How did modern systems of psychiatric diagnosis come into being? I will tell you, because it came to me in a dream. There were these men, hanging from hooks, looking down into a pit of unwashed humanity. Above them was a golden globe, containing the ideal person, someone mentally healthy, sane, and normal in every way. The men on hooks, having only vaguely examined the ideal man floating above, looked down on all that lay beneath. They scowled. They laughed. They were appalled.
You see, the people below deviated in all sorts of ways from the ideal man floating in the golden globe. In fact the pit contained a virtual sea of departures from the radiant ideal in the sky. The men on hooks noted down these departures and created a list: there turned out to be hundreds of ways the human beings in the pit fell short of the perfection inside the globe.
Then the men on hooks noticed something and began to tremble with excitement. There were groupings, clusters of co-occurring deviations. Collections of individual people shared in common not just one but a set of the same departures from the golden ideal.
For example, the men saw that a number of the pit-persons were walking and talking very slowly. This is not normal, they thought, because a person ought to speak more quickly and move more rapidly. They should not move too fast, mind you, because that would be a deviation in the other direction. God did not tell them human beings should move at a particular clip; they just decided that this was so. Then it was seen that the slow moving ones very often were saying bad things about themselves, like: “I am worthless,” “I hate myself,” “No one loves me,” “I am trash.”
The hanging, suspended men conferred among themselves and agreed such negative self-descriptions were not normal and certainly did not occur in the thinking and speaking of the ideal being in the globe. He, according to them, thought well of himself, although not too well. This again they just arbitrarily decided. Then still another feature of the slow moving, self-hating humans under observation jumped into view: a great many of them were thinking about killing themselves! Closely connected with these thoughts, every last one of them was expressing an attitude of despair about their futures and they were making no constructive plans for themselves, except perhaps for suicide.
So the suspended men were witnessing, in a subset of the unwashed, the correlated presence of the following features: a slowing of action and thought, feelings of worthlessness, despair about the future, and suicidality. The men on hooks decided to give a name to the people showing these features: they called them ‘depressives’ and they named their state ‘depression.’ The words ‘melancholia’ and ‘dysthymia’ also came up in their mid-air discussions.
Later on that same day, the men gazing down noted a parallel clustering that involved a different set of deviations from transcendent perfection. They saw that the structure of the thinking and reasoning of some of the pit-men and pit-women was unusual and hard to follow. Conclusions seemed to be drawn that did not follow from premises, and thoughts radiated off into all manner of tangents and strange associations instead of proceeding along linear, comprehensible pathways.
The glowing entity in the globe, by contrast, reasoned in tight little Aristotelian syllogisms that were transparently intelligible. Many of the illogical people, dispersed in the masses below also turned out to have odd expressions on their faces that did not seem to fit with what they were perceiving and thinking about. People in the midst of tragedy were laughing, and people having success were crying. The golden man above, as the men imagined him, was very different: his emotions coordinated perfectly and appropriately with all that he was thinking and perceiving.
His affects and his cognitions showed no slippage at all! Then they spotted still another feature often correlating with the illogic and the disjunction between thought and feeling: these same pit-persons, in many instances anyway, had beliefs and experiences that seemed unconnected to the real, almost as if they had been swept into a private reality of their own imagining. They were hearing voices no one else could perceive, seeing and otherwise sensing things that were not there, and believing all manner of absurd things that were not true.
The radiant being in the globe had clear, sharp perceptions of the objective world. His contact with reality was flawless. A final feature, often salient in these same poor individuals under the sweeping gaze of the men on high, was that what feelings they did show alternated between all positive and all negative, with no shades of grey in between. It was as if this group among the unwashed did not know of the possibility of mixed emotions: everything was black and white. So our suspended examiners gave a name to this cluster: illogic, inappropriate affect, lostness in a private reality, and splitting apart of positive and negative feelings. That name was schizophrenia.
Other collections of correlated deviations from the magnificent standard of the globe-man were noted and named: psychopathy, hypomania, obsessiveness, hysteria, narcissism, bipolarity, multilplicity, and a vast range of others. But then, something ominous began to take place: a process of making the abstract concretely real, of objectifying what is really just a name that has been placed on some things that appear to go together. The men on hooks were swinging back and forth more and more rapidly, trembling, perspiring, surveying and classifying, and they believed they saw something beyond mere correlations.
Their labels for the groupings of co-occurring deviations turned, in their minds, into objective conditions existing inside the poor pit-people. They were transformed into mental diseases, emotional illnesses, psychological disorders. The men on hooks imagined they had stumbled upon conditions actually existing inside people, and the various departures from the golden ideal now turned into ‘symptoms,’ seen to emanate from these internal conditions.
The genesis of the diagnostic system was now complete. Any individual person, whatever his troubled state in the particular world he or she inhabited, was now to be examined in relation to the clusters of deviations from the golden ideal. In other words, people became instances of diagnostic categories. In this way the unique experience of the individual was erased and the stage was set for a psychiatry of mental illnesses. There is no scientific foundation for our diagnostic systems: they are the brainchildren of men suspended on hooks.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Thank you for this great post describing the mythical creatures that make up of psychiatry’s zoo of pseudo-labels. This made me recall a story entitled “The Psychiatrist and His Apprentice Visit the Zoo”:
Psychiatrist: “My young apprentice, I’m glad we’re visiting the county zoo to practice identifying diagnoses! Do you see that sloth hanging from that tree? What would you diagnose him as?”
Trainee: “I think he’s exhibiting the negative symptoms of schizophrenia, don’t you think so, sir?”
Psychiatrist: “Indeed! Well done, my young apprentice. And what about that tiger angrily pacing back and forth?”
Trainee: “That tiger looks to be exhibiting a conduct disorder, or perhaps sociopathy proper, although I’d be hesitate to assign such a bleak diagnosis to this fine creature.”
Psychiatrist: “Our job is to label and describe, not judge, young man. But indeed, this aggressive beast appears to meet criteria for a sociopathic spectrum condition. Now what about those wildly chirping birds in the cage behind us?”
Trainee: “Well, they appear hysterical, but I thought that label disappeared from the DSM? So maybe we can call those birds borderline? Their squawking is rather manipulative and attention-seeking.”
Psychiatrist: “I’d take either. And what about that young monkey that is leaping excitedly from branch to branch?”
Trainee: “That’s easy. ADHD writ large. I hope the zookeepers are keeping his Ritalin dose high.”
Psychiatrist: “But of course, this young simian’s diagnosis is unavoidable. And don’t worry, the pharmaceutical companies I work for will ask zoo management if they have need of an early identification program for hyperactive young monkeys. We want to make sure we intervene early, just like we do in human children. And we must not forget to ask if they need antipsychotics at the sloth house.”
Trainee: “Indeed, my master.”
Psychiatrist: “Now, my young apprentice, let us observe this chameleon in the reptile house that is changing from red to blue as it moves across its landscape.”
This is so brilliant – made my day, thank you :D.
Loved it, you nailed the diagnostic spectrum”’
“Men on hooks” – I like this one ;).
B – yeah, super funny, here, and let’s you go with the middle way, laughing loud, too. So, listen, B–relatedly on getting the big pictures to what good thinking ought to seem to all who know, have you heard of the book called “Logic Comix”? I picked this neat book up and have only checked it out to consider its value and see how it might settle on logical asides in the drawings and their juxtapositions…”beyond” the remarks. Taken seriously as your introductory text it provides a sweeping survey of intellection on logical theory, and coughs up the general facts of the history of its multidisciplinary implications in relation to the History of Ideas. I am sure you could find howlers from one chapter to the next, since they work through Russell and Whitehead, and Russell thought bad work was what “genius” makes most well into its owner’s bad jokes about his own soon to be “prior self”–in faculty and publication terms, anyway.
I have not heard about that book, thanks :).
This is awesome!!
I second the awesome!
It is in the imagination of the observer.
Had the men hanging from hooks been hanging instead from ropes around there necks and left a note signed by all of them .” We were conspiring to do crimes against humanity and instead diagnosed and treated ourselves .” signed…… The Would Be Architects Of The PsychoPharmElectricGulogarchipeligo .
Creative piece, thank you. And great minds think alike, I’m working on my own painting of the Vitruvian Man. Although I modified mine somewhat, based upon theories within so called sacred geometry. I have the circle and square both centered on the man’s belly button, the true source of life, rather than the square centered upon what currently seems to rule this too paternalistic world.
I have also painted a tree of life into mine, and the perfect man theoretically will be Jesus, a shadow of the crucified man, and the one to return alive – although I’m still working on figuring out how to properly translate the pencil drawings of the figures into the painted form. Hopefully, I’ll be successful.
And I hope and pray for a day when common decency rules, and all understand they are to treat all others as they’d like to be treated, rather than lunetics on hooks dreaming up ways to stigmatize all who did not choose to go into psychiatry rule the world, largely based upon what’s important to what’s centered in da Vinci’s box.
Pardon my cynicism, but some of us ‘pit people’ / spiritual artists have theories, hopes, and dreams of a better world some day, too. And we’d like the psychiatric industry / “men on hooks” to get out of the business of covering up abuse of small children by turning crime victims into ‘bipolar / schizophrenics’ with the ADHD drugs, antidepressants, and neuroleptics, please.
Thank you very much for the brilliant and frightening Article.
I hope I am not deviating too much with my contribution:
From the UK General Medical Council (yesterday) on Diagnosis:
“Though we do appreciate that you disagree with Dr xxxs clinical assessment, this is not something that suggests his fitness to practice may have been impaired. The referral to a local Psychiatrist to clarify what the correct diagnosis should be an appropriate step to take under the circumstances.”
I had actually complained about Dr xxxs Mental Capacity. He had claimed mental illness (on my part) due to my objections to a 30 year old historical record and my “denial” regarding my 30 year old historical experience.
At the time Dr xxx had made this claim, the historical record had already been removed from my record’s on account of its ‘inaccuracy’. And Regarding my historical experience “denial”: my longterm recovery (of 30 years) had followed me taking myself off strong medications (the GMC had all of this information on file).
I talked on the phone today with the GMC “letter writer”, a very pleasant young man who reassured me “that of course I needn’t see a Psychiatrist “, and who advised me to apply for a rule no 12.
I preferred Dantes version where the Frauds and Traitors to humanity were in the pits.
That’s my theory of what will eventually happen.
Thank you for this creative piece of writing.
It’ hard not to consider the spiritual dilemma of those doing the judging… Acting as little ‘gods’… I’m reminded of ancient scriptures that address this head-on:
“Judge ye not… Let he who throws the first stone… ”
These say more about the one who judges others, than those being judged. Unfortunately however, we all do it to some extent, even if we judge those who judge others.
Typo – let he without sin (imperfection) cast the first stone.
Boans hurls a huge brick through the window of the APA. Well they did say I was delusional, enough to think I’m perfect 🙂
Im in the process of building one of those giant boulder throwing siege machines and try to land a boulder on Murphy . After all, they said I had Illusions of Grandeur before they held me down and injected me with thorazine. I realize now that since then I’ve been anti-psychiatry. I just haven’t been able to come up with a grand enough illusion to shove psychiatry into the dustbin of history fast enough. I must have become normal.
Wonderful piece. The imagery seems to indicate that these men on hooks see themselves as the new Messiahs.
The DSM is such a flawed and potentially dangerous tome whose evolution I would describe this way:
A Den of Sanctimonious Men
on a Decidedly Self-serving Mission
Declaring Scientific Method
Determined to Supplant Moderation
and aid Dr. Spitzer’s Motive
to Destroy Sigmund’s Memory
while Debasing the Search for Meaning
by Describing Sensitivity as Madness
in their Dehumanizing Saddening Mockery
and Dangerous Sardonic Manual.
Dumb, Stupid Men (meaning men and women).
Dangerous, Stigmatizing Men.
Deceitful, growth Stunting Men.
Disabling, Shameful Men.
Disingenuous, Sadistic Men.
Following Dollars, Satan, and more Money.
Do men who call a book they write a “bible” have God complexes?
And how, exactly, are these men on hooks ‘ideal?’ I keep imaging a beam of light searing through those suspension ropes, causing these self-inflated black egotists to crash and burn into the pit. Perhaps, maybe, hopefully, that would cause a much-needed mass awakening to occur.