A Morality of Madness

Before 1974, the Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a mental disorder. The psychiatrists who collated the book, considerd it a disease, complete with symptomology. Something that could be diagnosed, treat and cured.

Things of course, have moved on. Now in its fourth iteration, DSM IV no longer lists homosexuality as a disorder. It does however, list the following; Fetishism, Gender Identity Disorder, Hypoactive sexual desire disorder (not Hyperactive), Kleptomania, Voyeurism, and my personal favourite - Frotterurism. This is a sexual 'disorder' involving rubbing against another person to achieve sexual arousal or even orgasm, discreetly and without being discovered, typically in a public place.

It strikes me that a diagnosis of the above requires as much moral judgement on the part of the Psychiatrist as it does clinical expertise.

It dosen't stop with sexual deviancy either. It gets into the meat and bones of our identities. 'Schizoid Personality Disorder' for example, presents in the following manner;


A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. neither desires nor enjoys close relationships, including being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having sexual experiences with another person
4. takes pleasure in few, if any, activities
5. lacks close friends or confidants other than first-degree relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affectivity

Other than sexual indifference, this sounds like a good few teenagers that I know. Should we be thinking of adolescence as a disorder then?

I wonder if the authors of DSM IV understood the awesome power of words. The power of labels. A tag beggining with Schizo, affixed to a young person, can ruin their life. For some, it's a death sentence. Words can indeed kill.

What's this got to do with spirituality then?

Well, for all its quantitative posturings, Psychiatry remains an art, not a science. Don't let anyone tell you otherwise. And art of course, is a metaphorical exploration of the human condition. An exploration of human spirit.

The DSM IV manual comes with a health warning - The application of these diagnostic criteria must only be made by people with the appropriate training and expertise.

Perhaps, if DSM IV was written in Latin, the judgements Psychiatry makes about people would be accepted even more as an absolute moral authority.

Countless copies of DSM IV have been made over the years. Rather than on a printing press, I imagine hundreds of aspiring psychiatrists, hunched over desks, lit by candle light carefully copying the DSM criteria onto parchment.

More on this another night.

Want to know more right now? You could do no worse than starting with Thomas Szasz.