This is the first of what I am planning to be monthly blog posts connected to the general theme of mental health systems as a form of oppression. Over the course of the coming year I will write other posts – some of which will expand on some of the ideas discussed below. I do hope that this comes through as the critical analysis that I intend it to be, and I welcome feedback!
The term “disorder” appears frequently in the context of mental health, particularly within the DSM (Diagnostic and Statistical Manual of Mental Disorders). The APA (American Psychiatric Association – the authors of the DSM) define “Mental Disorders” like this –
“… any condition characterized by cognitive and emotional disturbances, abnormal behaviors, impaired functioning, or any combination of these. Such disorders cannot be accounted for solely by environmental circumstances and may involve physiological, genetic, chemical, social, and other factors.”
In this definition they have identified causes including environmental, physiological, genetic, chemical, social, and “other factors” – basically everything. The term is then attached to a large list of “conditions” within the DSM – including:
- Neurodevelopmental Disorders
- Schizophrenia Spectrum and Other Psychotic Disorders
- Bipolar and Related Disorders
- Depressive Disorders
- Anxiety Disorders
- Obsessive-Compulsive and Related Disorders
- Trauma- and Stressor-Related Disorders
- Dissociative Disorders
- Somatic Symptom and Related Disorders
- Feeding and Eating Disorders
- Elimination Disorders
- Sleep-Wake Disorders
- Disruptive, Impulse-Control, and Conduct Disorders
- Substance-Related and Addictive Disorders
- Neurocognitive Disorders
- Personality Disorders
- Paraphilic Disorders[1]
These are just the broad categories, within each there are numerous “disorders” listed. This also doesn’t include those described as “dysfunctions” and “dysphoria,” which raise some of the same concerns as “disorder.” Within the full list of several hundred “disorders” there are no doubt some that have physiological causes and therefore are medical conditions that call for medical treatment. As a therapist I can help a client process what they are experiencing as a result of a medical condition (just as I would with a client diagnosed with cancer, diabetes, or any other medical condition), but I cannot treat a medical condition, neurological or otherwise.
In my experience – personal and professional – many of the “disorders” that people seek help with are “reasonable responses to unreasonable circumstances.” To label a person as having a “disorder” serves to pathologize what the person is experiencing, suggesting that there is something wrong with the person rather than with the circumstances.
To be clear, my use of the term “unreasonable circumstances” is VERY broad and includes a range of circumstances, many of which are unavoidable in life (e.g., the death of a close family member or friend, the end of a relationship, illness, etc.). But many of the circumstances are socially imposed, which goes to my trouble with the idea of “disorders” in that they tend to internalize the problem.
Consider for a moment how much of an impact the following would have on mental health:
- Socialized medicine
- A livable minimum wage
- Universal access to healthy food
- Universal access to safe housing
- Elimination of racism, sexism, homophobia, transphobia and other forms of prejudice
- Real reform of the criminal legal system
The full or even partial implementation of any of these would positively impact the mental health of millions of people. It wouldn’t eliminate all emotional and psychological suffering, but it would go a long way towards eliminating socially imposed suffering.
Another concern about the concept of “disorders” is that it may be pathologizing ways of thinking and being that are perfectly natural and healthy, but don’t fit within current social expectations. The idea of neurodiversity is increasingly being used to understand things like Autism and ADHD, among others.
If true, then the current and longstanding approaches to these “disorders” are attempts to force people to live in a way that is accepted by society rather than according to their own nature.
My own takeaway:
As a therapist – specifically as a Feminist Therapist – I see my role as helping a person understand what they have experienced and/or are experiencing and finding a way to live a meaningful life – whether that involves trying to change their circumstances or accepting them. I avoid much of the terminology that is too common within the mental health profession, including “mental disorders, “mental illness,” and other clinical terminology that can serve to pathologize a person’s experience.[2]
As a social worker, with a background in political science and law, I see my role as identifying and understanding areas in which the mental health profession may be acting in oppressive ways and advocating for change.
[1] Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (APA, 2013)
[2] Similarly, I don’t refer to the people I work with as “patients” as I am not a doctor.
Leave a Reply