It Reminds Me of the Great Soviet Encyclopedia...

It seemed that whenever they took someone out ("down the memory hole" as George Orwell would say), they had to put something else in that spot. Lavrentii Beria, Stalin's secret police chief, was replaced (not very well) with an entry on the Bering Sea.

The DSM is the "Bible" of mental illness treatment. Over the years, quite a number of emotional problems have been removed from it. Homosexuality (at least, if you were happy with it), was removed in the mid-1970s, after a prolonged debate within the profession about it.

A couple of years back, at the American Psychiatric Association conference in San Francisco, there was a debate about whether to remove some other sexual behaviors from the DSM:

On Monday, May 19th, 2003 in San Francisco, at a symposium hosted by the American Psychiatric Association, several long-recognized categories of mental illness were discussed for possible removal from the upcoming edition of the psychiatric manual of mental disorders.

Among the mental illnesses being debated in the symposium at the APA's annual convention were all the paraphilias--which include pedophilia, exhibitionism, fetishism, transvestism, voyeurism, and sadomasochism.

Also being debated was gender-identity disorder, a condition in which a person feels persistent discomfort with his or her biological sex. Gay activists have long claimed that gender-identity disorder should not be assumed to be abnormal, when, they say, it is usually an expression of healthy prehomosexuality.

Dr Robert Spitzer responded to the symposium as a discussant, urging that the paraphilias and gender-identity disorder be retained in the psychiatric manual.

Disagreeing, Psychiatrist Charles Moser of San Francisco's Institute for the Advanced Study of Human Sexuality and co-author Peggy Kleinplatz of the University of Ottawa presented a paper entitled, "DSM-IV-TR and the Paraphilias: An Argument for Removal." They argued that people whose sexual interests are atypical, culturally forbidden, or religiously proscribed should not, for those reasons, be labeled mentally ill.

I blogged about this a couple of years ago--and how the parallel to what happened with homosexuality suggests that we are going to see the courts legalize child molestation in the same way that they overturned laws against homosexuality. (If you think I'm exaggerating--read this article that reads like satire, but isn't.)

I received a few emails from people arguing that pedophilia shouldn't be considered a mental illness--just a crime. While I disagree with that point of view, I will confess that we don't have much consistency in how we distinguish mental problems from purely criminal acts. Exhibitionism is both a mental disorder in DSM (for the moment) and a crime--and a crime that we treat more seriously than rape. In most states, exhibitionists become registered sex offenders on conviction, and must notify the police every time they move--for life. I don't want guys running around exposing themselves in public, but I can tell you that a rapist is a far greater hazard to public safety than an exhibitionist. A garden variety rapist needs to be kept an eye at least as much as an exhibitionist--probably more. It is rather like our society regards rape as a natural act, but one that still needs to be punished, but exhibitionism regards as an unnatural act. Very peculiar.

In any case, if the psychiatric profession wants to start removing from the definition of mental illness every weird little behavior that a majority doesn't like, then why are there psychiatrists proposing to add some new kinky behavior to the list? Once you see what the kinky behavior is, you won't be surprised:

The 48-year-old man turned down a job because he feared that a co-worker would be gay. He was upset that gay culture was becoming mainstream and blamed most of his personal, professional and emotional problems on the gay and lesbian movement.

These fixations preoccupied him every day. Articles in magazines about gays made him agitated. He confessed that his fears had left him socially isolated and unemployed for years: A recovering alcoholic, the man even avoided 12-step meetings out of fear he might encounter a gay person.

"He had a fixed delusion about the world," said Sondra E. Solomon, a psychologist at the University of Vermont who treated the man for two years. "He felt under attack, he felt threatened."

Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are disabled by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.

Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.

I would actually agree that the guy who couldn't take a job because of his fear of having a gay co-worker has a serious emotional problem (or perhaps too much money in savings). But isn't this going just a little too far in the direction of a marvelous satire of Political Correctness?

If DSM left it at those prejudices or biases that interfered with a person's daily life, I suppose that I wouldn't disagree that this is a significant emotional problem. I just have my suspicions that a vote at an APA convention would expand the definition of a "serious bias problem" to include the 60% of the population that does not approve of homosexuality.

Here's a quote from the article that almost reads like someone wanted a real world example of "projection" (the tendency of a person with a serious problem to project it onto everyone else):

"I don't think racism is a mental illness, and that's because 100 percent of people are racist," said Paul J. Fink, a former president of the American Psychiatric Association. "If you have a diagnostic category that fits 100 percent of people, it's not a diagnostic category."

Speak for yourself Dr. Fink!

"Prejudice" as a word means so many different things that it is almost meaningless. I can identify the following different attitudes, ideas, or beliefs that would fall into the left's catch-all definition of prejudice:

1. A person who hates or fears all members of group X--no exceptions. I don't know that I have ever met someone like this about race or ethnicity--although I know that such people exist. I have met people who hate or fear all gay men--and in every case, these were men who were sexually abused as children. (These are guys who think of me as a flaming liberal about homosexuality.)

2. A person who believes that members of group X have certain characteristics in common--but recognizes that there are exceptional individual members of race X: hence, "you are a credit to your race." There was a time when people actually said that--now it is only used as a comic line in fiction to discredit a character.

3. A person who believes that members of group X are more likely to have certain qualities or defects than the general population. This belief exists in an unadulterated positive form, "Asians sure are good at math!" It also exists in a positive form with a dark implication, "Jews sure are clever!" (implying that perhaps the intelligence is being used for nefarious purposes). There is also the negative form. "Blacks are violent." "Men are violent."

What makes this category of prejudice especially complicated is that the stereotypes often have a grain of truth to them--members of group X may be disproportionately likely to engage in behavior Y. Most adults manage to figure out that these stereotypes, even if accurate, are only averages. My late father-in-law was (like a lot of men of his generation), pretty ferociously prejudiced. He would rant at times about blacks, Mexicans, and Jews--and often not using particularly pleasant terms. But he had worked with blacks and Mexicans quite well over the years, and his third wife was Jewish. He had been around long enough that even if he didn't like group X (as a whole), there were members of group X that were good and decent people, with whom he was quite willing to associate.

The biggest problem with this category of prejudice is that sometimes, the costs of finding out if A, a member of group X, fits the negative stereotype of his group, are quite high. These negative stereotypes, if they actually describe a real behavior quirk, are often believed by members of group X as well. A few years back, I've read that a black man had a heck of a time hailing a cab after dark in DC. Yet I'm told that taxi drivers in Washington, DC were almost entirely black. A black man hailing a cab in DC was not likely to be a robber--perhaps a fraction of 1% of all black men were criminals--but the risk if you picked up one of that tiny fraction was enormous. I've written before about my own experience of seeing a woman almost running to get away from me--simply because I was a man, and therefore I was a member of a group that was twice as likely as the average to be a rapist.

Prejudices like #1 should never be written into the law--and yet they often were. Prejudices like #2 and #3 should not be written into the law, either, simply because they (at best) reflect averages of group X--and our laws should apply only to individuals, not to group. At the same time, I am not happy when the government decides to punish people for holding prejudices like #3--especially when, as in the examples above, there may be substantial costs to pretending that these group averages have no meaning. (And yes, if that means that a daycare center decides to not hire members of group X because group X is disproportionately child molesters, so be it.)

I don't doubt that people suffering from prejudice #1 above are probably very seriously emotionally disturbed people, and if the APA decided to add a definition to the DSM that included people with such severe prejudices, it would seem entirely appropriate. But I must confess with the way in which the APA swings back and forth about what constitutes mental illness (and seemingly more following fashion than science), I could easily see this definition of "pathological bias" expand to cover membership in the National Rifle Association, or regularly attending a church that doesn't ordain homosexuals.