By Adam Zwig, PhD
Me and the Mad Hatters
When I'm not writing songs, recording, and touring, I work in the field of psychology and therapy. For ten years I lived in Zurich, Switzerland where I dealt with clients in both institutional psychiatric settings and private practice. I worked one-on-one with the most difficult, supposedly incurable folks whom the mental health profession considered "lost cases." In addition, I conducted and continue to do research on mental illness. Here's what I've discovered.
The concept of mental illness has no basis in science. While the experience of depression, anxiety, obsessive-compulsive behavior, phobias and delusions is painfully real, the notion that these problems are "diseases" has not a shred of evidence behind it. Tweet This In fact, there's never been a single scientific study demonstrating the existence of a mental disorder - no research showing that a specific group of symptoms can be clearly distinguished from other symptoms and from no symptoms, like is done in medicine. Tweet This
The psychology diagnostic manual is a dictionary of symptoms with no objective measures associated with them. A diagnosis of clinical depression is like a diagnosis of fever or chest pain—symptoms without any underlying principles or processes. Tweet This The diagnostic system is based on pseudoscientific methods that give practitioners a certain degree of consistency in diagnosis but offer no evidence of validity.
Bible of Bull
The manual, known as DSM (Diagnostic and Statistical Manual of Mental Disorders), uses language that's precise enough to sound scientific but vague enough so that you can't really pin it down. Words like, "excessive" (crying, sleep, weight fluctuation), "repeatedly" (going over thoughts), "overly" (reflective), and so on, are used in place of hard science. Who can say what "excessive" is? Excessive according to what or who? The terms are anything but scientific.
Since there's no science foundation upon which the disorders are based, each new edition of the manual freely changes and redefines the disease criteria. In addition, the diagnoses use arbitrary time-frames, for example, two weeks of feeling depressed as the threshold for receiving a diagnosis of clinical depression (I've always been curious as to what mysterious event occurs on the 15th day). Tweet This
Psychology and psychiatry want to be seen as respectable fields on par with medicine, and they seek to accomplish this by borrowing medicine's concept of disease entities. However, unlike in medicine, mental illnesses aren't identified through research but rather though consensus amongst a group of "experts" who feel that a certain cluster of symptoms belong together as one disease, even though they have no idea of how or why. Tweet This
Psychology is an imitation of medicine but without the science. Imagine if medicine used a dictionary of symptoms that had no underlying research foundation and was created by a small group of self-proclaimed experts.
NIMH Goes Rogue
Think I'm being unscientific or unreasonable? Well, guess what. Thomas Insel, the director of the National Institute of Mental Health until 2015 - a neuroscientist and psychiatrist - said the exact same thing about the newest diagnostic manual. In fact, just two weeks before the manual was due to appear, the National Institutes of Mental Health, the world's largest funding agency for research into mental health, withdrew its support for it.
In a humiliating blow to the American Psychiatric Association Insel said the agency would no longer fund research projects that rely exclusively on criteria from the manual. He said, "The weakness of the manual is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."
'Round the Bend and into the Light
What I've discovered is that what people call mental illness is actually a rational process that can be worked with and transformed. Even so-called "crazy" people have such a process. Tweet This The problem is that psychologists don't know how to work with them by thinking contextually in a way that understands extreme behavior as a reaction to the patient's environment, including over generations.
The notion that folks who exhibit violent, anti-social, or delusionary behavior have a disease is a philosophically-based conclusion, not an evidence-based science fact. Tweet This I've worked with nutters who thought they were Jesus, the Queen of England, and everything else you can imagine, and I was able help them develop a self awareness. In most cases, however, people diagnosed with a mental illness are perfectly normal.
Rock n Roller Coaster
Take, for example, the common diagnosis of Bipolar Disorder. This diagnosis is associated with mood swings from deeply depressive to manic highs. The depressed phase includes symptoms such as low energy, low motivation, and loss of interest in daily activities, while the manic episodes include symptoms such as high energy, reduced need for sleep, and in some cases, loss of touch with reality.
In the U.S. alone, there are three million cases diagnosed per year. The conventional wisdom about this illness is that it lasts your whole lifetime which means you will always need medication, talk therapy, and systems for managing your symptoms.
Semantic Snow Job
If you examine these criteria a bit closer, however, you enter into murky waters. "Low energy" and "low motivation"? How low? What's the threshold where feeling tired becomes a disease? Who and what determines this? Similarly, "high energy" and "reduced need for sleep"? How high can you go before you have the disease? "Loss of touch with reality" is a bit more of a complex notion that I will hack into after I tell you a case example.
Everyone is bipolar to some degree since we all have highs and lows in our lives. The idea of bipolar disorder is that some people have too much fluctuation in these moods. But again, how much is "too much" and how do we know when someone has arrived at this level? Even if there was a way to measure mood fluctuations how would we know what level constitutes a disease?
Shameful Shell Game
If these vague criteria are arrived at by consensus within a group of psychologists instead of by scientific research wouldn't that mean the diagnostic elements could be manipulated to alter the frequency of this diagnosis? Couldn't these folks arbitrarily decide who's sick simply by changing the rules? The answer is yes.
In the 1990's the authors of the DSM decided to lower the threshold for the manic side of the bipolar equation. They said you don't need to go crazy ecstatic high, just get into a nice state of mind where you feel really good. Guess what happened: Diagnoses sky-rocketed. Everyone and his sister suddenly had bipolar disorder because you no longer needed to flip out to get the diagnosis. All you needed to do was go back and forth between feeling depressed and being happy. People didn't change, nor did the incidence of the condition - only the diagnostic criteria changed. In effect, the diagnostic manual created an epidemic.
Big Pharma Fraud
Upon studying the time-frame of this change, I was shocked to find that it occurred at the exact same time that anti-psychotic drugs were being rebranded as mood stabilizers. When I dug further into this I discovered a pattern; new diagnostic criteria and even brand new diseases often appear in the manual at exactly the same time new psychiatric drugs which treat those same diseases are brought to market. Coincidence? Me thinks not.
Flash forward to today, and everyone seems to have bipolar disorder. More people don't have the condition, it's just easier to get the diagnosis. Oh, I forgot to mention this: A hundred per cent of the manual's authors have financial investments in the pharmaceutical industry.
Years ago in Switzerland I had a client who had been diagnosed with bipolar disorder. When I first met Clara, a 22 year-old university student, she told me she'd received her bipolar diagnosis and medication from her psychiatrist but hated the side-effects of the drugs.
The doctor had tried various meds on her and eventually said the side-effects were mild enough to be acceptable. I laughed when she said, "mild enough," and replied, "Mild enough for who?" Clara smiled and we began working on her process.
She told me that she goes back and forth between lying in bed in a depressed stupor for three or four days, unable to function and thinking about suicide, and then suddenly a cloud lifts and she feels super high and goes out partying for days on end. When she's in party mode she walks around Zurich imagining, and sometimes even believing, she's the most powerful woman in the world. Then she gets depressed again and realizes it was all just a fantasy.
I asked her what it's like to be depressed, and she described it by saying, "It's like a thousand pound gorilla. I feel paralyzed and don't want to live."
"A gorilla?" I said.
"Yeah. He's a thousand pounds and he's crushing the life out of me."
"Fantastic! Tell me more about him."
"I don't know. It's just an image that came to mind."
"What would it be like to be a thousand pound gorilla?"
"Uh… I don't know. Is this important?"
"Yes! What would it be like to be a gorilla?"
Clara giggled. "I don't know, I'd be big and hairy and move like this." She swayed back and forth and put her arms out to her sides. Then she covered her mouth.
"What just happened?" I asked. "Are you embarrassed?"
She nodded yes, and I asked why. After pausing she told me she'd grown up in a strict family where women and girls were supposed to act proper and stay in the background. Her dad was a Swiss banker whom she described as "stiff." He had conveyed to her the typical sexist conventions - look pretty, speak quietly, and don't be expressive or weird or challenging. Her mom followed these rules without any qualms, so the message to Clara was clear: Repress yourself if you want to be accepted.
I told her, "I promise no one will ever know, and I totally support you, so let's stand up and be gorillas!" She laughed but shook her head.
"Are you sure?"
"What would happen if we play-acted being gorillas?"
She got a fearful look on her face and replied, "I don't know, I'd get in trouble…but that sounds crazy."
"Yeah, you won't get in trouble, and you might even learn something."
Again, she shook her head. "Is this therapy?"
I laughed, and said, "Yup, it's Dr. Zwig therapy. But seriously, your imagination of a gorilla may help us."
With the fearful expression still on her face she took a deep breath and courageously stood up out of her chair. At first she was painfully hesitant but after a few minutes of me encouraging her we began walking around the room pretending we were great apes making funny movements and sounds! We did this for a good ten minutes, and at one point, she walked toward me raising her arms above her head and growled like a monster ready to devour it's prey.
"Woah, what are you doing!? What's it like for you to do that?" I asked.
"Like I'm the powerful one!"
"Yeah, I'm the queen gorilla."
"Awesome! Do you normally feel this powerful?"
"No! I usually feel like a weakling…well, unless I'm drunk… This is fun!"
"Imagine feeling this power all the time. What would that be like?
Again, she covered her mouth.
"Oops…what happened there?" I asked.
"I don't know… like this isn't allowed…"
"Right, your father says a woman shouldn't be powerful…but you are! Imagine always feeling like this."
She smiled. "If I always felt like this I'd feel like I can do whatever I want in life, like I don't have to follow my parents' rules and plans for me. I can do whatever I want in the world."
"Right! You'd be a powerful woman in charge of your destiny! How's that feel?"
"It's a high…"
"Um… it's like when I party, but not drunk or anything, just super strong!"
Next, I role-played her father saying the typical sexist things to her and she dialogued with me, using her power to push back against the him. In subsequent sessions we worked further on her power as a woman vs. the internalized negative father who wanted to repress her. After a few months she had no more crazy mood swings or weird delusions, and has remained that way ever since.
Saved by the Process
The two parts of the bipolar equation - depression and mania - are opposite sides of the same coin. They're two extremes compensating for each other but have a crucial missing element: Awareness of the process. The reason Clara's depression and mania went away was because she discovered this missing element. By identifying with her power as a woman she integrated the "gorilla" - the image onto which she had projected her strength - and was no longer a depressed victim of its power.
She also didn't have to fly off into delusionary manic episodes imagining she was the most powerful woman in the world because she actually became a strong woman. The loss of touch with reality that some bipolar people exhibit isn't a meaningless, random symptom of craziness; it's the psyche's attempt to free itself from something oppressive. Believing she was the most powerful woman on the planet sounds looney, but when you understand it's context and purpose it makes perfect sense.
Psychologists want to sound like they know what they're talking about even when they don't, and to this end say things like, "The exact cause of bipolar disorder isn't known, but a combination of genetics, environment, and altered brain structure and chemistry may play a role." What a bunch of rubbish. The truth is, the disease model of mental health is a byproduct of both ignorance and the financial interests of the pharmaceutical industry.Tweet This You don't have a mental illness; you have a meaningful process.Tweet This
Hail to the gorilla!
*Client names have been changed.
Dr. Zwig - psychotherapist, singer-songwriter, and author - is an internationally renowned workshop leader and lecturer, has had 9 Top Ten hit singles on the U.S Adult Contemporary charts, and has over 60 million views on YouTube. He has been featured in Billboard, Huffington Post, CNBC, MSNBC, ABC, CBS, Forbes, and Gibson. Dr Zwig has released 7 albums and his songs can regularly be heard on NBC, Fox, and Fuel TV. His forthcoming book, Music in the Mayhem: Tales of Total Transformation from a Rock n Roll Psychotherapist, arrives soon.