Why shrinks diagnose anti-authoritarians with mental illness

Bruce Levine, a clinical psychologist, has written on Mad in America about his colleagues' propensity for diagnosing anti-authoritarians with mental illness. Levine says diagnoses like oppositional defiant disorder, attention deficit hyperactive disorder and anxiety disorder are applied to people who question authority's legitimacy by mental health practitioners who are, themselves, unconsciously deferential to authority.

Gaining acceptance into graduate school or medical school and achieving a PhD or MD and becoming a psychologist or psychiatrist means jumping through many hoops, all of which require much behavioral and attentional compliance to authorities, even to those authorities that one lacks respect for. The selection and socialization of mental health professionals tends to breed out many anti-authoritarians. Having steered the higher-education terrain for a decade of my life, I know that degrees and credentials are primarily badges of compliance. Those with extended schooling have lived for many years in a world where one routinely conforms to the demands of authorities. Thus for many MDs and PhDs, people different from them who reject this attentional and behavioral compliance appear to be from another world—a diagnosable one.

I have found that most psychologists, psychiatrists, and other mental health professionals are not only extraordinarily compliant with authorities but also unaware of the magnitude of their obedience. And it also has become clear to me that the anti-authoritarianism of their patients creates enormous anxiety for these professionals, and their anxiety fuels diagnoses and treatments.

In graduate school, I discovered that all it took to be labeled as having “issues with authority” was to not kiss up to a director of clinical training whose personality was a combination of Donald Trump, Newt Gingrich, and Howard Cosell. When I was told by some faculty that I had “issues with authority,” I had mixed feelings about being so labeled. On the one hand, I found it quite amusing, because among the working-class kids whom I had grown up with, I was considered relatively compliant with authorities. After all, I had done my homework, studied, and received good grades. However, while my new “issues with authority” label made me grin because I was now being seen as a “bad boy,” it also very much concerned me about just what kind of a profession that I had entered. Specifically, if somebody such as myself was being labeled with “issues with authority,” what were they calling the kids I grew up with who paid attention to many things that they cared about but didn’t care enough about school to comply there? Well, the answer soon became clear.

Why Anti-Authoritarians are Diagnosed as Mentally Ill


  1. Bruce Levine, a clinical psychologist, has written on Mad in America about his colleagues’ propensity for diagnosing anti-authoritarians with mental illness.

    No surprise there, Mad magazine always had an anti-authoritarian streak.

    1. Hehe, is it my madness that makes me anti-authoritarian. Or is it my anti-authoritarian ways that makes me mad?

      Or for that matter, consider the number of dissidents that has been locked way via mental health diagnosis throughout history…

  2. This is an interesting twist on the medicalization of deviance.  I never considered it would be used by the group that creates the definitions to ostracize it’s own members, but it makes sense.  To my untrained way of looking at it, what is being labeled a disorder is just a strong component of  someone’s personality.  Classifying that component as deviant or a disorder, definitely says as much about the person making the classification as it does about the person being classified that way.

    1. Shrinks need shrinks, who in turns need shrinks…
      As with the turtles, it’s shrinks all the way down!

        1. Far too many people use the therapist as a confessional, which means that the therapist has to listen to the same story about the same sins week after week, year after year. I’m surprised that mental health professionals don’t have a higher homicide rate.

          1. I’ve a feeling the therapy industry got most of its seed money from rich women who hadn’t any real friends to discuss their personal issues with.

          2. Well Freud did give the European aristocracies a way to air their hangups without being seen as unfit to rule…

    2. Fundamentalist belief has always been central to psychiatry. From its foundation as a distinct discipline its function has been to instil a sense of ideological conformity in both practitioners and victims. This is nothing new really. They are right in identifying three particular problems – psychosis/schizophrenia and neurosis – but as they have no idea what they actually are there is plenty of scope for mischief trying to work them out.

  3. Some food for thought.

    Schools in general promote obedience, accepting others’ answers, submission to authority, sitting in place for long hours against one’s will, accepting an authority’s evaluation for what one is, training via reward and punishment via grading and disciplinary action. 
    Students are supposed to give up their interests and learn whatever is force-fed to them, out of fear. 

    Anyone who internalizes the values of an oppressive institution becomes its agent.

    Anyone who rebels against it, is defined by the rebellion.

    1. I think it is insulting to *real* rebels against authority — the ones that are revolting because of actual social injustice — to compare them to losers who think they are “cool” by making teachers and their fellow students miserable by not taking school seriously. Sure, you might not be interested in subject X. Things like grade school (and even high school) math are frankly dull as dishwater. But they are needed to get the foundation for more interesting things later on. Not everything can be immediately “fun” or “interesting”.

      1. It depends on how you take that comment. People who stand up for their civil rights “make their fellow students miserable” as evidenced in recent history both with desegregation and the questioning of school prayer.

        1. Of course there’s a pretty big difference between making a fuss by standing up for of civil rights and making a fuss just because you’d rather not be in school.

          1. Right… somehow we seem to be reading the same comment completely differently. I don’t think there’s any denying that at least in many places in the US school is less concerned with education as an academic exercise than, well, just about anything really.

            Since, Tynam pretty much summed up my problems with the comment I won’t bother repeating them.

          2. Surely it should be a civil right to educate yourself with methods  that exclude school if that happens to be inline with your personal philosophy?

          3.  @google-42d65025e2a6730b06b8051f8596c461:disqus :

            Surely it should be a civil right to educate yourself with methods  that exclude school if that happens to be inline with your personal philosophy?

            That’s a complex question; rights go hand in hand with responsibilities and most societies recognize that it is often necessary to curtail both in the case of children. If a five-year-old would rather stay home and play trucks than learn to read is it a violation of his civil rights for his parents to send him to kindergarten anyway?

          4. “just because you’d rather not be in school.” = just because you’d rather not be inprisoned, oppressed, being told what to do, punished if you deviate from someone else’s rules you never agreed to.

            How is that not a civil rights issue?

          5. @thecleaninglady:disqus :

            How is that not a civil rights issue?

            It’s not always a civil rights issue. Or rather, it’s often necessary for parents and guardians to make certain decisions on behalf of their children, so if it is a civil rights issue then so are many aspects of child-rearing. See my response to Luke Mills.

      2.  It’s interesting, and possibly telling, that you boil this comment down to people who aren’t “taking school seriously” or  think “everything can be immediately “fun””. The original post mentions neither.

        I also find the idea that “actual social injustice” doesn’t happen in school to be ridiculous; it’s the easiest place to find it. And the most important to deal with it.

        1. Well, the post did mention students “being forced” to “give up their interests” to study things they weren’t interested in, rather than than taking the broader view that their real interests later in life may not be Pokemon or whatever they are currently into but something that actually requires a knowledge of seemingly boring things. 

          1. “their real interests later in life may not be Pokemon”

            Why do I get the feeling when you say “students” you really have some one specific in mind?

      3. “But they are needed to get the foundation for more interesting things later on.” 
        So, you believe it is optimal to learn everything about everything before specializing? I call BS. If, at 15 you find you’re interested in something that requires math, you can learn it in a year, focusing only on math. Same with biology. Or chemistry.

        And before you tell me about the mythical “well-rounded individual*,” let me ask you, who exactly is well-rounded? 

        Is your dentist well-rounded? Does she use calculus? Are her astronomy skills the reason you see her?

        What about your car mechanic? Do you go to them because they know organic chemistry? What about your broker? You choose his service because he paints great landscapes?

        As for the “losers,” it is insanely ridiculous how we take children, place them in a prison-like structure**, and call the ones who endure it “normal.” So anyone who is not OK with being an inmate, is a loser. Great! 

        If you know about anything about learning (doing beats seeing beats talking beats listening), you’ll see that schools impede it.

        *Yes, Salman Khan is extremely well-rounded. He is an educator, interested in multiple subjects, and not a 10-year old. His creation  (http://khanacademy.org) is great, because allows for the elimination of (the excuse for) child-prisons. 

        **I am speaking of regular schools, not democratic or Montessori schools.

        1. I think some people will gravitate toward a more broad base. I know I tend to “scan” before I “dive” for instance. But at the same time, I think the only way to get people to broaden is to encourage them. Encouragement isn’t the same thing as force though,  outside of Orwellian usage.

        2. What would a democratic/Montessori school do if a five year old kid wanted to go home and play with his trucks so?

          1.  A great Montessori teacher would bring in some truck toys and build lessons around them.  Physics, leverage, machines, energy, social studies, city planning… I could go on for hours with ideas to teach around toy trucks.
            It is natural for children to ‘obsess’ around a subject. Why fight their natures?  If you use their natural tendency to ‘go deep’ on one topic the child and teacher will be allies in learning.

          2. @boingboing-a867f6232f98e46bcd33d0bb9e5a5d58:disqus 
            That may well be what a great Montessori teacher would do but Im not sure you understand the question. What would a democratic/Montessori teacher do if a five year old child wanted to go home and play with his truck? Let me paint you a picture so there can be no misunderstanding:

            A 5 year old child gets up in a freedom loving classroom and walks towards the door. The teacher, rather than just let the kid walk out the door like a free man, asks him a question:
            – Whatcha doing there, little buddy?
            – Im going home, teach. Schools for suckers. Im gonna spend the afternoon playing with my trucks.
            – There are many trucks to play with here, little guy. And you live on the other side of town. It would be great if you could stay with us.
            – Nah, dont think so, teach. I wanna go home so Im going home. What are you gonna do about it?

            I think the answer is obvious. The relationship between a parent and child is the clearest example of justifiable authority. This authority is not limitless but it certainly includes the child having to get schooled where the parent decides and if a parent drops their kid off to school the school has a responsibility to ensure the kid is still there at the end of the day.

            It is reasonable to question whether schools are focussed more on obediance than on education and to propose improvements. But forcing a child to stay in school is obviously not a denial of civil liberties as @thecleaninglady:disqus  seems to think. The idea is ridiculous.

          3.  You got a completely reasonable answer from simonbarsinister and in response pose a completely unreasonable scenario.  Nice.

          4. @wysinwyg:disqus
            Do you think it is unreasonable that someone could have legitimate authority over a child or do you think it is unreasonable that this authority would occasionally need to be excercised?

            I find it hard to see how the question could have been reasonably interpreted in any other way. Feel free to pretend otherwise of course.

          5. You need to learn a new song.  “Poisoning the Well” is getting old.  Kids are naturally interested in learning about the world around them and it’s not their fault that our society has decided education needs to be as stifling and boring as possible.

            I believe kids need discipline but you seem to be conflating discipline with our society’s decision to condition children to think that learning about the world is stupid and boring.  Two different issues.

            Edit: By “discipline” I do not mean any sort of corporal punishment.

          6. If you can show me how I am poisoning the well that would be great.

            Kids are certainly naturally curious about the world. I notice that that is not an answer to the question I unambiguously repeated with each post in this thread.

            you seem to be conflating discipline with our society’s decision to condition children to think that learning about the world is stupid and boring.

            I am genuinely curious as to why you believe this is what I think.

          7.  Poisoning the well: “I find it hard to see how the question could have been reasonably
            interpreted in any other way. Feel free to pretend otherwise of course.”
            The question simonbarsinister responded to was specifically about education.  Your new question was also about education.  Hmm, where could I possibly have gotten the idea you were talking about education?

            Prediction: If you respond it will be an indignant protest that just because your question was about education doesn’t mean you’re asking a question about something to do with education.  Or that a “are you still beating your wife” type response doesn’t constitute poisoning the well.

          8. My question was limited to the possibility of legitimate authority over a child. If you reread the thread and look again at each of my posts I do not think it is possible to find ambiguity there.

            Here is my first question:

            What would a democratic/Montessori school do if a five year old kid wanted to go home and play with his trucks so?

            Here is a question Brainspore earlier asked of the same commenter (my bolding):

            That’s a complex question; rights go hand in hand with responsibilities and most societies recognize that it is often necessary to curtail both in the case of children. If a five-year-old would rather stay home and play trucks than learn to read is it a violation of his civil rights for his parents to send him to kindergarten anyway?

            I found the response to this rhetorical question to be very surprising so I repeated it.

            Since you say that my first and second questions are different I assume you missed Brainspores original comment. With the context of that comment, I honestly dont see how my question could be interpreted any other way.

            Assuming this is the basis of the misunderstanding then I apologise for implying your error was deliberate rather than accidental.

        3. In reality, most people don’t actually discover what they want to be until after high school. But you don’t have to specialize then. Yes,I turned out to be a biologist. But I took additional courses in history, math, and physics in high school in addition to biology. I realized that I didn’t necessarily know what I’d end up as.

        4. I find the problem lies in the idea that education is about encouraging children to achieve their full potential – a fascistic means of creating feelings of inadequacy. What children need is to be encouraged to find their true potential – something altogether different.

        5. I call BS. If, at 15 you find you’re interested in something that requires math, you can learn it in a year, focusing only on math.

          A 15-year-old who never had any training whatsoever in math will always be at a serious disadvantage against a 15-year-old who started learning basic arithmetic ten years earlier. You can’t learn algebra without a foundation in addition and multiplication.

          There are many valid and differing approaches to education. “Don’t make any child do or learn anything they don’t want to, ever” is not one of them.

      4. The current school system used around most of the world grew out of the industrial revolution, where the need for worker ants is more important than enlightened citizens of the old Greek sense. Note that over the year, practical learning have more or less dropped like a rock. This means that those that are better with their hands than with their heads (and yes, they do exist) drop out or feel they are being singled out in some way or other. And the line between trouble for troubles sake, and trouble for a higher cause is hard to make out as a bystander unwilling to meet the troublemaker in a actual dialog.

      5. I know the kind of kid you’re talking about and I know (was/am) the kind of kid thecleaninglady is talking about.  Two entirely different groups.

        Here is the problem: “Things like grade school (and even high school) math are frankly dull as dishwater.”  It’s really not, though — or at least, it doesn’t have to be.  The way education has been institutionalized it teaches children that learning things is boring (and you’ve implicitly bought into that).  When you teach math as a bunch of disorganized algorithms for getting the right answer you completely rob your students of a deep and useful understanding of what mathematics is and instead convince them that “math is boring” or that they’re just naturally “bad at math” (not true, they just think it’s boring) and make further education in the subject completely impossible.  I learned mathematics in spite of my teachers, not from them. 

        The amount of nationalistic propaganda in the history curricula was also very worrying to me as a teenager.

        1.  As did I. I think if middle school math classes assigned students to read, say, “The Art of the Infinite,” or “A Mathematician Reads the Newspaper,” it would get many more kids interested in math.

          Unfortunately, my experience (on long island, which has much better than average schools) was that most math teachers didn’t have enough understanding of their fields to teach in an interesting way. They were taught, “If the problem looks like this, do that,” and they knew just enough to teach that same way.

    2. By contrast a good University teaches quite the opposite. Everything must be challenged and nothing must be taken on authority alone. This is particularly true for the sciences but also holds for any proper academic subject even classics.

      This is why Universities were always so dangerous and feared by the authorities be they old Soviet Russia, Maoist China or equally the USA, UK, and the rest of Europe. Intellectuals were feared by the ruling elites because they don’t accept things as they are and ask awkward questions. Much effort has been spent trying to marginalise such people: in the USSR they were dismissed as counter-revolutionaries; and in the USA the Right loves to blame left-wing academics for “indoctrinating” their students (i.e., getting them to question the status quo). Sadly this trait is back on the rise again.

      1. Also, more often than with schools, young adults choose to go to university. 

        And, to address the comment about the imaginary 5-y/o who chooses to stay home and play with trucks, turns out that children learn to read out of curiosity before the age of 10, without extrinsic requests or rewards. Check out unschooling. 

        The same curiosity that has driven man to invent writing, drives human children to discover it.

        1. I do think we have to have safeguards to help those people whose natural curiosity may be blocked by the… nature of their situations at present… though.

        1. Yes. I have serious doubts about the function of the university system. The education system now seems to be a service industry in thrall to the corporations and big business. It has come a long way from Mediaeval Bologna and Paris which truly challenged authority.

          1. And not so far from when the universities served as final finishing schools for aristocratic elite(Bush/Kerry: Yale, Obama: Harvard).

    1. If you’re rich, you’re eccentric.
      If you’re middle-class, you’re neurotic.
      If you’re poor, you’re psychotic.

      That’s a Communist aphorism, probably from Freud’s era.

    2.   I saw a graph not to long ago showing how many people we had in mental hospitals vs prisons, prior to 1970, many in mental hospitals, few in prisons, in the 1970s, the hospitals empty out, and then the prison population jumps, essentially reversing the pre 1970 stats, many people in prison, and few in hospitals, but the totals didn’t seem to change much.

      1. As the saying goes, there is likely as many sociopaths on Wall Street as there is in prison. And yes, i suspect there is also a high number of aspies and ADHDs to be found in prisons.

  4. Heh, my wife (who is a marital and family therapist) always joked that “oppositional defiant disorder” means “this person is a jerk, but we can’t put that down as a diagnosis”.

    1. In the business world, it’s ‘inappropriate behavior’, which means “I don’t like what you’re doing, so I’m going to make it sound vaguely like you’re a pedophile or something.”

      1.  They called me Combative, Aggressive and Anti Social for a reason to deny a raise to me.  I told them to go fuck themselves.

        1. Various bosses have described me as combative and aggressive, but they’ve usually regarded it as a useful skill set.

    2. Funny, it says nothing about what the opposition is TO. So, if you are a child, an authority has the power to tell you that there’s something wrong with you if you don’t do as told. 

      Human beings have many basic needs, one of which autonomy.

      Or, as it is probably called, “autonomy disorder.”

    3.  I do know a very young child with that diagnosis and…well let’s just say the kid’s social skills are so bad as to amount to a pathology.  Yeah, in some sense the kid’s just a jerk but to such an extreme that without some kind of intervention the kid’s life is going to be miserable. 

      I don’t know if a psychiatric Dx is really the answer though.

  5. Am I the only one having a hard time linking ADHD (which I *very* much have) and anxiety disorders to authoritarianism? Just because someone is hyper, can’t focus, and gets stressed in particular scenarios doesn’t necessarily say anything about their views on authority.

    1. I’m having a hard time making that link too, and I’m a clinical psychologist with a PhD, albeit not an American one (maybe that’s the difference?).

      1. When you argue based on the authority of your degree and not weight of evidence, you only serve to confirm Levine’s observations.

        1.  Um, my comment was meant to share some bemusement with the previous commenter. Since I’m from this profession I noted that as it seemed relevant. I’m not sure I was “arguing” anything. 

          1. Then why else would it be significant that you failed to see a connection if you’re not trying to imply that a connection isn’t there?

          2. I’m not sure I was “arguing” anything.

            Apparently, it’s surprisingly easy to be taking a strong stand in this thread whether you intend it or not. Who would have thought this was a hot button issue?

            Tallyho, smash the state.

            And homeschool your kids.

        2. I think it makes sense if you read the comment as saying “as a person who works in this field I would not see antiauthoritarian tendencies as a reason to diagnose ADHD” though.

          Edited because “not” is an important word.

          1.  Thanks blueelm. Honestly I can’t comprehend what hymenopterid is getting at.  Last time I looked antiauthoritarian tendencies weren’t a diagnostic criterion for diagnosing ADHD and shouldn’t thus be used as part of diagnosis. Do kids get labeled as ADHD if they are “difficult”? Sure, I bet that happens, and that sucks.

          2. Do kids get labeled as ADHD if they are “difficult”? Sure, I bet that happens, and that sucks.

            Then you DO comprehend what hymenopterid was getting at.  Maybe you’re just not acknowledging how widespread it is?

      2. Yeah, I’m guessing the connection is that when the subjects are small children, they get the ADHD diagnosis.  Then, around puberty, they add on the ODD diagnosis.  I’m an elementary school teacher, albeit not in the American school system, yet I can imagine how a 5 year old who won’t comply and simply keeps playing with other things instead of singing the song the teacher has planned is ‘unable’ to concentrate.  Teachers do threaten small kids, but the kids aren’t always forced to verbally answer, due to their age.  Older children must answer threats with words, which may be something to the tune of ‘fuck you then’, which would make it ‘willingly defiant’ instead of ‘pathetically scatterbrained’. 

        PS- your comment didn’t read badly to me, quite the contrary.  

    2. I think it has less to do with there being no ADHD than with people who are “problematic” being labeled as ADHD. I know I went through this as a kid, being labeled ADD, amazingly enough by some really stupid and inept teachers who wanted an excuse to get me on the ED list so I could be properly shunned. 

      That doesn’t mean there aren’t people with a disorder (I actually, FWIW, even do have a very real problem with anxiety) but that labeling behavior that is inconvenient to authority as a disorder is a nice way to use the social stigma of mental illness to shut people down. To be honest, both parts of that are pretty wrong.

    3. ADHD seems like the opposite of the “calm-submissive” receptive mental state that dominant leaders prefer in the people around them.  There’s a link.  A dominant would prefer that your mind is entrained to his/hers, while someone with ADHD is marching to his/her own interior bandleader. Someone with ADHD isn’t with the program.

    4. I think it’s an example of anti-psych rhetoric going over the top, myself. I’ve got anxiety disorders, and to be honest, at least some of my anxiety during my life has been because I wanted validation from people with some measure of power over me.

  6. Ha ha, boingboing is like a support group for people with this “disease”.
    “Hi, my name is MB44 and I am an anti-authoritarian.”

    1.  Yep, pretty sure everyone here, including the editors, would be labeled anti-authoritarian by the people this article describes – and we like it that way.

      Yet we’re not (necessarily) anarchists – our anti-authoritarianism is more refined. And in another way, it’s kind of ingrained in the maker psyche – rather than taking what “they” offer, there’s an innate desire to make something better (or just to do it yourself, even if you can’t do better).

      The greatest people in history, and today, are those who defy authority in one way or another. We all even learn about this in grade school, the American revolution being the obvious example – so why anti-authoritarianism gets such a bad rap is rather puzzling.

      1. I think the best term for most of us is one I’m going to invent right here on the spot*: authority-skeptical. The REAL meaning of “question authority”. We’re not so much knee-jerk against authorities, but we expect authority to be earned and are all to aware of how a few well-placed fnords can be used to grant undeserved authority.

        *Oh, I’m sure I’m not the first, but I can’t be arsed to find previous usage at the moment.

      2. I’m unsure what anti-authoritarian means.  I’m against authoritarians, but I’m not sure I’m completely against authority.


  7. keep in mind that the established standard for whether one is nuts is at root a work of “statistics”, the almighty DSM; and -everyone- knows you gotta be nuts to fight city-hall.

  8. It took decades for me to meet a psychiatrist who wasn’t an utter jackwad control freak. the article here explains why that was the case. Yet another reason to stick with the doctor I have, and wish more people like him made it through.

  9. This is bullshit. The Science of Psychiatry is absolutely, in each and every aspects of its theories and practices, devoid of any kind of authoritarianism or obscurantism, or anything that could remotely be the object of any kind of criticism. If you disagree, please feel free to say so. We have treatments for that.

  10. So this explains why all those shrinks said that anti-authoritarian Goldwater was nuts when he was running against authoritarian LBJ, right?

    In any case, I don’t think that psychiatrists and psychologists are being any different from normal humans here.  We also have a tendency to consider people different from us as crazy.  Indeed, people are particularly anti-authoritarian in mindset tend to consider relative conformists as crazy.

    Perhaps we should expect the people with the fancy learning and degrees to be better than other humans, but they’re not, it seems.

    1.  Let’s see…Johnson presided over the greatest expansion of civil rights since Reconstruction. Goldwater opposed almost all of what Johnson did in that field. That makes Goldwater an anti-authoritarian? That makes no sense at all, despite the Vietnam war.

    1.  I made this point in my undergraduate thesis (briefly, about the disconnect between the experience of psych patients and professionals). The professionals get all riled up about people being anti-authoritarian and defiant, labeling it as ODD or persecution paranoia or whatever. But they aren’t nearly so ready to diagnose those who are overly compliant (dependent personality disorder would fit into this) or overly gullible to the lies of the professionals (not to be conspiracy-theorist about it, but I have been told a lot of lies).

    2. What an interesting point.  From reading the comment chain, I’ll paraphrase what I learned:  that it isn’t really a disorder unless it is causing a problem in someone’s life.  And something I noticed when I moved out of the South, is that here in Colorado there are a disproportionate number of people who suffer from this un-named disorder.  They suffer vocationally because they focus so heavily on some company rule that they piss off their customers.   The have trouble making friends with their neighbors because, for instance, they are more focused on some HOA deed restriction nit, than getting to know someone.  They go through life annoyed and confused because they don’t understand the distinction between sometimes conflicting rules and cultural mores.  So while I am jokingly characterizing this as a disorder, I really think this is just a reflection of how people are raised and what kind of personality they have.

  11. “It is no measure of health to be well adjusted to a profoundly sick society.” — Jiddu Krishnamurti

    1.  ironically thought they’d get their jeans shrunk into skinny jeans? /half arse hipster joke

  12. Favorite line: “Having steered the higher-education terrain for a decade of my life, I know that degrees and credentials are primarily badges of compliance.”Oh, yeah.  I was essentially drummed out of my research group because I had the audacity to not be in constant (only periodic) fear of our ‘living legend’ PI.

    Life is better on the outside, kids.  Run, be free! 

  13. Didn’t think I’d see anti-psychiatry conspiracy stuff here. I get enough of that from my friends. (Disclaimer: I work in mental health).

    1.  I work in mental health too, and I’m surprised about people’s responses to my comments above. Apparently I’m part of the conspiracy. As part of my work as a psychologist I work one-on-one with people who come to see me because they know they have problems in living and want some help. I don’t generally give them a diagnosis, and diagnoses don’t really tell me anything about how I would work with that person. I work that out through hours of meeting with them, learning about them, and finding interventions that best fit their needs.  What is the problem with that?

      1. In the US a diagnosis is the only way you can get your insurance to pay. I don’t know how it is in other countries, or what country you are in, but it is significant in US. When I saw a therapist we actually had a discussion about what diagnosis would least impact my future ability to be insured. Yes, it’s that bad here.

        1.  I’m in New Zealand and we don’t have a requirement for a diagnosis for treatment, mostly because we have a publicly funded health system. As a clinician I decide whether a person’s problem could benefit from treatment, and for how long this treatment lasts (within reason!).

          1. I’m from another country with publicly funded health care, but trust me… a diagnosis helps, without one “they” don’t seem to know what to do and it is incredibly hard to get any treatment… other than some generic meetings with people who give some generic advice that has absolutely nothing to do with your situation. At this point any diagnosis would do… really. (I do have a pretty good idea of what the issues are… it’s not rocket science… but… I have run out of ideas and explanations for why this needs to be this hard…)

            //CH… a mom trying to find help for her daughter, but stuck in the system that seems to lead to absolutely nowhere and _very_ worn out and tired from it all

        2.  I have had therapists tell me that they were writing down a diagnosis on my insurance that indicated I was more severely ill than I was because they feared the insurance would reject the treatment otherwise. I know that happened a lot around me, too, but I don’t know how widespread it is. I don’t know how much that gets into one’s actual medical record (not that there is any one centralized version of my record anywhere anyway). I understand why they do this and appreciate it, but I do wish it weren’t necessary and that the insurance would take the doctors at their word.

  14. If you want to discover our society’s norms look in the DSM. Until the 1960s homosexuality was considered a mental illness.

    Bukowski had a poem about psychologists/therapists/psychiatrists being tools of enforcing normality but I’m unable to locate it.

    1. And the upcoming DSM-5 will still classify transsexualism as a mental illness. Iirc, I think the American Medical Association and Psychological Association have both denounced the American Psychiatric Association’s position here.

    2. And now it’s Gender Identity Disorder. However, it’s not the name that matters it’s what is done about it and how the person is regarded. That is to say, perhaps when one says “disorder” you have to consider that a part of what makes a disorder a disorder is the inability to function in society, which usually causes the person distress. This goes two ways. It doesn’t only mean that society is right, but so long as society is as it is the person will feel this. So what matters is what options the person has. 

      Do we further stigmatize this person, lock them up, castrate them, drug them until they don’t even care anymore? Obviously these are horrible things, but they are I think better seen as “wrong” treatments. Because the reality is that society is plastic, and there are often better ways to address the stress of “disorders” that are mainly disorders because they put you at odds with society.

      Personally, I’d like to see the stigma of mental illness itself removed. Would  that be too “crazy” though?

  15. Wow.
    Just Wow.
    I would think pessimists that see shrinks take more happy pills, even though some say that they tend to have a more objective view of reality, according to Dr. Martin Seligman. (book: Learned Optimism 1990)

    So if you don’t trust authority figures (because they abuse their powers so easily, and absolute power corrupts absolutely), and are pessimistic precisely BECAUSE of growing authoritarianism in America, that is apparently a wrong-headed view of the world? :-)

    I guess that the flip side is that Authoritarians supposedly see reality “more correctly”,  I think Professor Bob Altemeyer would disagree.

    TheAuthoritarians.com (his website)

    (A song about Authority)

    1. I read Altemeyer’s book a while ago and I thought it was pretty interesting. I score very low on his RWA index, placing me firmly in the anti-Authoritarian camp…so much so that I see all the pompous, self-righteous comments in this thread and it makes me just want to argue with them. Guess I’m screwed.

      Seriously, if one can see all of the overblown rhetoric and people trying to set themselves up as authority — on psychiatry, education, whatever –and not have one’s fur bristle, I don’t the anti-Authoritarian flag can be non-ironically flown!

  16. Antipsychiatry is sort of interesting because there are shards of truth in the little pieces. But they only explain a small part of the variance of the larger problem of human suffering and the fallibility of such a complex machine as the human brain. I only wish reality were so simple, that we could reverse suicides and real life catastrophes by blaming mental health workers tagged here with the stigmatizing term “shrink”. This definitely does not compute. There may be another issue here of improving the overall quality of mental health care by improving the science. Unfortunately, Dr. Levine is not in fact a scientist. His talents here seem to be in politics. His politics I admit are cool. The idea that depression is best addressed on the societal level: more power to him.

    1.  I struggle to find a place I fit in for inciting change in mental health care as a patient. Anti-psychiatry is too … violent? They aren’t trying to find common ground, rather increasing the us vs. them dynamic. I want to find common ground, but perhaps there is no one doing that because diplomacy has been tried and failed, so now we must go to war.

      1.  The lapses in useful science to guide mental health works causes havoc all over the place. So… as an example, I agree that Oppositional Defiant Disorder is a ridiculous diagnosis. Where I am sort of bothered by the article is that there is no acknowledgement that many many neuroscientists, psychiatrists, psychologists etc. also feel this way. I think a better example to bring up is  personality disorder diagnosis and discharges from the military. That’s really out of control.  Going to war and diplomacy are all valid options; it certainly would be authoritarian to preclude that. Another option is advocacy and continuing to push the scientific frontier back. Each small movement improves the lives of countless people. When a plane crashes, people don’t blame Engineering on the disaster or hold picket signs: they find out what caused the crash and try to prevent it in the future. Maybe professional organizations need to incorporate advocacy group input more seriously to prevent the equivalent of crashes: true examples where the field has failed somebody.

  17. This is the very definition of anecdotal evidence. I’m supposed to rely on his authority instead? If this is the hypothesis, collect some data.

    1.  I totally agree. This is an opinion piece that is being interpreted by some as if he’s presenting the results of a scientific study.

  18. I was having myself evaluated, concerned that I might be somewhere on the autism spectrum. One of the questions asked was “why do we pay taxes?” My answer was along the lines that if you don’t, men with guns chase you. The shrink seemed very confused, indicating that I hadn’t given the expected answer. I declined the opportunity to give thoreau’s thoughts on war taxes. Over-all, she suspected that I might be shizotypic, which for all I know might be right.

    1. Well, it’s up to how you interpret “we” and “why.”

      I imagine the question is there to test whether you treat it as “Why do taxes exist?” vs. “Why should you personally comply with the demand for taxes?” and I can’t see why the shrink would be surprised you went with option B.

      Maybe she was just expecting, “So you’re not arrested for tax evasion,” and was surprised at the further reduction to men with guns.

      Or you’ve over-estimated your ability to tell when she was confused.

  19. there’s a pretty important difference between anti-authoritarianism that is pathological and problematic across the domains of a person’s life (occupational, interpersonal, intrapersonal) and the romantic anti-authoritarianism that is really en vogue right now (how boingboing readers fancy themselves).  the author of the article doesn’t seem to differentiate and ends up making a rather flaccid, er, facile argument.  

    1.  Pathological anti-authoritarianism versus romantic anti-authoritarianism. I wonder if there might be some other version?

      I hereby diagnose the poster with crackpot realism.

  20. Levine is dead right when he says that nobody worships authority like a shrink worships authority.  Perhaps one  reason for this hyper-compliance is the lack of objective medical science to back up psychiatric diagnoses.  In other medical specialties physicians use blood tests, CAT scans, and biopsies to provide a solid, factual basis for diagnosis and treatment.  Psychiatrists, on the other hand, ask questions and give opinions.  While other physicians are learning the significance of quantitative biological indicators, psychiatrists are learning to pass judgement on a person’s behaviour and beliefs.  Unlike other medical disciplines, psychiatric training is all about memorizing  officially approved opinions of other people.  Unquestioning deference to authority is absolutely critical to this process.  Dispute the opinions of your elders, no matter how dubious those opinions may be, and you are simply unfit to be a shrink.  

    Until psychiatry becomes a legitimate medical science it will continue to be practised by people who “are not only extraordinarily compliant with authorities but also unaware of the magnitude of their obedience.”  And patients who are less subservient than their shrinks will continue to be told they are “sick”, and to be drugged into a lifetime of compliance.

    Psychiatry:  Suck up.  Diagnose.  Profit.

    1. I’m finding it really mind-boggling in this thread how many people have this impression that psychiatrists decree what needs fixing in their patients, regardless of the patient’s feelings on the matter. I’ve never heard of such a thing — in all my experiences with psychiatry (I’ve had a few personally, as have some of my friends), I’ve never heard of a “shrink” who would dogmatically insist that something’s wrong with their patient when the patient disagrees, and feels no distress caused by it. If one did, the patient would promptly go elsewhere.

      Maybe it’s different on the other side of the Atlantic — I’m in the UK here.

      1. Forgive me, but that would imply that no-one is ever sectioned against his or her will in the UK.  Which of course is not the case.  

        You may be more generally right in that it is not the norm.  But it does happen.

      2. Q:  If you have the misfortune to be diagnosed with oppositional defiant disorder,  but you disagree with your shrink and would like the diagnosis revised, what is the single worst action you can take?

        A: “disagree and go elsewhere.”   To dispute the diagnosis is to confirm the diagnosis.  There is no escape.

        Or say ODD is not on the table, but in the psychiatrist’s opinion you have disorder X.  You disagree, so you say you’re fine and the diagnosis is incorrect.   If you say it more than once and refuse to back down, guess what?  Now you have two psychiatric disorders: X plus ODD!Going to another psychiatrist doesn’t help at all: your medical record stays with you, and good luck finding a new shrink who will happily contradict the considered professional opinion of her esteemed colleague.   An unwillingness to do so is in part what Levine’s article is all about.  Those dubious diagnostic labels are attached to you with permanent cement.

        Of course all this assumes you have not been committed (I’ve heard the term “sectioned” in the U.K.)  Once that happens, it’s really game over.  Obviously you cannot go elsewhere, and should you have the temerity to gainsay your shrinks, well… may the gods be with you, brother.  At this sorry stage you are no more than a  money siphon made of meat.  You have been reduced to a conduit through which psychiatrists and pharma will suck treasure from the state, day after day after day, for as long as you can endure your chemical lobotomy.  The longer you exist, the richer they get.  

        And yet… there are decent people in this world,– people who think for themselves, who respect the feelings of others, and who have the guts to challenge received wisdom when they know it’s wrong.  Some of these decent people may even be psychiatrists.  Perhaps you have encountered one.  If so, treasure this person dearly.

        You have discovered a human unicorn.

        1. And thus the origin of the joke that mental health means agreeing with your doctor.

          I am glad to have found a unicorn.

      3.  I don’t know how many commenters have had personal experience in this, but I have personally had psychiatrists decree what needs fixing in me. There were things I knew needed fixing, things I didn’t want to fix but generally did know needed fixing, and things that absolutely did not need fixing. Psychiatrists and most mental health care professionals insisted on trying to fix many things in the third category, ignored some in the first, and tried to force me into some of the second category before establishing any sort of rapport with me (which never would have happened anyway because I didn’t trust them).

        A patient doesn’t always have the option to leave. People in distress do not always have the presence of mind to go elsewhere and sometimes do not know that there are other options available to them.

        I’m in the US, but I have plenty of friends in the UK who have faced similar problems. Perhaps it is that among people who are more severely ill, the professionals are less willing to recognize that some things do not need fixing, whereas with milder cases garner less of a sense of total global illness. I, too, am perplexed at how extremely different these two sets of experiences of mental health care are, and how extremely different are the experiences of the professionals themselves.

  21. I once represented someone I’ll call Bob.  I will modify some of the details of his story to preserve confidentiality, but the gist of the story is true. 

    Bob had spent a difficult life in and out of state mental hospitals.  After being charged with a rather violent crime, he was evaluated for sanity at a federal facility. 

    One of Bob’s hang-ups was that he was convinced that he had worms living under his skin.  Occasionally, the worms would start crawling around, which was quite disturbing to Bob.  Tellingly, whenever he got into serious trouble, it corresponded with the worms crawling around under his skin.  He was constantly demanding that the worms be removed, and claimed that the government had reneged on a promise made years earlier to remove the worms.

    I was discussing his situation with the government psychiatrist, who was trying to explain to me that there was nothing wrong with Bob, in spite of the multiple involuntary commitments, the lengthy history of anti-psychotic medication, reports by multiple mental health practitioners regarding psychotic behavior, etc.  I asked him if Bob had described the worms under his skin, and the psychiatrist rather condescendingly informed me that out of an abundance of caution, they had performed a thorough medical exam, including a screening for infectious diseases, and had found no evidence of an infestation of worms or any other parasite under Bob’s skin. 

    I’ve never really trusted psychiatrists since.

  22. “Why shrinks diagnose anti-authoritarians with mental illness”?? –get your copy of Wild Palms by Bruce Wagner, watch it and you’ll find the answer therein…

  23.  I am a doctoral student in clinical psychology about to go off on my internship. I have been working as a student therapist for about 5 years now.  There is such a difference between the older, psychodynamic therapies and the newer empirically-supported cognitive behavioral therapies that they could be seen at times as being almost two different professions. The newer behavioral therapies are much less about labeling and diagnosing a patient and much more about helping people live their lives more fully.

    I really wish there was a stronger push to advertise to the public what is possible with CBT and the even newer mindfulness-based therapies. Like the other sciences, psychology has advanced dramatically in the last few decades. Unlike the other sciences, the average tech and science oriented blog reader has almost never been exposed to the real gains in this field. A damn shame.

    1.  As a patient to a professional, I plead with you to be careful. CBT is very effective on a population level. It does very well in the studies. But it does not rate at 100% positive response. Don’t forget that. You will still meet people for whom CBT is not helpful. Like me. Please don’t beat those patients over the head with CBT, please don’t call them noncompliant just because CBT doesn’t work for them. I have seen CBT held up as a golden bullet that cures all ills. Please remember that it isn’t. Please also remember that some of those studies on which evidence-based treatment are based were done very poorly. I have been jaw-droppingly astounded at the poor logic behind some, including one by the highly regarded Mr. Aaron Beck.

      1.  This is a problem. I don’t understand why your professionals did not acknowledge to you that CBT has not been demonstrated to be particularly helpful for anorexia.  The first 3 hits on pubmed bring up some pivotal studies in this regard.  It has been a surprising finding and not at all “suppressed”. It doesn’t mean its unethical to try, but it would be unethical to claim that it “should” work or is the best treatment.

    2. I also work for a CBT organisation and have been trained in the application of Solution-Focused Brief Therapy myself (which is something completely different), and many of these responses sadden me.

      I wonder what all the “psychiatry is evil” people suppose we actually do? Do any of them have actual experience of coping with a close relative who suffers from a severe condition like bipolar affective disorder or paranoid schizophrenia. My grandma isn’t going to get any better from rainbows and crystals, I’m afraid. And I’m pretty sure she isn’t ill because an evil doctor gave her a label. It’s not imaginary. It’s quite real.

      I have experience from both sides of the table as someone who has suffered recurring bouts of low mood over the years, and as someone who has personally helped people cope with anxiety, phobias, OCD and the like. The idea that people go into mental health work because they are part of some conspiracy to trap everybody in “the system” or whatever, I find both bizarre and offensive. It’s like something out of a David Icke storybook. (I had someone say more or less this, the other day).

      It’s far from perfect, and I have strong feelings about the general over-prescription and efficacy of anti-depressants, when talking therapies are on balance more effective (but more expensive), but I’m worried by the apparent view shown in this thread that we are somehow out to cause harm.

      I’m sure this has a lot to do with the general stigma attached to the whole area of mental health in general.

      1. If you can’t acknowledge legitimate complaints about your profession then you shouldn’t be the least bit surprised when people don’t trust your profession.  This “I don’t understand what everyone’s so upset about!” stuff just makes me even more concerned about letting you guys be the Priesthood of Normal.

      2.  I, for one, do not assume that people go into this profession for nefarious reasons. However, as someone who has been treated so poorly as to have been made sicker by the majority of mental health care I experienced, it is puzzling how these seemingly well meaning people do so much harm. Of course, not every professional does so much harm, not every patient is harmed, and patients will not experience the same professionals as harmful. Something happens between “wanting to help patients” and “harming patients and refusing to have a rational discussion with them to clear the air”. I don’t know what that thing is. I very much want to know.

      3. It’s not imaginary. It’s quite real.

        –  Police routinely arrest people who are a threat to the public welfare because there are laws to stop such crimes and the police are there to protect the public.
        –  Police routinely arrest people who are harming nobody, either because the laws are horribly wrong or because they feel that they have the right to arrest anyone who gets on their nerves.

        Both statements are true.

        1.  As a civil liberties activist directly involved in ultimately bringing down the UK’s “ID card” scheme before the last general election, I should surely be ashamed of myself.

          I will go to work on Monday and tell everybody that they’re wrong and that we cause far more harm than good, and we must stop counselling people. Will that atone for my sins against humanity?

          Wysiwyg, please be quite specific about the legitimate complaints. I’m aware I’m apparently setting myself up here as the defender of some kind of evil empire.

          – @Antinous_Moderator:disqus
          Don’t even get me started on police abuses. This has nothing to do with what I said, and I have no desire to get into an arbitrary and irrelevant conflict with someone I respect.

          1. I’m just saying that there can be (and often are) multiple things going on in any profession, from helping people to abusing them.

  24. Obviously no one who commented actually bothered to read the entire article.  Hardly surprising, but still sad. 

    And so the empty trollwars rage.

  25. This stuff is real. Anecdote time:

    I have spent 9 years in mental health care as a patient. I have spent a lot of time outpatient and about a year total inpatient. I wasn’t initially diagnosed because I was anti-authoritarian, but my anti-authoritarianism was frequently interpreted as a symptom of my illness, essentially pathologizing it. My intelligence and the fact that many of the professionals’  favorite treatments did not work for me was also pathologized.

    This meant I was told that I was sicker than I really was. I got very confused because, knowing that my perception of reality was off, I trusted what the professionals told me about myself was true. I thought I was the inappropriate, manipulative bitch they told me I was, but I was really just a very depressed girl who was very desperate for help and who asked for that help, over and over because nothing was helping.

    When CBT and affirmations and other therapies didn’t work for me, I was accused of being noncompliant with treatment. I was kept in the hospital longer and, instead of trying different treatment methods, they just yelled louder (metaphorically) at me to “work  the program”. (CBT may be a very effective treatment over populations, but if it has a 90% positive response rate, that still means 10% aren’t responding positively. When this, blunt force CBT, happens, some of those 10% respond negatively and are made sicker by the CBT treatment.)

    When the professionals gave me rules and treatments that contradicted each other, I was genuinely confused and asked for clarification. I was accused of “intellectualizing” things as a way to avoid treatment when I was really just trying to get the treatment out of what I was being told.

    After so much of this and after realizing that it wasn’t that I was so sick or noncompliant or intellectualizing things, I was very distrustful and anti-authoritarian toward mental health care professionals. These professionals were not a legitimate authority. I had tried to obey the authority the way they wanted, but they interpreted those genuine attempts as disobedience. If even genuine attempts to obey are interpreted as disobedience, it doesn’t matter if you are anti-authoritarian or not. Eventually, as an anorexic 20-something with otherwise excessively low blood pressure, I had, in the hospital, frighteningly high blood pressure because I was so angry all the time about all of this.

    There is a relatively good ending: After 11 years of illness and 7 years of mental heath care that made me sicker than I started out, I finally found a psychologist who was a reasonable person and who directed me to a psychiatrist who was also a reasonable person. They are willing to work with my 100% refusal to enter a psych ward again. And I am almost sane now.

  26. This article and discussion thread make me think about a couple of things. First, there’s a big difference between “oppositional defiant disorder” and being anti-authoritarian. Someone who understands their situation and feels they have reason to question another’s authority isn’t disordered at all. It only becomes a disorder if the protestor’s quality of life suffers. When suffering becomes the norm, it’s time to think about ways to alleviate it.

    Having a shitty boss is a good example of suffering needing alleviation. It doesn’t necessarily mean the protestor is disordered, though such a situation can create disorders.

    Meanwhile, a person with oppositional defiant disorder is the sort of person who will literally argue anything with anybody, even if it means flip-flopping their position in order to maintain a contrary stance. They do this because they feel that they need to never reach consensus with anybody. This not only creates problems in the workplace, but it can isolate a person socially, because nobody can find any common ground with such people. They can’t even agree on a place to eat lunch, never mind more weighty issues.

    The problem Levine addresses is basically the divide between the old school and new school of therapy models. The old way made it very easy to pigeon-hole a client without really having to think about it. These are the ones calling an anti-authoritarian disordered. The newer behavioral cognitive therapists have a more fluid perspective and generally are better able to determine if a person’s suffering is being caused by a crappy situation or by an inner disorder.

  27. I saw a therapist for a while who summarized his doctoral dissertation and its very long title— which of course he proved, because as he explained, no matter what data comes back, you damn well better prove the damn thing if you want to get the degree— as amounting to : “Mental health professionals measure their patient’s progress by the degree to which the patients evince attitudes and values congruent with those of the person treating them.” Or in other words, to the psychologist “healthy” means “thinks like me.” He described it as a needed “fuck you” hidden in the text of the paper to make getting through the process bearable. What amazed him is that this hypothesis, seemingly damning in its potential implications, passed muster without any particular comment on those implications.

    What should be evident from the very nature of the mental health profession is that it deals in subjective, values based problems. What is, or is not, considered a healthy outlook or behavior is entirely a culture bound phenomenon. It is not because of scientific advance that homosexuality is no longer a mental health problem, but because of changes in the cultural attitudes that used to characterize the behavior as deviant.

    1. That thesis sounds intriguing.  Would you be willing to share the name of this therapist?  That sounds like something I would be interested to look at.

  28. From Hopalong-Freud and Other Parodies, by Ira Wallach, in an article entitled “Relation of Father Image to Persecution Syndrome”:
         “At present, subject has been released after an unsatisfactory course of therapy. He continues to give evidence of homosexual impulses as implied in various statements of what he would like to do to the corporation or Father Image.     Since the author’s contract with the Father Image has not yet been renewed, further study is impractical at the present moment.”

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