On February 14, 2013, Oscar Pistorius, a South African Olympic runner, shot and killed his girlfriend in his home in Pretoria, South Africa. Mr. Pistorius’ defense is that the shooting was accidental – that he shot his girlfriend through the bathroom door in a state of panic because he believed she was an intruder. Prosecutors contend that the killing was intentional – and the trial is ongoing.
On May 12, 2014, the defense introduced testimony from Merryll Vorster, MD, a psychiatrist. According to an article in BBC News Africa, Dr. Vorster told the court that Mr. Pistorius has generalized anxiety disorder, and that because of this mental disorder his actions on the occasion in question would differ from those of a “…normal able-bodied person without generalized anxiety disorder.”
In response, the prosecution asked for a full psychiatric evaluation at a state hospital. This evaluation is currently under way, on an outpatient basis, and is expected to last one month.
For the past fifty years or so, psychiatrists have been engaged in an enormously successful drive to expand their professional turf. They have accomplished this by arbitrarily increasing the number of “mental illnesses,” by lowering the diagnostic thresholds for these “illnesses,” and by promoting drug “treatment” as a way of correcting the putative chemical imbalances that cause these “illnesses.” It is a central theme of this website that this entire endeavor is spurious, destructive, and disempowering, and I have pursued these themes throughout the site. For our present purpose, however, it need only be noted that psychiatry’s self-promotion has been very successful, and today vast numbers of people worldwide identify themselves as having “mental illnesses,” and express the belief that these conditions are real illnesses – just like diabetes. In addition, the concept of mental illness has infiltrated our social, political, legal, and educational institutions to an extraordinary degree.
In this context, it is not surprising that we are seeing an increase in the number of individuals who adduce a mental illness defense when facing serious criminal charges. The law in most jurisdictions has long recognized that physical illness can diminish responsibility. A person who has a heart attack while behind the wheel of a car, for instance, is not generally considered criminally responsible for resultant damage or injury. People with clear and marked neurological damage/deficits have traditionally been afforded similar considerations.
PSYCHIATRIC DIAGNOSIS – INHERENTLY FLAWED
Mr. Pistorius’ defense essentially is that because he “has” generalized anxiety disorder, he reacted in an abnormal way to his misperception that an intruder had entered his house. What’s not generally appreciated, however, is that the notion of anxiety as an illness is a spurious psychiatric invention with no basis in scientific fact. The reality is that the phrase “has generalized anxiety disorder” means precisely the same as the phrase: “is given to extreme worrying.” There is no additional meaning in the former phrase. It is simply a re-statement of the latter phrase in the guise of medical terminology. So when Mr. Pistorius or his lawyers tell the courts that he “has generalized anxiety disorder,” all that they are saying is that he is a very worrying sort of person, which as a legal defense doesn’t sound nearly as impressive.
At the present time Mr. Pistorius is reporting daily to the state hospital for the court-ordered evaluation. The matter is being aired widely in the press, and the psychiatric assessment is being discussed as if it had the same kind of validity and reliability as tests for cancer or hepatitis. On May 20, for instance, Rikki Klieman, CBS News legal analyst, posed the question: “What happens if it winds up that he is truly mentally ill and he gets sentenced forever into a mental institution?”
In fact, psychiatric “diagnoses” are nothing more than loose clusters of vaguely-defined behaviors, thoughts, and feelings. They have no validity – something that even Thomas Insel, MD, Director of NIMH, has acknowledged publicly. On April 29, 2013, he wrote that DSM
“…is, at best, a dictionary, creating a set of labels and defining each.”
It remains to be seen what, if any, diagnosis will emerge from Mr. Pistorius’ present evaluation – but this much is certain: it will shed no light whatsoever on the critical question of why he fired his gun through that bathroom door on February 14, 2013. Psychiatry’s claim that because of their specialized training and their simplistic DSM checklists they can cast light on these kinds of questions is a gross deception.
Psychiatric “diagnoses” have no general explanatory value. Consider the hypothetical conversation:
Client: Why do I worry so much?
Psychiatrist: Because you have an illness called generalized anxiety disorder.
Client: How do you know I have this illness?
Psychiatrist: Because you worry so much.
Nor do psychiatric diagnoses have explanatory value in particular cases.
Judge: Why did Mr. Pistorius overreact and panic on the night in question?
Psychiatrist: Because he has generalized anxiety disorder.
Judge: How do you know he has generalized anxiety disorder?
Psychiatrist: Because he is given to overreaction and panic.
The only evidence for a psychiatric “diagnosis” is the very behavior that it purports to explain. All psychiatric diagnoses (except those that are clearly identified as being due to a general medical condition or to the effects of a substance) have this fatal flaw. They have no explanatory value – and explanatory value is precisely the point of a diagnosis in real medicine. Psychiatric diagnoses are nothing more than re-statements of the presenting problems in pseudo-medicalese language.
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On a separate, but related, matter, it is noteworthy that the two psychiatric reports on Norwegian 2011 mass shooter Anders Behring Breivik arrived at very different conclusions. One report diagnosed him with paranoid schizophrenia, but a second evaluation diagnosed him with narcissistic personality disorder with antisocial traits. And these evaluations were conducted under the glare of intense international press coverage, so the psychiatrists were probably affording the matter a very high level of priority.
The complexity of human presentation cannot be reduced to a few facile labels derived from equally facile checklists. An individual will respond differently to different interviewers. So one psychiatrist might see signs of hostility, where another doesn’t. A psychiatrist who has an unusual sense of humor might find a client’s neologisms charming and enriching; another psychiatrist might see them as indicative of pathology. Or one psychiatrist might see boastfulness as indicative of healthy self-esteem, whereas another sees pathological narcissism. And people present themselves differently in different circumstances from one day to the next. And so on. Psychiatrists like to think that they are objective, and that they can transcend these limitations, but this is not the case.
The increased use of psychiatric evaluations in the criminal justice system is just one more example of psychiatric turf expansion – another expression of psychiatry’s persistent claim that they can accomplish things that they cannot. It also, tragically, affords credence and publicity to psychiatry’s fundamentally flawed and destructive perspective.