But if some people turn out happy and good despite a lifetime of withering hardships, why can’t some people be mean or bad for no discernible reason?
There can be a relationship between nastiness and mental illness, and many therapists assume that when patients are mentally ill and mean, the illness is probably the cause of the ill temper.
But human meanness is far more common than all the mental illness in the population combined, so the contribution of mental illness to this essential human trait must be very small indeed.” — Richard Friedman MD (New York Times )
This is one in my continuing series of posts objecting to the medicalization of everyday life, which is particularly rampant in the mental health field. Psychiatrists are taught, as the writer above alludes to, to avoid passing moral judgment on others’ souls, but what if the only other way to validate your perceptions of or reactions to the way someone does business with you is to diagnose them with a disorder?
One of my particular interests in my work is the treatment of irritability and interpersonal violence, some of which is attributable to personality disorders and some to brain pathologies. Some, but not most…
The duty of the psychiatrist is as much to know when not to treat as to treat. We have to be very careful not to contribute to the epidemic of erosion of personal responsibility for behavior in modern society. Giving someone a diagnosis can serve to let them “off the hook”; this is a relief and a service when it is appropriate but a travesty when it is not, as it often is not. How many times have I heard a patient say, “I can’t help it. They tell me I’ve got a chemical imbalance” or the like?
An essay such as Friedman’s is a bold affront to a worrisome facet of the medical status quo, to be heartily welcomed from one curmudgeon to another.
