Kevin Vail Making Us Crazy 1

Making Us Crazy
Kevin Vail
P 637 Psychopathology and Assessent
!r" #iesel Polizi instr$ctor
Kevin Vail Making Us Crazy %
Introduction
&he last 1''( years have seen the rise to proinence o) the science o) psychology
and the practice o) psychotherapy" Aerican and other *estern societies t$rn to the
psychologist to e+plain h$an ,ehavior in nearly all its )acets" A psychiatric diagnosis o)
pathology can a))ect everything )ro yo$r personal )reedo- to yo$r eployent and the
c$stody o) yo$r children" &he tool $sed ,y the psychiatric co$nity to validate these
li)e.altering decisions is called the /!iagnostic and 0tatistical Man$al o) Mental
!isorders1 2hence)orth the !"0"M"3" &he !"0"M" is open to criti4$e on a n$,er o) )ronts"
5er, K$tchins and 0t$art A" Kirk e+plore several o) the in their ,ook Making Us
Crazy6 !0M &he Psychiatric 7i,le and the Creation o) Mental !isorders" 0oe o) the
areas they e+plore in their criti4$e incl$de6 its lack o) epirical )o$ndation8 the
politicized nat$re o) its9 content8 and its9 i,edded racis- se+is and *estern c$lt$ral
,ias" &he a$thors o))er scathing- i) at ties poleical- analyses o) these pro,les ,$t
)e: sol$tions" &his paper :ill e+plore their criticis and o))er a )e: criticiss o) its o:n
o) ,oth the !"0"M" and o) K$tchins9 and Kirk9s criti4$e itsel)"
Kevin Vail Making Us Crazy 3
The Science
Kevin Vail Making Us Crazy ;
&he )irst part o) K$tchins9 and Kirk9s criti4$e charges that the !"0"M" lacks
epirical )o$ndation" &he a$thors assert that the diagnoses :ithin the !"0"M" lack
,oth relia,ility and validity" &he a$thors o) the constr$cts in the !"0"M" have gone
to great lengths to give their )or$lations the appearance o) scienti)ic certainties
,$t )ail to provide the $sers :ith in)oration on any s$pporting research"
K$tchins and Kirk arg$e that the !"0"M" is not a care)$lly )or$lated :ork ,ased
on peer.revie:ed scienti)ic research ,$t is rather /a strange i+ o) social val$es-
political coproise- scienti)ic evidence and aterial )or ins$rance clai )ors1
21<<7- p" +3" &he a$thors deconstr$ct the !"0"M" de)inition o) /ental disorder1-
:hich appears in the last three editions o) the !"0"M"- concl$ding that the
de)inition /does not govern :hat conditions get incl$ded as disorders18 /the
content and n$,er o) criteria that $st ,e et to 4$ali)y )or each disorder are
largely ar,itrary18 and it /has no consistent re4$ireents that everyday ,ehaviors
$sed as diagnostic criteria act$ally ,e the res$lt o) ental disorder and not the
res$lt o) other li)e e+periences1 2pp" 36.373" &he constr$ction o) the psychiatric
nosology has ,een ore a process o) negotiation /aong contending interest
gro$ps o) theoreticians- researchers- clinicians- hospitals- clinics- and dr$g
copanies1 than a copiling o) o,=ective psychological and clinical research 2p"
373" &he process o) revising the !"0"M" has ,ecoe a /cycle o) denigration-
enth$sias- and denigration1 2p" 3>3" ?ach revision re4$ires that the prior
revisions ,e ade to appear /anti4$ated1" &he )irst edition to $ndergo this cycle
:as the !"0"M".@@@ p$,lished in 1<>'" &he developers o) this edition hailed it as a
a=or ,reakthro$gh in the )ield o) clinical psychiatry" @t had reoved the
Kevin Vail Making Us Crazy A
theoretical ,iases o) the t:o previo$s versions and )or the )irst tie presented a
detailed syptoology )or each diagnosis- :hich :as intended to iprove
relia,ility" According to K$tchins and Kirk- it :as the increase o) the involveent
o) the pharace$tical ind$stry and third.party payers )or psychiatric care
in)l$enced the developers to ephasize ,oth relia,ility and validity o) the
constr$cts" &he !"0"M".@@@ so$ght to de)ine the entally ill as /those seen ,y
psychiatrists1 and /desired )or every client a rei,$rsa,le diagnosis1 2p";33" &he
!"0"M".@@@ radically e+panded the n$,er o) psychiatric diagnoses to %6A and
incl$ded /in)oration a,o$t age o) onset- co$rse- ipairent- coplications-
predisposing )actors- prevalence- se+ ratio and )ailial pattern1 :hich gave it the
appearance o) scienti)ic validity" 2p" ;A3" 5o:ever- the a$thors arg$e that /there is
still not a single a=or st$dy sho:ing that BtheC !"0"M" 2any version3 is ro$tinely
$sed :ith high relia,ility ,y reg$lar ental health clinicians" Dor is there any
credi,le evidence that any version o) the an$al has greatly increased its
relia,ility ,eyond the previo$s version1" 2p" A33" &he process o) revision )ro the
!"0"M".@@@ to the !"0"M".@V.tr 2the c$rrent version3 /rati)ied the s:eeping
changes )irst incorporated into the !"0"M".@@@1- despite the /shaky epirical
)o$ndation1 o) those changes" 2p" ;>3"
Kevin Vail Making Us Crazy 6
At the root o) this controversy appears to ,e the need )or psychiatry to present
itsel) as /o,=ective science1" &his has ,een its attit$de and goal since the )irst
:ritings o) 0ig$nd Ere$d" Modern psychology :as ,orn into the c$lt$ral
Weltanschauung o) epiricis o) the 1<
th
cent$ry" 7$t i) indeed /:e have had a
h$ndred years o) psychotherapy and the :orld9s getting :orse1 as Faes
5illan laented in his ,ook o) that title- is it not tie to eval$ate these largely
$nackno:ledged ass$ptions o) odern psychologyG K$tchins9 and Kirk9s
criti4$e e+poses the deceptive and even )ra$d$lent clais o) epiricis in the
!"0"M" constr$cts ,$t is this the right 4$estionG 5as psychology lost itsel) and
any hope o) $nderstanding its o,=ect ,y distancing itsel) )ro the non.
4$anti)ia,leG A n$,er o) :riters have directly 4$estioned these epiricist
ass$ptions and have arg$ed )or a ret$rn to a )$ller de)inition o) /science1" !r"
*ol)gang 0ith- a proinent physicist and philosopher o) science has arg$ed that
d$e to the etaphysical ass$ptions :hich $nderlie this c$lt$ral Weltanschauung
o) epiricis- /scientists have pro$lgated philosophic opinions o) the ost
d$,io$s kind as esta,lished scienti)ic tr$ths- and in the nae o) science have
thr$st $pon an a:ed and cred$lo$s p$,lic a shallo: :orld.vie: )or :hich in
reality there is not a shred o) scienti)ic s$pport1 2%'''3"
Kevin Vail Making Us Crazy 7
Dearly %A'' years ago Aristotle )or$lated a de)inition o) science as /an
organized ,ody o) kno:ledge o) things thro$gh their ca$ses1 2McKeon- %''13"
Eor /the aster o) those :ho kno:1 those ca$ses :ere )o$r the aterial- the
)oral- the e))icient and the )inal" Modern science- incl$ding the science o)
psychology- typically liits itsel) to disc$ssions o) only one- the e))icient ca$se"
K$tchins and Kirk st$,le $pon this :hen they noted that in order to classi)y
soething as a /dys)$nction1- this /requires that the natural function of mental
mechanisms be known before claims of dysfunction can be made 21<<7- 3A3" &his
is :hat is kno:n as teleology- or aong Aristotle9s ca$ses- it is kno:n as the
/)inal1 ca$se" @t is precisely the )inal ca$se that psychology is ost rel$ctant to
ask a,o$t and since odern psychology /does not have a solid )o$ndation in an
a$thentic vie: o) anHBitC has ade little real progress in helping the entally
ill1 and /cannot help ,$t prod$ce $seless and soeties even har)$l theories
and reedies )or ental illness1 2Iipperger- %''3- +iii3" A tr$ly /post.odern1
approach to psychology $st transcend this ass$ption and e,race a greater
episteological pl$ralis i) it hopes to $nderstand its o,=ect"
Kevin Vail Making Us Crazy >
@) then the diagnostic categories o) the !"0"M" do not rest on epirical
)o$ndations- as K$tchins and Kirk contend- :hat do they rest onG &he a$thors o)
Making Us Crazy arg$e that the !"0"M"9s )or$lations :ere attepts ,y
psychiatry to ake /clais a,o$t :hat is noral1 and :hat is psychiatry9s
legitiate doain" @nstead o) an o,=ective process o) copiling research data- the
developent o) the !"0"M"9s constr$cts has ,een a process o) political
coproise ,et:een vario$s special interest gro$ps- :hich represent ental
health practitioners- the pharace$tical ind$stry and third.party payers incl$ding
ins$rance copanies and governent agencies" &his process o)ten took place
s$rro$nded ,y an a$ra o) secrecy :ith handpicked coittees and /tightly
controlled1 processes" &he !"0"M".@V in partic$lar :as created in an atosphere
that so$ght to avoid p$,lic controversy and /to reap the h$ge and $ne+pected
pro)it that BtheC !"0"M".@@@ H generated1 21<<7- p" ;<3"
&he a$thors s$,se4$ently detail the political :rangling and in)ighting :hich
s$rro$nded s$ch iss$es as the reoval o) the ter /ne$rosis1 )ro !"0"M".@@@8 the
reoval o) hoose+$ality as a disorder8 the incl$sion o) a ne: disorder- Post.
&ra$atic 0tress !isorder 2P"&"0"!"38 and the $ns$ccess)$l attept to create a
/Masochistic Personality !isorder1 all o) :hich ill$strates the vario$s )actions
and ideologies that have to ,e satis)ied in order to arrive at a )inished prod$ct"
Arg$a,ly the ost sinister )actor in these de,ates has ,een the lo,,ying o)
pharace$tical copanies and ins$rance copanies )or the creation or e+cl$sion
o) certain diagnostic constr$cts"
Kevin Vail Making Us Crazy <
Einally- K$tchins and Kirk descri,e the history o) racis and *estern c$lt$ral
,ias that is i,edded in any o) the diagnostic constr$cts" &hey cite st$dies
:hich deonstrate that even :hen clinicians are presented :ith identical
syptoologies- racial inorities and :oen receive ore and ore severe
diagnoses than :hite en" &he !"0"M" @V did incl$de /213 a disc$ssion o)
Jc$lt$ral variations in the clinical presentation9 in the description o) each o) the
o))icial diagnoses and 2%3 an appendi+ that contains ,oth an JK$tline )or C$lt$ral
Eor$lation9 and a JLlossary o) C$lt$re.7o$nd 0yndroes1 21<<7- p" %333
5o:ever- they arg$e that the e))ect o) this approach /iplies there is a $niversal
4$ality to the !"0"M".@V diagnoses that is not to ,e )o$nd in c$lt$re.,o$nd
syndroes- even i) a certain e+aple o) the latter occ$r in areas o) the :orld that
encopass a ,illion or ore people and any c$lt$res1 2p" %363" @n other :ords-
the disorders o) :hite Aerican ales are /$niversal1 :hile those that pertain to
those living in Asia or A)rica are /c$lt$rally.,o$nd1" &his :o$ld see to not
di))er signi)icantly )ro the terinology $sed in 1<
th
and early %'
th
cent$ry
psychology te+ts that di))erentiated ,et:een /advanced1 and /priitive1 c$lt$res
or peoples"
Kevin Vail Making Us Crazy 1'
Eor the iediate )$t$re it :o$ld see the doinance o) the !"0"M" is nearly
ass$red ,$t as :e ove into post.odernity and a:ay )ro the o$tdated or :orse
conceptions o) ental illness- diagnosis- and treatent- ental health
pro)essionals sho$ld ,egin asking hard 4$estions as K$tchins and Kirk have"
People s$ch as !r" *ol)gang 0ith- Er" Chad Iipperger- !r" Pa$l Vitz- :ho have
ill$inated the $nspoken etaphysical and episteological ass$ptions in
odern science in general and odern psychology in partic$lar- have taken the
)irst steps" 0t$dents in grad$ate progras and practitioners in the )ield sho$ld ,e
ade a:are that siply going along :ith the stat$s 4$o is to tacitly participate in
its racis- se+is and c$lt$ral iperialis"
Kevin Vail Making Us Crazy 11
Bibliography
K$tchins- 5" M Kirk- 0"A" 21<<73" Making Us Crazy. DSM !he "sychiatric #ible
and the Creation of Mental Disorders" De: Nork- DN6 Eree Press"
McKeon- I" 2ed"3" 2%''13" !he #asic Works of $ristotle" De: Nork- DN6 Modern
#i,rary"
Iipperger- C" Er" 2%''33 %ntroduction to the Science of Mental &ealth. 'ol. (
"hiloso)hical "sychology *
nd
+d. ,w- .orward and %m)rimatur by /e0. .abian
#ruskewitz3" #incoln- D?6 Eraternity P$,lications"
0ith- *" 2%'''3" &he Plag$e o) 0cientistic 7elie)" &omiletic 1 "astoral /e0iew- Vol" C-
Do" 7" Ietrieved May A- %''>- )ro
http6OO:::"catholic"netOrccOPeriodicalsO5PIOAprilP%'%'''O,elie)"htl"