Judging from the way psychiatrists respond to Szasz's critique, most of them believe schizophrenia and perhaps a few other conditions described in the DSM are diseases of the brain in the same sense as Alzheimer's or multiple sclerosis, albeit with etiologies that are not yet clear. But when it comes to habits and traits such as smoking, gambling, gluttony, shyness, impulsiveness, inattentiveness, dishonesty, and nastiness -- not to mention diagnoses that have fallen out of psychiatric fashion, such as homosexuality and multiple personality disorder -- even psychiatrists recognize the arbitrariness of their taxonomy.
"The problem is that the diagnostic manual we are using in psychiatry is like a field guide, and it just keeps expanding and expanding," Johns Hopkins psychiatrist Paul McHugh told the Times. "Pretty soon, we'll have a syndrome for short, fat Irish guys with a Boston accent, and I'll be mentally ill."
Based on DSM criteria, the government's survey indicates that mental illnesses afflict one-quarter of us every year and more than half of us during our lives, with anxiety and mood disorders the most common problems, followed by impulse control and substance use disorders. Citing several limitations of the survey, the researchers argue that the true rates are even higher. Evidently mental illness is the new normal.
This pathologization of the human condition might be less troubling if psychiatric prescriptions were more effective than Theodoric of York's remedies. But by and large, it's not clear they are.
The survey's lead author says "we don't have a clue as to what will be effective" in treating all the "psychiatric hangnails" his study found. He and his colleagues note that mental illness rates have remained steady during the last decade despite the expansion of treatment; that "most treatment . . . falls below the minimal standards of quality"; and that there's "no evidence that pharmacotherapy significantly improves mild disorders."
Then they call for more treatment. Another bloodletting, Brungilda.