The Politics of Psychiatry

Worldwide, annual investments in scientific research to cure devastating mental pathologies such as bipolar disorder, schizophrenia, and clinical depression are huge – comparable to spending on finding a cure for any other disease. But while mental disorders are indeed medical diseases, with their own culprit molecules and aberrant anatomies, they are also different from “physical” diseases in important ways. For no matter how thoroughly “medical” mental illnesses are, they are also thoroughly social. The reasons for this stem from the nature of mental disorders themselves.

There is no question that pathologies like heart disease, pneumonia, or diabetes have a large impact on a sufferer’s sense of self and place in the community. But only in illnesses like schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depression do we find disease processes that directly and profoundly transform a person’s self, identity, and place in the community.

A person with schizophrenia may experience his self as another, may experience his identity as controlled by others, and may regard the entire community as suspect and threatening. A person in the manic phase of bipolar disorder has, in addition to serious, even life-threatening lapses in judgment, an extraordinary sense of well-being that the mentally well rarely, if ever, experience. The individual with obsessive-compulsive disorder both dreads and is ashamed by irrational obsessions and compulsions, yet finds engaging in these thoughts and actions irresistible. The person with clinical depression finds his or her entire being dark and vapid, devoid of ordinary human feelings like anticipation, pleasure, and meaningfulness.

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