In his book Anatomy of an Epidemic, Robert Whitaker drew attention to the increasing numbers on the Social Security disability rolls due to so-called mental illness. Robert raises the possibility that the drugs routinely used to “treat” depression may be contributing to the problem. In a recent post, he discusses this matter further.
I think the reasons for the increase in the disability rolls are as follows:
1. People who seek psychiatric help are being told routinely that they have brain abnormalities and that they need to take drugs for the rest of their lives –“just like diabetics.” This promotes a disability mindset which often translates into a disability application.
2. Applicants for disability based on the so-called mental illnesses are screened by either a psychiatrist or a psychologist. Both of these professional groups are immersed and heavily invested in the conceptualization of ordinary living problems as illnesses, and tend to accept uncritically the applicants’ claims that they “just can’t do anything.”
3. In the mid 1990’s there was a great groundswell in political circles to get people off the welfare rolls. It was pretty much an open secret (at least in my area) that Social Services Department caseworkers were referring their welfare recipients “across the road” to the mental health center, so that they could establish a treatment record for mental illness, with a view to applying for disability.
4. Mental health clients routinely share information concerning which “symptoms” to emphasize, what to say, etc., during the evaluation. Clients whose application for disability has been successful are often seen as resources for those coming behind.
5. Mental health workers inadvertently teach their clients how to qualify for a “diagnosis.” When the worker asks the client if he/she has been having trouble sleeping and writes down the answer in a case file, the client realizes that sleeplessness is a factor in determining disability. Similarly for “loss of energy,” “poor concentration,” “recurrent thoughts of suicide,” etc.. An even moderately motivated client can readily identify the criteria questions for whichever “diagnosis” is being pursued. This is because the worker’s primary objective is not to get to know and understand the client, but rather to assign a diagnosis – to get the client into a billable pigeonhole.
6. The APA’s infinitely flexible definition of a mental disorder and the equally flexible criteria for each particular “disability” make it possible for virtually anybody to receive a diagnosis. All that the client has to do then is leave a trail of disasters in his wake and make sure it is adequately documented. I knew a man one time who was receiving disability benefits for alcoholism (I think from the VA). This puzzled me because I had never seen him drunk or even drinking. But later his wife told me that three or four times a year he would go into town, have a few drinks, make a nuisance of himself, get arrested, and spend the night in jail. The ensuing paper trail was sufficient to sustain his disability status and income. You can’t fake kidney failure, but you can fake every DSM diagnosis.
7. And of course, the drugs themselves are causing damage which contributes to genuine disability. There is evidence that benzodiazepines shrink brain tissue. See my post Business as Usual. And an article by Nancy Andreasen (Long-term Antipsychotic Treatment and Brain Volumes) indicates that the major tranquilizers (or “antipsychotics” as the bio-pharma-psychiatric bloc likes to call them) also shrink brain tissue. Obviously as brains shrink, disability rolls expand!
There are no mental illnesses. “Mental illness” is a spurious explanatory concept whose purpose is to medicalize for profit the ordinary problems of human existence which our ancestors tackled and resolved without drugs for thousands of years. The bio-pharma-psychiatric system is nothing more than a façade for legalized drug-dealing which is eating away at the quality of life and the fabric of our society.
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