How do we define “Mental Illness?”

I spent much of yesterday afternoon writing an editorial to submit to USA TODAY about an insulting statement that U.S. Solicitor General Elena Kagan made Tuesday when she testified before the Supreme Court.

Kagan was testifying in favor of a law that would allow the government to keep inmates locked up even after they had served their time if officials felt they were “sexually dangerous.”

USA TODAY Reporter Joan Biskupic quoted Kagan as saying: ”The federal government has mentally ill, seriously dangerous persons in its custody. It knows that those persons, if released, will commit serious sexual offenses.”

I accused Kagan of insulting millions of American by insinuating that persons with mental illnesses are sexually dangerous.  I explained that the Justice Department’s Bureau of Statistics has estimated that sixteen percent of persons in American jails and prisons – some 300,000 – have been diagnosed with a serious mental illness.  Many of them have bipolar disorder, schizophrenia, and major depression.  Did Kagan really think these prisoners, if released, would commit serious sexual offenses?

In addition to insulting persons in jail with traditional mental illnesses,  Kagan’s  use of the term “mentally ill” also sullied the reputation of persons with Alzheimer’s, Autism, Attention Deficit Hyperactivity, Post Traumatic Stress Disorder and a slew of phobias that are all listed by the National Institutes of Mental Illness as “mental illnesses/disorders.”

I wrote passionately about how Kagan’s poor choice of language had contributed to stigma and was just plain wrong.

I was about to hit the send button on my computer when I decided to read what the medical definition of “mental illness”  actually was.

I wish I hadn’t.

According to  the American Heritage Medical Dictionary,  mental illness is defined as “Any of various psychiatric conditions, usually characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by physiological or psychosocial factors. Mental illness also is called mental disorders.”

Still confused, I looked up “mental disorders.”

“Mental Disorder: Imprecise term, primarily used by laypeople to refer to mental conditions.”

Okay,  I decided, I was going about this the wrong way. Rather than looking up mental illness and mental disorders, I typed “do sexual predators have a mental illness” into my browser. Before my slow AOL connection could come up with listings, I had typed in a new command.

I consulted the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition –better known as the DSM-IV. It’s the manual published by the American Psychiatric Association that covers all mental health disorders for both children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches.

Pedophilia was there– along with a slew of other deviant sexual acts — under  Paraphilias and Sexual Disorders.

So technically, Kagan was correct — sexual predators do have a mental illness — although the blanket wording of her quote remained insulting.

My research got me thinking about how we define mental disorders. There’s more at stake here than semantics and political correctness.

The reason why Kagan was testifying in front of the Supreme Court was because the federal government doesn’t know what to do with dangerous sexual predators after they finish their sentences. At least seventeen states have passed various versions of what has come to be called “sexual predator” legislation to deal with this problem. The impetus for this legislation was the repeal of  indeterminate sentencing laws. Those laws used to keep serious sex offenders confined in prison until officials were satisfied that they were no longer dangerous.

Now, as soon as these predators finish their jail time, they are immediately driven from the prison to a locked down, state mental treatment facility. They are committed under the same involuntary commitment laws as everyone else.

Mental Health America, the oldest mental health organization, has led the  fight against this practice of dumping sexual predators into mental health facilities. If you want to read MHA’s reasons visit  http://www.mentalhealthamerica.net/go/position-statements/55 It is really interesting.

MHA’s main reason for opposing the sexual predator laws is a sound one — the mental health system is for treatment, not punishment.  It also warns that placing sexual predators into facilities with persons with serious mental illnesses is unconscionable. But the point that I found most interesting was this paragraph:

“Sex Offenders Often do not have a Diagnosable Mental Illness.  Many sexual predator statutes refer generically and inaccurately to sex offenders as having a mental illness. In fact, many sex offenders do not have a diagnosable or treatable mental illness.  Rather, the sex offenses under which sexual predators are convicted are a manifestation of personality disorders that are not amenable to most kinds of treatment.  Because these disorders are not traditional mental illnesses, mental health professionals have difficulty determining which sex offenders will be dangerous if not committed and what if any treatment should be provided.  This means that courts, which must rely on professional expertise, will regularly make mistakes in deciding who should be committed or released, with serious consequences for both the public and the offender.”

Huh? If I understand that statement, then MHA is clearly stating that the APA is wrong when it identifies pedophilia as a mental illness? Instead it is a “manifestation of personality disorders.”

Personality versus mental defects, organic versus psychosocial — the debate rages on.

So how do you define what  is a “mental illness?”

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

  • B. Jones

    Most brain disorders fall into two categories: psychosocial, such as PTSD, which are believed to be the result of environmental or outside influcences; and organic or biological, such as schizophrenia.
    The problem is that we don’t really know enough about the brain and how it works to know if some disorders have roots in both camps.
    I think it would be helpful is we stopped calling psychiatric problems “mental illness” and instead called them what they are “brain disorders.”

  • B. Jones

    Most brain disorders fall into two categories: psychosocial, such as PTSD, which are believed to be the result of environmental or outside influcences; and organic or biological, such as schizophrenia.
    The problem is that we don’t really know enough about the brain and how it works to know if some disorders have roots in both camps.
    I think it would be helpful is we stopped calling psychiatric problems “mental illness” and instead called them what they are “brain disorders.”

  • Dave Almeida

    The APA is wrong in defining pedophilia as a mental illness.

    Clearly there is something wrong with a pedophile, but not in the same sense of an individual having a serious and persistent mental illness as the vast majority of the mental health community defines mental illnesses. The APA should exclude pedophilia and other sexual disorders relating to criminal activity, in the DSM V.

    To not do so, would continue to perpetuate stigma, lumping people with mental illnesses who are more likely to be the victims of crime, with individuals who carry out viscous crimes.

    Further, the inclusion of these disorders has the unintended consequence of giving Solicitor General Kagan and others an out when it comes to what to do with sex offenders who have completed their sentences. That out, in many states, means inappropriately using the involuntary commitment laws to detain indefinitely, sexual predators.

    While few would argue with the reasons for wanting to do so, the fact is that in most states, individuals who are involuntarily committed then become the responsibility of the state mental health system. That responsibility includes the cost of “treatment,” diverting much needed funding for community and inpatient mental health services to “treat” this false community of “mentally ill” individuals.

    Once a state goes down that road, there is no end in sight. As MHA correctly points out, these individuals “…are not amenable to most kinds of treatment.” What this boils down to is that few sexual predators are ever released once involuntarily committed, more continue to come in the front door, and eventually this population has the potential to suck the life wind out of what is already a seriously underfunded mental health system.

    The APA should not include sexual deviant behavior in the DSM V, and the answer for how to deal with the repeal of indeterminate sentencing laws should not be on the backs of people with bona fide biological diseases of the brain that can be successfully treated.

  • Dave Almeida

    The APA is wrong in defining pedophilia as a mental illness.

    Clearly there is something wrong with a pedophile, but not in the same sense of an individual having a serious and persistent mental illness as the vast majority of the mental health community defines mental illnesses. The APA should exclude pedophilia and other sexual disorders relating to criminal activity, in the DSM V.

    To not do so, would continue to perpetuate stigma, lumping people with mental illnesses who are more likely to be the victims of crime, with individuals who carry out viscous crimes.

    Further, the inclusion of these disorders has the unintended consequence of giving Solicitor General Kagan and others an out when it comes to what to do with sex offenders who have completed their sentences. That out, in many states, means inappropriately using the involuntary commitment laws to detain indefinitely, sexual predators.

    While few would argue with the reasons for wanting to do so, the fact is that in most states, individuals who are involuntarily committed then become the responsibility of the state mental health system. That responsibility includes the cost of “treatment,” diverting much needed funding for community and inpatient mental health services to “treat” this false community of “mentally ill” individuals.

    Once a state goes down that road, there is no end in sight. As MHA correctly points out, these individuals “…are not amenable to most kinds of treatment.” What this boils down to is that few sexual predators are ever released once involuntarily committed, more continue to come in the front door, and eventually this population has the potential to suck the life wind out of what is already a seriously underfunded mental health system.

    The APA should not include sexual deviant behavior in the DSM V, and the answer for how to deal with the repeal of indeterminate sentencing laws should not be on the backs of people with bona fide biological diseases of the brain that can be successfully treated.

    • Rosie H.

      As I age and become more educated both personally and professionally in the field of mental health care, I am ashamed to be a US citizen, and enraged about how the media handles this very uncomfortable and complex issue; the issue of mental illness and broad spectrum disorders such as sexual symptoms and an issue that has tremendous sociological effects on our society, as we struggle for answers to brain diseases, simplifying what continues to be a stigmatized and catastrophic journey for families and their loved ones. Families not individuals. If we identify ourselves as caring and compassionate human beings, you can understand this on a much deeper level by reading a new book titled “Lies In Silence” by SJ Hart. It is gut-wrenching as she describes in horrific detail the authentic experience including small children, and the biochemical symptoms that accompany mood disorders, including sexual symptoms and the lack of assistance and validation given to her family and millions just like hers. Humanitarian is only a word unless you put it into action.

      Rosie

  • Sandra Johnson

    If you want to read about sexual predator laws and mental illness, I’d suggest you visit

    http://www.reidpsychiatry.com/columns/Reid07-98.pdf

    This doctor presents a much different view from Mental Health America’s.

    Thank you.

  • Sandra Johnson

    If you want to read about sexual predator laws and mental illness, I’d suggest you visit

    http://www.reidpsychiatry.com/columns/Reid07-98.pdf

    This doctor presents a much different view from Mental Health America’s.

    Thank you.

  • Maria Lissintoome

    Many individuals with Bipolar Disorder experience hypersexuality during manic phases. Bipolar Disorder and Schizophrenia impair social judgements and individuals can act inappropriately.

    Child rapist Mary Kay Letourneau has Bipolar Disorder. This website lists the many cases of female teachers who have been accused of having sex with students, many of them have Bipolar Disorder.

    http://www.wnd.com/news/article.asp?ARTICLE_ID=53859

    Psychiatrists like Dr. Kayoko Kifuji are diagnosing children as young as two years old as having Bipolar Disorder.

    The Miami Herald reported about 7 year old Gabriel Myers:

    “The boy who hanged himself in a Broward County foster home had acted out sexually in front of others and showed signs of other behavior problems, a report said. At age 7, Gabriel Myers was already well on his way to becoming a sexual predator.” Gabriel was on several anti-psychotic medications.

    There is a strong correlation between Bipolar Disorder and inappropriate sexual behavior.

  • Maria Lissintoome

    Many individuals with Bipolar Disorder experience hypersexuality during manic phases. Bipolar Disorder and Schizophrenia impair social judgements and individuals can act inappropriately.

    Child rapist Mary Kay Letourneau has Bipolar Disorder. This website lists the many cases of female teachers who have been accused of having sex with students, many of them have Bipolar Disorder.

    http://www.wnd.com/news/article.asp?ARTICLE_ID=53859

    Psychiatrists like Dr. Kayoko Kifuji are diagnosing children as young as two years old as having Bipolar Disorder.

    The Miami Herald reported about 7 year old Gabriel Myers:

    “The boy who hanged himself in a Broward County foster home had acted out sexually in front of others and showed signs of other behavior problems, a report said. At age 7, Gabriel Myers was already well on his way to becoming a sexual predator.” Gabriel was on several anti-psychotic medications.

    There is a strong correlation between Bipolar Disorder and inappropriate sexual behavior.

  • Rosie H.

    As I age and become more educated both personally and professionally in the field of mental health care, I am ashamed to be a US citizen, and enraged about how the media handles this very uncomfortable and complex issue; the issue of mental illness and broad spectrum disorders such as sexual symptoms and an issue that has tremendous sociological effects on our society, as we struggle for answers to brain diseases, simplifying what continues to be a stigmatized and catastrophic journey for families and their loved ones. Families not individuals. If we identify ourselves as caring and compassionate human beings, you can understand this on a much deeper level by reading a new book titled “Lies In Silence” by SJ Hart. It is gut-wrenching as she describes in horrific detail the authentic experience including small children, and the biochemical symptoms that accompany mood disorders, including sexual symptoms and the lack of assistance and validation given to her family and millions just like hers. Humanitarian is only a word unless you put it into action.

    Rosie

  • Connie Schuster

    The corporate media and the psychopharmaceutical complex have succeeded in brainwashing most of you.  You should know that there are many of us in disagreement with the concept of “mental illness” as being either scientifically valid, or useful.  Also, many of us disagree with labels and standard psychiatric treatment.  We all have difficulties because of how we’ve been hurt.  We all have the ability to heal emotionally.  Babies and children know that they need to release the feelings, e.g., crying, “tantrums,” etc.  People in crisis are the most ready to heal, because their feelings are on top; in other words, they’re not numb.  Alternatives such as Soteria and Diabasis provided safe settings for people in crisis; without psychiatric drugs, people were weller than well in two to three months.  In the psychiatric system, people have a choice: drugs or drugs.  They are trapped for life.  All psychiatric drugs damage the brain and central nervous system, as well as all the other organs of the body.  Life expectancy of people on these drugs is twenty-five years less than average.  The drugs can cause blunted intelligence, bizarre behavior, confusion, hallucinations, depression, anxiety, violent or suicidal behavior; conversely, withdrawal from these drugs can cause all the same.  It’s confusing, because different people are affected at different rates and to varying degrees.  I have seen too many lives destroyed, and people killed by these drugs.  By the way, NAMI is funded by the pharmaceutical industry.  AND, frequently the people who are put in the system are those who are scapegoated within their families as the problem, when they are actually the victims, and the “normal” family members are the perpetrators.