Illnesses or Loose Collections of Vaguely Described Problems?

On February 10, 2022, Joe Pierre MD, Chief Psychiatrist, VA West Los Angeles Healthcare Center, and Clinical Professor, UCLA, posted the following short entry on his Twitter stream:

“Cancer is a normal and understandable reaction to environmental trauma.”

This innocent-looking assertion is a glib and fallacious counter to those of us in the anti-psychiatry movement who for years have been saying and writing similar things about psychiatry’s so-called “mental illnesses”. The tweet is followed by the hashtag #dropthedisorder, followed by a question mark. Drop the Disorder is a Facebook group based in the UK headed by Lucy Johnstone, Jo Watson, Jacqui Dillon and Nollaig McSweeney.

Essentially what Dr. Pierre is asserting is this:

Anti-psychiatry people insist that psychiatrists’ illnesses are merely normal and understandable reactions to environmental trauma. Cancer is a normal and understandable reaction to environmental trauma, but nobody would conclude from that fact that cancer is not an illness. Therefore, the anti-psychiatry contention is specious.

DEFINATIONS

In a certain sense, all of the disagreements around this topic are essentially debates about the meaning of words. But such debates are futile because 1) the assignment of meaning to a certain sound or to a grouping of written characters is entirely arbitrary; and 2) the meaning attached to a word is subject to change if a sufficient number of people start using it in a different sense. The rapid pace of mass communication has made this latter trend more pronounced in recent decades.

In particular, we need a definition of the term illness because the crux of the matter is psychiatry’s insistence that the various items in its DSM catalogs are “mental illnesses.

Since the meanings of words are arbitrary, the only logical way to resolve these kinds of disputes is to focus on how the word(s) in question are used by ordinary people in their day-to-day conversations. This is the method used by the compilers of dictionaries, and is particularly important in the present matter because the words illness, disease, disorder, sickness, etc. are routinely used by physicians of all specialties in their conversations with lay people about their health status.

SOME EXAMPLES

With this in mind, let’s examine some examples of how physicians use the words illness, disease, disorder, etc. in these kinds of conversations.

It is common in modern medical treatment for physicians to order lab tests to confirm the presence or otherwise of an illness. Sometimes the lab result confirms the illness; other times it refutes the illness; And on other occasions the lab result is slightly elevated but not sufficiently elevated to confirm the presence of the illness. In the latter situation, the physician might tell the patient that the lab result does not indicate the illness, but is more like a slight deviation from normal.

The clear implication here is that the word normal indicates an absence of illness or disease.

Sometimes physicians order X-rays, CT scans, and other imaging techniques to confirm or refute the presence of an illness. A common phrase used in the reporting of these findings is: “no acute abnormality detected”. In this example, the term “abnormality” is being used as a synonym for disease/illness, clearly implying that the opposite term normality indicates a lack of illness/disease.

In the same vein, dictionaries also draw a clear parallel between disease and abnormalities. My Random House dictionary (1992) defines disease as “a disordered or abnormal condition of an organ or other part of an organism resulting from the effect of genetic or developmental errors, infection, nutritional deficiencies, toxic, or unfavorable environmental factors; illness; sickness” (p 384). Note the clear statement that a disease is abnormal.

My Merriam Webster dictionary (2009) defines disease as “a condition of the living animal or plant body or one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms; SICKNESS, MALADY”. (p 358) In other words, a disease is a condition that impairs normal functioning.

Anyone with even a remote familiarity with the basics of medical jargon is familiar with these usages.

THE REALITY

The clearest and least controversial definition of illness that I’ve ever come across is: a malfunction or structural defect in an organ or in a system of organs. The essential point is that illness entails pathology: real physical or chemical or biological pathology. All the illnesses that are studied and treated by general medicine meet the criteria embodied in this definition. But none of psychiatry’s “illnesses” (except for those that are clearly and accurately described in the various DSMs as caused by a medical illness) meet the criteria.

In addition, the definition accords perfectly with how the term illness is used in everyday speech and in specialized medical communications. The only group that routinely challenges this definition of illness are the psychiatrists. They insist that the term illness merely implies the presence of distress or impairment, and they have dutifully written these two “requirements” into every item in their various DSMs since DSM-III. Essentially what they are asserting here is that: 1) is defined by the presence of distress or impairment; 2) psychiatric illnesses entail the presence of distress or impairment because that’s what’s written in our catalogs (DSMs); 3) Therefore, our illnesses are real illnesses.

The following analogy is illustrative of what’s involved in this scam.

Imagine a company makes metal ornaments, which they advertise in magazines and other publications, and sell by mail order only. Their ads specifically highlight the claim that all their products are made from “precious metals”. But in their warehouse, which customers never visit, there is a sign on the wall that states that the following precious metals are used in their products: brass; bronze; and stainless steel.

When customers complain that the ornaments that they’ve purchased are not made from precious metals but from brass and stainless steel, the company points out that there is a sign on the wall of their warehouse that clearly states that all the kinds of metals used in the production are in fact precious metals. So what is there to complain about? The metals in question are precious metals. Otherwise, the sign wouldn’t claim that they are. Besides, we pay a lot of money for them, so they’re precious to us.

So when psychiatrists claim that their illnesses are real illnesses, they are relying on a non-standard definition of illness, but they never reveal this to the clients.

And, although the scam has been working well for decades, they betrayed a total lack of confidence in their bogus criteria by the effort and money that they have expended for the last fifty years searching for the biological pathologies that they are convinced, without evidence, must underlie or cause their various “mental illnesses”.

So, to put the matter succinctly, they invent a spurious and misleading definition of the word illness. On the basis of this spurious definition, they invent an entire nosology of “mental illnesses” (real illnesses, just like diabetes). Then, having established the illusion of legitimacy with this fabricated material, they proceed to discuss and develop their nosology as if the items therein were real illnesses based on genuine pathology. For years they promoted to the public, the government, and the insurance companies that their “illnesses” were “real illnesses, just like diabetes”, while at the same time pouring billions of dollars world-wide into the search for proof. This was an enormous fraud, constructed on an enormous hoax, and it continues to this day in every mental health facility and in almost all psychiatrists’ offices. It should also be noted that the psychiatric method of discovering illnesses (make them up, sell them to the public, and look for proof later) is in marked contrast to the method used in real medicine (find proof, give them names, and then inform the public).

CANCER

Cancer, in sharp contrast to psychiatric “illnesses”, is a real illness, with real biological causes, many of which are indeed triggered by environmental forces, eg sunburn, tobacco use, industrial pollutants, etc. To attempt to draw parallels between cancer and “psychiatric illnesses” is to dishonor the work of oncologists and the victims of this dreadful disease. It’s a bit like saying that there are parallels between dying of cancer and losing one’s job. The latter would be a serious setback for most people, but not even in the same league as dying of cancer.

WHAT’S NEEDED

What’s needed at this time are not glib, inane rejoinders, but an honest scrutiny by psychiatrists of their fundamental assumptions and methods; apologies and amends to the people they’ve wronged; and a switch to honest work. There is also a pressing need for real physicians to challenge the legitimacy of psychiatric “illnesses” and “treatments”.

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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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