aNewDomain — The question comes up every time someone acts “crazy.”
A man shoots up a school or a theater.
A woman drowns her children.
A man confronts police in such a way that they have little choice but to shoot him.
A pilot intentionally crashes his plane, killing himself and all his passengers.
What is the meaning of crazy? Don’t you need a mental health screening in order to own a gun? Should you have a screening to be a parent? To fly a plane?
And who decides what is healthy, anyway? Psychiatry might like to have the authority to say who is mentally healthy and who is mentally ill. But there are fundamental problems with that construct, problems so fundamental that the American Psychiatric Association might hand back such authority as soon as they realized the implications: that suddenly they were legally liable for every bad act committed by a human.
The DSM, the APA’s diagnostic manual, has deep flaws. Whenever we have power and authority we have the potential for profit. The United States operates a for-profit health-care system. There exists a powerful set of incentives to create mental health problems that can be medicated. Medications represent the number one moneymaker in psychiatry, for psychiatrists and drug companies alike.
Indeed, the way diagnostic categories are themselves created is a deeply troubling process, with strong confirmation bias and drug-company representation.
The DSM itself is the biggest moneymaker for the APA and has been strongly and roundly criticized for its focus on the medical aspects of mental processes, its corrupt processes, and the way its reconstructed categories expand the potential for diagnosis (and therefore prescription) such that nearly anyone could be diagnosed with a mental illness.
Is It Always Crazy to Commit Suicide?
Are you mentally well? Go see a psychiatrist, and you could come back with a number of labels and a fistful of prescriptions.
Go see a psychologist, and there’s a chance you will get a more honest answer: we just don’t know. The instruments we use are quite sophisticated in the right hands but still are not designed to diagnose specific mental health issues.
They help us discover differences between potential and performance in school-aged children, or classify aspects of personality, or discover whether someone is lying to the examiner. They have far-from-perfect clinical accuracy. And if the person chooses not to take part or not to respond authentically, the very best we can do is say, “This person seems to be hiding something.”
Next problem: We have very different ideas of what insanity means.
Psychology doesn’t use the term at all. The courts use it to mean a person who, at the time of a crime, was not capable of moral reasoning. We for sure have no category for that.
Is it always crazy to commit suicide? There are many instances where the question might be weird — do you have the right to die, for example, when experiencing a painful and terminal illness that will rob you of your dignity and eventually transfer all of your family wealth into the hands of for-profit medicine?
Is Evil Crazy?
And is evil crazy? What is the nature of evil? Most of us think that evil lies at the opposite end of reason and that reasonable people must all arrive at the same conclusion given the same information. So if someone does not reach our moral conclusions — for example, that shooting children is wrong — are they evil or crazy?
We don’t have a reliable instrument for moral appropriateness, for pro-social behavior. We can find some level of anti-social traits or thinking, if the subject agrees to take part in our assessments — but this does not help us determine what the person is going to do with their lives. Antisocial traits are common in perfectly functional persons.
Psychopathy, the tendency to act in self-interest without recourse to empathy, is found in doctors, lawyers, investment bankers, police officers, in your next-door neighbor. Most criminals are not psychopaths, and most psychopaths are not criminals. Serial killers do not qualify for psychiatric diagnoses at rates higher than the general population.
So, are you mentally healthy?
What are you asking me to do? The very construct is broken. There’s no reliable way to measure it, and this gives power to people who have historical and currently abused it. It becomes a tool to enforce conformity and, worse, to make piles of cash.
When talking about gun violence, why can’t we talk about gun control and the social issues that lead to violent crime — namely, joblessness and poverty?
When talking about parents murdering their children, why can’t we talk about the social conditions that leave troubled mothers at home without family support? Isolated, segregated from society by our psychopathic needs to make money, and only pay people the minimum we can? Where were the father, grand parents, in-laws, neighbors…
When talking about pilots, can we examine the psychopathic way we treat pilots? Pilots have it as bad as adjunct faculty, fast food workers, or even worse. They often have second jobs to pay the bills.
When you can’t make a living doing something, you go to those jobs for reasons other than money. The majority of the time, this means pilots go into airlines because they love to fly. They’ll do anything to fly. But sometimes, rarely, someone will go into the job for some other reason. or power, escapism, or maybe — just maybe — a long-term suicide plan.
Is that sick?
Don’t ask me. I’m just a psychologist.
For aNewDomain, I’m Jason Dias, PsyD.
Cover and first inline image: “Wide eyes” by http://www.flickr.com/people/mickamato/ Mikamatto – http://www.flickr.com/photos/mickamato/7630728730/in/photostream. Licensed under CC BY 2.0 via Wikimedia Commons.