When I think of a mental hospital or mental asylum, the first image that pops into my head is the one from Batman. I picture crazy patients in a dark and dingy Gotham hospital, with wide eyes, straitjackets, creepy laughter and imaginary friends.

Mental hospital in Gotham City.
Arkham Asylum in Gotham City

What is mental illness?

But what exactly is mental illness?

How is it defined?

How prevalent is it?

How is mental illness diagnosed?

What are the clinical criteria?

How Hollywood has caricatured lunatic asylums

Diagnoses are often based on subjective assessments and self-reported symptoms, leading to obvious discrepancies in prevalence rates. There are significant variations in the definition of mental illness across different geographical regions and cultural contexts, meaning that ‘mental illness’ lacks consistency.

Allen Francis is a psychiatrist and lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV). He is the man who wrote the book on mental illness.

There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it. These concepts are virtually impossible to define precisely with bright lines at the boundaries.

We’re taking every day experiences that are part of the human condition and we’re over-diagnosing them as mental disorders, and way too often providing a pill when there’s not really a pill solution for every problem in life.

Allen Francis

Deliberate over-diagnosis of drugs

In spite of the supposed high prevalence of mental illness, a substantial proportion of “mentally ill” people neither seek help nor receive formal diagnoses, which also means that the actual prevalence is probably inflated.

The pharmaceutical industry has a huge financial interest in promoting the identification and treatment of mental illnesses.

Big Pharma doesn’t like healthy people.

The widespread use of psychotropic medications has become a multi-billion dollar industry, which obviously incentivises over-diagnosis and over-prescription of drugs for conditions that probably don’t even exist (or soon to be invented).

Peter Breggin is a psychiatrist and said that over-diagnosis is driven by profit.

All these antidepressants, the SSRI antidepressants, and the serotonin-norepinephrine uptake inhibitors, SNRI antidepressants, are all knock-offs of a drug that’s very common on the street, and it’s called cocaine.

Peter Breggin

So, does mental illness exist?

Yes and no.

Mental illness lacks evidence to support such a classification. Extreme forms of distress, such as suicidal despair, hearing hostile voices, and severe mood swings, are real experiences.

Nobody would argue that.

A severely distressed patient in an asylum

But categorising these as mental illnesses is problematic because the concept is largely abstract.

There’s no concrete evidence of chemical imbalances, genetic flaws, or bodily malfunctions corresponding to the labels given by the pharmaceutical industry.

Ultimately, symptoms are a mix of social judgements about an individual’s thoughts, feelings, and behaviours, rather than clear indicators of bodily dysfunction.

Mask denier versus establishment sheep
Sometimes I think the Branch Covidians were mentally ill

Furthermore, many symptoms attributed to mental illnesses can be responses to personal and social contexts. For example, behaviours associated with ‘borderline personality disorder’ or ‘schizophrenia’ might be reactions to past traumas such as abuse or bullying.

Kevin Corbett is a British nurse who grew up in a mental hospital and spoke to me about the above.

Madness is to think of too many things in succession too fast, or of one thing too exclusively.


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