Do Mental Disorders Really Exist?

“My doctor says that I have bipolar disorder. A friend of mine recently told me about a famous psychiatrist who maintained that mental disorders don’t really exist, that it is just society’s way of controlling some of its people by labeling them mentally ill. Could this mean that I really don’t have bipolar disorder?” 

You bring up an interesting point and an ageless argument. As far back as ancient times, people who were different and went against the political or societal norms were labeled as “disturbed” or “crazy.” Whether throwing dissenters to the lions, burning witches at the stake, or confining people to insane asylums, the process of ridding society of those who thought “outside the mainstream” has gone on for centuries, if not throughout time.

Possibly, your friend has heard about the writings of a famous twentieth century psychiatrist, Thomas Szasz. He wrote a book called The Myth of Mental Illness. In this volume, he posited that mental illness is not an illness, like a physical illness. Rather, he stated that “no further evidence is needed to show that mental illness is not the name of a biological condition but just a man made concept.” In another quote, he stated that “there is no psychology; there is only biography and autobiography. We make our own misery and happiness.“ His work encompassed the middle of the twentieth century, and it is now seriously dated. In his time, he had a strong following and many prominent professionals agreed with his position; however, in the last twenty years there have been boundless advances in medical science and technology. While Szasz contended that mental illness had no neurological base, now it can be demonstrated that there are differences between “normal” people and the “mentally ill” in their neurological makeup. We now know that mental illness can have a strong physiological component and that mental disorders do, indeed exist.

This being said, another well know twentieth century psychiatrist, Seymour Halleck, wrote a number of books, one of which was entitled The Politics of Therapy. He wrote of the politicizing of mental illness in the Soviet Union, namely the jailing of political dissidents. This same process has been repeated throughout the world at different times as a way of dealing with protest. He also wrote about the “medicalization” of deviant behavior, which, he stated, may well be based in a school, home, work, or other social venue. By making the deviant behavior an individual, neurological disorder, the deviant behavior is rendered meaningless in a broader social context. In other words, the problem might lie outside the person and be a societal problem rather than a mental illness. As Szasz stated: “Insanity is the only sane reaction to an insane society.”

So with the backdrop of this psychiatric history lesson regarding mental illness, we can attempt to address your question. Do you have bipolar disorder? Maybe you do, maybe you don’t. What was the process of your doctor’s diagnosis? Did he or she do a comprehensive workup regarding your medical and family history? Did he or she ask about current behavior which might be labeled as “odd,” or “different?” Were current social, political, economic or work related issues discussed? Did the doctor get any collaboration from any of your friends or family members? Was there an evaluation by a psychologist regarding any psychological disorders? And, finally, was there a physical examination, to rule out the possibilities of any physical disorder contributing to the perception of bipolar disorder?

If a comprehensive protocol was following in this diagnostic phase incorporating current guidelines, you should be relatively assured that the diagnosis, whether bipolar or not, is probably accurate.

Dr. Manuel S. Silverman, PhD