Why I Don’t Like the Idea that Mental Disorder is a Disease


I have been too busy organising the RADAR programme recently to have much time for blogging, but at the moment I am preparing to give a talk at the conference of the American Association for Philosophy and Psychiatry in May. The title of this talk is: Many ways of being human: challenging the medical view of mental disorders and the implications for psychiatry.

This is the first of a series of short blogs in which I set out my thinking behind this title.

The title is taken from a book by British psychiatrist Alec Jenner and three Portuguese colleagues entitled: Schizophrenia: A Disease or Some Ways of Being Human? The book sketches out an approach to the understanding of schizophrenia that challenges the idea that schizophrenia can be understood using the cause and effect paradigm of the natural sciences.

Whether some, or all, mental disorders are diseases in the medical sense is both a philosophical and empirical matter. I will address both of these areas in future blogs, looking in particular at the work of Thomas Szasz, but first I want to set out what I don’t like about the idea that mental disorders are diseases ‘just like any other’.

If mental illness is a brain disease, then the behaviour it is manifested in is irrelevant and uninteresting. It has nothing to do with being human in a general sense. There is no lesson to be learnt from it, and we may as well just eliminate it in whatever way we can. Indeed, we have an obligation under this way of thinking to liberate the ‘normal’ person that is buried somewhere behind the illness. The behaviours and experiences (or symptoms) have nothing to do with that person as a person, they are just an aberrant part of their physical body. Nothing is to be lost, no inherent cost incurred, by eradicating the condition without trace.

What attracted me (and I believe many others) to psychiatry is not that the symptoms of mental illness are bizarre curiosities arising from brain irregularities. If this was the case, I could have gone into neurology. What attracted me to psychiatry, and what still interests me, is the intuition that mental disorder has something profound to teach us about the nature of being human. And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.

The title of the talk is also meant to emphasise that mental disorders need to be understood in the same way that we understand other sorts of human behaviour. There is not a categorical distinction between normal behaviour and emotions and what we might call mental disorder. This is not the same as saying that all mental disorder is on a continuum with normality. Depression and anxiety may be familiar to all of us to some degree, but despite the research saying we all hear voices, I think that true psychotic experiences are rare, and most people probably only get a glimmer of what these might be like when they are very tired or have taken certain mind-altering drugs. Therefore I do not think it makes sense to suggest that psychosis is on a continuum with normal experience. However, it is not a different sort of thing either. As Luc Ciompi, founder of the Swiss Soteria project commented (as cited in Jenner and colleagues’ book), psychotic states, like that sometimes referred to as ‘schizophrenia,’ are better thought of as a life process than an illness.

As another Swiss psychiatrist, Manfred Bleuler, said (also cited in Jenner et al), people with ‘schizophrenia’ “flounder under the same difficulties with which all of us struggle all of our lives.”

What we need to try and understand these extreme and unusual states of being are not the specialised methods of natural science. In contrast, it is the ways in which we understand ordinary, everyday behaviour that can, if anything can, help to reveal the nature and meaning of madness. Madness is an unusual way of being human, but a way of being human nonetheless!

I realize this might not be a new idea for Mad in America readers, but that is why I wanted to share this here — I am interested in your responses.


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.


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  1. Thank you for this thoughtful blog.

    As i stated in my very first blog at MIA:

    “Similarly, extreme states of psychological distress can lead to altered states of consciousness that are mislabeled as a “mental illness” and a “disease,” but could instead be better looked at as a creative and necessary coping mechanism dealing with an experienced and/or perceived hostile and threatening environment. This coping mechanism, as with addiction, may also prevent more extreme reactive behaviors or provide an escape or temporary relief from intense physical or emotional pain….”

    “Here is the rub. A problem often arises with both substance use leading to addiction and also with extreme states of psychological distress, when these behaviors and related thought patterns are sustained for extended periods of time, the formerly helpful coping mechanisms can gradually, or even suddenly, turn into their opposite and now become primarily self-destructive, self-defeating, and socially unacceptable*. This is especially true when the short term benefits of the behavior and resulting thought patterns start to shift and begin to cause far more immediate, as well as long term negative consequences for the individual and the people around them. Some people may now actually get stuck in this new state of being and be unable to find their way out by themselves. This is the point when we might say that these once helpful coping mechanisms have now seemingly become “stuck in the on position.” ”

    I would add the point that all of these “extreme states” have there own internal logic to them based on each person’s individual conflict with their environment. And the more conscious a person can become of this internal logic (within a safe and supportive environment) the better able they will be at resolving or adapting to this conflict; thereby ending or significantly reducing any self-defeating, self-destructive, or socially unacceptable behaviors or thought processes.

    Psychiatry and their entire Disease/Drug based/Medical Model of “mental illness” must not only be vigorously opposed, but ultimately abolished as a legitimate part of medicine.


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  2. This should prove interesting. When I was first incarcerated in a mental institution, I was aghast at the difficulties “the mental illness is brain disease” approach to people created for me in particular. It made communication between myself and staff very difficult to say the least. The approach, in effect, cancelled me out as a human being. Personality mattered for nothing, as motivation, purpose, etc. was attributed to the symptomatology of such a “brain disease”. I was no longer seen as a person but rather as a collection of symptoms spelling out disease, disease to be completely suppressed. Were I to express myself on a subject of importance to myself, it was discounted as a symptom of “mental illness”. I am not a “disease”, but I couldn’t say anything about myself and my goals, etc., without it being construed as pathological. Subsequently, it was pretty easy for me to dismiss their theories as bunk, just as it had been easy for them to dismiss anything issuing from my mouth as symptomatic of disease. Our philosophical differences, in other words, became irreconcilable. I didn’t appreciate, as a human being, being confused for a “disease”. There is simply no talking to people who confuse everything I say for a symptom of some kind of dispensable aberration, not until they cease to confuse me for such a dispensable aberration anyway, and they were not ceasing to do so so long as I had any kind of social intercourse with them.

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  3. What I believe:
    “Depression and anxiety may be familiar to all of us to some degree, but … I think that true psychotic experiences are rare” “True psychotic experiences are rare” because the extreme distressfulness of the experiences that produce “psychotic experiences” are rare.

    “Therefore I do not think it makes sense to suggest that psychosis is on a continuum with normal experience.” “True psychotic experiences are rare” on a bell-curve that plots the distressfulness of experiences (of distressful life circumstances); they are the extreme end of “a continuum with normal experience.”

    “What attracted me to psychiatry … is the intuition that mental disorder has something profound to teach us about the nature of being human.” Good intuition on your part; mental distress teaches us that emotions are feelings that are understood physically rather than intellectually. Extreme mental distress teaches us that the brain has a natural aversion to distressful experiences. Natural emotional suffering from extremely distressful experiences is experienced by the brain as averse- similarly to extreme physical pain (except it does not subside like physical pain). Mental distress is human nature; human aversion to mental distress naturally motivates behavior to avoid distressful experiences. The problem arises when the brain cannot find a behavior to relieve the distress; “fight or flight” will not solve most modern distressful experiences.

    “And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.” I would have totally agreed with this sentence until I experienced a reversal of fortune in early adulthood; thereafter, I found my “bizarre” and often “dysfunctional” behavior to completely understandable. The commanding emotional pain of psychosis is analogous to extreme physical pain that does not subside; if you want to understand psychosis, submit to physical torture for a couple months.

    When a person lives “on top of the stack” (as I did during my youth), it is hard to imagine what life feels like “at the bottom of the pecking order” (as I did for a couple decades).

    Best wishes, Steve

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  4. “What attracted me to psychiatry, and what still interests me, is the intuition that mental disorder has something profound to teach us about the nature of being human. And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.”

    With respect…my wife has d.i.d. I have guided her thru the healing process without medications and mostly using attachment theory and the concepts of neural plasticity. But my attitude was always to downplay the ‘bizarre’ aspects of the disorder. It’s not that I thought her actions and/or thinking weren’t dysfunctional, but I always treated her with respect and whenever she got side-lined by various ‘co-morbidities’, I would simply assure her that these were the result of the various girls in the system being separated/dissociated and once I got them all together, those ‘bizarre’ or ‘dysfunctional’ things would melt away. And that has, indeed, been the case. At this point, 9 years into the healing process, where I have 7 of 8 girls connected, and the 8th one, nearly connected, she (as a whole) is one of the most put-together and beautiful people I know. I believe I was able to help her and guide her partially because I entered the world of each dissociated girl, understood things from her point of view, and then gently guided her toward a more healthy and interconnected life with the others.

    To me it was about my ability to simultaneously live in 2 realities: mine and hers and NEVER belittle her or cause her to feel like a dysfunctional freak even though she was highly dysfunctional.

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    • Like you, I’ve always believed that if you begin to understand the person’s reality you create a door that allows at least some understanding about what motivates the person. But clinicians immediately dismiss the person’s reality as having no value, since they don’t live in the consensus “reality” that the clinician wants to impose on the “patient”. We must quit labeling people as “patients” and deal with them as real people whose realities are valuable in themselves.

      To be gifted by someone allowing you to enter their reality is both a humbling and enriching experience.

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  5. Too much thinking, too much construction- language and concepts are hopeless. It’s arguable that we ‘understand’ anything. The best thing is try and accept uncertainty creatively, study the Taoists and Buddhists- particularly Tibetan schools who have been practicing for thousands of years with the aim of ‘not knowing’

    I do admire this piece, it’s wonderfully crafted- intellectually and descriptively brilliant, but it is quite: ‘on the surface’ much more depth and golden silence is needed.

    This koan might be helpful:

    To know is not to know- Tzu

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  6. Joanne, why do you think people presume that “mental disorder” is a useful term conceptually? Why not consider that distress of varying degrees and understandable and expectable reactions/adaptations to varying degrees of stress, rather than abnormal responses or aberrations from “normality”?

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    • Hi Matt,

      Psychologists and counsellors use the description psychosis quite a bit, but in real terms what they are describing 90 per cent of the time is not really psychosis – but a distressed person sharing what’s inside in their head. If anyone was to take the risk in sharing their reality at different times it might sound the same.

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      • You know, as much as I hear about psychosis, and even psychosis related to d.i.d., I can only think of ONE instance in 9 years that any of the girls in my wife’s system talked about something that clearly was impossible. At first I kind of argued with her every time she brought it up as it was clearly impossible (being a spy in Europe in her past). But then I changed tactics, and the moment I validated the girl and sincerely asked her if she could tell me more about it, I NEVER heard about it again….almost like she simply wanted someone to validate and ‘hear’ her…

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  7. I like the article, but it lacks a lot. Can you please define “nornal,” and tell me why psychosis and other so-called mental diseases are not on a continuum with normal? Why do different psychiatirsts give the same person dfiierent diagnoses? What about cross-cultural references to what is “normal” and what is not?

    In my opinion, psychiatric diagnoses are for people uncomfrotable with somone else’s behavior. Period. Normal or not has little to do with it. It is about controlling behavior making someone uncomfortable.

    I have interviewed people with these labels, and unfortunately, many of them are afraid to divuluge their experiences with their psychiatirsts. They fear they will be institutionalized or forced into other treatments.

    Let’s hope that like homosexuality, which was removed from the DSM, that all of these labels become meaningless!

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    • Don, I couldn’t agree with you more, particularly ‘many of them are afraid to divulge their experiences with their psychiatrists. They fear they will be institutionalized or forced into other treatments’. This fear cannot be understated. As the mother of an adult psychiatric survivor who recently returned home after years of involuntary treatment, I see how this fear plays out in the recovery process nearly every day.

      I know my daughter quickly learned about the importance of hiding her feelings and thoughts from a litany of psychiatrists in order to win her discharge from the institution-du-jour or prevent her prescriber-du-jour from upping her dose, since she was court ordered to take medications and she knew it was a lost cause to refuse to comply with the treatment orders and the only way to avoid being destroyed like her peers who had been in the system for decades, was to ‘fake’ normality by appearing to be grateful for her ‘treatment’ a profoundly destructive practice.

      The enormous full time effort exerted by my daughter to hide her authentic feelings and sensations, because of the very real risk of being labeled and drugged even more, combined with the dissociative side effects of medications she is taking is antithetical to the process of healing and recovery from trauma that anyone with a modicum of common sense would envision for his/her loved one.

      Supporting someone who is recovering from trauma requires impeccable communication. It is very challenging to obtain even basic information from someone who has been deeply harmed by labeling and involuntary treatment. Even conventions like everyday banter and small talk can be painstakingly difficult for that person. It takes a rebuilding of trust for that person to be able to reveal ‘symptoms’ and what if a person’s ‘symptoms’ are enjoyable, helpful, stimulating, or critical for them to cope with some long buried pain or trauma?

      I would only add that many are afraid to divulge their experiences not just to a professional but to a family member or friend as well out of fear that the family member will then run and divulge everything to the professional in his/her life. Family members collude routinely with psychiatrists to pathologize the behavior of a loved one and justify involuntary treatment. I know this from talking personally to other parents in NAMI and simply reading the comments of family members posted on the internet.

      Let’s not forget that the multi-billion dollar ‘anti-stigma’ campaigns funded by big Pharma have impressed upon people the importance of talking to one another about mental health but not in a way that makes it safe for people who are experiencing unusual thoughts or perceptions to reveal how they are thinking and feeling to their family members.

      Family members have been conditioned from decades of marketing propaganda to believe that ‘normal’ exists and anyone whose thoughts and perceptions do not meet the criteria for ‘normal’ should immediately seek help from the ‘system’ which is laden with problems of its own but unlike individuals and families who make themselves vulnerable by seeking help, the spokespeople for the ‘system’ will not admit that they too, have issues and put the protection of their status and the legitimacy of their profession ahead of the welfare of those they serve.

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      • Glad your daughter is out of that Hellhole!

        As far as recovery goes, who says the psychiatrists want that?

        In order to get discharged from a Nazi concentration camp you had to sign a paper stating how well you were treated. Sounds like how shrinks insist on “gratitude” from their victims. Usually too stupid to know when you fake it. Gotta kiss up to Colonel Klink! 😛

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    • This is not surprising when every word, gesture, look, etc. is observed and interpreted through the lens of pathology. Thank you medical model, which is a deficit based model rather than a model that emphasizes strengths. One of the biggest things that I fight against in the “hospital” where I work is this attitude of interpreting every little thing that the person says or does through the lens of their diagnosis, through pathology, rather than just seeing them as human beings with some quirks here or there. And on top of this, no matter what you claim or say, if your are or were a patient clinicians always believe that you are lying

      I know an older women who was held on one of the units where I work. During her intake interview with the treatment team she stated that she had a masters degree in Political Science. The entire team automatically dismissed her information and said that she had no such degree. Well……come to find out, she was being humble and it was discovered that she actually had a doctorate in Political Science. All I could do was laugh out loud as I handed the salt and pepper around at the treatment team meeting so that everyone could eat the crow that they had dished out on their own plates. Most days I just want to slap everyone silly since they’re already pretty stupid.

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  8. If a person reads and understands Szasz, he or she will understand that a “mental disorder” does not correspond to any biological reality, but that it is a myth or a metaphor. There is no such thing as an actual “mental disorder” any more than there is such a thing as an Easter bunny. Psychiatry is the very definition of madness. It is antithetical to reason because it is an institution that is based on the pseudo-medical justification of torture, drugging, involuntary incarceration, and the stigmatization of the innocent. This should come as no surprise when a person considers the thinking and the character of the founders of psychiatry. Charcot’s chicanery, Freud’s fraudulence, Jung’s errors, Bleuler’s blunders, Kraeplin’s calumny and the mendacity of Mesmer and many others combined to create the behemoth that now subjugates, oppresses and obliterates millions of innocent people on a daily basis.

    Think of the word “psychiatry.” A simple reflection on the etymology ought to deter anyone from ever exploring the field as a legitimate discipline. What does it mean? From the Greek “psyche,” meaning “mind” or “soul,” and “iatros,” meaning “healing” or “cure.” As Szasz makes clear in many of his books, the role that was once played by false priests and clergymen has assumed a new form in psychiatry. As Szasz also makes clear, psychiatry is comprised of fake physicians who “diagnose” fake diseases in fake patients in a drama that used to belong to priests and laymen. Modern psychiatry has added psychotropic drugs, Electro shock torture, and a fake Bible of fictitious “illnesses” to augment its own authority and prestige, and to line its pockets with that filthy lucre that corrupts. What a great partner has been found in the pharmaceutical industry. It is a match made in Heaven’s counterpart.

    Of course “mental disorders” are not diseases. They are no more diseases than Easter bunnies are furry little mammals. They are no more diseases than tooth fairies are dentists. Szasz may be a bit confused in his atheism and his libertarianism, but he is right that liberty and responsibility are foundational to human life, and he is right about the history of psychiatry and all that it entails. If people could read and understand the simple truths that Szasz communicates in his books, then they would no longer be blinded by the inanities and the propaganda of the psycho-pharmaceutical industrial complex or threat of the therapeutic state. Psychiatry is, as one of the titles of Szasz’s books proclaims, the science of lies. It is like a gargantuan, scaly, fire-breathing monster that cannot be reformed or revolutionized. Just as in the legends and tales, it must be defeated. We must work together to slay the dragon of psychiatry.

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  9. I was impressed that my young adult son came through a two week experience of what gets called psychosis almost three years ago with the help of an Open Dialogue trained psychiatrist, a supportive family therapist and our family network who was very committed to keeping him both safe and out of the hospital. He has since shared that there was a questioning part of him that gained strength as we connected and shared our thoughts and feelings while also deeply listening to his non-consensual experiences. I have come to believe that the respect for all voices in the dialogic process empowered his agency and self understanding while also helping each of us hear each other and ourselves. He came through the ‘psychosis’ with only 3 nights of Klonopin to help him get back on a sleep schedule and has not experienced psychosis again. The respect and curiosity we offer each other, especially at moments of great intensity or vulnerability can be very empowering and healing – quite the opposite of the diagnose and drug medical model! Thank you for all of your very insightful work Joanna.

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  10. I agree wholeheartedly, and think the harm done by diagnosis is substantial and sometimes irreversible, even more so in cases where overt abuse is involved. I worked with foster youth for 20 years, and saw so many cases of hurt, insult, confusion, and anger created by the invalidation of the youth’s difficult experiences prior to and during their stay in foster care. It is the very opposite of what is helpful, namely, NORMALIZING the youth’s experiences and reactions and helping them make sense of what happened to them and what they want in their lives. There is not much you can do worse than taking the meaning away from someone’s painful experiences.

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  11. “mental disorder has something profound to teach us about the nature of being human. And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.”

    I would have said: “all human behaviour has something profound to teach us about the nature of being human and that we should avoid value judgments and the use of loaded words like extreme, bizarre, dysfunctional, disordered, etc. as these are sure to cloud and limit our understanding of others and of how they make sense of their lives.”

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  12. It was your book “The Myth Of The Chemical Cure” that woke me up and either saved my life or saved me from years more of hell thinking a pile of pills was the answer to my problems, anxiety insomnia, those chemicals nasty mix that only made it 100 times worse and as usual that leads to more of them prescribed by the army of incompetents out there that destroy lives.

    This is Zyprexa, it helps anxiety and insomnia and its “non addictive” so non addictive if you try and quit to escape anhedonia hell it creates heroin withdrawal looks like a fun time in comparison. Vomit on my back steps dried an inch thick being sick for weeks getting off that poison.

    I will take a pill for sleep, I know one that works if up all night is not what I am into that day, I am not Mr Anti Drug but the truth about how psychiatry really works is what saved me.

    I was reading and reading your book…. THATS how it really works and that’s all what they know ! There is nothing proven wrong with my serotonin… It Changed everything.

    Strong healthy alive now after those years, now several back but they were hell.


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  13. Hi.

    I believe that mental ill health is another alternative narrative we see ourselves and yet there are so many narratives that define who we are. Truly believe we need to speak up. I am wondering if you could help with my initiative here –
    I am developing a storytelling and mental health platform with the ultimate aim of curating a museum exhibition. Soul relics Museum is a platform for people to read and tell stories of mental health through objects that help them connect or express to a present or past experience they have had with their mental health. The object can be anything personal to something in the system. It’s a unique and creative idea to help people come forward and share with others what mental health problems have been like for them and a safe and constructive way to read of others experiences while being brave enough to share your own. Together, we can create a collective voice in raising awareness and education on mental health!
    All you need to do to help is to take a look (http://soulrelicsmuseum.me ) and write a short personal story (http://soulrelicsmuseum.me/Contribute.html)!
    If you agree with the initiative, I would be super grateful if you could help me promote it (eg. share on social media and contribute to the discussion) as me as an individual can only do so little in unifying people’s voices.
    Let me know if you have any thoughts!

    With Solidarity,

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  14. Sounds like an interesting conference you have coming up.
    It would be helpful, I think, to address the confusion in psychiatry about theories and models. At least here in Denmark psychiatric practice is supposedly based on an in theory holistic biopsychosocial approach to the whole person. And it probably also is the intention of many mental health professionals to ‘see the whole person’. In practice, though, there is very little guidance in the biopsychosocial model – so often the whole person enters the consultation room and after the consultation a diseased brain supported by an ignored body leaves the room to return to living in a not further specified environment.

    The lack of a sound, integrative model within psychiatry leaves space for bringing all sorts of arguments forth in public debates – so present practice can always be defended by referring eclectically to different recent findings in brain imaging, genetics etc., spiced up with humane-sounding psychosocial considerations and a nod to the amazing breakthrough waiting round the corner, without ever having any idea how it all fits together.

    The question is what sort of framework could be adopted to integrate the major parallel perspectives on mind? I think the so called 4E (Embodied, Embedded, Extended, Enactive) approach will be helpful – it both provides a strong critique of brain-centered views as well as grounding alternatives to both reductionism and dualism. And it requires radical re-thinking of psychiatric services as well, I think – probably in the direction of pluralism, ecological/local embeddedness and a more realistic approach to the use of medication.

    I can see from the conference program that you actually have a presenter suggesting an enactive approach – any chance the conference will be webcast?

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  15. “by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency”


    you said you were interested in our comments, but I haven’t seen you back since the original post. Maybe you are simply observing the responses. I do hope you understand that I am thrilled for the attitude that you displayed in your original article and so I hope you understand that I am NOT trying to attack you. But I think your use of ‘bizarre’ and ‘unfathomable’ reveal an unhelpful attitude that ‘experts’ too often have, even ones like you who are open to a better paradigm concerning mental health.

    I have lived with the 8 ‘alters’ in my wife’s d.i.d. system for the last 9 years. They have joined me over the course of that time with the last one joining me 2 years ago. But I just interact with them as girls because that’s how they begged me to do so. Some see me as a father figure. Some as a friend. Two are dating me and have promised to marry me some day. And one sees me as her husband. The three youngest view themselves as 2-3 years old, 2 are ‘middles’, the girlfriends are teens and the host is the body’s age, 51.

    I would NEVER characterize these girls, their thoughts or actions, or my interactions with ANY of them as bizarre. And the only time things were unfathomable was in the beginning because of my own ignorance. Once I began to understand the logical way that my wife’s d.i.d was constructed, ALL the things associated with d.i.d. made sense and I could help my wife thru the healing process and avoid so many pitfalls that are common.

    But I’ve been in the ‘trenches’ with them 24/7 for the last 9 years. It saddens me when I hear the majority of ‘experts’ using similar terms you did. Maybe it’s the clinical setting and the experts never get a chance to deeply interact with their patients in everyday settings like family and friends do.

    I guess my hope for you, when you are speaking to your colleagues, is that you will urge them to step out of their own perspectives and into the perspective of the ones they are helping. When I learned to do that, it revolutionized my ability to help my wife heal.

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    • Good point, OldHead. In the not only department, aren’t we being way too Greco-Roman, that is, in the Western tradition, and in the Western imperialist tradition at that, when we equate this would be/would not be “illness” with “disorder”? You’d think that the problem with certain people is only that they lacked a decent organizer. Fractals are, in part, about the order accruing to chaos. An unreasonable command is still a mad command, but should such make it a disordered order as well?

      In 19th century France precocious young poet Arthur Rimbaud, on a related note, made a literary theory out of the systematic derangement of the senses. The writer was to make of himself a visionary by pursuing it. Doing so did not make Arthur Rimbaud mad, no, that requires the intervention of a psychiatrist, alienist, or mad doctor.

      If, and only if, the problem is “disorder”, what then? Does the shrink “help” the client order their disorder the way a housekeeper assists at keeping a mussed house in order, or what? And should “disordered thoughts”, if that is the problem, be forced by the state into some kind of conformation with the more orderly “norm”? Are we not free, as we should be, to be as “disordered” as we would choose to be?

      It would seem that I’m not as critical of insubordination as some of these professionals would be, and with reason, as it supports their claims to authority, claims I would dispute.

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      • To say behavior constitutes a “disorder” is to express a judgement (even though it might sometimes be a reasonable judgement) represented as an objective truth. Behavior is behavior, some forms of which are more disturbing or annoying than others. It’s also true that often people have behavioral tendencies which are comparable to others’ in terms of how they react to similar circumstances. But to categorize people or behavior in terms of “disorder” implies that there IS an objective, rational “order.” So we’re talking philosophy or politics here, not medicine.

        I think I recall you once referring to “disorder” as a “weasel word” used by some to avoid being accused of supporting the “mental illness” concept.

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        • Yes, we first meet “mental disorder” in the DSM where psychiatrists were leery of using the word “mental illness”. It was Thomas Szasz who referred to “mental disorder”, and similar expressions, as “weasel words”. I agree with him totally on that score.

          As I wrote earlier, I think the dictionary definition of “illness” is much too broad because, essentially, if you entertain such a nebulous definition, “illness” becomes an abstraction and, obviously, real illness is no abstraction.

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  16. Hi to everyone who has commented here and thank you so much for sharing your thoughts. I have been following them, and they have given me much to think about. I will write a response shortly (hopefully by the end of the weekend) and I am sorry that I have been too busy to do so earlier.

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  17. Thanks again to everyone for taking the time to comment. I really like Richard D. Lewis suggestion that what we call ‘mental disorders’ can start off as adaptive coping mechanisms that become self-defeating and self-destructive. In other words they can be made some sense of if we try to understand the individual’s reality (as Stephen Gilbert suggests).
    Frank Blankenship expresses the dehumanising effects of the medical/disease model very starkly with the idea that it ‘cancels you out as a human being’. I think this sums up what I was trying to say very powerfully.
    In reply to Misfitxxx, I certainly think there is something in the Eastern idea of silence and accepting uncertainty, and that it is likely we cannot pin down the experience of many states of mental disorder precisely in words.
    In response to Slaying the Dragon of Psychiatry, I agree that Szasz is the key thinker here. I was just starting off with some thoughts about what inclines me to accepting Szasz’ analysis. Where I probably disagree with you and maybe with Szasz (although he was always vague on the question of how else you deal with the ‘problems of living’ he identifies) is that I think there needs to be some system to take care of people whose capacity to function is compromised by an extreme state of mind. I want to think about what a system that is not based around a disease model would look like.
    In relation to this, and in response to some points raised by Matt Stevenson, Don and then by Oldhead, I think that at least some of the behaviour we refer to as mental disorder is behaviour that is not organised and motivated in quite the same way as more familiar forms of behaviour. I am not trying to say it is completely different (as I said, I think Richard Lewis makes a very sensible suggestion about how to understand it). But in states of psychosis or mania for example, people seem to lack the usual capacity to make judgements and understand the consequences of their actions. These states may be reactions to terrible circumstances or past events. I firmly believe that the real key to preventing mental health problems is to construct a fairer, more inclusive society in which all people have opportunities to flourish and develop their potential. Only then will conflict and mistreatment of some by others be reduced. However, states of extreme mental disturbance or distress still seem to me to require a response now.
    Thank you to everyone who shared their personal experiences of the current system, the dehumanising effects of the disease model and inspiring stories of how to help people in other ways. And thank you too for some very kind comments. I am posting this response a bit nervously, as I know there will be those who disagree, but as always I am so grateful that there is a space such as Mad in America in which to have these debates.

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  18. thank you Johanna I found your book the bitterest pill on the horror of anti-psychotic drugs inspiring and it firmly set me on a path that has led to major conflict with the evil that is psychiatry, Never have so few done some much harm to so many and with so little care and zero consequences for them other than earning the big bucks !.. when in doubt increase the drugs .. and ensure nothing else is available so they can continue to label and vilify some of the bravest and nicest people you are ever likely to meet!
    nothing will ever steer me from the belief that avoidance of these powerful people ( I use the term loosely) is the best solution for survival. shrink that is what they do shrink you to a one word label
    Garth Daniels featured here some months ago who was forcibly given ect against his and family consent in Victoria ‘escaped” to Queensland and is now locked up again being given clozapine by a different shrink..
    keep up the good work Johanna it is refreshing that you are genuinely interested in a debate and response and actually post a reply unlike other ‘famous” professionals!

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