neuro-protective — but this is wrong, and in fact the opposite is true; the drugs are known to cause brain damage!

[Picture of a psychiatrist and patient on couch]If you meet five out of the nine check boxes you are classed as having Bipolar Disorder — which is why it is the most common mental illness today!  Almost everyone has it!  This is because the criteria is so broad and open to interpretation, and this in turn is because it is not actually certain that Bipolar Disorder even exists!

Wikipedia actually has a list of “celebrities” who have Bipolar Disorder! (en.wikipedia.org/wiki/List…disorder) — at the time of writing, this long and bizarre list claims as disparate types as Beethoven and Russell Brand, of whom it says:

“In a low-key admission at the end of the book, he says he was finally diagnosed with bipolar disorder – manic depression – after he kicked the drugs for good in 2002 which goes some way to explaining his almost superhuman indifference to the chaos and catastrophe that almost lead him to obscurity.”

This is popular culture, folks, Bipolar Disorder is an accepted FACT.

About.com has a celebrity list too — celebrities are listed by birthdate (for some unknown reason).  The preamble to the list is as follows:

“Some of the people listed here are celebrities who have talked openly about having bipolar disorder; others have been judged by history to have suffered from manic depression…

The list will grow as the next year goes by. We are adding short biographical pieces about each of these famous bipolars on their birthdays”

It is actually FASHIONABLE to be Bipolar!

Britney Spears, Kerry Katona and other Z-list celebrities can get away with anything they want to do, because they will have the excuse of either being Bipolar or being medicated with Lithium because of the disorder.

I just do not believe that so many people can claim to be insane, it is statistically unlikely, and I am more inclined to believe that showbiz folks want headlines. They may want to appear hard-done by, or want sympathy or an excuse for spoiled brat behaviour or maybe they want to appear brave in the face of adversity.

To summarise my understanding:

  • Bipolar Disorder is not (and has never been) Manic Depression, they are not the same thing, the terms are not interchangeable;
  • Bipolar Disorder is very likely to be misdiagnosed — as a result of loose diagnostic criteria and possibly influence by drug companies;
  • Bipolar Disorder may not actually even exist — half the psychiatric community think that.

So who is insane? The answer is very few people — and certainly not as many as the celebrities would have us believe.

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8 Responses to “Who is Insane?”

  1. Brian Says:

    Yes it is terrible that these “celebrities” use bipolar disorder the way they do, especially as they are role models for young kids. A lot of teenage behaviour is about mood swings so this is probably worse than the old debate about celebrities promoting or causing kids to develop anorexia and bulimia.

  2. Brainy Says:

    Transsexuality will no longer be classified as a mental disorder in France 05/16/2009 — so whether or not you have a “mental illness” really just depends on where you live!

  3. Joel Says:

    The Americanization of Mental Illness in the New York Times by Ethan Watters…
    http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?em
    This essay is adapted from his book “Crazy Like Us: The Globalization of the American Psyche,” which will be published later this month by Free Press.

  4. Drew K Says:

    Lost the remote control and can’t be bothered to get up to change the channel on the TV? Don’t worry, you’re not lazy, you simply have sluggish cognitive tempo disorder.

    Or maybe you’re prone to a bit of a tantrum when you misplace the car keys? Possibly a sign of intermittent explosive disorder.

    These are just two of dozens of extravagantly titled ‘conditions’ under consideration for the latest edition of the Diagnostics and Statistical Manual of Mental Disorders – the psychiatrists’ ‘bible’.

    Read more: http://www.dailymail.co.uk/health/article-1250962/From-hypersexuality-sluggish-cognitive-tempo-disorder-The-excuses-lazy-new-psychiatrists-Bible.html#ixzz0fcXrlsu2

  5. Brendan Wilkes Says:

    I just read today that the whole idea of multiple personalities is rubbish too.

    Brilliant article from a wonderfully thought-provoking site. thanks

  6. dotterman Says:

    Hi, just dropped by to say that in DSM5 they have got rid of Aspergers Syndrome!!! I saw it on slashdot at… http://science.slashdot.org/story/12/12/03/0151218/no-more-aspergers-syndrome?sdsrc=popbyskid

  7. Chris Says:

    Psychiatry framework seeks to reform diagnostic doctrine

    Critics say clinical manual unfit for mental-health research.

    http://www.nature.com/news/psychiatry-framework-seeks-to-reform-diagnostic-doctrine-1.12972


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