The Three Body Problem: How the Mental Health Industry, Society and the Individual Interact
In a companion post to this, I discussed The Psychopath Test: A Journey Through the Madness Industry by Jon Ronson. In this book, the author attempts to describe the relationship between the mental health industry, society, and the individual. The idea of being able to spot a psychopath in our midst seems to captivate the public. In the book, the author notices that when individuals (including himself) with very little exposure to the clinical concept of psychopathy appear to be able to diagnose the condition in others. Ronson is about to embark on an extensive 15-year anniversary celebration of this book. Out of all his eclectic work, this book seems to have caught the public’s attention the most. Moreover, this appetite has only increased with concepts such as the Dark Triad entering the public domain, allowing us to hone in on specific psychopathic traits such as narcissism.
It would appear that almost everone can now diagnose family, friends and famous indiviuals as having some form of psychopathy. To my knowledge, most of them are not experts or have ever had a conversation with the individual being diagnosed. When I hear things like this, I always think that Ronson should be praised for his foresight in predicting all of this. It is not just pop psychologist friends and the media that are discussing these issues. More concerningly, it has permeated institutions and HR departments. In my recent studies, I had to sit through a psychologist's panicked presentation suggesting we should have a process for CEO recruitment that would screen out psychopaths.
Fortunately, or unfortunately depending on your view, certain mental health diagnoses do not create the same level of excitement as being a psychopath. This would be true of Prolonged Grief Disorder, a recent addition to the DSM-5. I think it will not be the subject of many articles, podcasts, or social media posts. I understand why, as it almost seems self-evident what the condition is.
Below, I have tried to outline some of the complexities involved in the relationships between the mental health industry, society, and the individual. It is complex, never straightforward, and too often misunderstood by one or all parties. As much as I would like to use psychopathy, I am going to use the more pedestrian example of an individual receiving a diagnosis from a psychiatrist for Prolonged Grief Disorder. Over the years, I have collated vignettes from my own and other people's experiences. I have tried to encapsulate them in the scenario laid out below. With this, I hope to illustrate how the lack of congruence between each party's understanding of this diagnosis can result in society labeling individuals with conditions and not knowing what to do with them. Ultimately, what does a diagnosis mean for each party, and what action should they take?
Relationship 1 – Individual and Mental Health Industry
If a psychiatrist gave a Prolonged Grief Disorder diagnosis to a person, they would probably be satisfied that they had been understood by their doctor. At the level of patient and doctor their understanding and what this means for this individual has congruence.
Relationship 2 – Individual and Society
The individual is now moving through society with their diagnosis. They discuss it with a work colleague who tells them they felt just like that after their dog died, i.e., quite sad for some time and missing the dog. Clearly, both parties' understanding of this diagnosis is not aligned.
The same individual attends a support group of people who have suffered similar losses and announces their diagnosis. These people express concern that normal grief reactions might be pathologised. Ironically, the individual’s diagnosis is not being accepted by a section of society who would appear to be best placed to understand this and support it.
Finally, the individual takes their diagnosis to an employer. The employer accepts the diagnosis but will not give the person any additional time off work or amend any duties because no policy currently covers this condition. This time the diagnosis has been accepted on a superficial level but does not carry sufficient importance to compel the employer to act. It does not really mean anything to the employer.
Relationship 3 - Mental Health Industry and Society
The mental health industry is funded through a mixture of government and private insurance money. The government of a country may wish to fund certain projects, and the mental health industry will provide this service. If the government does not see certain mental health issues as a priority, it will not get funded, and ultimately it will not be serviced. Conversely, the mental health industry may start to diagnose certain conditions, e.g., female diagnosis of ADHD; the government may then come to see this issue as a priority and fund the industry more to provide a service. This will be particularly true if “female” ADHD starts appearing in social media and news stories. Celebrities may even comment on the condition. This means the government will be compelled to react and seen to be doing something.
The individual with their Prolonged Grief Disorder diagnosis will have to hope that their diagnosis aligns with government and mental health industry priorities, or they may find all they have is a meaningless label that invokes a lot of misunderstanding.
What to do with more types of Mental Health Disorders
It has been reported that mental disorders daignoses are increasing. I am not going to dispute this fact, but I would like to add that the actual number of different mental disorder types will increase as they are added to the DSM-5 and later revisions (DSM-6, 7, etc.). This means the opportunity for misunderstanding mental disorders will also increase. We cannot expect wider society to have the level of understanding that a mental health professional has, but it is incumbent that we all do a bit more research on a condition and what it means, prior to making any claims of understanding it or even worse, diagnosing it.