Essay:Mental illness

Mental illness refers to emotional or cognitive problems that causes distress or maladaption to one's environment. It is subjectively determined, since one can blame maladaptation either on faulty behavior of the individual, or on societal unwillingness to accept the individual's behavior. Thomas Szasz has spent his career arguing that people who are not incapacitated should be treated as normal adults. Most psychologists rely heavily on the diagnostic categories and criteria established by the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM is constructed by committee and has been significantly expanded and revised over the years, often in response to political, social and financial pressures from such actors as the pharmaceutical and medical insurance industry. Agencies such as the Federal Bureau of Prison define mental illness in terms of DSM-IV criteria and insurance companies usually require a DSM code be cited by psychologists seeking payment for services rendered. Pursuant to U.S. Supreme Court cases such as O'Connor v. Donaldson 422 U.S. 563 (1975), a person can only be involuntarily committed to a mental hospital if he is both mentally ill and dangerous to himself or others. 18 U.S.C. § 4248 allows civil commitment of those who are sexually dangerous to others, a term defined by 18 U.S.C. § 4247 as meaning that the person "suffers from a serious mental illness, abnormality, or disorder as a result of which he would have serious difficulty in refraining from sexually violent conduct or child molestation if released." Thus, if he is merely sexually dangerous, but not mentally ill, he can go free. Because of statutes like this, how mental illness is defined becomes of great importance.

Ludwig von Mises points out that "it is clear that if the mere fact that a man shares erroneous views and acts according to his errors qualifies him as mentally disabled, it would be very hard to discover an individual to which the epithet sane or normal could be attributed. Then we are bound to call the past generations lunatic because their ideas about the problems of the naturalsciences and concomitantly their techniques differed from ours. Coming generations will call us lunatics for the same reason. Man is liable to error. If to err were the characteristic feature of mental disability, then everybody should be called mentally disabled."

Art Carden has argued that the rate of mental illness may be increasing because modern civilization creates greater survival probabilities for those with mental disorders. As Mises points out, "The very existence of a comparatively great number of invalids is, however paradoxical, a characteristic mark of civilization and material well-being."

Jeffrey Tucker has pointed out that we are all sick in the head and that the State is not addressing the very serious problem that government intervention makes people with economics knowledge crazy. Murray Rothbard devoted a section of For a New Liberty to compulsory commitment, arguing that it is "One of the most shameful areas of involuntary servitude in our society" that allows "disgruntled relatives to put away their loved ones without suffering a guilty conscience." The aptness of the terminology "loved ones" in the context of relatives being treated this way is, perhaps, a bit dubious. The 2004 U.S. Libertarian Party national platform included a plank against involuntary treatment. Sheldon Richman has argued that libertarians should not ignore the therapeutic state.

Many aspects of the human condition have been medicalized. For example, it used to be considered fairly normal to have melancholy moods, especially if one's life were not going well. The Finnish psyche is said to be underpinned by gloom and melancholy, which Finns are comfortable with, not feeling pressured to be cheerful all the time.

In contemporary America, these feelings are labelled depression and regarded as an illness to be treated. It apparently does not occur to doctors that such feelings serve the potentially useful purpose of producing either a resignation that prompts one to "shut down" and take a safer, more conservative approach to life, or take other necessary steps to stop being burdensome on others; or as a way of making the person feel uncomfortable and therefore motivated to change his situation. Labelling a person as mentally ill — a victim, perhaps, of a genetically inherited "chemical imbalance" — gives people a reason to think of themselves (and, perhaps, for others to think of them) as being defective, which can be a saddening thought in and of itself. This may, ironically, prompt them to give up when there was still hope, or lead them to devote so much effort to treating their "symptoms" (i.e. their unhappy feelings) that they neglect addressing the root problems that are the source of their unhappiness.

Majoritarian and authoritarian biases

Adhering to fringe beliefs does not necessarily qualify someone as mentally ill. Michael Shermer points out in The Believing Brain that even intelligent people will often form beliefs for unintelligent reasons and then use their intelligence to find justifications for their continued belief. In fact, there may be a link between creativity and what society regards as madness: "Some people are ultraconservative in their patternicity, see very few patterns, and are not very creative, while others are indiscriminate in their patternicity and find patterns everywhere they look; this may lead to creative genius or conspiratorial paranoia."

Some of the characteristics categorized by psychiatrists as evidence of mental illness are questionable. A narcissist, for example, is an individual who is high in the need for achievement and low in the need for affiliation. He is preoccupied with dreams of success rather than prioritizing most highly the intrinsic satisfaction of interacting with and connecting with others. "Antisocial" practices include being "Anti-authority, rationalizing and identifying with criminal behavior, admitting to antisocial or unlawful behaviors". Research indicates that self-report instruments assessing the DSM personality disorders are characterized by overdiagnosis due to their emphasis on the measurement of personality traits rather than the impairment and distress associated with the criteria. It also appears that childhood "misbehavior" is sometimes being inappropriately medicalized.

Personality disorders are particularly prone to overdiagnosis. At least in the case of delusional disorders, there is a requirement that the beliefs be unfounded. As Mises points out, "If a statement were not exposed as logically erroneous, psychopathology would not be in a position to qualify the state of mind from which it stems as pathological. If a man imagines himself to be the king of Siam, the first thing which the psychiatrist has to establish is whether or not he really is what he believes himself to be. Only if this question is answered in the negative can the man be considered insane." But "The procedure of some contemporary psychiatrists is really outrageous. They are utterly ignorant of the theories of praxeology and economics. Their familiarity with present-day ideologies is superficial and uncritical. Yet they blithely call the supporters of some ideologies paranoid persons." A personality disorder is characterized by "inflexible, pervasive, stable, and enduring patterns of inner experience and behavior that deviate markedly from the expectations of the individual's culture and lead to clinically significant distress or impairment in important areas of functioning." Paranoid individuals have "very weak of nonexistent social attachments and odd or eccentric behavior."

Of course, a person's lack of social attachments, and other people's perception of his behavior as odd or eccentric, or as "impaired functioning," could be attributed to misguided opinions or preferences of the rest of the society, rather than to a problem with the individual. But the assumption is that anything that the majority, and especially a large majority, of society does not like, agree with, or appreciate must be considered abnormal and wrong until the majority decides otherwise. It is deemed to be acceptable to infringe the rights of the individual in any way whatsoever that the majority desires, in order to "cure" the offending person of his desire or willingness to deviate from conventional wisdom and practice. This defeats the point of evolution providing each individual with his own brain, which equips him to think for himself if he so wishes. Presumably the capacity for independent thought and action was adaptive; otherwise it is hard to explain why humans, rather than hive animals, came to dominate the earth.

In A Plea for Captain John Brown, Henry David Thoreau addresses allegations that the leader of the raid on Harper's Ferry was insane: "Ask the tyrant who is his most dangerous foe, the sane man or the insane."

Mental health professionals' conflicts of interest

Szasz has pointed out that psychiatrists' expressed opinions are influenced by their employers. A psychiatrist hired by a court to perform an insanity evaluation "is expressly barred from stating, for example, that it is not the criminal who is 'insane' but the men who wrote the law on the basis of which the very actions that are being judged are regarded as 'criminal.' Such an opinion could be voiced, of course, but not in a courtroom, and not by a psychiatrist who makes it his practice to assist the court in performing its daily work."

A whole industry has arisen to make money off of people referred by courts for various forms of mental health treatment. Prime examples are those defendants who have been accused of possessing drugs, engaging in proscribed sexual behavior, or committing or threatening violence motivated by divergent political or philosophical opinions or by beliefs that differ from the mainstream perceptions of what the facts are. For beliefs to be considered delusional, the content or themes of the beliefs must be uncommon in the person's culture or religion; in other words, as long as millions of people agree that a mistaken belief is true, then it is not delusional. This is consistent with the majoritarian philosophy of democracy which holds that the majority, right or wrong, should get its way and not be subject to any form of persecution, while the minority is fair game.

The treatment professionals are either paid for by the defendant or, if he is indigent, by the taxpayers. He is not in a position to fire his psychologist if he deems the therapy to be unhelpful. Sheldon Richman notes that "Nationwide, the taxpayers pay millions of dollars to finance this inflated nonsense that goes by the name 'treatment.' Most of the people there are trying to stay out of jail." Insurance companies have sought to keep costs down by limiting the number of permitted psychiatric sessions, but some legislators have supported interventionist policies to require more mental health care be offered.

Rationality

Economists use the word "rational" in a different way than the general public. To the latter, it usually implies "sensible," "judicious," "chosen in accordance with wisdom or prudence; likely to be of benefit" and the like. Economists use it to mean simply "purposeful." Thus, for example, a person can think that, based on the evidence he has seen, enforcing a minimum wage will help the poor. Economists would state that this action is rational but contrary to purpose. Thinking is an action in and of itself, and since all thinking is purpose-driven, aimed at increasing satisfaction, therefore all thinking is rational. As for the choice of goals, Mises points out, "The characteristic mark of ultimate ends is that they depend entirely on each individual's personal and subjective judgment, which cannot be examined, measured, still less corrected by any other person. Each individual is the only and final arbiter in matters concerning his own satisfaction and happiness."

In the wake of mass shootings, people often state that the killer must have been crazy. Mises argues to the contrary: "The murderer whom a subconscious urge (the Id) drives toward his crime and the neurotic whose aberrant behavior seems to be simply meaningless to an untrained observer both act; they like anybody else are aiming at certain ends. It is the merit of psychoanalysis that it has demonstrated that even the behavior of neurotics and psychopaths is meaningful, that they too act and aim at ends, although we who consider ourselves normal and sane call the reasoning determining their choice of ends nonsensical and the means they choose for the attainment of these ends contrary to purpose." This concept of what is and is not rational is so fundamental to precise and objective praxeological reasoning that it appears in the fourth paragraph of a several-hundred-pages opus on human action.

Perceptions of libertarians as mentally ill

Libertarians are sometimes described as "whackos," "nutjobs," etc. P.J. O'Rourke's book Parliament of Whores refers to the Democratic and Republic parties as "our country's only two political parties with more than one hundred members not under psychiatric care," a none-too-favorable judgment of big-L Libertarians and other minor party adherents. There could be many reasons for such perceptions.

Firstly, people have a self-serving bias that causes them to tend to think approvingly of their own thinking and behavior. Therefore, a person who deviates from mainstream thinking and behavior will often tend to be judged unfavorably by the masses, who find their own thought and behavioral patterns superior. Many people fall prey to the argumentum ad populum, which assumes that an opinion that is popular is necessarily more likely to be correct.

Mises points out, "Neither can the fact that a man is at variance with the opinions held by the majority of his contemporaries qualify him as a lunatic. Were Copernicus, Galileo and Lavoisier insane? It is the regular course of history that a man conceives new ideas, contrary to those of other people. Some of these ideas are later embodied in the system of knowledge accepted by public opinion as true. Is it permissible to apply the epithet "sane" only to boors who never had ideas of their own and to deny it to all innovators?"

Libertarians may be more likely than other members of society to have other unorthodox thoughts and behaviors unrelated to politics. This could be because a libertarian way of thinking makes them believe that it is acceptable to engage in deviant behavior. It could also be that those who engage in deviant behavior feel a greater need for liberty from the rule of the majority, because it affects them more directly and perhaps with greater severity than it would a person whose behavior is more mainstream.

Libertarians may also have a greater likelihood to believe in "conspiracy theories" and other unorthodox beliefs. This could reflect a greater receptiveness and open-mindedness on the part of some people toward minority opinions in general; thus, the same type of person who is willing to adopt a minority political opinion might also be more willing to believe in some other fringe opinions. This is sometimes derided as "crank magnetism." However, the fact that a person believes in some spurious minority opinions does not mean that all of his minority opinions, including libertarian opinions, are necessarily false.

Libertarians are more likely to give serious consideration to conspiracy theories, because they believe that there are many rent seeking interest groups that wish to influence the government to reward them at the expense of others. Libertarian beliefs could be either a cause or a result of believing that there are malevolent people and entities conspiring to exercise power. Rothbard points out that "conspiracy" is loaded language.

Libertarianism is a philosophy that stresses logical consistency and sharp distinctions between right and wrong. It is not as comfortable with self-contradictions as, say, conservative or leftist philosophies that allow a person to support aggression against others while condemning restrictions on his own freedom. Libertarians, then, may be people who are in the habit of avoiding hypocrisy; such as "rigid" approach, unwilling to yield to the seeming expediency of the moment, may strike others as counterproductive and therefore mentally unhealthy.

Collectivist theories stress the reaching of decisions (whether by a dictator or by majority vote) that will be applicable to the whole community. These ideologies value enculteration, conformity and obedience to authority. The psychological literature, particularly the DSM, recognizes the impact of enculteration by, in many cases, exempting those with false beliefs instilled in them by their culture from being labeled as mentally ill. No such leeway is given for individuals who come up with their own beliefs. Independent thinkers are more likely than others to be libertarian because they recognize the benefits of independent thought and action, but their unusual ideas could sometimes also lead others to suspect them of mental illness.

Libertarianism has sometimes been described in ways that border on referring to the ideology as a sign of mental illness. Psychologists have developed a "Libertarian Mental Health Ideology Scale" to measure libertarian views on mental illness mythology, antimedical model, social deviance control, and anti-coercive treatment.

People who devote a great deal of effort to political change are sometimes viewed as weird because such work is unlikely to be personally remunerative. However, it is quite common for people to engage in self-defeating or self-destructive behavior. For example, a person will drive 55 mph down the highway without wearing a seatbelt, despite the fact that the costs of going through the windshield in the event of a crash would probably outweigh the benefits of saving a few seconds every day in putting on the seatbelt and taking it off. People do not view them as crazy, although they may view them as reckless. Political effort is less likely than refraining from wearing a seatbelt to render a person quadriplegic, so arguably it is less crazy.

External link

• Mises and Psychiatry