Pathologising unhappiness

The Bible.
The Bible. 

Last month I wrote about the subject of cognitive behavioural therapy (CBT) and the philosophy of the Stoics, both of which may be incompletely summed up by the saying "nothing is either good or bad, but thinking makes it so".

Ever keen to challenge my own assumptions, I came across a fascinating article that argued against this mode of thinking, an interview by Guernica magazine's Katherine Rowland with psychotherapist Gary Greenberg.

Greenberg, who is also a contributor to The New Yorker, is the author of 2010's Manufacturing Depression and this year's The Book of Woe, The DSM and the Unmaking of Psychiatry.

The DSM, of course, is The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, described by Greenberg as being as important to shrinks "as the Constitution is to US government or the Bible is to Christians".

Writes Rowland: "According to Greenberg ... The DSM is not a medically or scientifically valid text, but rather a 'strange chimerical document' whose definitions of pathology change with shifting social values - as was evidenced by homosexuality's overlong tenure on its pages.

"Greenberg is certainly not the first to call attention to the social nature of disease, either in terms of origins or medical interpretations. But he may be among the first to get The DSM's former editor, Allen Frances, on the record as saying, 'there is no definition of a mental disorder. It's bullshit'."

That's a pretty startling admission from a man who oversaw "the Bible" of psychiatry, but Greenberg argues this characterisation is especially pertinent when referencing depression and anxiety, which affects three million Australians, according to Beyond Blue.

"People come to think of their unhappiness as a disease, rather than as a result of the material conditions of their world," says Greenberg who sees much depression as a normal, if not healthy, response to living in an insane world.

Greenberg says The DSM is both "unpopular" and "held in universal contempt" by mental health professionals, but this doesn't mean it's not vastly influential in the way mental disorders are diagnosed, saying "you can have the importance and the authority without the faith". 

He criticises the "fictive placeholders" in The DSM that attempt to describe different types of human suffering, yet also admits they fulfil a very human yearning to name things.

"We're hungry for myth, and as impoverished and deracinated and downright uninteresting a mythology as it is, The DSM is a mythology," Greenberg says. 

"It provides a framework for understanding mental suffering. Myth is a kind of knowledge that helps people negotiate the world, and the particular kind of myth-making that The DSM is engaged with is one of the oldest forms of myth-making in western civilisation, which is naming things.

"Go back to Genesis: God tells Adam to name the plants and the animals. This is a very primordial way of attempting to know the world, to name and to distinguish among the phenomena with which we're presented. What that really means is that when you name something you are in some way claiming to know it," Greenberg says.

The problem with naming such a "widespread and amorphous" condition as depression a "mental disorder" is that once someone has been "diagnosed", it often becomes their identity and takes on a life of its own, even when an individual is reacting quite naturally to stress, financial problems, loss of a loved one, or just simple confusion about a complex world. 

"There is no way to draw the line between mental health and mental illness, and to do so has always been more about ass-covering than anything else," Greenberg says.


Of course, once you have a disease or "disorder", then drug companies and doctors - specifically psychiatrists and psychologists - can charge you to "cure" it or at least pretend they know what's going on, when often they do not.

"It’s not that complicated, just be honest with people. Do the same thing that any doctor does when you go to them with migraine or lower back pain. Say, 'I don’t know what’s going on, but here's what helps'.

"Lower back pain: rest, ice, the occasional narcotic. With the case of migraine, same deal: find out what triggers them. But there's no claim there that we know what's going on."

"Psychiatry doesn't have any slam dunks," says Greenberg, opening up the question whether it's the expectations of doctors, patients or both that insists complex mental issues can be neatly summed up by a visit or 10 visits to a shrink. 

That said, Greenberg concedes most mental health professionals and drug researchers are coming from a good place.

"I've yet to meet one who wants to manipulate people's consciousness, who's really rubbing their hands in glee when people get sick. They're basically as humane as the next guy. So what's really going on for me is ideology at work.



Another part of the ideological matrix is the widely-held Western assumption that to be a good citizen, a success, someone worthy of emulation, you need to be "confident, resilient, happy, optimistic".

By positioning this set of character traits as the ideal, we've cast the millions of people who don't fit that mindset into the turbulence of not belonging, not fitting in, perhaps being abnormal.

Says Greenberg: "There have been studies using a different approach to measuring what anti-depressants do, that instead of looking at mood have looked at personality.

"And they come up with ... that their main effect is personality - not chemistry - and the reason that they have a positive effect when they do is that people like themselves better. And why do people like themselves better?


Greenberg says the ideological re-orientation extends to CBT: "Cognitive behavioural therapy sees anything other than resilience and optimism as pathology.


It's a very interesting article and I strongly encourage you to read the whole thing.

It left me asking myself if it's actually become socially unacceptable to be unhappy and whether the almost universally accepted mantra of "talk to someone", "get some help" isn't just part of this new delusional denial of human suffering?

