I am a mental health professional, a clinical psychologist, which is not quite as bad as being a psychiatrist but still nothing to brag about. Hypocrisy in U.S. mental health professional policy abounds damn near as much as in U.S. foreign policy. Among psychiatrists and psychologists, there is no more politically correct promulgation than the one “to abolish the stigma of mental illness”; yet these professions use mental illness labels to stigmatize people—to remove them from society, to force them into “treatment,” and on occasion as long-range missiles aimed at enraging politicians.
My mental health profession wants people to be comfortable being diagnosed with a mental illness; however, at the same time, my profession embraces the societal status of having a unique weaponry to diagnostically take out those who create intolerable tension for “nice people.”
Like the police and military, psychiatrists and psychologists do have ethical restrictions against unlimited weaponry use, and that boundary was breached by the 2017 book The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. In response to the book’s publication, the CEO of the American Psychiatric Association, in January 2018, reminded his colleagues that it is “unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement.” This is the so-called “Goldwater Rule,” and it is also the policy of the American Psychological Association that “neither psychiatrists nor psychologists should offer diagnoses of candidates or any other living public figure they have never examined.” Despite these rebukes, the petition “Mental Health Professionals Declare Trump is Mentally Ill and Must Be Removed” has over 70,000 signees (though probably not all of them are actually mental health professionals).
Still, many psychiatrists and psychologists do take the Goldwater Rule seriously, believing it evidences to the general public how ethical they are. By their embrace of certain ethical standards, mental health professionals hope the general public ignores the fact that the entire process of diagnosing patients is pseudoscientific—and thus unethical.
Specifically, the American Psychiatric Association’s diagnostic bible, the DSM, lacks scientific validity according to the director of the National Institute of Mental Health, who in 2013 announced that “the NIMH will be re-orienting its research away from DSM categories.” Historically, mental health professionals have simply applied DSM mental illnesses labels to people behaving in ways that create significant tension for “nice people.”
Until 1973, when homosexuals still made most “nice people” uptight, homosexuality was a DSM mental illness and “treated” with various aversion “therapies” including electric shock to the genitals and nausea-inducing drugs administered simultaneously with the presentation of homoerotic stimuli. Since the designation of homosexuality as a mental illness was the result not of science but of politics, the abolition of homosexuality as a mental illness could only come about through political activism, which ultimately occurred.
Today, young people who have done nothing illegal but who create tension for “nice people” by refusing to comply with adults’ requests or rules, arguing with adults, losing their temper, and being generally disagreeable are diagnosed with the DSM diagnosis, 313.81 “oppositional defiant disorder”; which is considered a “disruptive disorder” for which these noncompliant kids are increasingly drugged with tranquilizing antipsychotics.
How have mental health professionals retained their status despite a lengthy list of invalid diagnoses, punitive treatments, and pseudoscientific theories of mental illness (e.g., in 2011, the Editor-in-Chief Emeritus of the Psychiatric Times Ronald Pies stated, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists”)?
The answer to this question, according to professor of social welfare at UCLA, David Cohen, goes beyond the corrupting influence of the pharmaceutical-industrial complex. The answer is actually darker. Society so values psychiatry’s unique weaponry or what Cohen calls “psychiatry’s extra- and intra-legal police function” that the lack of science in psychiatry does not matter. In his 2014 article “It’s the Coercion, Stupid!” Cohen argues that “It seems to me that this coercive function is what society and most people actually appreciate most about psychiatry.”
Society so appreciates psychiatry’s weaponry to take out those who create unpleasant tension that society ignores psychiatry’s pseudoscience and historical cruelties. As Cohen puts it, “Because of psychiatric coercion, society gives psychiatric theories a free pass. These theories never need to pass any rigorously devised tests (as we expect other important scientific theories to pass), they only need to be asserted.” For Cohen, “The power to coerce is what excuses the lack of valid knowledge.”
Cohen concludes, “Let’s face it: No one cares that psychiatric research of the past 50 years failed to turn up one finding of use for a scientific clinical psychiatry. The business of psychiatry continues with barely a pause. In order to prosper, all psychiatry (and, increasingly, other mental health professions whose formerly distinctive training and theories are slowly blurring into one psychiatrized whole) needs is the social support for its coercive practices.”
The 2017 book The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President and the current petition “Mental Health Professionals Declare Trump is Mentally Ill and Must Be Removed” are embarrassments for politically astute authorities within psychiatry and psychology. Such politicos know that brandishing this diagnostic weaponry says loudly to the general public, “Yes, a mental illness diagnosis is a stigma that can be used against you.” And the politically astute in the mental health profession know that while this weaponry gives the mental health profession its societal status, flaunting this weaponry might get more people to consider the hypocrisy behind mental health professionals’ promulgations to end the stigma of mental illness.