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The Irrationality of Abnormal and Therapeutic Psychology

© Peter Zohrab 2010

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Introduction

As in the case of my essay The Invalidity of the Wechsler Adult Intelligence Scale-III, the relevance of this webpage to the political theme of equality (which is what this website is about) is that Psychologists are very powerful in Family Law and elsewhere, so that their level of stupidity, bias etc. is highly relevant to outcomes for men and fathers.

There is so much wrong with the theory and practice of Abnormal and Therapeutic Psychology that it is difficult to list it all -- let alone discuss it in sufficient depth in a brief webpage. The following three are perhaps the most significant problems:

  1. The definition of abnormality/mental disorder;

  2. the diagnostic methodology of Abnormal and Therapeutic Psychology;

  3. the power structure and lack of transparency of the practitioner-patient relationship.

 

The definition of abnormality

My reason for discussing the definition of abnormality before the other problems is that it is probably a necessary and sufficient condition for creating the doubt in the authenticity of this profession which alone will permit the reader to consider the other issues with a receptive mind.  I have used the word "irrationality" in the title of this page.  It may seem that psychological abnormality is linked to irrationality, but this is not the case.  Many people who are deemed psychologically abnormal may in fact be much more rational than the professionals who deem them abnormal.

According to Kring et al (2007), the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ("DSM-IV-TR") defines "mental disorder" as:

A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom.  In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one.  Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual.

There would appear to be substantial professional subjectivity involved in applying the terms "clinically significant" and "dysfunction", considerable uncertainty involved in applying the terms "syndrome or pattern"and "significantly increased risk", and substantial third-party, lay, societal input into the designation "culturally sanctioned." People of a sceptical turn of mind would perhaps not be happy working in a field which involved so many basic uncertainties, so it might be assumed that clinical and forensic psychologists are not, in general, of a sceptical turn of mind. 

There is no reference to rationality or irrationality in that definition.  Moreover, behaviour which might otherwise be a sign of a mental disorder is held to be normal if it is "an expectable and culturally sanctioned response to a particular event."  Societies and their cultures are not known for rationality; religious beliefs and superstitions, for example, are widely considered (sometimes even by the believers themselves) to be faith-based, i.e. irrational.  So a religious ritual connected with the death of an individual, for example, may produce irrational behaviour which is not a sign of a mental disorder, as long as it is an expectable and culturally sanctioned response to that death.

It is surely irrational for a clinical profession which claims to be able to diagnose and treat -- or even cure -- mental disorders to consider the same behaviour to be sane or insane on the basis of whether some irrational society of lay people considers it to be sane or insane.  This already hints at the power relationship between the individual and society, and the Psychologist/Psychiatrist's place within that power relationship, which we be discussing further below.

Another relevant example is the issue of homosexuality.  Homosexuality has been, in various places and at various times, regarded as a crime, a form of mental disorder, or neither.  My aim here is not to argue which of these is the correct approach; my point is that each society makes its own, essentially political, choice about which approach to take to homosexuality at any point in its history, and the so-called experts in the field of Abnormal and Therapeutic Psychology in that society merely tag along and assent to that society's decision.  According to the webpage Facts About Homosexuality and Mental Health the Diagnostic and Statistical Manual of Mental Disorders removed homosexuality from its list of disorders in 1973, by which time homosexual activists had made the decriminalisation and destigmatisation of homosexuality a high-profile political issue.

A further example of how unscientific Abnormal and Therapeutic Psychology is is how the treatment of the mentally disordered has undergone more changes for humanitarian reasons than for scientific reasons related to objective treatment outcomes.  For example, Philippe Pinel is famous for having reformed the treatment of inmates in French asylums, being said to "have begun to treat the inmates as sick human beings rather than as beasts" (Kring et al 2007, p. 11).  Similarly, the textbook Kring et al 2007 itself treats the issue of the stigma that is often borne by the mentally disordered as the very first topic that it sees fit to discuss!  My point is not that the mentally disordered should be treated like animals or that stigmatising them is a good idea; my point is that these side-issues are central to the history and practice of Abnormal and Therapeutic Psychology for the reason that the field really has little else that it can agree on!  Almost everything else in this textbook is subject to dispute between the various "schools". 

 

The diagnostic methodology of Abnormal and Therapeutic Psychology, taking Paranoia as an example

Kring et al. (2007, p. 390), cite the DSM-IV-TR Criteria for Paranoid Personality Disorder, which involve the "(p)resence of four or more of" seven listed symptoms, which include:

• Unwarranted doubts about the loyalty or trustworthiness of friends or associates; and

• Unwarranted suspiciousness of the fidelity of partner.

A sceptically-minded person might well ask how a clinical psychologist, sitting in his/her office, and not intimately acquainted at first hand with the dynamics of the relationships between these various parties, could possibly reasonably make a judgment as to whether such doubts and suspiciousness, in a particular case, are unwarranted. Does the psychologist have the time, or make the effort to ask the partner if they have been, or are likely to be unfaithful, for example? Even if he/she does, on what basis can he/she judge whether the partner is telling the truth? The same questions can be asked in relation to the loyalty or trustworthiness of the patient's friends and associates. A sceptically-minded person would be simply astounded at the thought that, in fact, clinical psychologists in fact do make these sorts of judgments routinely!  Sometimes they make these judgements tentatively, using words like "possibly" or "perhaps" -- but even this involves raising doubts about the patient's rationality based on absolutely no objective evidence.

Reddy & Keshavan give the following assessment strategy for "uncovering delusions":

First listen; the manner and content of the verbalizations will offer many clues to the delusional thinking; then probe sensitively about the details of the delusions, and their effect on the patient's life; do not challenge the delusions. (Reddy & Keshavan, 2006, p. 24)

Our hypothetical sceptically-minded person might wonder, again, how the "manner and content" of the patient's utterances could be at all relevant to the question of the truth or otherwise of the patient's beliefs. What might well be relevant to the manner of the patient's utterances is whether people believed his/her claims. If they did not, that would tend to produce a certain desperation, if he/she persisted in these unpopular beliefs. This desperation of manner, in the presence of a clinical psychologist, might well be interpreted (following the advice in Reddy & Keshavan 2006), as a sign that the patient's beliefs were delusional.

The clinical psychologist would then proceed to intensify the patient's problems, because (in the above quote) Reddy & Keshavan (2006) advise clinical psychologists not to indicate to the patient that they do not believe his/her claims. If a patient is highly sensitive to how people react to his/her statements (as he/she almost certainly is, by definition), then he/she is very likely to be able to tell from the clinical psychologist's utterances and body language that he/she is only pretending not to disbelieve the patient.

This state of being deceived is exactly what the patient has come to see the clinical psychologist about in the first place. The patient claims that other people are deceiving him/her, and other people say they do not believe him/her, so he/she ends up in front of a clinical psychologist, who also does not believe that the patient is being deceived -- but then proceeds to deceive him/her. It is easy to see that a visit to a clinical psychologist can make such a person worse than they were when they arrived!

Rosenhan (1973) reports on two experiments that supported the view that the mental health professions cannot reliably tell the sane from the insane. In the first experiment, eight (supposedly) sane people got themselves admitted to various psychiatric hospitals by complaining that they had been hearing voices, of the same sex as themselves, which said "empty", "hollow" and "thud". Apart from that single symptom, there was nothing seriously pathological in any other aspect of their histories or behaviour. After succeeding in gaining admission, these pseudopatients did not behave abnormally and ceased complaining of any abnormal symptoms. Despite this, none of the staff ever detected the fact that these pseudopatients (most of whom were diagnosed as having schizophrenia) were actually sane -- although many of the patients did realise that they were sane! Rosenhan states that "the evidence is strong that, once labeled schizophrenic, the pseudopatient was stuck with that label."

After these findings had become known, the reverse experiment was carried out: the staff at one research and teaching hospital, who doubted that they would be capable of committing the same mistakes as occurred in the first experiment, were told that one or more pseudopatients would attempt to gain admission into their hospital within the next three months, and the staff were asked to rate each patient's likelihood of being a pseudopatient. A total of 193 patients were rated by the staff during that period, and, despite the fact that no pseudopatient from the experimental group actually did attempt to gain admission,

Forty-one patients were alleged, with high confidence, to be pseudopatients by at least one member of the staff. Twenty-three were considered suspect by at least one psychiatrist. Nineteen were suspected by one psychiatrist and one other staff member. (Rosenhan, 1973, p. 252).

Rosenhan (1973) reports, with approval, the view that "(p)sychiatric diagnoses ... are in the minds of the observers and are not valid summaries of characteristics displayed by the observed."

Kinderman & Bentall (2007, p. 286) report that there is "some evidence to suggest that paranoid beliefs often arise in a context of actual victimization." They cite the words of prominent figures such as Golda Meir (then Israeli Prime Minister), who -- in response to an accusation that the Israelis were paranoid about the Arabs -- said that, "Even paranoids have enemies," and they also quote the then CEO of Intel Corporation, Andrew Grove, who was quoted in the Times as having stated, "Only the paranoid survive." They also cite research that links paranoia to actual past or present experiences or feelings of victimisation, powerlessness, humiliation, discrimination, being threatened, and "'intrusive' life-events in which some other person tries to exercise a high degree of control over the sufferer."

Kinderman & Bentall (2007) suggest, in fact, that paranoia might be an adaptation to the past or even current social environment in which the patient lives. Someone as influential as Golda Meir or Andrew Grove is not likely to be deemed in need of help from the mental health professions because of their remarks quoted above, but someone with virtually the same beliefs, who is isolated and uninfluential, is (I suggest) likely to exhibit the very "manner of verbalisation" (resulting from distress at not being believed) which Reddy & Keshavan (2006) state is a sign of delusions.

It is not particularly rational to act on the methodological assumption that human groups are always well-meaning and incapable of conspiracies against individuals, and that any statements by individuals which attribute negative motives to groups are necessarily delusional. For example, Messerschmidt (2000) refers to reported cases of school shootings in the United States, where boys carried out their crimes as a response to bullying (e.g. by "jocks") and to being called such things as "pudgy", "gay", "faggot" and "fat". Some of these boys had also been rejected by girls, although how/whether this related to the bullying is not clear. It must be assumed that many people react to such bullying and life-events in ways other than by shooting people, and it seems at least plausible to assume that one reaction that occurs is for the victim to become paranoid.

The page Facts About Homosexuality and Mental Health states:

"... given the stresses created by sexual stigma and prejudice, it would be surprising if some (sexual minority individuals) did not manifest psychological problems..... The data from some studies suggest that, although most sexual minority individuals are well adjusted, nonheterosexuals may be at somewhat heightened risk for depression, anxiety, and related problems, compared to exclusive heterosexuals..."

Mental health professionals have little understanding of the causation of paranoia, do not have an adequate basis for deciding when or if it has crossed a hypothetical threshhold from normalcy to pathology, and therefore are not able to diagnose or treat it -- assuming it even needs treatment.  If the patient's paranoia "is associated with present distress ... or disability ... or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom" (Kring et al., 2007, p. 4, quoted above), that is not so much a clinical as a socio-psychological issue, involving interactions between the patient and his/her human environment which it would be very difficult for the patient -- even with the assistance of the mental health professional, if the latter does not venture out to investigate the patient's human environment -- to resolve unilaterally.

The mental health professional should attempt to isolate specific events that apparently caused the patient distress, and attempt to get to the bottom of what actually did happen, acting on the assumption that "there is no smoke without fire", and that there must be something going on in the relationship between the parties involved in this distress which may not be obvious on the surface, and/or which may not be admitted by one or all of the parties. It is suggested that, if the mental health professional is able to find some kernel of believability in all the paranoid beliefs, a resolution of the patient's problems may be, at least to some extent, achievable.

Jean-Paul Sartre is famous (amongst other things) for having said "Hell is other people" (in his play "No Exit").  Human beings should be famous for all the crimes they commit (including genocide and other war crimes), for all the bullying they do, for all the discrimination they are guilty of (against all sorts of categories of people), for the constant gossip they indulge in, for the constant social pressure they apply to individuals in an effort to make them conform to all sorts of norms, for the way they constantly judge other people, for the "Tall Poppy Syndrome" -- which is phrased as if it were a disease of the tall poppy, whereas it is really a disease of the jealous weeds that surround the poppy, and so on and so forth. 

It is also important to keep in mind how stupid people are.  Let us pretend that IQ is an adequate method of measuring intelligence.  A person with an IQ in the top 2% of the population (who is therefore eligible to join Mensa), for example, would probably be of the opinion that the vast majority of the population is pretty stupid.  That is because even Mensa members are probably well aware of their own mental limitations, so they are almost bound to be aghast at the even greater mental limitations of the lower 98% of the population!  Yet these stupid people have immense power to put pressure on individuals and do various things to them, including driving them insane. 

Social groups drive individuals insane, if the individual is unable to arrive at a better form of symbiosis with society.  In the case of paranoia, what happens is that social groups pick on some individual and combine covert, deniable bullying with overt behaviour that is non-discriminatory.  Once the individual picks up on the covert bullying and reacts to it in some way, the bulliers deny the bullying and start to depict the individual as paranoid.  This treatment is often successful in making the individual paranoid in fact.

 

The power structure and lack of transparency of the practitioner-patient relationship

As in the case of the lawyer-client relationship, the clinical psychologist is in a position of great power relative to the patient, and there is little transparency in the relationship.  Nor does the psychologist or psychiatrist need to have much fear that the relationship will be investigated or reviewed (unless there is a suspicion of a sexual or abusive relationship).

The cause of a lot of a lot of mental disorder is undoubtedly the interactions between individuals and social groups.  Since social groups are more powerful than individuals, the blame (if there is any to be attributed) should be attributed to the groups, rather than to the individuals.  However, psychologists and psychiatrists are agents of society -- not agents of individuals.  One does not hire a psychiatrist, as one does a lawyer, to defend one against society -- although that might be an idea worth pursuing, if one is interested in reforming mental health policy!

Members of professions are self-selecting to some degree: one would not expect that people who believe that lawyers are self-serving blood-suckers who exploit hapless clients merely in order to line their own pockets would themselves become lawyers, one would not expect that people who believe that politicians are people with inflated egos who merely manipulate the public in order to achieve power would themselves become politicians, and one would not expect that people who believe that mental health professionals really have little idea what they are doing would themselves become mental health professionals. Therefore, one would expect that mental health professionals have a more optimistic view of their ability to diagnose patients than a similarly well educated member of the public would.

A key issue is the (arguable) conflict of interest under which the clinical psychologist labours. Spiller (2002) defines conflict of interest as "A situation where a person has a personal interest or divided loyalties in a matter which is the subject of a decision or duty of that person." A clinical psychologist will find it hard to make a living if he/she makes a habit of turning away potential clients, on the grounds that he/she cannot be sure that their symptoms might not be reasonable responses to their environments.

After all, he/she probably does not feel themselves equipped to go out into the patient's environment (which will likely be much larger than just his/her family) and research all the interactions between the patient and other people. In any case, it is possible that these interactions would be different if an observer was present from what they would be if there was no witness. In addition, the patient will often have been referred to the professional by some agency or group, and their needs and wishes may take precedence over what might otherwise appear to be the interests of the patient -- especially if the professional is able to convince him/herself that the interests of the patient are also being catered for. Moreover, there is an element of "diagnosis by society" in much mental illness: if a person's behaviour appears "abnormal" to their associates, then that behaviour is not "culturally sanctioned," as per Kring et al.'s definition of mental disorder (cited above).

The desire of psychologists and psychiatrists to help people and the wish to earn a living in a field which one finds congenial and at which one seems to be talented may override any inclination to be completely certain that the theoretical foundations of the field are completely sound. This is, arguably, the situation in the mental health professions in general, especially with respect to paranoid symptoms. In fact, one could go further, and state that the field appears to be dominated by stupid women who are in this field because they like interacting with people and like the feeling that they are helping other people.

Else (2009) quotes Bentall as follows:

We are, he says, still attached to the "myth" of mental illnesses as brain disease, and despite claims of dramatic advances, patients are doing no better than they did 100 years ago.

 

Conclusion

Is there a solution?  Well, societies do have their norms, and they feel entitled to enforce their norms.  Societies also value evil, as well as good, because evil people can be turned against an external enemy in time of crisis, and a society full of goody-goodies would probably die out when faced with a more evil opponent in time of war.  Women are also constantly criticised for liking "bad guys", which means that this type of person passes on his genes quite successfully.  Maybe there is no solution.

 

References

Aldhous, Peter (2009). Psychiatry's Civil War.  New Scientist 12 December 2009.

Else, Liz (2010). Reviews of Kirsch, Irving, The Emperor's New Drugs: Exploding the antidepressant myth, Bodley Head, and of Bentall, Richard, Allen Lane Publishers, Doctoring the Mind, New York University Press.  New Scientist 5 September 2009.

Else, Liz (2010). Review of Gary Greenberg, Manufacturing Depression: The secret history of modern disease. Simon & Schuster.  New Scientist 13 February 2010.

Kinderman, P. & Bentall, R.P. (2007). The functions of delusional beliefs. In M.C.Chung, K.W.M.Fulford, & G.Graham (Eds.), Reconceiving schizophrenia (pp. 276-294).

Kring, A.M., Davison, G.C., Neale, J.M., & Johnson, S.L. (2007). Abnormal psychology (10th ed.). Hoboken, New Jersey: Wiley.

Messerschmidt, J.W. (2000). Nine lives. Adolescent masculinities, the body and violence. Colorado: Westview Press.

Reddy, R. & Keshavan, M. (2006). Schizophrenia: A practical primer. Abington, England: Informa Healthcare.

Rosenhan, D.L. (1973). On being sane in insane places. Science, 179, 250-258.

Spiller, P. (2002). Butterworths New Zealand Law Dictionary: a fifth edition of Hinde and Hinde's law dictionary (5th ed.). Wellington: Butterworths.

 

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