I pulled this information from the work of renowned Israeli psychiatrist, Schmuel (Sam) Vaknin, and added in my two cents. But, I’ve also said these things in my book and directly to clients and friends, alike. Mental health itself is as important as physical health but, as it relates to mood, all of it – the endless types of anxiety and depression that are made to seem special so people have something to cling to to help them understand why they are moving through life the way they are – is a crock of shit. PTSD, bipolar disorder, etc. are forms of the same anxiety and depressive disorders that people make out to be these grand diseases; some psychosomatic, others nonsensical, or manufactured in clinical practice.  “I just found out I am bipolar. Now, I can put a name to what’s been wrong with me all of this time. I guess it wasn’t the unresolved issues from all my traumas after all that should my healing focus. I now have to live my entire life drugged out of normal and safe cognition and living in a bubble of the living dead because I cannot handle life right now or for years.” Jesus Laquan Christ! I am so over people giving themselves death sentences because they are still heartbroken that their best friend stole their poodle skirt (hmm…these should make a comeback!) 60 years ago; and it has made them the most insufferable person, like, ever. Now, on to getting the big girl stuff out of the way before diving in to Dr. Vaknin’s observation and theory.

“You can know the name of a bird in all the languages of the world, but when you’re finished, you’ll know absolutely nothing whatsoever about the bird… So let’s look at the bird and see what it’s doing – that’s what counts. I learned very early the difference between knowing the name of something and knowing something.”

Richard Feynman, Physicist and 1965 Nobel Prize laureate (1918-1988)

I.  Someone is considered mentally “ill”, if:

• Their conduct rigidly and consistently deviates from the typical behavior of all other people in their culture and society that fit their profile (whether this conventional behavior is moral or rational is immaterial);

• Their judgment and grasp of objective, physical reality is impaired;

• One’s conduct is not a matter of choice but is innate and irresistible;

• One’s behavior causes him or others discomfort; and/or,

• Dysfunctional, self-defeating, and self-destructive even by one’s own yardsticks.

Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated – is the illness “gone”, or is it still lurking there, latent, waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) – or brought on by abusive or disinclined nurturance?

These questions are the domain of the “medical” school of mental health, while others cling to the spiritual view of the human psyche. Spiritualists believe that mental ailments amount to the metaphysical discomposure of an unknown medium – the soul. Theirs is a holistic approach, taking in the patient in his or her entirety, as well as his milieu.

The members of the functional school regard mental health disorders as perturbations in the proper, statistically “normal” behaviors and manifestations of “healthy” individuals, or as dysfunctions. The “sick” individual – ill at ease with himself (ego-dystonic) or making others unhappy (deviant) – is “mended” when rendered functional again by the prevailing standards of his social and cultural frame of reference.

In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter – but, to a counterintuitively large degree, a faulty methodology.

As the renowned anti-psychiatrist, Thomas Szasz, of the State University of New York (SUNY), notes in his article, “The Lying Truths of Psychiatry,” mental health scholars, regardless of academic predilection, infer the etiology of mental disorders from the success or failure of treatment modalities.

This form of “reverse engineering” of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological “theories” – even the “medical” ones (the role of serotonin and dopamine in mood disorders, for instance) – are usually none of these things.

The outcome is a bewildering array of ever-shifting mental health “diagnoses” expressly centred around Western civilization and its standards (e.g.: the ethical objection to suicide). Neurosis, a historically fundamental “condition”,  vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973. Seven years later, narcissism was declared a “personality disorder”, almost seven decades after it was first described by Freud.

II. Personality Disorders

Indeed, personality disorders are an excellent example of the kaleidoscopic landscape of “objective” psychiatry. The classification of Axis II personality disorders – deeply ingrained, maladaptive, lifelong behavior patterns – in the Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. DSM-IV-TR, Washington, 2000] – or the DSM-IV-TR for short – has come under sustained and serious criticism from its inception in 1952, in the first edition of the DSM.

The DSM IV-TR adopts a categorical approach, postulating that personality disorders are “qualitatively distinct clinical syndromes” (p. 689). This is widely doubted. Even the distinction made between “normal” and “disordered” personalities is increasingly being rejected. The “diagnostic thresholds” between normal and abnormal are either absent or weakly supported. The polythetic form of the DSM’s Diagnostic Criteria – only a subset of the criteria is adequate grounds for a diagnosis – generates unacceptable diagnostic heterogeneity. In other words, people diagnosed with the same personality disorder may share only one criterion or none.

The DSM fails to clarify the exact relationship between Axis II and Axis I disorders and the way chronic childhood and developmental problems interact with personality disorders. The differential diagnoses are vague and the personality disorders are insufficiently demarcated. The result is excessive co-morbidity (multiple Axis II diagnoses). The DSM contains little discussion of what distinguishes normal character (personality), personality traits, or personality style (Millon) – from personality disorders.

A dearth of documented clinical experience regarding both the disorders themselves and the utility of various treatment modalities. Numerous personality disorders are “not otherwise specified” – a catchall, basket “category”.

Cultural bias is evident in certain disorders (such as the Antisocial and the Schizotypal).

The emergence of dimensional alternatives to the categorical approach is acknowledged in the DSM-IV-TR itself:

“An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another” (p.689)

The following issues – long neglected in the DSM – are likely to be tackled in future editions as well as in current research. But their omission from official discourse hitherto is both startling and telling:

• The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;
• The genetic and biological underpinnings of personality disorder(s);
• The development of personality psychopathology during childhood and its emergence in adolescence;
• The interactions between physical health and disease and personality disorders; and,
• The effectiveness of various treatments – talk therapies as well as psychopharmacology. 

III. The Biochemistry and Genetics of Mental Health

Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain – or are ameliorated with medication. Yet, the two facts are not indelible facets of the same underlying phenomenon. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.

To designate a pattern of behavior as a mental health disorder is a value judgment, or at best, a statistical observation. Such designation is affected regardless of the facts of brain science.  Moreover, correlation is not causation. Deviant brain or body biochemistry (once called “polluted animal spirits”) do exist – but are they truly the roots of mental perversion? Nor, is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause mental illness – or, the other way around?

That psychoactive medication alters behavior and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That the changes brought about by prescription are desirable – is debatable and involves tautological thinking. If a certain pattern of behavior is described as (socially) “dysfunctional” or (psychologically) “sick” – clearly, every change would be welcomed as “healing” and every agent of transformation would be called a “cure”.

The same applies to the alleged heredity of mental illness. Single genes or gene complexes are frequently “associated” with mental health diagnoses, personality traits, or behavior patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.

Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the interaction with a therapist also affect the brain, its processes, and chemistry – albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines – as David Kaiser reminds us in “Against Biologic Psychiatry” (Psychiatric Times, Volume XIII, Issue 12, December 1996) – treat symptoms, not the underlying processes that yield them. 

Let’s say that last part again, loudly, for the people in the back who swear by their anti-anxiety meds.

IV. The Variance of Mental Disease

If mental illnesses are bodily and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed, the case. Psychological diseases are not context dependent – but the pathologizing of certain behaviors is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are considered sick by some cultures – and utterly normative or advantageous in others.  This was to be expected. The human mind and its dysfunctions are alike around the world across every human body. But, values differ from time to time and from one place to another. Hence, disagreements about the propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.

As long as the pseudo-medical definitions of mental health disorders continue to rely exclusively on signs and symptoms – i.e., mostly on observed or reported behaviors – they remain vulnerable to such discord and devoid of much-sought universality and rigor.

V. Mental Disorders and the Social Order

The mentally sick receive the same treatment as carriers of AIDS or SARS, the Ebola virus, or smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done in the name of the greater good, largely as a preventive policy.  Conspiracy theories notwithstanding, it is impossible to ignore the enormous interests vested in psychiatry and psychopharmacology. The multibillion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies rely, for their continued and exponential growth, on the propagation of the concept of “mental illness” and its corollaries: treatment and research.

VI. Mental Ailment as a Useful Metaphor

Abstract concepts form the core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visited the unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power.

“Mental health disorders” are no different. They are shorthand for capturing the unsettling quiddity of “the Other”. Useful as taxonomies, they are also tools of social coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating both the dangerous and the idiosyncratic to the collective fringes is a vital technique of social engineering. 

The aim is progress through social cohesion and the regulation of innovation and creative destruction. Psychiatry, therefore, reifies society’s preference of evolution to revolution, or, worse still, to mayhem. As is often the case with human endeavor, it is a noble cause, unscrupulously and dogmatically pursued.

So, in laymen’s terms, you can’t make something infinite, like the psyche of every single sentient being, a finite entity through science. Though our DNA is similar, what may work for my sister, uncles, kids, friends, etc. may not work for me. The same for you all. Psychology is only a science in its method of study and experimenting in the quest to understand the mind, but not in anything else. We aren’t lab rats when it comes to mental health and wellness. Science can figure out through experimentation using animals to bridge similar mammalian qualities – like, pigs, rats, and monkeys – to understand and maintain the physical human body, but science shouldn’t be used to help the mind be one with soul. The mind is beyond the limits and rigidity of science. Science and matters of the psyche/soul are separate like church and state should be. Our minds are our own to manage and should not be messed with because they are, like much of the body, self-healing. Supplementing with more chemicals via MTM, especially to an already imbalanced sphere, is a disservice and inevitably sets one back in their healing process. Short-term, these meds can be helpful to help minimize some symptoms and bolster, or work alongside, the internal work we are doing. Long-term, it can stunt one’s own healing process, in effect, making the problem worse. Think about it…when going through medication management, you try a drug to see if it works. When it doesn’t, the doses are titrated or the drug is exchanged altogether for a new one, then the process starts again. This cycle repeats for a lot of people where before they know it, it’s many years later still on the same meds at a significantly much higher dose, and the original problem – like, unresolved past trauma & its results – is still there affecting your present life in worse ways than they were before inception of their MTM process. No matter if we decide to do MTM or not as it is the prerogative of any and everyone to put their lives in the hands of psychopharm as we already must do for our physical health, the internal work still needs to be done. Period. I said period, bitches! Psychotherapy is more enriching than the effects of psychotropic medication with an assload of side effects. Pull the mask off, look in the mirror to see who you really are, and heal that person you fear or just don’t know. They are reaching out because they need you to face them and stop relying on external means to fix internal problems. As laid out by further research of Dr. Vaknin’s work and as I repeat in mine, how we heal is 100% under our control – not our drs’, not our support systems’, nor anyone’s God. I find it hilarious when people ask their God to change their minds and states of being, as if they can’t do their own shit, for real. “God, please take these shoes off my feet. You know I worked hard today with your children, especially the devil, trying me left and right. I don’t feel like it right now with undressing myself. Please do this in your infinite wisdom. Amen!”     

Sources: I recommend to Google Dr. Sam Vaknin and do your own research on his extensive psych work.