Creating Mental Illness

"Creating Mental Illness" provides an excellent account of how mental disorders are defined, diagnosed and treated, as well as how and why the criteria for them have changed so much over time. I used this book in an upper-level undergraduate course on mental health & policy and my students thoroughly enjoyed it. Very well written and organized, "Creating Mental Illness" is that rare book that is both pleasurable to read and educational. I highly recommend it to anyone wanting to learn more about mental health and disorders.

I was working the BiPolar shift in the cafeteria of the local mental hospital and overheard this and wanted to share it with you. Bernard Lumbert, orthopolar designate1st Dr. "So Carl, I see you have finished "Creating Mental Illness" by Alan Horwitz?" (The author spells his name with two "l's" I noted but then I am delusional and observe things others miss)2nd Dr. "Yes Sig, Enjoyed it very much. A pretty good read." (He would probably fake an orgasm, I mused, all reviewers say "good read")1st Dr. "Good read? My gawd it's supposed to be fairly heavy stuff. You and I went through Dynamic Psychotherapy and we thought that was heavy. Isn't this social source stuff new? Wasn't Compte an alienist or something?" (Yess, dear sir, and the thought will surge up to your senium that if Sociologists can define maladaptive behavior, they may be able to cure it. Bye bye MD/OD)2nd Dr. "Well, I skipped around a lot but read chapter 7, about social sources of mental illness, twice." (Read it twice; understand it once, I thought)1st Dr. "We are psychiatrists, aren't we supposed to know that about sources, and origins and genetic vulnerability? Doesn't that nature trump the nurture of homelife?" (You are drawing to an inside straight with your trump I sez, you can't change people's minds with facts.)2nd Dr. "Let me give you an example. Do you have patients that are involved with heavy drinking, drug use, and cooking their company books?" (I wait breathlessly)1st Dr. "Why sure we see them every day. They are not sick, not diagnosable with medical syndromes." (hawl-a lu-ya!)2nd Dr. "And that is what Dr. Horwitz explains so very well. Many cultural excesses can be transformed into a morbid fixation just like a personality trait becomes a personality disorder if you find it in the DSM. You just add.. "Just add three or more digits..," chortled Dr. Sig. "If it has numbers, it is a personality DISORDER, otherwise it is a personality TRAIT like biting your nails." (Bite this I thought as I handed them each a sliver of new whitefish we just got in.) 2nd Dr. "Well, yes and yes. In our heart of hearts we all know that the etiology, the origin, the mother load(sic) of most dysfunction in most patients is societal." (yes, and you can inherit post traumatic stress syndrome from your grandchildren, I thought as I ladled out a side of creamcheese.)1st Dr. "But, as Howrwitz noted, the DSM manual, our bible, now lists over 400 mental illnesses and when my dad was practicing there was only 40 on the list. That's quite an increase." (once there were only two rabbits in Australia, I thought, now look at how many there are.)2nd Dr. "How do you explain the vast increase?" (I waited breathlessly for a vast response)1st Dr. "Simple, according to Horwitz, there is a hobby amongst the authors of the DSM to create all new diseases that could be treated with all new meds only, thereby creating an expanding market for pharmacies and script writers

Dr. Horwitz provides in this book a well researched assessment of the current state of affairs of the mental health system, primarily in America. He discusses the growth of the number of accepted mental disorders from only a few (around 1900) to somewhere around 500 (DSM-IV, for instance). Much of this growth seems to be attributable to efforts to get third-party payers (generally insurance companies) to pay for treatment.Horwitz presents plenty of evidence and argument about how clinical trials favor the use of psychiatric medications over counseling (it is difficult to conduct a double-blind controlled, with placebo, study with counseling: usually someone knows when he/she is being counseled or not counseled). He presents additional evidence that professionally trained counselors/therapists have not been shown to be better than untrained counselors -- for the main ingredients in counseling are empathy and support (something often missing in professionally trained mental health workers). He discusses how many of the "new" disorders (that give 500, versus the few that were considered to exist in 1900) are merely sociological problems or the result of sociological problems -- and medications do not usually make them go away, but merely help them be tolerated.My words cannot really do justice to the high quality of this book. Recommended reading for all mental health professionals and for anyone with concerns about the current status of mental health practices in America, and perhaps the world.