History is chock-full of individuals with oversized egos who have been very successful – they often think more clearly and are better leaders than so-called normal people. Trump’s track record bears this out. There are also people with big egos who have destroyed themselves and others around them. Hillary is this type. She went down in flames, doing great harm to the DNC, destroying many careers of her supporters who helped to cover for her crimes. Until the psychiatrists can successfully differentiate and predict the future on these two types, they have no business telling us who is fit to lead. Saying, “Where’s the blood test” is just another way of calling out the waffling, the ever-changing standards, the mistakes in judgment, the ruined lives. This is not science.

By all means, let’s identify problems like depression and OCD, but let’s not pretend we can treat them with molecules created in a lab. Or with sessions with a PhD. Let’s not call it Science, especially now that Science is a monolithic consensus project. Let’s leave it to independent research and common wisdom.

But that doesn’t mean there aren’t actually unhealthy patterns of behavior and pathological personalities associated with that behavior — to claim otherwise would be to descend into a kind of all-out postmodern relativism with regard to mental health. There’s a reason that homosexuality was removed as a disorder while most others remain. The values around it were more readily and reasonably changeable. Whereas washing your hands 500 times a day or perceiving yourself as fat while you waste away are quite readily and persistently seen as unhealthy, negative patterns of thought and behavior — value judgments that are more obviously on solid ground. Finding a biological signature for OCD or anorexia wouldn’t make it more or less sound to judge these behavioral patterns to be problematic and to constitute a “disorder”.

Thanks for helping me get to the heart of why I think the demand for biological tests to validate mental pathologies is fundamentally unwarranted.

P.S. “the “order” of society”…makes me think of how secret societies are often referred to as “orders”. And yes, psychopathologies can reveal much about the societies they arise in.

This also came into my head: http://www.metrolyrics.com/toxicity-lyrics-system-of-a-down.html (see lower right under “Artist Videos” for the music vid).

No need to even bring up the many improper uses of psychiatry, or its spectacular failures in the past. It’s the whole question of whether unusual or detrimental behavior is proper and healthy or not. Should the Foxconn factory in China hire an army of psychiatrists to help its workers to stop throwing themselves out of windows? In China, you would be hard-pressed to find a psychiatrist who would instead recommend closing down the factory. He wouldn’t have a job the next day. And there you go – agreeing with your colleagues, fitting in to the established order – that’s supposed to be healthy, and of course it is rewarded by job security. The only way to define normal behavior is to use yourself or society as a standard, and that assumes that you or society is normal. Notice that as society changes, the DSM changes. No longer is homosexuality considered a disorder. The very word disorder means not fitting in to the “order” of society. Someday, this mistake will be recognized for what it is. We need our disorders – they warn us that what appears to be in good order around us is just an illusion. Children who have ADHD warn us that school is a kind of concentration camp, and that video games are exploitative entertainment. The scientists have normalcy bias, and won’t go there.

So not having a biological test for a disorder is important, because it should lead you to examine these assumptions about normalcy.

If you have obsessive compulsive “disorder”, this terminology points to the fact that you are displaying and experiencing a recognizable pattern of behavior that is detrimental. It is mental ill-health, whether or not there might be some neurological underpinning. And “disorder” refers to an “out-of-whack”, or unhealthy, pattern of behavior/thought. The usage is abstract and is not meant to signify any “thing”, even if the materialist imagines it ultimately must. There is obviously a difference between what is unhealthy and destructive versus what some people simply don’t like or expect, even if the distinction is contested at the margins. Of course, OCD behavior is actually very ordered — a good example of why “disorder” is a misleading term.

I think it’s incorrect to say that the identification of a “disorder” is typically meant to excuse a person from responsibility for his or her actions. There are people whose brains are physically damaged or malfunctioning in a way that makes them actually not responsible for what they do. This is not the case with personality/character “disorders”. People’s criminal behavior is not excused because they typify “antisocial personality disorder”, for example. It is well known that much of the prison population would score high for APD, and for psychopathy in general.

“You can’t diagnose by mere appearance.” …Again, this is not physical diagnosis. We can only go by observed behavior, self-report, and third-party report. And because some of these pathological personalities, like narcissists, tend to be highly manipulative, pathological liars, self-report wouldn’t be very reliable, except to discern patterns of grandiosity, delusion, self-absorption etc., and to compare with what is observed and what others close to the individual report. It doesn’t mean you’re left to just throw up your hands and say, “oh, he’s quirky”, all while the individual in question and/or those in his life are suffering from the behavior and seeking to understand it. Maybe try searching sometime for accounts from people who’ve been in relationships with pathological narcissists, and see if it sounds “OK” to you.

“A mere system of classification is neither medicine nor science.” …We’re dealing with the human psyche here, so one would not expect a hard, physical science. Does this mean that behavior and psychology cannot be understood in methodical, structured, and consistent ways? Much of biology is classification, and boundaries between categories are contested, but species, genuses etc. remain meaningful groupings. Personality psychology in general can be studied using scientific methodology (repeatable experimental design using statistically valid population samples and producing consistent results), which can generate predictive and explanatory power. But having an explanation for behavior or a framework to understand it within is not the same as excusing it.

If you want to claim something is interfering with voluntary behavior, then yes, a physiological basis would help (leaving aside possession or mind control). But, if someone exhibits behavior that is obviously insane or deranged in general, and it is obvious he/she has no idea what they are doing if they commit an act of violence, for example, then it is not necessary to have physical proof that his/her neurology is compromised, or to know how it is compromised, to understand that he/she cannot hold normal responsibility. But this does not describe the personality disordered, or the psychopath who knows and controls what he does.

I realize that putting everything in the DSM under the primary purview of medical doctors is dubious at best, and that the heavy involvement of what calls itself a branch of medicine only conflates mental and behavioral issues that are and are not physiologically based. Part of the problem is knowing what is biologically rooted and what isn’t. The DSM is really a dictionary of abnormal psychology — some of which intersects with medicine and neuroscience — that has been fluffed up and distorted by psychopharmacological interests and medical authoritarians.

“psychiatry is a kind of quasi-morality” …Sure, it can be, but isn’t necessarily. It can be a paternalistic, authoritarian tool, but so can many things. It need not mean it is inherently invalid or useless, or that is has not and cannot contribute to human knowledge. It, and clinical psychology, can and do serve as modalities for understanding mental health. We shouldn’t throw out all of psychiatry and clinical psychology just because they (particularly psychiatry) can be and have been and are being used in negative ways.

http://nautil.us/issue/45/power/does-depression-have-an-evolutionary-purpose

Because the word “disorder” signifies that some-THING is out of order. If there is no “thing” out of order, then all we are saying is that a behavior pattern does not fit our expectations or our liking. If there is a thing out of order, then we could say – “AHA, you see, he is not responsible for his actions, this thing is making him behave this way.” Without that thing, who is to say that this person has chosen freely to behave this way, that it is his preference?

Suppose a patient goes to the doctor, and he sees a small brown tattoo on her shoulder, and decides that it is a precancerous growth. Does he just start treating her for skin cancer? You can’t diagnose by mere appearance. In this example, the patient could explain to the doctor that it is a tattoo, and all would be well. But what if someone who is called a narcissist says, “But this is the way I decided to be. I enjoy it, and so do many other people, but you can’t please everyone, so some people hate me for it. But that’s OK.”

Psychiatry says, “No, we have decided that you fit the pattern, therefore you are disordered. Something in your past caused you to turn out wrong, and therefore you are sick.” A mere system of classification is neither medicine nor science. There has to be an underlying rational theory based in nature, in observable, detectable things that have a physical existence, that can prove that a person actually has something wrong in their physiology that unduly interferes with voluntary behavior.

If a person is acting voluntarily but doing bad things, then we can say they are evil, but that is not within the scope of science. Now we are dealing with morality. Morality deals with the invisible world of what should be, what is right and what is wrong. And really, psychiatry is a kind of quasi-morality. It is a judgment of what is good and bad in a person, based on their actions. But it short-circuits any kind of Socratic dialog on the nature of the good, by merely asserting that someone fits a pattern.