The InterPsych Newsletter 2(1)



IPN 2(1) Section D: Article



                    SECTION D: ARTICLE

| In   this  section  is  an  non-reviewed  article |
| submitted  by Dr. Schaler.    In the future, this |
| section  will  be  devoted  to  refereed research |
| articles.   To submit an article to this section, |
| please  send  an  ASCII version of the manuscript |
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                 Jeffrey A. Schaler

"What  has allowed us to get to the point where mental
illness and substance abuse  services  are  viewed  as
essential components  of a comprehensive medical bene-
fit package,"   explains  Tipper  Gore,   holder  of a
master's degree in  psychology and wife of  Vice Pres.
Gore, is that as a country, "we have come to recognize
that mental and addictive disorders  are  real medical
disorders just like other physical illnesses; they are
diagnosable and treatable," (1). Ms. Gore says that 23
percent of people  between  the ages of 15 and 54, and
16 percent of Americans ages 65 and older, suffer from
"depression."   Five  percent of  all  children  under
the  age  of 8 have  "severe  emotional  disturbances"
and  at  least  10 percent  of children  in  the  U.S.
manifest a specific "learning disability."     Alcohol
use disorders  allegedly affect  approximately 23 % of
the population, and drug use disorders affect about 12
%.   On the basis of these statistics, it would appear
that 89 percent  of  the  American population  suffers
from mental and addictive disorders.  In other  words,
almost everyone  is sick.    I think  we need to  take
another  look at  the difference between mental [fake]
and physical [real] illness. For the policies  that we
implement based on explanations for behaviors and ill-
ness can vary  significantly.   "Ideas," wrote Richard
Weaver,  "have  consequences," (2).  Ms. Gore endorses
the "medical model" of behavior. She advances the idea
that  biological factors determine "mental disorders."
There  two  other explanatory models  used  by  social
scientists - and  the public  is generally unaware  of
that. Psychological models  focus on  self-environment
interaction.  Those  may include  free-will  oriented,
existential perspectives on human behavior, as well as
deterministic approaches  such  as psychoanalysis  and
behaviorism.    Those  may  also  include  volitional-
learning approaches such as social-cognitive theory.

   Sociocultural  models  explain  abnormal behaviors
through  norms  and  mores.     Those  proponents  may
question  the  existence  of  mental  disorders, i.e.,
that  they  are  social  inventions,   not  scientific
discoveries. For example,  they view homelessness as a
socioeconomic problem.   Ms. Gore sees it as untreated
mental illness.   What we may do  [or won't do]  about
homelessness  varies  by the explanation  that we give
for it. It's important for the public to realize  that
psychology and psychiatry are not "hard" sciences like
chemistry  or  engineering.   Behavior is choice,  the
function of moral agency.  Thus, the state should con-
sider  the  view that  mental  disorders  are   unlike
physical illnesses, before it gets too involved in the
"diagnosis"  and  "treatment"  field.   There are good
arguments  against the idea  that  mental illness  and
addictive  disorders   even   exist.   Certainly,  the
medical model dominates public  policy.    However, by
scrutinizing  mental and physical illness  we may con-
clude that the two are quite different.  Policy makers
should  take  these  points   in  consideration.   For
example,    mental   and   addictive   disorders   are
"diagnosed" and "treated" based  on symptoms,  or sub-
jective  complaints.   Medical  disorders  are usually
diagnosed  and  treated based on signs,   or objective

    In  mental  and addictive disorders,   people  are
designated   "patients"   against  their consent.   In
medical disorders,  treatment without consent   occurs
only in cases of unconsciousness,   for children,  and
contagious disease.   Real diseases occur in the body,
usually  involve lesions,   and are present  at death.
That's  not true  for mental and addictive  disorders.
There  are no definitive lesions for any of the mental
and  addictive disorders.   Mental  and addictive dis-
orders are diagnosed  by something that  a person does
and feels,   e.g.,   acting  in  a  peculiar  fashion,
complaining of hopelessness.   Real diseases are some-
thing that a person has,  e.g.,  a  person has cancer,
diabetes, or heart disease.

     Mental and addictive disorders are  behaviors and
thus a function of personal values. Real diseases have
little to do with morality.  Clearly certain behaviors
may lead to disease:   Smoking is a behavior  that may
lead to cancer.  Heavy drinking is a behavior that may
lead to liver disease.   No matter how "good" or "bad"
people  are,   they're  equally  susceptible  to  con-
tracting a disease, e.g.,  AIDS.   Furthermore, people
can  change behaviors through desire,  but they cannot
change their disease by desiring to be  well.   People
labeled with addictive disorder  are  often  "treated"
with spiritual-conversion experience,  e.g.,  "turning
one's  life over to a higher power"  as  in Alcoholics
Anonymous.  That's not so for physical diseases. More-
over,   drug addicts get "better"  when  they  give up
heroin and cocaine. Diabetics get worse when they give
up insulin (3).   Finally, real diseases are listed in
standard textbooks on pathology.  Mental and addictive
disorders are  not.   Most  behaviors referred  to  as
mental and addictive disorders  are categorized in the
Diagnostic  and  Statistical  Manual  of  the American
Psychiatric Association as not having an organic base:
"The diagnosis is made only when it cannot be establi-
shed that an organic factor initiated  and  maintained
the  disturbance,"  here referring to "schizophrenia,"
(4).   As Thomas Szasz explains, the medicalization of
socially deviant behavior  is moralism masquerading as
medicine, (5).  The  government  has no place  telling
people how to behave, when their behavior harms no one
but themselves.   I submit that  the government has no
place  telling people  how  they  should  regard them-
selves, e.g., dictating self concept.  When government
gets involved  in  "treating" mental disorders  that's
exactly   what   it  ends up doing   -   dictating  an
"appropriate" way for people to think about themselves
and the world.   As  constitutional  scholar  Lawrence
Tribe wrote: "Not surprisingly the [Supreme] Court has
insisted that activities actually going on  within the
head are absolutely beyond  the power of government to
control.    In a society  whose  whole  constitutional
heritage rebels  at the thought  of giving the govern-
ment  the power to control men's minds,  the governing
institutions, and especially the courts, must not only
reject   direct   attempts   to   exercise   forbidden
domination over mental processes;   they must strictly
examine as  well oblique intrusions likely to produce,
or designed to produce, the same result," (6)     That
church-state entanglement  through  health-care reform
may   bring  unanticipated  conflict  regarding  First
Amendment   rights   violations  is   one  reason  why
coverage    for  mental  and  addictive  disorders  is
inappropriate. The fact that mental and addictive dis-
orders  are  quite  different  from "real" diseases is
another. The economic drain on coverage for legitimate
diseases   that  people  cannot  control   because  of
"mental-health  coverage"    is   perhaps   the   most
important, (7). While Ms. Gore,   as Mental Health Ad-
visor  to Pres. Clinton,   asserts  that  people  with
"mental illness"  and "drug addictions   are just like
those with cancer, diabetes, AIDS, and  heart disease,
a person with diabetes is hardly like a heroin addict.
Those  struggling  with cancer are  hardly like people
labeled "manic-depressive."   Psychiatry  and  psycho-
therapy should  remain  personal,  contractual engage-
ments  and belong  in the private sector,  free of any
and all state intrusion and involvement.

1.   Gore, T. (1994).  Moving policy toward medical
     reality:  Mental and addictive disorders and
     the Health Security Act.  Treatment Today,
     Vol. 6., No. 1, 6-9.
2.   Weaver, R.  (1962).  Ideas have consequences.
     Chicago:  Phoenix Books.
3.   The idea was suggested to me by Nelson Bolero,
     MD, in 1989.
4.   American Psychiatric Association.  (1987).
     DST-III-R.  Washington, D.C.; American
     Psychiatric Association, p. 187.
5.   Szasz, T. (1994).  Cruel compassion:
     Psychiatric  control of society Us unwanted.
     New York:  Wiley.
6.   Tribe, L.  (1988).  Constitutional law, 2nd
     Ed.,  p. 1315.
7.   Hilzenrath, D.S.  (1994).  The quandary over
     Mental health care costs.  The Washington
     Post, July 25, A6.