Macsmind links to this story today on MSNBC, Should bias be treated as a mental illness? The title is a little misleading but the story features some truly nonsensical Psychiatric intellectualizations and shows what can be achieved when professionals allow their language abilities to trump their reality testing.
Most Psychiatrists have high level proficiency in their language skills. They have succeeded in college and medical school, and entered a part of medicine which offers a premium to those who can use the language in an elegant manner. There is really nothing wrong with that, as far as it goes. However, while Psychoanalysts spend years trying to understand their own unconscious biases and learn ways to keep their biases out of the treatment setting, it is not a requirement for Psychiatrists to undergo Psychoanalysis, or any other kind of therapy (though many do, for their own personal reasons or to help make them better at their work.) It is clear that even with the most careful attention to one's own biases, they still can pervade our thinking and influence how we experience the world. Many people have a powerful tendency to see the world through a particular prism that distorts everything they see. The classic reduction of such thinking is the aphorism that says that "to a hammer, everything is a nail."
For some Psychiatrists, all misbehavior is pathology. When you add in an unconscious need to tell other people what to think and how to behave (the kinds of "control" issues that are frequently unconscious and conflicted in the helping professions), you have a dangerous mix.
The MSNBC article poses this dilemma:
Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are disabled by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.
....
The proposed guidelines that California psychologist Edward Dunbar created describe people whose daily functioning is paralyzed by persistent fears and worries about other groups. The guidelines have not been endorsed by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM); advocates are mostly seeking support for systematic study.
In a society which values tolerance above almost anything else, there is a superficial plausibility to this proposal. However, if I may use a sophisticated Psychiatric term to encapsulate this idea: putting this into the DSM would not only be ridiculous but it would be crazy!
The DSM (Diagnostic and Statistical Manual, which is the "official" listing of accepted Psychiatric diagnoses) already contains diagnostic entities which cover delusions (fixed, false ideas that do not conform with reality) and obsessions (preoccupations with ideas that limit a person's daily functioning). All of the examples of pathology mentioned in the article could be covered by diagnoses that contain such symptom complexes. On the other hand, once the DSM includes pathological bias, just imagine the fun the legal professional and the professional victims associations could have with such a diagnosis.
Consider the racist who insults his Asian or Black co-worker. Charges of racism fill the air. Charges are brought. Lawyers are engaged. Levels of victimhood are assessed. The racist is threatened with job loss but responds with the Americans with Disabilities Act that makes it illegal to fire him because he has a Psychiatric illness. The aggrieved victim of the racist sues the company for allowing an atmosphere of intimidation. The company is then forced to pay millions to both the racist (for putting him in a situation which encourages his outbursts and makes him uncomfortable) and the victim is paid millions because he was forced by his company to tolerate such abuse. Teams of lawyers become wealthy destroying companies across America. The worst thing is that this is not even a far fetched fantasy. Once bias is entered as an illness, almost anyone can be charged with it and/or use the illness as a defense. At what point does bias become pathological? It seems to me that for Psychiatrists to offer the legal/grievance professions such ammunition is foolhardy and idiotic.
In one of those coincidences that confirm such fears, this morning on the radio I heard an ad for a lawyer asking people who have taken Zyprexa to call him. To paraphrase, if you have developed Diabetes, had Pancreatitis, Ketoacidosis, (or any of several other problems), call the law firm of AAA; you may be in line for a cash award! I am not making this up.
In June, I wrote several posts, starting with The Doctor's Dilemma: Risks, benefits, and liabilities detailing the difficult balance one must find when prescribing medications, all of which have risks and benefits which must be incorporated into the decision process. (The second post was here, and dealt specifically with the risk/benefit analysis of Zyprexa; a later post, Science Mis-Reporting, described the poor reporting done by the Times science reporter referring to a large study of Psychotropic drugs which included Zyprexa.)
Between the Psychiatric profession's need to pathologize all forms of behavior (which tends to mitigate responsibility for selected, favored, victim classes) and the legal profession's need to make money off of any and every misfortune (which requires assigning blame for everything untoward that occurs, whether it originates from malice, misconduct, or bad luck), we are attacking some of the foundations of our society. It is difficult enough to have a functioning, complex society, with all our competing needs and desires, without spending so much energy excusing the poor behavior of the "victim" classes while extorting money from those who are most productive. The Congress has begun to address tort reform, which is hopeful; now somebody has to stop the out-of-control Psychiatrists.
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