Four Assumptive Worlds of Psychopathy V: The World of Mental Illness
I will have much more to say about DSM in the sixth essay and will be ably assisted in this description and analysis by several colleagues in the graduate school where I serve as president (The Professional School of Psychology). At this point, let me just note that DSM has a very broad, global reach. DSM not only strongly influences (even determines) third party payments in the United States and some other countries (including those providing government funding of psychiatric and psychological treatment). It also has become a firmly enforced social construction in many of the human service fields (including not just psychiatry and psychology, but also such fields as social work, school counselling and pastoral counseling). This enforcement includes a requirement that old versions of DSM be destroyed, since they no longer provide the “truth” about psychiatric categorization. It was even suggested that these manuals be “burned” so that someone unsuspectingly would pick up an outdated version at their local dump and be misguided in their use of this manual.
As we will report more fully in our sixth essay, the battle over the constructs established in a new version of DSM is often waged with great passion (and a substantial amount of politicking, marketing and expenditure of funds by pharmacological, medical and allied health institutions). Issues related to societal biases regarding classification of sexual orientations (such as homosexual and transgender) and specific asocial behaviors (such as aggression and sexual promiscuity). Should any of these orientations or behavior patterns be considered “mental illnesses”? We know that having a heart attack is a bad thing. What about being Gay or verbally abuse or paying for (or providing) sexual services? Are these signs of being “crazy.”?
At this point; the third and fourth assumptive world converge (or collide): when does a medical model replace a model of social deviance? When does the management of power transfer from the courts, prisons and asylums of a society to the wards of hospitals and offices of insurance company executives or government officials? Who is best qualified to identify and classify psychopathy: the doctor or the legislator? We will have much more to say about these important issues in our next essay. Now on to the choice of interventions, that are clearly influenced by the classification that is made regarding a specific psychopathy.