I should like to die of consumption . . Because the ladies will say, “look at that poor [Lord] Byron, look how interesting he looks in dying.”

If there is scientific infighting more significant than that over macro-stabilization, it is that going on inside the Psychiatric community.

What make its particularly hard, however, is in most pursuits we can always lean back on the notion that if we hope to make the best world, then understanding the world as it is – not as we wish it to be – is our best hope.  This is not true with mental disease.

In many different ways, not just in the debate over psychotropics, the truth may increase suffering. There are times when you know that forcing someone to acknowledge their insanity, is nothing less than cruel. .

Gary Greenberg gives a admirably even handed take – given what I know his beliefs to be – on the run-up to the DSM-5. Of course, he still lobs the standard grenade:

The fact that diseases can be invented (or, as with homosexuality, uninvented) and their criteria tweaked in response to social conditions is exactly what worries critics like Frances about some of the disorders proposed for the DSM-5—not only attenuated psychotic symptoms syndrome but also binge eating disorder, temper dysregulation disorder, and other “sub-threshold” diagnoses. To harness the power of medicine in service of kids with hallucinations, or compulsive overeaters, or 8-year-olds who throw frequent tantrums, is to command attention and resources for suffering that is undeniable. But it is also to increase psychiatry’s intrusion into everyday life, even as it gives us tidy names for our eternally messy problems.

Its standard to object to the medicalization of everyday disorders. Where does it stop, people ask? Is everything a disorder?

It never stops, I answer. And, it’s a disorder if you dislike it.

The normative element in non-mental health conditions is somewhat hidden because death, disability and pain are almost universally disliked. So, if I say cancer is a disease because it kills, no one is likely to object to this. It doesn’t matter that cancer is, almost as much as anything, a part of life.

As far as we can tell no human has ever been born without the propensity to develop cancer. That people don’t die of cancer is purely a function of the fact that they die of something else before the cancer gets them.

So, why is cancer not just a part of life? Part and parcel with being a multicellular organism? The simple answer is that it causes death, disability and pain. These are widely recognized as bad and so is cancer.

What about feeling sad? To my knowledge no human has ever been born without the propensity to feel sadness. Is sadness simply part and parcel with life? The answer from my corner is, not if you don’t want to be sad.

This is the rub in all mental illness. It is the malady of not wanting to experience the world as we do. And, it raises the deepest questions about what it means to improve wellness.

I stick firmly to the notion that we improve wellness when we alter physiology to produce a preferred state of being. Preference is in the eye of the patient.

However, I do know the question “Am I sick?” has moral meaning to people. Giving a name to a condition can bring comfort or despair, even when it doesn’t change the essential experiences of the person at all.

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