To perceive a human being as being a diagnostic category -- a "schizophrenic" or "a depressive" -- dehumanizes that person, and when it comes to people who
suffer mental illness, this is the way many, including physicians, too often see them. Thus, when my brother repeated a request to a psychiatrist for a
diet of kosher food, the psychiatrist screamed at him to "stop talking like a lunatic." But Robert and I grew up in an strictly kosher home, and if the
psychiatrist had any sense of empathy, or even curiosity, he might have discovered that Robert's request was attached to yet one more element of his life
that had, through the years, been lost.
Since there are no known or agreed-upon biological or chemical causes for any of the mental illnesses, it would, at the least, be helpful to have
the mental health profession, advocacy groups, government agencies, and drug companies stop claiming that because mental illnesses result from alleged
"brain diseases" or "chemical imbalances," these conditions can be cured by medications. (Even David Satcher, who, when U.S. Surgeon General, endorsed a
government report that supported a strong bio-chemical version of mental illness, admitted that "the precise causes of mental disorders are not known.")
While thousands of physicians and researchers argue about often arbitrary and ever-changing diagnostic distinctions, and while vast resources are expended
in this enterprise, wherever individuals suffer from the misery and confusion of chronic mental illness, and from the stigmatization, despair, and shame
that invariably accompany this pernicious condition, they often remain in pain and in need.
On the day the APA released its draft proposals, The New York Times reported that New York State did not have a single full-time psychiatrist
overseeing the treatment of 800 or so young people in state detention facilities, "the vast majority of whom suffer from some form of mental illness."
Three weeks later, a federal judge ordered the state to move 4500 people with serious mental illnesses out of adult homes within three years -- out of
residences The Times had called "psychiatric flophouses." The state disputed the judge's ruling, claiming the best it could do would be to find
supported housing units for 200 residents a year for a maximum of five years.
Robert, living until recently in a Manhattan group home with 14 others who have long-term mental illnesses, is on 17 different daily medications, has no
teeth or dentures, suffers drug-induced Parkinsonism caused by years of antipsychotic drugs (drooling, tremors, walking disabilities), and despite repeated
pleas for regular or even occasional talk-therapy, receives none.
Although he and his housemates are not caged in dreary, locked, and overcrowded state asylums the way they were a generation ago, and though a newer
generation of medications seems to have fewer nasty side-effects than those prescribed in earlier times, they live in relative isolation from the rest of
the world,. In the half-dozen years I have regularly visited with my brother, I never saw a single family member or friend visiting another resident. I
wonder, then, what difference the revised diagnostic categories will make in their lives.
On one visit, Robert, obsessing about money, began explaining all the "income" he was expecting -- from Social Security, from his bank account at his
residence, from his monthly SSDI allowance, etc.
"I have all this income," he said. "But do you know what my problem is?"
"No," I said. "What's your problem?"