if psychiatry is really dead then perhaps it will be economics not psychology that will replace it. Not likely, but Bryan Caplan's paper below is still well worth a read (thanks Sarah). in general, there has been a decent literature in the last few years examining the political and economic preferences of those who have been diagnosed with mental illnesses. it is interesting that even economists like Friedman were willing to concede that some classes of mental diagnoses required paternalistic involvement with the persons life. this is the first full economic statement that ive read saying that mental illness is simply an expression of preferences. as i said a fascinating article, but i cant see the APA rewriting the DSM with this in mind. although, it would be a fun task.
http://rss.sagepub.com/cgi/content/abstract/18/3/333
1 comment:
This is a really interesting article and should be the kind of paper that's given in undergraduate psychology to get people thinking about what the term psychological disorder really means. However, this account does go slightly over the top..
"Most mental diseases amount to nothing more than unusual preferences; they do not affect what a person can do, only what
they want to do."
This sounds like something Joe Soap would have said twenty years ago. Fair enough, the line should be drawn somewhere especially with the rising prevalence of new "disorders" involving addiction(shopaholics, internet addiction, sex addiction), impulsive urges (pyromania, kleptomania), and rare symptom cases (intermittant explosive disroder). However, when a person involuntarily ingests a hallucinogen they do not choose to have warped perceptions. The contents may be malleable but the state is unavoidable. Similarly, in schizophrenia positive symptoms such as disordered perception have little to do with preference. Serious mental illness isn't like the scenes in the fairy tales where the spell is broken by ferocious willpower. There are clear neurological abnormalities:
"Results from structural imaging studies indicate that brain abnormalities play an important role in the pathology of schizophrenia". Abnormalities include lateral ventricle enlargement, reductions in cortical gray and white matter, structural abnormalities of the thalamus, the amygdala,the hippocampus...the list goes on.
The definition of ADHD as a "high disutility of work combined
with a strong taste for variety." is interesting but the counter case could easily be argued that those with ADHD do have a preference for work albeit maybe not school or office work. Also the repetitive nature of many ADHD symptoms and its commorbidity with autism would suggest that there's a big difference between being easily disturbed and having a strong taste for variety.
There are definitely drawbacks in medicalising and casting the responsibility robbing title of disorder over certain extreme behaviours, and subsequently using brain states to attempt to prove a biological etiology. However, producing an account of mental disorder which points entirely to preferance and "paying the full social cost" of the associated behaviour in order to find out how extreme ones preferences really are disrespects the suffering of those living with mental illness and adds futher hardship to their lives in terms of lack of societal empathy from both institutions and citizens.
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