"The art of running a comp mill consists in amusing the patient while forbidding nature to cure an imagined disease." (James O'Brien, M.D. b. 1959)
by James O'Brien, M.D.
Well, I'm not that cynical--except on Mondays--but there is some truth in that statement. What psychiatrists and psychologists label as "mental illness" are often simply problems of everyday living, wisdom problems, or normal adjustment to life's slings and arrows. The controversial psychiatrist Thomas Szasz took on the medicalization of everyday problems in the 1960 work, "The Myth of Mental Illness". He questions the very concept of mental illness even to the point of doubting the existence of schizophrenia and major mental disorders. He sees patterns of abnormal behavior as game-playing in order to obtain some type of discernible gain, whether it be material or emotional. Szasz obviously goes too far (if schizophrenics are deliberately seeking material or emotional gain, they are doing a lousy job of it) in his repudiation of conventional wisdom, and genetic and biological studies of major mental illnesses have refuted his oversimplification. Yet his analysis of "neurotic" problems and character traits remains convincing.
Take "Adjustment Disorder", which is classified as a "mental illness" under the Bible of psychiatry, The Diagnostic and Statistical Manual of Mental Disorders-IV, or DSM4. The "syndrome" consists of:
A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant as evidenced by either of the following:
(2) significant impairment in social or occupational (academic) functioning
D. The symptoms do not represent Bereavement.
E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Hmm. Let's say Bambi, an aspiring young starlet has no history of major mental illness or diagnosable personality disorder (there are some who say a personality disorder is the only way to survive in Hollywood, but that's another article). She wakes up on the day of an important modeling shoot and just can't do anything with her hair. This makes her very anxious, so much so that she makes herself late, loses control of her temper while stuck in traffic and begins pounding the dashboard in frustration. She has a lousy day at the studio and finds it difficult to smile for the photographer. She goes home feeling rotten , has a drink, checks her messages and doesn't return her boyfriend's calls because she is in no mood to talk to anyone and falls asleep watching television. The following day she wakes up in a better mood when she looks in the mirror and discovers to her delight that her bad hair day has passed.
According to DSM IV, Bambi's bad hair day is mental illness. Am I twisting the language of DSM IV? Look again at the criteria. Am I being too inclusive? According to DSM IV, "There is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder at all." There you have it. But what can one expect from a manual based not upon scientific research but rather on the consensus of psychiatrists who have a vested economic interest in defining mental illness as broadly as possible?
I use this as an example to illustrate an important point--just because a psychiatrist offers an adjuster, attorney, judge, jury, etc. a "diagnosis", that does not mean the label is particularly meaningful. Psychiatrists and psychologists don't have to stretch the truth very hard to describe someone as having a mental illness. In DSM IV, Adjustment Disorder is considered as legitimate a category as Alzheimer's Disease, which actually can be defined by biological markers and other objective criteria. Organized psychiatry has gone a long way to discredit itself in blurring the distinction between normal human misery and mental disease. It is incumbent that an attorney handling any case involving claims of psychiatric disability or incompetence (particularly those predicated on "Adjustment Disorder") incessantly cross-examine the so-called expert on the validity of the diagnosis in order to expose the fallacy of over inclusion that most mental health experts accept as Gospel. Likewise, claims adjusters would be wise to treat any claim of emotional damage due to "soft" psychiatric syndromes with a high degree of skepticism and request a second opinion from a psychiatrist with a reputation for clarity in distinguishing ordinary human suffering from mental disorder.