By Adam Zwig, PhD
If you’re okay with taking psychiatric medications, you may not want to read this. Also, never stop meds without doctor supervision and therapeutic support.
In this blog post I identify a core problem in psychiatry and psychology. At the bottom of the post there's a link to one of my case stories which illustrates how to fix the problem.
Before jumping in I want to address two issues with critiquing mental health practice. The first is that it’s a highly sensitive topic: The awful stigma around mental health issues has people on guard against being put down and marginalized, and rightfully so. Therefore, from the outset, let me say I’m a champion of the fact that every human being has a life process to deal with, and problems are a natural part of it. However, we must be careful not to misinterpret critiques of the system as indications of stigmatizing those suffering. To the contrary, the only way to make progress is to identify and challenge faulty methods.
The second has to do with language. Modern linguistics tells us that our words don't just reflect reality, they create it. They do so by describing experiences from a particular viewpoint. Mental health terminology creates the way in which we view and respond to painful states of mind. Therefore, we must know the implications of the words we use—terms like, “mental illness,” “disorder,” “diagnosis,” etc.. Remember: These words denote specific viewpoints on peoples’ problems, not the experience of pain and suffering itself. In other words, asking whether bad states of mind are illnesses questions the interpretation and labeling of those problems, not the reality of their existence.
Me and the Mad Hatters
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 some of the most extreme cases in the population. In addition, I conducted and continue to do research on mental illness. Here's what I've learned.
Cart Before the Horse
What’s the origin of the idea that bad states of mind are illnesses like medical diseases? Is it a scientific concept or just a common way to think about human problems? The answer may surprise you. For millennia humans attributed deep mystery to physical ailments. The idea that abnormal signs and symptoms could indicate a variety of underlying diseases was a conclusion arrived at only after years of rigorous scientific research involving hundreds of peer reviewed studies. No one just spontaneously thought to himself, “I’ll bet chest pain can be a sign of heart attack, gastroesophageal reflux disease, muscle or bone problems, lung conditions, stomach problems or stress.” Each disease contains its own highly specific parameters as demonstrated in experiments.
In contrast, the notion that depression, anxiety, etc., are illnesses didn't arise from scientific research but rather from a desire to make psychology more like medicine. Instead of scientific evidence leading researchers to the conclusion that bad states of mind are diseases, the idea originated from the common everyday assumption we make when we see someone who feels messed up or acts weird, and think, “Oh, there's something wrong with him, he's disturbed, sick." Everything about mental health practice—diagnosis, prognosis, treatment, etc—is built on this core assumption. Only problem is there's never been a single scientific study providing evidence for it.
To make a medical diagnosis, a doctor uses research data to differentiate the many possible reasons for one’s signs and symptoms, and arrives at a specific disease entity. In contrast, there’s no research demonstrating that mental / emotional pain can be differentiated into distinct psychological entities—no studies showing that a specific group of symptoms and underlying processes can be clearly distinguished from all other symptoms and processes and from no symptoms and processes. Tweet Without research data to distinguish between underlying causes we can’t identify diseases. Psychiatry and psychology use the word, “illness,” in the common lay sense, not in the scientific sense. Nevertheless they label groups of symptoms in a way that makes them sound like diseases even though there's no underlying research data. They’ve put the cart before the horse.
Before the 1800s when germs were discovered to cause sickness medicine did the same thing. It classified symptoms into clusters and gave them disease names without any idea of what was causing them. The psychiatry / psychology diagnostic manual, despite its scientific sounding jargon, is a dictionary of symptoms with no objective measures associated with them; a diagnosis of clinical depression is like a diagnosis of chest pain—a symptom without any underlying principles or processes. Tweet The diagnostic system is based on pseudoscientific methods that give practitioners a certain degree of consistency in diagnosis but offer no evidence of validity.
So why has the public bought into the fraudulent claim that a troubled mind indicates a psychological disease? Precisely because it appeals to our shared common sense feeling that abnormal behavior and experiences are pathologies. But remember: The whole reason science exists is to transcend the limitations of common sense ways of perceiving the world. Without it we'd still believe the sun goes around the Earth, the Earth is flat, and infectious diseases are caused by "bad air." So, while it may make intuitive sense to think that depression, anxiety, etc. are illnesses there's simply no science to back it up.
Furthermore, there still aren't any studies confirming the hypothesis that mental health problems are caused by a chemical imbalance in the brain. Despite psychiatry and the pharmaceutical industry's billion dollar ad campaigns aimed at selling the public on the chemical imbalance idea, causation has never actually been demonstrated. Psychiatric medication doesn’t target a specific brain disorder but rather induces a generalized altered state that simply takes one’s attention away from one's symptoms. Read more on this here: Why People Believe Falsehoods About the Brain and Mental Health
Bible of Bull
The diagnostic 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
Psychology wants to be seen as respectable field on par with medicine, and psychiatry wishes to be taken as seriously as the other medical specialities. They both 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
Mental health diagnosis is an imitation of medical diagnosis but without the science. Tweet 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 process that’s meant to be worked with and transformed, not suppressed or simply managed. Tweet This Years of clinical work taught me that every problem, no matter how crazy and severe, is meaningful and purposeful. Rather than being a pathology to diagnose and treat, it’s an expression of personal growth and change desperately trying to happen. The worse the state of mind the stronger and more urgent the process needing to come to awareness. This isn’t just a “theory” I’ve come up with or a philosophical viewpoint I identify with, but rather a conclusion I arrived at after empirical observation and experience with thousands of clients.
The problem is that the mental health field has failed to develop its own model, relying instead on the medical model as a template. Medicine views problems as pathologies to get rid of—an appropriate and effective paradigm for addressing many physical ailments. But when you try to apply this to mental / emotional issues you run into a major obstacle because these experiences are intangible, fluid events of meaning with none of the quantitative parameters used in medicine. The result is a well-meaning mental health profession that uses a completely non-scientific classification system of diseases. To the uneducated public it looks, sounds, and feels like real science but it’s simply not.
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.
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.
Clara's Process *
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. Find out how she transformed her life in my next blog post, How Clara Healed Her Severe Mood Swings.
*Client names have been changed.
Dr. Zwig—psychotherapist, singer-songwriter, educator, and author holds a PhD in clinical psychology, is an internationally renowned workshop leader and lecturer, and has had 9 Top Ten hit singles on the U.S Adult Contemporary charts. He has been featured in Billboard, Huffington Post, CNBC, MSNBC, ABC, CBS, Forbes, Gibson, and many other publications, and has over 75 million views on YouTube. 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.
DISCLAIMER: The content contained herein is for inspirational, educational, and entertainment purposes only. Nowhere in this Blog does Dr. Zwig diagnose or treat a viewer with any kind of psychological, mental, emotional or physical disorder as might be diagnosed and treated by a personal psychologist or other professional advisor. The content is not intended to be a substitute for working with a therapist but is for the purpose of educating the viewer about new approaches to working on personal problems. Viewers should use this Blog at their own risk, with the understanding that Dr. Zwig is not liable for its impact or effect on its users. Viewing this Blog does not form a practitioner/client relationship between the viewer and Dr. Zwig. Dr. Zwig is not responsible for any action taken by a viewer based upon any information in this Blog. Never disregard professional medical advice or stop taking psychiatric medication based on something you have read on this Blog without a doctor’s supervision and ongoing therapeutic support. Dr. Zwig is an educator, author, and life coach in the U.S., and a psychotherapist in Switzerland. He holds a PhD in clinical psychology. He is also a rock n roll musician.