As a parent and not a mental health reformer there’s no reason why you should know that just because a definition of a mental disorder exists (as defined by the American Psychiatric Association), that doesn’t mean that mental disorders actually exist. There’s no reason at all why that distinction should have ever crossed your mind. But it’s an important one!
Defining a made-up thing or naming the attributes of a made-up thing does not make that thing exist. For example, naming the attributes of a unicorn—that it must have one horn and not two or that it must stand on four legs and not five—does not make a unicorn exist. Similarly, just creating a definition of a mental disorder does not make a mental disorder exist. In fact, there is nothing easier than defining things: defining is child’s play. That something appears in a dictionary because it can be defined does not make that thing real.
Let’s take a look at how blissfully easy the folks who define non-existing mental disorders—the American Psychiatric Association—have it. First they defined “mental disorder” one way in the DSM-4 (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), as follows: “A mental disorder is a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” First, this says nothing in particular. Second, it completely leaves out biology! Third, and pertinent to our discussion, it does not somehow make mental disorders exist just by virtue of saying so.
Notice the ease with which they ditched the above definition and replaced it with a completely different one in the DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders). Under pressure by skeptics as to the whether the above definition made any sense, the American Psychiatric Association redefined non-existing mental disorders in a new way in the DSM-5:
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
Forget for a moment what this definition seems to be saying. Just consider the following. The very idea that you can radically change the definition of something without anything in the real world changing and with no new increases in knowledge or understanding is at first glance remarkable—remarkable until you realize that the thing being defined does not exist. It is completely easy—effortless, really—to change the definition of something that does not exist to suit your current purposes. In fact, there is hardly any better proof of the non-existence of a non-existing thing than that you can define it one way today, another way tomorrow, and a third way on Sunday.
If you had the patience and the interest you might want to scrutinize the changes made to the definition of a “mental disorder” and come to your own personal understanding of how language has been employed here to cover all bases, support societal goals, and say absolutely nothing about human reality. A mental disorder is a psychological thing—or maybe it isn’t. A mental disorder is a biological thing—or maybe it isn’t. You can rail against your society unless you have a “dysfunction,” at which point your railing is a mental disorder. You can disagree with your politicians unless you have a “dysfunction,” at which point you are a mental deviant. One could go on making such observations; yet making such observations actually plays into the hands of the creators of non-existing things, who love it if you play their game. They can slip about with impunity, adding, qualifying, and shifting, while you waste your breath being reasonable and thoughtful.
The question is not, “What is the best definition of a mental disorder?” The question is not, “Is the DSM-5 definition of a mental disorder better than the DSM-4 definition of a mental disorder?” Those are not the right questions. The first and only question is, “Do mental disorders actually exist?” The phenomena of sadness, worry, pain, distress, angst, and so on of course exist. Just as horses and donkeys exist, pain and suffering exist. But horses and donkeys do not prove the existence of unicorns and pain and suffering do not prove the existence of mental disorders.
Consider a second phrase that is very important to this discussion: the phrase “mental health.” Just as it matters a great deal what the phrase “mental disorder” actually stands for, it matters a great deal what the phrase “mental health” stands for. Let’s look at how the idea of “mental health” is defined into existence. Here are some commonly employed dictionary definitions of “mental health”:
“Mental health is a state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.” In this view you are abnormal or unhealthy (as opposed to, for example, despairing or stressed out) if you are unable to meet the ordinary demands of everyday life. Or: “Mental health is a person’s overall emotional and psychological condition.” What does that mean? Or: “Mental health describes a level of psychological well-being or an absence of a mental disorder.” Mental health is the absence of a mental disorder? Do you see the circularity there?
Here is the definition of mental health as employed by the World Health Organization: “Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Have you ever heard a less psychological definition and a more social definition of mental health than that? Can’t you just feel the coercion coming if and when you refuse to “make a contribution to your community”?
Phrases like “mental health” and “mental disorder” matter a lot. The states they supposedly represent must not be idly defined into existence. It is one thing if there is no such thing as a “mental disorder”—that is a huge deal. Just as huge a deal is the possibility that there are multiple varieties of “mental health”—or rather, nothing that really resembles “mental health” but rather different ways of looking at human reality such that an aware person might say to himself, “You know, this is what I think I mean by mental health and this is what I would like to achieve for myself.” Concepts like “mental disorder” and “mental health” have to make more than definitional sense—they have to make real sense. Currently they do not.
Is it your job as a parent to get involved in the language analysis and logical analysis of concepts like “mental health” and “mental disorder”? Surely you are busy enough and taxed enough already! Yet these ideas may matter very much in your life and in the life of your family and your children. It would be lovely if you didn’t have to pay attention to the ways that the folks in charge of the concepts define non-existent things into existence but, unfortunately, you do. I hope that the above discussion will help you apply a little necessary skepticism to the idea that simply because you can define a thing that means that you are being sensible and honest in doing so.
Download this Resource: Defining a Mental Disorder
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.