We All Have Personality Disorders Now: If You're Happy or Sad, Neat or Messy, Outgoing or Withdrawn, You've Got a Symptom. Nick Cohen Argues That Psychiatry Has Expanded by Pathologising Everyday Life

By Cohen, Nick | New Statesman (1996), July 11, 2005 | Go to article overview

We All Have Personality Disorders Now: If You're Happy or Sad, Neat or Messy, Outgoing or Withdrawn, You've Got a Symptom. Nick Cohen Argues That Psychiatry Has Expanded by Pathologising Everyday Life


Cohen, Nick, New Statesman (1996)


Brian Blackwell got a disorder and got away with it, so why shouldn't you? He battered his parents to death with a claw hammer but, instead of imprisoning him for life, Mr Justice Royce allowed him to plead manslaughter on the grounds of diminished responsibility. He will be eligible for parole in five years and seven months, which, for a defendant who might never have been released, is a result.

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Blackwell's lawyers argued that he was suffering from acute narcissistic personality disorder. They weren't simply saying that he was selfish--most killers are that--but that he had a verifiable illness which meant he was no more fully responsible for his crimes than a blind man would be fully responsible for bumping into you in the street.

According to the textbooks, a sufferer--or should that be a victim?--has five or more of the following traits: an extravagant sense of self-importance; fantasies of unlimited success; the belief that they are special and can be understood only by their equals; an unreasonable sense of entitlement; a yearning for admiration; a willingness to exploit others; lack of empathy; envy of others and the belief that others envy him; and a visible arrogance or hauteur.

It sounds frightfully specific, but look at that list again. How many people do you know with five or more of its grandiose vices? My diffident self aside, I would say it encompasses most managers of my acquaintance, all actors, many politicians and the entire senior editorial staff of the New Statesman.

After the Blackwell case, Oliver James, the most garrulous of the Fleet Street shrinks, boldly declared that 80 per cent of all convicted prisoners had a personality disorder, and 74 per cent had more than one. James didn't follow his argument that they were bad because they were mad to its conclusion, and say that 80 per cent of convicts should go to the Court of Appeal and demand that their sentences be cut because of diminished responsibility. But then his trade is rarely consistent.

It is not only criminals who should be able to cop a plea. The late 20th century brought an explosion of psychiatric diagnoses. The bible of therapy is the Diagnostic and Statistical Manual of Mental Disorders, written by the American Psychiatric Association. The first edition (DSM-I) was published in 1952. It was a pamphlet which listed a mere 60 disorders. At 134 pages, the 1968 second edition might have been mistaken for a novella. The third, in its revised version of 1987, had 567 pages and was longer than most novels. DSM-IV, the current dictionary of delusion, was published in 1994 and would be easier to handle if it had appeared in two volumes. It has 886 pages and even in paperback weighs 3lb 4oz. DSM-V will be out in 2011. No one is expecting a haiku.

Herb Kutchins and Stuart A Kirk, two sceptical American academics, argue that psychiatry has expanded by pathologising everyday life. To give a sense of how its empire has inflated, they took ordinary human troubles and showed how they could be, and were being, reclassified as disorders:

An ambitious friend is striving for promotion and says he's not sleeping well. (Not sleeping equals major depressive disorder.)

A former classmate says she has never forgotten how you humiliated her in the playground. (Bearing grudges equals paranoid personality disorder.)

A colleague won't go for a drink after work and spends his weekends at home by himself. (A desire for solitude equals schizoid personality disorder.)

A wife says that after ten years of marriage she is no longer aroused by the sight of her husband. (Absence of sexual interest equals hypoactive sexual desire disorder.)

Your sister cannot stop thinking about a boyfriend who has left her. (Infatuation equals obsessive-compulsive personality disorder.)

Your child won't listen to his teacher. (Lack of respect for authority equals oppositional defiance disorder. …

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