Setting the Record Straight: The Psychiatric Legacy of Robert Spitzer

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On December 25, 2015, renowned psychiatrist Robert Spitzer died. Spitzer was a giant in world psychiatry, best known as the architect of the third edition of the psychiatry’s diagnostic bible — The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) — the edition that effected a turnaround and became the template for how psychiatric diagnosing has proceeded ever after. As such, this death has hardly gone unnoticed, with stories about him proliferating. Most of what is written is highly laudatory. We are told, for instance, that he placed psychiatric diagnosis on a scientific foundation, that he introduced rigor (see, for instance, this article in the New York Times), that he was a “pro-gay psychiatrist” who “campaigned to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders.” (Newsman. This article takes serious issue with the most significant of the claims.

To be clear, it is always sad when someone dies — and I in no way wish to detract from the personal tragedy. Nor do I intend to make any pronouncement about Spitzer the individual. What concerns me in this article is one thing only — how to understand his “psychiatric contribution” to society. Now no one denies that Spitzer was enormously influential. However, it is precisely because his legacy endures and because vulnerable people are forced to live with what was set in motion that I felt compelled to write this article.

So what are we to make of the claims? And what in fact is Spitzer’s legacy?

Claim: Spitzer Was Enlightened and Opposed the Pathologizing of Gays

It is claimed that Spitzer was largely responsible for removing “Homosexuality” as a disorder from the DSM. This claim has some merit. Nonetheless, the situation is not as straightforward as it appears.

The American Psychiatric Association (APA) was in difficulty at the time. Gay rights activists were skillfully protesting the inclusion of said disorder, interrupting meeting after meeting of the APA (see Teal, 1971). Spitzer was called in to help. His actions eventually culminated in a postal vote and the concomitant removal of the offending diagnosis from the DSM. That this is an important legacy is without question.

At the same time, Spitzer was hardly the great liberator suggested by most who tell this story. What is significant in this regard; he went on to introduce another disorder which also pathologized gay life — ego-dystonic homosexuality. This was a particular worrisome diagnosis for it pathologized discomfort with being gay — a reaction totally expectable in a homophobic world. Herein we find an unfortunate default mode which characterized Spitzer and those who followed him — totally ignoring context. As for the question of gay existence per se, for most of his professional career, Spitzer flip-flopped on it. In the early 2000s, for example, mounting a study in support of a therapy to “cure” people of being gay, and in 2012 retracting said study — albeit only after it was exposed for shoddy scholarship (see this article in the Washington Post).

The Major Claim: With the DSM-III, Spitzer Introduced Rigorous Science and Thereby Made Diagnostic Psychiatry Credible

This brings us to the main claims and without question the central “contribution” for which Spitzer is known – the revolution that constitutes DSM-III. On this “contribution” clarity is critical — for to misunderstand it is to misunderstand the nature of the psychiatric quagmire that we as a society are facing to this day.

The claim put forward by almost all psychiatrists, including those of a reformist bent, is that Spitzer placed psychiatric assessment on a more or less solid scientific foundation. States “psychiatric reformer” Dr. Allen Frances in this regard, “He [Spitzer] saved the field … from a crisis of credibility, raising its scientific standards.

There are two sets of claims involved. The first is that psychiatry was suffering a crisis of credibility, that Spitzer introduced a new approach to diagnosis with DSM-III, and that in the process he shepherded psychiatry through the crisis. To start at the beginning, there was indeed a crisis at the time: Psychiatric diagnoses had been shown to have extremely low inter-rater reliability. That is, the chance of different psychiatrists assigning the identical diagnostic category to the same patient was low — little more than chance. Moreover, a major experiment by Rosenhan (1973) had exposed psychiatry on an even more basic level.

The experiment involved Professor Rosenhan sending students pretending to be disturbed into hospitals. While the students proceeded to act “normal” except for initially telling staff that they had heard a voice saying, “hollow,” “thud,” and “empty,” all were kept a sizeable time and all were assigned major diagnoses. When the results of the experiment became known, the public’s reaction was that psychiatrists could not even distinguish between “real patients” and “pseudo-patients” — never mind between different “disorders.” And as such, the credibility of the diagnoses, and by extension, psychiatry itself, was at an all-time low.

Did the reputation of each improve after the introduction of DSM-III (1980)? Yes, it very much did. And was this because of how DSM-III was constructed? To a significant degree, yes. And was this because, as claimed, psychiatric diagnosing had finally been placed on a sound scientific footing? In a word; no.

By way of explanation; Spitzer for sure created discrete diagnoses. Correspondingly, unlike in the past, they came complete with explicit sets of criteria, superficially at least reflecting how physical disorders are delineated. And for sure, tests were conducted and validity thereby “claimed” for each of the included disorders. The point is, however, that mirroring the trappings of medicine — that is, using medical-sounding language — has no bearing on validity.

Aside from the inherent persuasiveness of medicalized language, what exactly was Spitzer’s claim to validity? Quite simply, that the research conducted by his team had established high inter-rater reliability. The problem here is that high inter-rater reliability similarly has nothing to do with validity. To quote a passage from Burstow (2015) in this regard:

“The fact that people can be trained to apply a label in a consistent way, note, does not mean that the label points to anything real. To use an extreme example, let us say that we want doctors to be able to identify people walking about who secretly hail from Mars. We might provide clear criteria for such people and so carefully train the doctors that they achieved a high level of agreement when making their determinations. None of this gets around the problem that there are in all likelihood no people from Mars walking the earth.” (p. 78)

A still further problem enters in with Spitzer’s very claim to high inter-rater reliability. At their most successful, there was miniscule difference between the reliability ratings for DSM-III diagnoses and the rating for previous “disorders.” Often there was no difference at all, and at times the DSM-III scores were lower. This despite the fact, as Kirk and Kutchins (1997, p. 52 ff.) demonstrate, that experiments were rigged so as to create superior results, including providing the DSM-III raters with extensive training so that their scores would be bolstered. Additionally, different criteria were used when re-evaluating the DSM-II studies than when interpreting the DSM-III studies — thereby creating the impression/misimpression that the DSM-III categories yielded superior results. One obvious example is that the very same level of agreement that was deemed “only satisfactory” in the reevaluation studies (e.g., 7) was deemed “high” or “very high” in the studies involving the DSM-III categories.

This is not medicine. This is not science. And this is not rigor.

So if the claim to high scientific standards will not hold—and, as you can see, it will not — exactly what was the revolution that DSM-III constituted?

What was introduced was a classification schema that was avowedly neo-Kraepelian (see Kraepelin, 1907 and Burstow, 2014) — that is, an etiology-free schema which has little tie-in with the realities of people’s actual lives and, as such, is largely classification for classification’s sake. In the DSM as it emerged, there is no thought to why people are acting as they are. The not-so-hidden benefit to psychiatry is that the new schema put an end to most internal squabbles, for it is precisely when it comes to issues of cause and what something is “about” that arguments break out. The ramification of such a system, correspondingly, is that the label or diagnosis itself ends up being treated as causal. The circularity thereby engendered is visible in this comment which I made in a recent interview:

“[The DSM) sets practitioners up to look at distressed and/or distressing people in certain ways. So, if they go into a psychiatric interview, they’re going to be honing on questions that follow the logic of the DSM, or to use their vocabulary, the “symptoms” for any given “disease” they’re considering. In the process it rips people out of their lives. And so now there’s no explanation for the things people do, no way to see their words or actions as meaningful because the context has been removed. In essence, the DSM decontextualizes people’s problems, then re-contextualizes them in terms of an invented concept called a “disorder.” Let me give you an example. “Selective Mutism” is a diagnosis given to people who elect not speak in certain situations. So, if I were…trying to get a handle on what’s going on with somebody—I would try to figure out what situations they aren’t speaking in, try to find out if there’s some kind of common denominator, to ascertain whether there’s something in their background or their current context that would help explain what they are doing. You know, as in: Is it safe to speak? Is this, for example,  a person of color going silent at times when racists might be present? Alternatively, is this a childhood sexual abuse survivor who is being triggered? Whatever it is, I would need to do that. But this is not what the DSM, as it were, prompts. In the DSM, “Selective Mutism” is a discrete disease. So, according to psychiatry, what causes these “symptoms” of not speaking? Well, “Selective Mutism” does.” (Burstow’s response in Spring and Burstow, 2015)

Combine this vacuousness and this circularity with medicalized language, such is the revolution that was DSM-III.

Concluding Remarks

I began this article by taking issue with claims about Spitzer’s legacy. Clearly Spitzer’s most formidable contribution to psychiatry is his overall contribution to diagnostic psychiatry via introducing a whole new way of constructing diagnoses, as spearheaded in DSM-III. On this, everyone agrees. However, what is it that Spitzer — and his colleagues — set in motion? Contrary to the claims being made, through the use of scrupulously medicalized terms and through the pretense of carefully conducted research they created “the appearance” of science, medicine, and rigor. That is, they set psychiatric diagnosing decisively on a path where it would look scientifically rigorous; where it could claim the authority of medicine on the basis of appearance, while in point of fact being vacuous. Correspondingly, subsequent DSMs have continued in the same vein — hence the difficulty confronting psychiatry.

In ending, I would remind readers once again that a human life has been snuffed out. At the same time, I invite readers not to lose sight of the real legacy of Spitzer and his brainchild, the DSM-III.

Otherwise, how are we to keep our bearings in the struggle ahead?

* * * * *

References:

Burstow, B. (2014). Neo-Kraepelinian Psychiatry. In Cultural Sociology of Mental Illness (Andrew Scull, Ed.). (pp. 575-576). Thousand Oaks, California: Sage.

Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave Macmillan.

Rosenhan, D. L. (1973). On being sane in insane places. Science, 179, 250-258.

Kraepelin, E. (1907). Clinical psychiatry. (Ross Diefendorf, Trans. and Ed.). New York: Macmillan.

Kutchins, H. and Kirk, S. (1997). Making us crazy. New York: The Free Press.

Spring, L. and Burstow, B. (2015). Probing Psychiatry and the business of madness. Retrieved January 5, 2016 from http://rabble.ca/books/reviews/2015/07/probing-psychiatry-and-business-madness

Teal, D. (1971). The gay militants. New York: Steiner and Day.

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34 COMMENTS

  1. Thank you for this articulate article and your community service.

    I believe that your article is an objective criticism of Spitzer’s legacy but misses why his work is so valued by the field of psychiatry. Before the DSM III, psychiatry was in the awkward position of claiming to be a medical science while being based on the imaginary world of Sigmund Freud. Freud’s subconscious battle between a primitive “id” and a moral “superego” was an absurd foundation for a medical science; besides public criticism, other medical professions mocked psychiatry. Spitzer gave psychiatry the appearance of a scientific foundation; the “movement” will eventually succeed in exposing the fraud.

    Best wishes, Steve

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      • I see nothing more absurd in Freud’s “id” and “ego” formulation than anything in the DSM series since Spitzer. Actually, I like Freud’s conceptualization better, because at least it’s simple and easier to apply, and doesn’t completely remove behavior from its context.

        Of course, the real truth about Freud and psychoanalysis is that Freud was the first to honestly observe that women were being sexually abused in massive numbers as children, and to say that out loud. He was so severely castigated by his colleagues at the time that he reacanted and invented his “fantasy” theories including the Oedipus complex and so forth, and thereby helped set us back 100 years before the truth once again came to the surface. But compared to Spitzer, Freud appears to have been much more genuinely interested in understanding what was really going on with people. It’s unfortunate that even in his day, organized psychiatry was already suppressing any effort to contextualize suffering and severely punished anyone who did so.

        — Steve

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          • Can’t argue with you there, Steve. He totally sold out and the consequences were dire. My point was more that the psychiatric/medical establishment of Freud’s time was no more interested in hearing the truth about trauma and its effect on the mind than today’s psychiatric leaders. I think it’s about more than just money – the people in power positions don’t want to believe that their arbitrary use of power is or can be harmful to the rest of the populace. Blaming the victim is an old game, and it’s very unfortunate that Freud decided to go there, but he’s in very good company!

            —- Steve

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      • Bonnie: I have been reading your posts and others here for about two years.. I also read Robert Whitaker’s latest book over the Summer. As someone trained as an Historian, I can understand the emphasis on the release of the DSM in 1980, as a watershed event. Hopefully, one outcome of this site, will be a success effort to recognize these sea changes as they are unfolding, rather than just documenting them for posterity after the fact.
        While some of the contributors here are psychiatric survivors, and others are dissident mental healthcare providers, I am like some on this site, who have a foot in both worlds. I met with my supervisor of the youth agency where I work, wherein we discussed psychotropic medication along with other topics-I loaned her a copy of Anatomy of an Epidemic. She was also encouraged by my decision to run for the local legislature. In my experience, I am not familiar with an office holder who is open about past experience with involuntary commitment.

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    • There was plenty of diagnosing going on pre-1980. And few if any shrinks I came into contact back then gave a hoot about Freud or psychoanalysis.

      the DSM decontextualizes people’s problems, then re-contextualizes them in terms of an invented concept called a “disorder.”

      Yes, and even looking for a substitute term for “mental illness” presupposes that there is a “something” which needs categorizing.

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      • Indeed, it does, Oldhead. I totally agree. At the same time, I should add that psychoanalytic psychiatrists made up a 100% of the taskforce for DSM-II. It is not that psychoanalysis was not big at the time–it was huge. Rather it is that it was applied to some population and not others.

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      • Old head: I was ensnared into the system, in 1980, so I can’t really speak to the sea change brought, allegedly or otherwise, by the DSM III. I did buy a book about Psychiatry and its depiction by Hollywood, a few years back. The psychiatrist who co-authored the book, seems to be pushing back against the negative depiction of psychiatry in film, which I hazard was capturing, or at least refracturing public sentiment of the time.

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  2. Thanks for exposing what most psychiatric survivors and most outpatient psychotherapists already know:

    Robert Spitzer contributed nothing of lasting value, but his “contributions” enabled significant harms associated with psychiatric diagnosing and drugging. His primary contribution was to enrich thousands of psychiatrists and many drug companies.

    I for one do not shed a tear at his passing, similar to how I don’t regret the passing of other individuals who have contributed to harming a large group of people. It is a relief that Spitzer is gone.

    His brainchild of the DSM III culminated in the disgrace that was the DSM V, with its worsening reliability and the massive protests against it. Mickey Nardo showed how horribly unscientific the process of having old white men invent diseases in board rooms really is:

    http://1boringoldman.com/index.php/2012/05/22/to-take-us-seriously/

    Spitzer’s “contributions” enabled a whole group of people to be stigmatized as “others” having “brain diseases”, causing pessimism, fear, worse outcomes, and legitimizing the long-term drugging with terrible side effects of millions of people. Spitzer is therefore one of the people whose contributions have led to the most harm worldwide, measured in emotional suffering and lost years of life, in the last several decades. We are better off without people like him.

    Hopefully in a few more years we can add E. Fulley Torrey to the same list of deceased con artists. When Torrey kicks the bucket it will truly be a day of celebration for psychiatric survivors.

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  5. Dr. Sptizer was a medical doctor. He wanted to raise the image of psychiatry as a specialty that would fit into the medical model, so he devised diagnosis. He tried to describe the symptoms of “mental illness.” In the early twentieth century most medical diagnosis were based on descriptions, but by the end of the twentieth century other medical diagnoses were based on more objective, measurable, physical data. There are x-rays, blood counts, MRIs, blood pressure, temperatures, biopsies, and many other lab tests to help determine what causes the symptoms. That never happened for emotional, psychological or behavior problems.

    What are the causes of “mental health” difficulties? Here is a list from the top of my head:

    Loss, loneliness, illness, stress from work, stress from a relationship, financial problems, racial discrimination, poverty, as well as sexual abuse, domestic violence, living in a war zone, living in a family that seems like a war zone. Also, genetics play a part, and now we also see epigenetics have something to do with behavior, and the microbes in our digestive tracts, and brain injury, and the toxins from food, lead paint, air pollution, water pollution. And a dark, cold winter, and being bullied, being very fearful for no apparent reason, being very fearful for very apparent reasons, losing a job, going to war. having parents who are rigid and mean, having parents who spoil you, not conforming to the local culture, conforming too the local culture….

    The cause of psychological, behavioral and emotional problems are all of those things and much more. It comes from many of those thing happening at the same time and all of them interacting with each other. The causes are physical and environmental. They are personal, social and political. If only the biological is treated, then the environmental and social will make progress difficult. If you only treat the environmental, the biological and social will still cause difficulties.

    The trouble is that if our society is going to pay for treatment the problem needs to fit a medical model. Emotional and behavioral problems really don’t fit. Spitzer tried to make everyone think that it did. The more he succeeded, the more the treatments failed.

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    • The trouble is that if our society is going to pay for treatment the problem needs to fit a medical model.

      By “our society” you refer to the corporate dictatorship that decides these things, of course?

      So I think you’re intending with your list of causes to bolster the argument against categorizing behavior sans context, correct? Except for the biological part I agree; I think actual neurotoxicity (other than that induced by pharmaceuticals) is a minute part of the equation.

      All this talk reminds me of Dr. Bonker’s listed causes of “depression” (hope he doesn’t mind me quoting him):

      Researchers have identified the five primary causes of mild, moderate and severe clinical depression:
      1. Imbalance of key chemical neurotransmitters in the brain;
      2. Chronic low-grade hopelessness generated by early childhood trauma;
      3. Marriage to the wrong person;
      4. Sudden realization of the essential absurdity of life;
      5. Ecological catastrophe on a scale never before seen in human history.

      Other factors which might trigger a depressive episode include:
      * having either too much or not enough of something;
      * being trapped in an utterly hopeless situation with no way of escape;
      * remorse, guilt, shame, failure, disappointment, frustration, grief, heartache, pain or loss of some kind;
      * infestation of household pests such as termites or rodents;
      * omega-3 deficiency from not eating sufficient quantities of cauliflower and other vegetables;
      * leaky faucet, clogged drain or similar plumbing problem;
      * global economic collapse, thermonuclear war, mass starvation, genocide, etc.

      (Source: http://www.bonkersinstitute.org/asymptomatic.html)

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  6. This is a good point, Bonnie, “In essence, the DSM decontextualizes people’s problems, then re-contextualizes them in terms of an invented concept called a ‘disorder.'” And I will tell you, because of this, I quickly found it completely counterproductive, actually insane, to try to talk to psychiatric practitioners.

    You go into a psychologist to talk, because you want to find out why you started having “brain zaps,” not coincidentally, just after being abruptly taken off a non- “safe smoking cessation med” / mind altering antidepressant. And you’re occasionally having odd thoughts and scary dreams, ever since 9.11.2001, when the terrorization of our entire country began. And you want to know if these symptoms could have anything to do your “safe pain killer” / actually mind altering and addictive, synthetic opioid. And, according to a psychologist and two psychiatrists, the common symptoms of antidepressant discontinuation syndrome and opioids have nothing to do with “brain zaps,” “odd dreams,” or uncommon thoughts. Really? Not.

    Instead, psychiatric practitioners become obsessed with trying to fit their theories of possible symptoms you might have, into the “disorder” they want to pin on you. My psychologist became obsessed with asking about “voices.” I had no idea what she was talking about at the time. Everything, according to her medical records, became a “voice” – a dream query is a “voice,” thoughts are “voices,” an unknown scream in a parking lot at Nordstroms becomes a “voice in head,” gut instincts are “voices” to psychiatric practitioners, too.

    And driving to Chicago to get a haircut with my regular hairstylist, and having lunch with my sibling, was considered to be a “sign of mania.” Contemplating going back to school for my masters degree was also claimed to be a “sign of mania,” according to my, apparently still living in the 19th century, seemingly misogynistic psychiatrist. Regular moderate exercise is a “sign of mania,” to my psychiatrist also.

    Truly, psychiatric practitioners “decontextualize people’s problems, then re-contextualize them in terms of an invented concept called a ‘disorder.'” They literally approach patient “care” by looking to try to fulfill a symptom list within the DSM, rather than actually listening to their patients. And, in reality, this insane behavior does actually render the psychiatric practitioners to be the “delusional” people.

    I have to agree, Spitzer’s contributions to humanity have resulted in a delusional stupidity fest taking over the psychiatric industry, lots and lots of profits for big Phama, and way too many lost lives and lost productivity amongst the patient populations. My condolences to his family, but I believe he brought about more harm, than good in his life.

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  7. Bonnie, glad that you highlighted once again psychiatry’s ridiculous tautologies. You might take some pleasure in my little fantasia on the subject!

    ‘When I make a word do a lot of work like that,’ said Humpty Dumpty, ‘I always pay it extra.’

    ‘”Oh!” said Alice. She was too much puzzled to make any other remark….

    “Ah, you should see ’em come round me of a Saturday night,” Humpty Dumpty went on, wagging his head gravely from side to side, “for to get their wages, you know.”…

    “Impenetrable”, said Alice. “I think we’ve had enough of that subject for now.”

    “Now, Humpty, you are an expert on most things: I need your help. I’m very worried about Aunt Matilda. She’s getting schizophrenia, which sounds really frightening, but I don’t know what it is. Do you?”

    “Schizophrenia”, said Humpty Dumpty, grandly, “is a chronic, severe, and disabling brain disorder”.

    “Oh,” said Alice, clapping her hands in delight. “It’s great to hear all that from an expert like yourself: maybe she’s not really ill at all! Can you arrange for a blood test or brain x-ray? I’m going to INSIST we get tests done on her at once: maybe she was just having one of her funny turns, and we can go to Bognor for the week-end after all.

    “Bugger Bognor!”, said Humpty, shifting about uneasily.” It’s not that simple, Alice”, said Humpty Dumpty, who had trained in psychiatry at Cambridge. “We have no x-rays, urine or blood tests to let us be sure that somebody IS “schizophrenic”, or even “mentally ill.”

    “But how, then, can you know EXACTLY what it is?”, said Alice.

    “It’s hard to say exactly what it is,” said Humpty, nervously, “but it’s delusions, hallucinations, impenetrable speech, that sort of thing…”

    “Caused by what?”, said Alice.

    “By schizophrenia, you silly little seven-year old.”

    “So, are you saying that delusions, hallucinations and impenetrable speech are THE CAUSES OF delusions, hallucinations and impenetrable speech, then? Do you think I came up the Thames on a doughnut?” said Alice, in a daze. “You’re just treating me like a fool again; making words mean anything you want them to.”

    “Look Alice,” said Humpty Dumpty, wearily, many admit that the causes of schizophrenia are still unknown; as we used to say in the Royal College, its precise aetiology has not been identified.Now will you PLEASE STOP asking me all these awkward questions: you’re frying my yolk! Just take it from me: after all, I WAS a Cambridge psychiatrist.”

    “But you said its origin lay in a diseased brain”, said Alice, doggedly.

    “I know I did”, said Humpty: “that’s what I was told by my masters.”

    “So, you’re asking me to believe that it’s some kind of brain disease, even though there’s not a single test to prove that there is something actually wrong IN the brain!”

    “That, I’m afraid, is the position, Alice”, said Humpty, crestfallen.

    “But if it’s a very serious biological disease, with no verifiable biological basis, why have so many millions of patients’ and taxpayers’ money been poured into medicines for a disease that doesn’t seem to really exist?”

    “Well, that, I’m afraid, is the position”, said Humpty. “As I said to you some time ago, Alice, it’s impenetrable; an infinite series of variations on an enigma. A real aporia. Most confusing. That’s why I left psychiatry: my colleagues just couldn’t admit that they didn’t really know what it meant or what its aetiology was, and told me not to worry either, as there was plenty of money in it all. That’s why Ludwig, Wittgenstein to you, told me that psychiatry, with its fuzzy, empty concepts would do my head in…would drive me into madness or suicide – and recent research has borne him out. Cognizant of the threat posed by the smoke and mirrors of psychiatry to my delicate shell, he convinced me to leave it altogether and devote myself entirely to the clarity of philosophical reflection, though some of my former colleagues get very angry when I suggest that wherof they cannot speak they should remain silent, or, as I prefer to put it,following dear old Ludwig’s great dictum: ”Davon muss man schweigen.”

    “Oh, dear!”, said Alice.

    “You know, Alice, that word ”schizophrenia” nearly drove me mad: in the hospitals they waved it around and beat us over the head with it to force us into believing that it corresponded to something in the real world. And THAT’S how I learned about the power of certain words, especially “schizophrenia” – which is a very powerful word that makes some people very rich, indeed. Except me, as it’s one of those words for which I have to pay A LOT extra. You should see the queues behind her of a Saturday night when I have to pay out a small fortune to Her Majesty Schizophrenia, Major Depressive Disorder and Colonel Bi-polar Disorder.They’re absolutely ruining me, they are; them and their thousands of medical lackeys, all lined down the Holloway Road with hands outstretched. You’d think Arsenal was playing ’Spurs at Highbury. And the costs of security!!! That’s another reason I had to get out: I was bankrupted by the whole thing, and a promising career soon lay in tatters.”

    “Humpty Dumpty,” said Alice, “I am deeply touched by your sad story, but am as confused as ever by all your word-games and impenetrabilities. I need to go to someone who really knows,” said Alice, storming out, “I’m going to a psychiatrist.”

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    • LOL!!! You actually made me laugh this morning as I prepared to go to work in the state “hospital” where I was once held. I wish I could post this on every psychiatrist’s office door who works there. I’d have to do it anonymously since I’d lose my job otherwise, since you’re not allowed to make fun of the Great and Powerful Oz!!!! They won’t hear of it and won’t stand for it in any form as they all stand behind the curtain pulling stops and pushing buttons to make the smoke and mirrors work properly so that everyone will bow down as they’re supposed to!

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  9. What you say is very true regarding the lack of credibility to claims that Robert Spitzer introduced a new scientific rigor to the field. I was making a power-point recently in which I referenced Robert Spitzer, and I thought it relevant to this post and the discussion.

    Freud’s Monkey

    The psychotics best friend, neurosis, heats up a booming business.

    Pseudo-Science History As Parable

    * There was a man by the name of Sigmund Freud, and this Mr. Freud, he was an organ grinder by trade. He had a monkey he named Neurosis, and this Neurosis managed to stir up a brisk business for him. He would go out on the square and play his organ while Neurosis, attached to him by a chain from his collar, danced, and then when the tune was done, Neurosis would go around holding out his tin cup and collecting change.
    * Neurosis was actually the replacement for an earlier monkey Mr. Freud had owned. This earlier monkey, also a money maker, he had named Hysteria.
    * Round about 1980 came another man, one Robert Spitzer. Mr. Spitzer was also an organ grinder. He thought all domestic animals should have three names. He named his monkey Minor Mental Disorder. Minor, on top of dancing, could juggle. What’s more, he’d mastered a few other tricks beside, and so: cha-ching.

    Nothing Spontaneously Generates Mental Disorder so Much as a New Edition of the DSM

    * 1952 DSM I 106 Mental Disorders
    * 1968 DSM II 182 Mental Disorders
    * 1980 DSM III 265 Mental Disorders
    * 1994 DSM IV 297 Mental Disorders
    * 2013 DSM 5 although the number of mental disorders is about the same, the criteria for diagnosis specific to most mental disorders has been relaxed so that the numbers are certain to go up.

    Estimates Percentage Wise

    * 18.1 % of the people have a “mental illness” according to NIMH (Serious mental illness SMI rates at 4.2 %)
    * A recent report conducted by the National Institute of Mental Health claims that roughly 26.2 percent of American adults age 18 or older suffer from a diagnosable mental illness in a year.
    * 2015 Guardian reports 8 of 10 students in the UK – 78 % had “mental health issues” last year according to National Union of Students survey.

    Obviously “mental illness” is BIG business!

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        • 26.2 % is a figure I’ve seen used in a number of instances. So, yes, it is an actual figure being quoted. It isn’t the same as the figures put forward by the NIMH for the current US figures on the website though, this is supposed to be a figure they got out of some study or other.

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      • BPDTransformation, I was just using stats from current news stories online. You’re right though, if you’re stats are correct, maybe they miscalculated their approximation by a point percent. I’m thinking maybe they got leery about the size of their own calculation. When the “mental illness” rate is approaching 1/3 of the population what do you do then? Continually stress how many people out there who are in need of treatment aren’t receiving it? Tick, tick, tick. And ridiculous doesn’t ever seem ridiculous because they are seeking funding for what they’ve got, and that means loading the dice on the need side.

        Please pardon the way my comment came out, folks, and read the whole, just as in a power-point presentation, with the asterix as a bullet, and spaces between the bullet-ed sections. I had a few design flaws in the presentation of my comment, and, as you all know, there is no edit feature for comments made here at MIA.

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          • I didn’t say my reply wasn’t meant to be a joke. Actually if “mental illness” wasn’t a metaphor, that is, if it was an actual medical condition, or a permanent mark on a person’s historical record, etc., that is, a tangible, we could go there perhaps. As it is nonsense, well, relatives with relatives to throw away are going there all the time. The population is a number, and any percentage of it is a number. Of course, the decimal in two is not going to be the same as the decimal in one. I guess though, as you were joking, we’re still talking 26.2 % rather than 26.3 %.

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          • It used to be that the “mental illness” rate pertained only to prisoners of the psychiatric system, and as the system has changed, the numbers have climbed. I imagine any day now there could be a study confirming the numbers of people bearing a psychiatric label has climbed another digit. As you no longer have a captive population made up solely of prisoners, people are encouraged, if they think they have one, that is a “mental illness”, and there are mega-tons of books to tell one what a “mental illness” is, to seek treatment for it. Formerly, one just turned oneself in.

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        • I’m thinking maybe they got leery about the size of their own calculation. When the “mental illness” rate is approaching 1/3 of the population what do you do then? Continually stress how many people out there who are in need of treatment aren’t receiving it?

          Yeah, those are the sort of lines I was thinking along when I asked about the “official” figures. The higher the % goes the more it could help our talking points, any time someone addressed a group they could ask people things like, which one of you will be the one in three or four in danger of being labeled and psychiatrized? Maybe ask 25%-33% of the room to report to the front.

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  10. Frank,

    Your comments remind me of the time I went to a psychiatrist some years ago, for what I thought was a temporary problem that I wanted some advice and help for. After talking to him for 10 minutes I could see the psychiatrist thought I was a candidate for serious treatment, so I asked him “How do you know when somebody is crazy?” “By their behavior,” he answered promptly. I was surprised, because I thought psychiatrists had some kind of scientific test or something. “By the way they ACT?” I said, not sure I understood. “By their behavior,” he repeated firmly. Obviously, I thought, it wasn’t too safe for me to be pouring out my heart to this guy, because who knew what he would think of my “behavior” if I really got emotional? So I thanked him for his time and took my leave as politely as I could.

    But his words stayed with me, and when my problems got worse and I really needed some help, my mind kept going around them like a rat in a trap. If I went back to the psychiatrist and asked for help, I knew I would start bawling out of fear and pain and frustration. He would see I was behaving like a crazy person and he would diagnose and treat me accordingly. I would BE crazy. But if I didn’t go back to him and didn’t ask for help, then I was sane. It all depended on my “behavior,” on how I acted. If I asked for help, I was crazy. If I kept my mouth shut and toughed it out, I was sane. Around and around, like a rat in a trap.

    I had two small children and I couldn’t risk being sent to an institution, so I kept my mouth shut and endured that towering paradox, and all the others that followed it, until the monkey business in my brain calmed down after a few months. But it left me with a permanent suspicion of the entire concept of “mental illness” and the over-educated “experts” that think they can “treat” it. I think the shamans in Africa and South America probably do a better job.

    Best,
    Mary Newton

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