Pass the drugs, and bless you
With a certain amount of horror I read today’s New York Times article on current revisions to the Diagnostic and Statistical Manual of Mental Disorders.
Let me say first that anyone who reads this article also needs to listen to Part 1 of Volume 89 of the Mars Hill Audio Journal, and read C. S. Lewis’ potent little piece (on a related topic), “The Humanitarian Theory of Punishment,” found in God in the Dock.
So much is unsettling in this article, it’s hard to know where to begin. For starters, I would worry about the amount of guesswork involved in psychiatric diagnoses. Irritable, aggressive children, we are told, have often been misdiagnosed as having bipolar disorder, and treated with “powerful antipsychotic drugs, which have serious side effects, including metabolic changes.” (We draw a curtain of charity over the further comment: “there have been widespread reports that doctors promoting the diagnosis received consulting and speaking fees from the makers of the drugs.”)
Well, I guess it’s a good thing they got this straightened out in the new edition of the DSMMD, because that all sounds rather cruel. But I’m not sure what to think when the alternative diagnosis is “temper dysregulation disorder with dysphoria.” Do they have a drug for this? Does it involve metabolic changes? Forgive me for speaking outside my field, but is it possible – just possible – that Johnny’s problem is . . . well, not so much biological as attitudinal; that maybe what he needs is not a drug but a switch to the behind? Or is someone seriously going to tell me the switch is abusive while these “powerful antipsychotic drugs” are marvelously humane? We would never inflict pain on Johnny; by the time we’ve finished doping him, he can’t feel any.
But the really chilling stuff lies deeper than this. The DSMMD proceeds on the assumption – and make no mistake, it is an assumption – that all human emotions and behaviors are variations on brain chemistry, pure and simple. There are no spiritual, indeed no metaphysical, realities in play in the human psyche at all; everything is a matter of strictly material biology.
But when you think about it, where does this leave us? In the first place, all moral responsibility is out the window. There’s nothing morally wrong about John Doe’s beating his wife; it’s just a manifestation of some pathology. Johnny can’t be held responsible for his disobedience and his temper tantrums; he needs treatment.
Okay, but let’s take this materialistic view of things a step further. Under the old moral way of thinking about humans, there were meaningful distinctions between “good” and “bad” behavior, between behavior that is in bounds and behavior that is out of bounds. Hitting one’s mother in a fit of rage, for example, was simply wrong, and Johnny would be punished for it, hugged and held, set back on his feet, and sent on his way again. But how, pray, can similar categorizations of emotion and behavior be justified when everything is just brain chemistry. What, precisely, makes one manifestation of brain chemistry “normal” or “better” than another? How do we know when the brain is “malfunctioning” and when it is clicking along nicely?
Well, the answer to this must be – the experts will tell us. I couldn’t tell you, looking at my five year old, what’s going on with his brain chemistry. He looks pretty normal to me, but what do I know? I’m just a lowly father whom no pharmaceutical research company would think of hiring.
So the experts – the people with long white coats and various postgraduate degrees – will tell us what is “normal” and “abnormal” human behavior (I don’t think they use terms such as “good” and “bad” anymore). Okay. But once they start talking, there are some real head-scratchers. For instance, they tell us “hypersexuality” is a mental disorder in which “a great deal of time is consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior.” Hmmm. Does it make any difference if this “disorder” arises in the context of a happy marriage? Is the problem here really the quantity of sexual urges, or the object of those urges? On the old way of thinking about human psychology, sexual urges were to be regulated by love, chastity, and faithfulness, because these were considered virtues. But if sexual drive is just chemistry, I would have thought it chemistry of a very “normal” kind, and I’m not clear on why it should be regulated. Certainly it may flare up in ways we consider “unhealthy” (stalking a victim, for example), and in such cases bring on the drugs.
Another head-scratcher: “binge eating disorder” is defined as “at least one binge a week for three months – eating platefuls of food, fast, and to the point of discomfort – accompanied by severe guilt and plunges in mood.” This is not normal overeating, mind you; it “involves much more loss of control, more distress, deeper feelings of guilt and unhappiness.” Here again the experts have lost me. We all overeat (they say). But if we feel deep guilt and unhappiness along with our overeating, this is a chemical malfunction. Well, most of us have told lies in our lifetime, too. It’s pretty normal. But what if I happen to feel deep guilt and unhappiness about my lying? Or what if I’m having sexual fantasies about my neighbor’s wife (not “hypersexual” fantasies, just normal and well-regulated ones)? If I feel distress about that, can you give me a drug? ‘Cause it’s no fun, and according to the experts it ain’t normal.
A final question. Not to be conspiratorial or anything, but what happens if the “experts” end up on the payroll of, say, a really powerful political entity? Has it ever happened that people in high places have decided certain emotions, expressions, and behaviors are politically inconvenient or undesirable? Would it, could it ever happen that behaviors might be termed “abnormal” because they are against prevailing political interests? And could it happen (indistinct stories from the Iron Curtain days keep rolling around in my head) that those afflicted with such pathologies might be confined to institutions for treatment? Could this even be justified in terms of human “kindness”? Maybe I’m just paranoid. Bring on the . . . yes, that feels better.
There’s some good news, at least. Some experts are working on a proposal to identify “risk syndromes,” meaning that if you appear even to be at risk for developing one of the syndromes in the DSMMD, you can be labeled and treated and cured. Now that’s a relief. I think I look like a candidate for psychosis. Pass the drugs, and bless you, doc.