Continuing my response to a paper by Awais Aftab, MD, titled It’s Time for Us to Stop Being So Defensive About Criticisms of Psychiatry. I published Part 1 of this post on January 27, 2022. Because the post was becoming lengthy, I decided to split it into two parts. This is Part 2.
Part 1 ended with this quote from Dr. Aftab’s paper:
“Morehead references the 2012 paper by Phillips et al on conceptual and definitional issues in psychiatric diagnosis.20 This article highlights some of the most prominent names in philosophy of psychiatry and reveals the philosophical difficulties that surround the notion of mental illness and the elusiveness of a satisfactory definition. This has been a topic of interest to me for many years, and my own philosophical work in this area reflects the conceptual inadequacies of our notion of mental illness.21″
My position is that the definition of “mental illness” is not at all elusive, and that whatever conceptual inadequacies exist in “our notion of mental illness” are deliberate obfuscations on the part of psychiatrists.
DEFINITIONS
The definition of an illness is: a condition of the body that entails subjective complaints and history; clinical signs; and abnormal and characteristic lab, radiographic, or other objective findings. Or, to put it more simply: a reliably identifiable flaw or deficiency in the structure or function of one or more bodily organs.
I realize, of course, that there are some psychiatrists who claim that this is not an accurate definition of illness; that the true definition of illness is: any condition that entails a significant degree of suffering or impairment. I’ve discussed this issue several times in various posts, and have no wish to rehash this material further.
But let me simply make this point. Over the past 20 years, I have personally experienced a great deal of serious illness, including total kidney loss, chronic peritonitis, etc. I have received treatment and consultations from literally dozens of physicians.
A good deal of the work done by these physicians concerned the diagnosis of my various problems, many of which are still ongoing. And this diagnostic work was always focused on: what is going wrong? what organic pathology is creating these symptoms, and, of course, what can we do to ameliorate the problem?
Indeed, through all these treatments and consultations, I have never encountered a physician – nor even heard of one – who adhered to the distress-or-impairment definition of illness favored by most psychiatrists. I suspect that if I had asked any of these individuals “what about the definition of illness as something that entails significant personal distress or impairment, but does not require any structural or biological impairment?” they would have pursed their lips thoughtfully, coughed politely, and changed the subject. Real physicians are generous with their time, but most are also skilled at deflecting inanities and keeping discussions to the point.
And this is the critical point: Psychiatry is a hoax, in that most of the human problems that it purports to treat aren’t real illnesses. Psychiatry, over the past several decades, has “solved” this problem by the simple expedient of adopting an unorthodox definition of the term illness – a definition that requires no evidence whatsoever of organic or systemic pathology, and voila – out of nowhere, they have not only a slew of “valid” psychiatric diagnoses, but a license to create as many more as they choose, which has been psychiatry’s main endeavor for the past seventy years or so.
Just as there are a limitless number of ways to incur feelings of distress or impairment, so there are a limitless number of “mental illnesses” that psychiatrists can, and do, conjure up, in their relentless drive to grow their businesses and enhance their sense of self-importance.
For instance, there are a great many people here in the US who are distressed by the destructive and illegal insurrection that occurred on January 6 of last year. It would take just a little help from the APA’s PR consultants to turn this distress into a new mental illness: Insurrection Phobia. We could also have COVID Phobia; Mask Phobia, and even Ukraine-invasion Phobia. In many parts of the Midwest we could have Wildfire Anxiety Disorder; and also Groundwater Depletion Phobia. And in other parts of the country, I’m sure people might have Rising Sea Phobia, or Tornado or Hurricane Phobia. And the widespread concern about rising prices could be morphed, with little difficulty, into Inflation Phobia, or even Supply Chain Problems Phobia. And so on.
But I digress. I’ve set out above the definition of illness. But what about mental illness? How can we capture this “elusive” phenomenon in a definition. Well, as I mentioned earlier, the definition is not at all elusive.
Mental illnesses are illnesses (as defined above) whose primary symptoms are confined to problems of thinking, feeling, and/or behaving. The term “mental illness” embraces:
Intellectual Disability due to Brain Problems;
Multi-infarct Dementia;
Dementia due to other brain problems, including injury;
Various brain problems (temporary or permanent) associated with ingestion of, or withdrawal from, a psychoactive substance (e.g. Cocaine Delusional Disorder, Alcohol-induced Hallucinations, etc.)
Other significant problems of thinking, feeling, and/or behaving that have clearly been caused by organic or systemic pathology.
All of these items are listed in the various DSM’s and are real illnesses. In addition, they primarily affect mental processes. So they could be called real mental illnesses, though I personally favor the term “brain illnesses”, in that the pathology is primarily based in that organ. Traditionally brain illnesses have been the province of neurologists with one exception: those brain illnesses that impair mental processes (thinking, feeling and behaving) have been seen as the province of psychiatry, while neurology deals with all the rest.
So, if psychiatry had confined its assertions to what was known instead of flagrantly asserting the validity of their irresponsible, self-aggrandizing speculations, they might have a respectable profession today. But, to state the obvious – they didn’t. They allowed their aspirations to run rampant, and having discovered how easy it was to invent diagnoses in this particular field, they abandoned whatever initial principles they might have had and went on a rampage of destructive fabrication which continues to the present time.
In addition, the psychiatric “treatment” that they have afforded to people suffering from dementias and intellectual disability due to brain damage has consisted largely of prescribing drugs to make them more “manageable”. This, coupled with their avid support and promotion of the various spurious neurochemical imbalance theories, casts enormous doubt on their collective fitness for any kind of health-related role. For these reasons, I would prefer to see these brain illnesses transferred to the ambit of neurology. How these matters will work out, only time can tell. But at present, recruitment into psychiatry is down, which is a positive sign.
FUNCTIONAL MENTAL ILLNESSES
It follows clearly from all this that psychiatry’s functional mental illnesses have no validity whatsoever. This is because they are not actually illnesses. They are merely loose clusters of vaguely-defined thoughts, feelings, and behaviors, with no clearly defined or characteristic etiology. They were simply made up by psychiatrists to provide the appearance of a nosology as a peg on which to hang their billing codes. Let’s see if we can elaborate on this further by examining “Major Depression”, which is one of the most frequent diagnoses used by psychiatrists at this time.
MAJOR DEPRESSIVE DISORDER
The DSM-5 criteria for this “diagnosis” are five or more hits out of nine on a facile, unvalidated checklist plus the requirement that “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” (p 161)
As is the case in most DSM “diagnoses”, the criteria items are extremely vague. For instance, here’s item 1. “Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)” (p 160)
How much of the day is “most of the day”? how often is “nearly every day” – 6 days out of 7? 5 out of 7? 4 out of 7? Can a person who is heart-broken or despondent even provide information of this sort? And how in the world can a child’s irritability be considered an indication of depression? Irritability is much more likely to be an indication of hostility, passive aggressiveness, or rebellion than depression. So why is childhood irritability considered a sign of depression? Because psychiatrists say so! There is no validity to this whatsoever. Just good old-fashioned psychiatric arrogance.
Here’s item 2: “Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).” (p 160)
How diminished does one’s interest or pleasure have to be to be considered “markedly diminished”? Whose observation is considered accurate? A family member? A colleague? A friend? The psychiatrist?
The fact is that most psychiatric diagnoses of depression are made by interviewing the client and possibly a short interview with a collateral informant if the client has brought someone to the office for support, moral courage, etc. What’s often overlooked in these matters is that there is enormous pressure on the potential client and the friend to endorse the items /questions put by the psychiatrist. A person who has taken the step to consult a psychiatrist realizes that he/she has a problem, and is vulnerable to any suggestions as to the seriousness or source of the matter. People aren’t stupid, and it wouldn’t take a person too long to figure out what kind of response was needed to the psychiatrist’s questions to ensure enrollment as a “depressed patient”. As obvious as this is, I don’t ever recall meeting a psychiatrist who displayed much appreciation of these dynamics.
Besides, questions always have the potential to be interpreted, especially by people who are feeling vulnerable, as challenges or even threats. Many years ago I had the privilege of studying for a short while under the direction of the late psychotherapist Theodora Alcock. One of Theodora’s favorite maxims was: “Ask no questions, and you’ll be told no lies.” In other words, don’t grill or interrogate your client in a third-degree fashion. Instead, just chat and allow the clients space to tell their stories at their own pace and in their own words. And never use a DSM cheat sheet to check off the criteria items as they are being endorsed by the client. Of course, this kind of in-depth interviewing is not compatible with the 15-minute med checks that have become the established norm in present-day psychiatric care.
THE ORIGIN OF THE DSM CHECKLIST
In 1972, John Feighner MD, a psychiatry resident at Washington University, St. Louis, co-authored an article titled Diagnostic Criteria for Use in Psychiatric Research. It was published in Archives of General Psychiatry (Vol 26, 1972). AGP later became JAMA Psychiatry.
Here’s the abstract:
“Diagnostic criteria for 14 psychiatric illnesses (and for secondary depression) along with the validating evidence for these diagnostic categories comes from workers outside our group as well as from those within; it consists of studies of both outpatients and inpatients, of family studies, and of follow-up studies. These criteria are the most efficient currently available; however, it is expected that the criteria be tested and not be considered a final, closed system. It is expected that the criteria will change as various illnesses are studied by different groups. Such criteria provide a framework for comparison of data gathered in different centers, and serve to promote communication between investigators.” [Emphasis added]
Note firstly that the term “illnesses” occurs twice in the abstract, and it is clear both from the abstract, and from the later text, that the notion that psychiatric problems are illnesses is an a priori assumption, not something that has ever been proven. In fact, in DSM-I, the various non-organic entries were referred to as reactions (to psychosocial stressors) rather than illnesses or disorders (schizophrenic reaction; anxiety reaction; depressive reaction; etc.). The term “reaction” was slipped quietly to the wings in DSM II (1968) as part of the ongoing psychiatric effort to medicalize their diagnoses. It’s difficult to maintain the fiction that one’s “diagnoses” are primary illnesses while, at the same time, referring to them as “reactions to psychosocial stressors”.
Feighner et al specified five phases for establishing diagnostic validity in “psychiatric illness”. These are:
- Clinical description
- Lab studies, including chemical, physiological, radiological, and anatomical findings.
- Delimitation From Other Disorders
- Follow-up Study
- Family Study
Feighner et al mention that lab studies “are generally more reliable, precise, and reproducible than are clinical descriptions”. They also point out that:
“Unfortunately, consistent and reliable laboratory findings have not yet been demonstrated in the more common psychiatric disorders.”
a state of affairs that continues to this day. And later in the article:
“While no psychiatric syndrome has yet been fully validated by a complete series of steps, a great deal of work has been published indicating that substantial validation is possible.” [Emphases added] Note the word “possible”!
Feighner et al go on to provide tentative diagnostic criteria for thirteen psychiatric “illnesses”. Earlier they had stated very clearly:
“These criteria are not intended as final for any illness. The criteria represent a distillation of our clinical research experience and of the experiences of others cited in the references. This communication is meant to provide common ground for different research groups so that diagnostic definitions can be emended constructively as further studies are completed.” [Emphasis added]
Here are the authors’ criteria for a “diagnosis of depression”:
“Depression.– For a diagnosis of depression, A through C are required.
A. Dysphoric mood characterized by symptoms such as the following: depressed, sad, blue, despondent, hopeless, ‘down in the dumps,’ irritable, fearful, worried, or discouraged.
B. At least five of the following criteria are required for ‘definite’ depression; four are required for ‘probable’ depression. (1) Poor appetite or weight loss (positive if 2 lb a week or 10 lb or more a year when not dieting). (2) Sleep difficulty (include insomnia or hypersomnia). (3) Loss of energy, eg. fatigability, tiredness. (4) Agitation or retardation. (5) Loss of interest in usual activities, or decrease in sexual drive. (6) Feelings of self-reproach or guilt (either may be delusional). (7) Complains of or actually diminished ability to think or concentrate such as slow thinking or mixed-up thoughts. (8) Recurrent thoughts of death or suicide, including thoughts of wishing to be dead.
C. A psychiatric illness lasting at least one month with no preexisting psychiatric conditions such as schizophrenia, anxiety neurosis, phobic neurosis, obsessive compulsive neurosis, hysteria, alcoholism, drug dependency, antisocial personality, homosexuality and other sexual deviations, mental retardation, or organic brain syndrome. (Patients with life-threatening or incapacitating medical illness preceding and paralleling the depression do not receive the diagnosis of primary depression.)”
It is noteworthy that these nine criteria (A, and B 1-8) are essentially the same as the nine criteria for major depressive disorder as listed in DSM-III through DSM-5. In many cases the wording is almost identical. The requirement of five “hits” out of the nine criteria is also a feature of the DSM’s.
So, although Feighner et al stressed that their criteria were provisional, and would need amendment in the light of further studies, the same criteria are being used to this day, 50 years later. So either Feighner et al were unbelievably lucky or, no progress whatsoever has been made in the endeavor to create a scientifically validated nosology from Feighner et al’s tentative beginnings. In addition, DSM-5 (2013) acknowledges that “…no lab test has yielded results of sufficient sensitivity to be used as a diagnostic tool for this disorder [major depressive disorder]” (p 165). DSM-III; DSM-III-R; DSM-IV, and DSM IV-TR have all made similar acknowledgements, not only for major depressive disorder, but for the vast majority of the other so-called diagnoses.
In other words, the notion that “major depressive disorder” is a bona fide illness is nothing more than a working assumption adopted by Feighner et al and others in the late 60’s and early 70’s to make psychiatry seem like real medicine. Psychiatry has made no progress in validating its criteria for this loose grouping of vaguely-defined thoughts, feelings, and behaviors. The lab tests and other characteristic biological markers that psychiatrists at the time insisted were “just around the corner” didn’t materialize – and still haven’t materialized. This is what Thomas Insel, MD, then the Director of NIMH, meant when he stated publically, in 2013, with regards to DSM diagnoses:
“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” (here) [Emphasis added]
The fundamental basis of psychiatry – that it treats real illnesses – is still just an unproven assumption despite a staggering expenditure of money, effort, and cognitive acrobatics to try to prove otherwise. But the real illness (“just like diabetes”) fiction is crucial to psychiatry’s credibility. Once this fiction is exposed, it becomes obvious that they are simply providing mind-altering fixes in the same manner as the street-corner vendors: “something to help you feel better”.
DEPRESSION AS AN ADAPTIVE MECHANISM (I have written in more detail on this topic in an earlier post.)
Far from being an illness, depression is actually an adaptive mechanism. It is nature’s signal that something is not going well in our lives. Just as pain provides a signal that tissue is being damaged, and encourages us to take prompt remedial action, so depression alerts us to the fact that we need to take analogous measures with regards to relationships, lifestyle, goals, etc. Depression is an unpleasant feeling and it is only natural that we would want it to end. We want the pain to stop precisely because it is unpleasant. And if we don’t or, for whatever reason can’t, take appropriate remedial action, then the pain of depression/despondency will likely become worse, and the individual may reach the point of self-depreciating despair.
Depression is NOT an illness. The fact is that humans are born with feeling “mechanisms”. There are good-feeling mechanisms, that when activated induce feelings of joy and even elation; and there are bad-feeling mechanisms, that induce feelings of depression and heartache. The good-feeling mechanism is activated when our lives are “on an even keel” and they encourage us to try to stay on an even keel. The bad-feeling mechanisms are activated when our lives are – for whatever reason – off-kilter, and they encourage us to take steps to improve our situation.
Here are some of the ways that our lives can go off-kilter, resulting in feelings of depression:
-
- being stuck in a job that one dislikes intensely;
- being discriminated against (racism, gender, age, etc.);
- being a victim of spousal abuse;
- being a victim of any kind of abuse;
- living in substandard accommodation;
- living in chronic poverty;
- being entangled in relationships that are not helpful or satisfying;
- recent bereavement.
- family conflict
- chronic illness
- being exploited
- loneliness
etc.
The feelings of depression are nature’s way of telling us – in the only language that nature has – to make appropriate changes in, or adaptations to, the status quo.
Depression is not an instance of something going wrong in our brains. Rather, it is an instance of something going right. Tragically, the depression-as-an-illness notion which has been promoted by psychiatry for the past hundred years or so, has come to be accepted widely in our culture, and pills have become accepted as the appropriate “treatment”. But the pills are not much better than placebos, and entail a wide range of adverse effects, some of which can be life-threatening.
Depression is not an illness. It is an adaptive mechanism that encourages us to seek and find ways to improve our lives, realize our goals, and find a measure of peace and happiness.
Almost all of us encounter depression at some point in our lives. Most people are able to take the appropriate remedial action either from their own resources or perhaps with the help of a close friend. In other cases, the depression-causing circumstances are overpowering, and the individual may need additional help to resolve the problems or extricate him or herself from the depressing situation. In this regard, self-help groups, life coaches, counselors, etc. can be particularly helpful, but in extreme cases more formal support, or even police protection, may be needed.
Tragically, there is a great deal wrong with the world. Exploitation and discrimination abound in almost all walks of life. Women are victimized more frequently than men, which is presumably why women report more episodes of depression than men.
I would like to say that the world is improving in these regards, and indeed in former years, I thought that this was the case. Now I’m not so sure. I see wealth and income gaps widening and little motivation on the part of politicians, or others in power, to do anything about this. I see people all over the US living in tents or in their cars.
And, of course, I see psychiatry – the supposed helping profession – making a living by selling happy pills to the victims of all this exploitation, sadness, despair, and discrimination. And even the happy pills carry warnings of suicide risk! How do psychiatrists manage to live with that reality? And how can psychiatrists continue to propagate the falsehood that …your depression is an illness caused by your faulty brain chemistry, and needs to be treated with our safe and effective drugs and electric shocks.
THE STATUS QUO
At the present time there are far more non-illnesses in the DSM than genuine illnesses. Psychiatrists insist on retaining these non-illnesses in their catalog and in their practices because it’s good for business to do so. And then they shed crocodile tears because no definition of mental illness can ever be entirely satisfactory. Statements to this effect are included in every edition of DSM from DSM-I to DSM-5. But the fact is that the true definition of mental illness is patently obvious – an illness whose primary symptoms are confined to problems of thinking, feeling, and/or behaving. But this doesn’t suit psychiatry’s expansionist agenda. The present operational definition of mental illness (i.e. the actual definition used in the compilation of the DSM and in psychiatric practice) is: every conceivable problem of thinking, feeling, and/or behaving that can be sold to real doctors and to the general public. Real doctors should have seen through this hoax from the beginning, and it’s quite likely that many of them did. But as drug therapy became increasingly the norm in many areas of medicine, the real doctors realized that they could supplement their business by providing services essentially similar to those provided by psychiatrists (i.e. med checks).
Psychiatry’s expansion of its turf has been decades in the making. They had to remove the notion of pathology from their definition of illness. This they accomplished by the simple expedient of declaring that pathology as such is not needed for a condition to be called an illness. All that’s needed is significant levels of distress or impairment in one or more areas of functioning. Once that was done, and was widely accepted by real doctors and by the general public, the next step was to grow the DSM to include an ever-increasing number of new mental illnesses. They simply had to remember to include distress or impairment in the definition, and voila – more business. And their latest complaint is that there’s so much business out there that they cannot keep up with it, and many “patients” have to resort to GPs for their psychotropic prescriptions. Oh dear!
Back to Dr. Aftab:
“Morehead says that ‘the time has come for all psychiatrists to consistently speak out on behalf of our patients.’ Indeed, it has, and I would add that we can only do so genuinely and meaningfully if we also speak out on behalf of our patients who have been harmed by psychiatric care. Not only that, but we should go a step further and facilitate the process of empowering our patients to speak for themselves—as is the goal of the service user and lived-experience communities, as well as movements such as neurodiversity and mad pride.”
Note that Dr. Aftab concedes that some psychiatric “patients” have been harmed by psychiatric care, but doesn’t offer any estimates of the numbers involved. Nationwide, are we talking about ten people, a hundred people, a thousand, more than half, or the great majority: And how severe is the harm? Negligible? Mild? Moderate? Severe? Life-threatening? In this sort of context, the prevalence and severity of the problem are fundamental. However, Dr. Aftab has conceded that some psychiatric “patients” have been harmed by the care they have received, and this is an important and honest admission. It’s not entirely new. Other psychiatrists have been writing and saying similar things for decades.
In the same paragraph, Dr. Aftab also writes:
“Not only that, but we should go a step further and facilitate the process of empowering our patients to speak for themselves”
But why limit ourselves to just one step further? Why don’t psychiatrists routinely help their customers figure out why they’re depressed or habitually inattentive, etc.? Why have they effectively barred such questions from the process known as psychiatric care? Why do they routinely leap to the false, and indeed inane, conclusion that any episode of depression which meets or exceeds the facile and unvalidated five out of nine DSM criteria items inevitably indicates a brain illness which has to be “corrected” with anti-depressant drugs?
We know that depression, far from being an illness, is actually an adaptive neuro-mechanism, whose purpose is to alert the individual to the need to make changes. But one can’t help people make fundamental life changes without first assessing what needs to be changed. What incidents have occurred, or what abiding adverse circumstances are present in the person’s life, that are precipitating these kinds of negative feelings? The assumption that the neuro-mechanisms are simply broken, is not only false, it is stigmatizing, disempowering, and destructive. Yet this assumption is encased in the fifteen minute med check for the simple reason that psychiatrists can double their incomes by adopting the latter course.
SO WHAT’S NEEDED?
I have written many times that psychiatry is essentially a wrong turning in human history. The pivotal moment occurred when decisions were made in both Europe and America to place medical doctors in charge of the asylums. The notion was that this would humanize the care and lead to better outcomes. But the results were disastrous. Treatments were more like medieval tortures than any medical treatment, and discharge rates declined steadily.
Psychiatry has tidied up its facade considerably since then, of course, but the erroneous notion that medicine should be the primary care-giver in this area is still deeply embedded in our language, in our practices, and in our institutions. And the results are still disastrous. The catalog of errors has been exposed by many writers and activists, but psychiatric practitioners, with the exception of a very small minority, have remained arrogantly and self-servingly blind to these realities.
The great irony here is that the most successful period in modern psychiatry was the Moral Era, which extended from about 1800 to 1850. Moral treatment is associated with Phillippe Pinel in France, William Tuke in England, and to a lesser extent, Benjamin Rush in the US. Here are some quotes from Ullmann and Krasner, A Psychological Approach to Abnormal Behavior, 1975:
“Moral treatment strove to create a complete therapeutic environment – social, psychological, and physical. Although emphasis was placed on the relationship between physician and patient, moral treatment embraced a much larger psychological approach than individual psychotherapy.” (p 135)
“Humanitarian treatment based on a psychological model and the expectation of improvement (Goldstein 1962) was a major reason for the effectiveness of moral treatment. Reports that are available for this period (see Bockoven, 1963 and Dain, 1964) indicate a higher discharge rate than for previous and most subsequent periods of time.” (p 136)
“Moral treatment involved a way of life, a teaching program in how to make friends and develop outside interests. The goal was to help the patient enjoy life and take part in society.” (p 136)
And here are some quotes from James Coleman, Abnormal Psychology and Modern Life, 1972:
“During the early part of this period of humanitarian reform, the use of moral therapy in mental hospitals was relatively widespread. This approach stemmed largely from the work of Pinel and Tuke and was based on the view that most of the insane were essentially normal people who could profit from a favorable environment and help with personal problems.” (p 43)
“There seems little doubt that moral therapy was remarkably effective, however ‘unscientific’ it may have been.” (p 43)
“Some recovery rates were reported to be as high as 80 to 90 percent.” (p 43)
“Despite these impressive results, moral therapy declined in the latter half of the nineteenth century – in part, paradoxically, because of the acceptance of the view that the insane were ill people.” (p 43)
“In any event, hospital statistics show that recovery and discharge rates declined as moral therapy gave way to the medical approach.” (p 44)
Similar accounts of Moral Therapy can be found in most textbooks that cover the history of these matters.
. . . . . . . . . . . . . . . .
It comes to this: it is entirely normal for people:
- who are victims of systemic discrimination, to lose their sense of purpose;
- who work long hours for meager returns, to feel weary;
- who are being exploited, to feel resentful;
- who have been unable to afford the basic necessities of life, to feel pessimistic about the future;
- who have been beaten down, to feel undervalued;
- who have been unable to provide adequately for their families, to feel pessimistic concerning the future;
- who have known nothing but drudgery and failure, to give up trying.
For psychiatrists to declare that people in these kinds of circumstances are actually suffering from an illness is essentially a condoning of the real precipitating problems, and serves as a formidable barrier to meaningful social reform. The people and organizations that abuse and exploit and discriminate can simply say: these individuals are ill. They have mental illnesses. It’s not our fault.
And as long as psychiatry and its bogus diagnoses reign, there is no counter argument that can prevail.