Mental Health and Social Norms:

The death of Charles Socarides has brought to mind a regrettable tendency (one that often borders on tyranny) of the mental health profession. Socarides, if you don't know, was one of the godfathers of the "homosexuality is a mental illness" school of thought. And (Providentially, in my opinion) one of his sons turned out to be not just gay but one of the leading gay rights activists of the 90s.

The "regrettable tendency" to which I refer is the (mis)use of the concept of "mental illness" to enforce moral or social norms. Back in Socarides's day, it was the 1950s style social conservative morality which was "medicalized." Today it's PC. Previously, homosexuality and other behaviors which violated "traditional morality" were "mental illnesses." Today "racism" and "homophobia" are mental illnesses (or at least, some folks within the profession seriously advance this notion). As Pete Townsend put it: "Meet the new boss, same as the old boss."

This problem within psychiatry doesn't lead me to the extreme position advanced by Thomas Szasz or Michel Foucault that "mental illness" doesn't exist. Psychiatric disorders do exist, some of them rather minor (a moderate anxiety disorder), some of them deadly serious (severe depression, which often results in suicide). But we should realize that underlying mental disorders have (or ought to have) nothing, absolutely nothing to do with social norms. They are "health" problems, not "moral" problems and as such are socially neutral and more analogous to concepts like "race" and "gender." Indeed, mental disorders are protected civil rights categories under the ADA and other related disabilities legislation. To say that someone has a "psychiatric disorder" is to say that their health is impaired in the same way that someone with high cholesterol or hypertension has their health impaired.

[One thinks of the recent hubub on Lincoln and homosexuality. Though historians strive mightily in their battles over whether Lincoln suffered from the "mental disorder" of homosexuality, no one seriously disputes that Lincoln suffered from the true mental disorder of bipolar. Likewise Thomas Jefferson most likely suffered from a physiatric disorder -- depression, as did Madison, who, given that he was convinced he would die an early death (he actually lived into his 80s), most likely had an anxiety neurosis. These conditions don't raise controversy because we properly regard them as socially neutral. Finding out that Madison had an anxiety disorder really ought to be no different than finding out he had male pattern baldness (which I don't think he did; but who knows? they all wore wigs).]

Therefore, properly understood, categorizing something as a "mental disorder" cuts against the moral and social stigma of that condition, and cuts in favor of social neutrality and civil rights protection of the underlying "disorder."

This isn't to say that there is no intersection between behavior that results from "mental disorders" and behavior that is immoral or otherwise socially unacceptable. One thinks of conditions like kleptomania or alcoholism. But still, those who wish to maintain a social stigma on the underlying behavior of for instance, kleptomania (stealing) must do so with no reliance on such behavior resulting from a "psychiatric disorder." Again, to rely on the mental health body of science to enforce your desired social norms is a fundamental misuse of the profession.

Even if tomorrow we discovered that kleptomania doesn't really exist as a "mental disorder" that would not (or at least it shouldn't) do one thing to "normalize" stealing if for no other reason than the vast majority of people who steal aren't kleptomaniacs and had no "mental disorder" prompting them to steal to begin with. They are simply bad people who wanted to get something for nothing. Indeed, take a person with a moral conscience, who truly desires not to steal and does everything he can to pay for his items, but "just can't help himself." And then he feels terrible guilt after the act is done and seeks mental help. Such a person, in my opinion, is more moral than the lazy jerk who wants to get something for nothing. Thus, while the kleptomania doesn't excuse the underlying stealing, it does indeed mitigate the behavior. Therefore, if kleptomania really doesn't exist as a mental disorder, all the worse for thieves.

My personal opinion is that Frank Kameny and Barbara Gittings were on the right side of not just history, but science in helping to get homosexuality removed from the DSM. To hear the social right tell the story, homosexuality was "removed" for "political," not sound medical reasons. But this gets it exactly backwards. Homosexuality was put on the DSM list for "political," not sound medical reasons, and it took some political action to reverse that mistake.

If getting homosexuality removed from the list of "disorders" helped "normalize" it in a "social" or "moral" sense, then that's only because the social right improperly relied on psychiatry for maintaining the social and moral stigma on homosexuality. As with kleptomania, if homosexual behavior were truly "wrong," then removing homosexuality from the list of "disorders" would only make things all the worse for homosexuals.