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What Is Mental Illness and Who Has It?

By August 19, 2019August 21st, 2019No Comments

Are mass murderers mentally ill?

Are the white supremacist shooters mentally ill? The answer to this question rests on a foundation of observations and cultural assumptions. In reality, the term “mental illness” is an aspiration rather than a reality used by psychiatrists, who are indeed medical doctors and whose national association, the American Psychiatric Association, publishes the Diagnostic and Statistical Manual, the official system of diagnosis accepted by the insurance companies for reimbursement.

This use of the word “illness” is controversial and is based on the dualistic assumption that mental illness is separate from, but parallel to, physical illness, about which we know many of the causes. It is based on the “germ theory,” which searches for an underlying micro-cause. Mental illness is designed to characterize individuals’ dysfunctions and not those of society.

The DSM is not a compendium of illnesses or even known disorders. Adding and removing disorders have so far been more political than scientific. In reality, the paid-up members of the psychiatric association vote on each “disorder” that is added or subtracted from this bible, as most therapists refer colloquially and knowingly to the big book. It is largely culturally determined and may even be more analogous to the Bible than to a scientific publication. Nevertheless, most, if not all, therapists use it to receive third-party reimbursement because that is what pays the bills.

The DSM is a collection of clusters of so-called symptoms that tend to emerge together in individuals. They overlap quite a bit so that the process of diagnosis of “mental illness” is only descriptive and done by the elimination of other possible diagnoses. We do not know the causes of any of these “illnesses” and in recent years they have been demoted to “disorders” as a professional nod to this issue.

For example, social problems such as gun use, racism and misogyny are considered outside the bounds of psychology and instead the purview of culturally and socially focused disciplines, such as sociology, criminal justice and human rights (Bell, 2004). Many feminists have argued against this decontextualized version of mental illness, but, at this time, it remains officially endorsed.

In a much earlier diagnostic system, psychiatry used a mental illness called “draepetomania, defined as the irresistible impulse to run away from slavery.” (White, 2002) Obviously, it has long since been removed as society changed and not as individual brains grew or were “cured.” The question of how far mental illness should reach into cultural problems remains.

In the beginning years of feminist psychology, many women protested the diagnoses that applied only to women, such as hysteria, and some of them were finally removed from the Bible. They were seen to be a function of gender and not an illness at all, Freud notwithstanding (Chesler, 1972, Kaschak, 1992). By 1973, the lesbian and gay rights movement had lobbied the APA sufficiently so that homosexuality was removed as a diagnosis. This political process of enacting change continues to this day. Until we know more about individual pathology and can define it clearly, the categories will not be truly scientific.

Epigenetics is adding a new voice to the discussion of where the line is between social and psychological problems. From my perspective, there is no permanent line, as the context becomes self and the self, context for others. That is, influences on the brain/mind are multiple, complex and shifting.

Neuroscience is making some headway, as the technology becomes available, in understanding the “orders” and “disorders” of the brain, but psychiatry and psychology are far from being empirical sciences, as these professionals are observing problems that are strongly influenced by familial, social and cultural trends.

Even medication, the purview of the medical profession, is based upon observation, more precisely on educated trial and error. A patient with certain so-called symptoms is treated with a particular chemical cocktail. If it doesn’t work, then another is tried until something stops the pain. Stopping the psychological pain is then attributed to undoing a chemical imbalance of neurotransmitters such as serotonin or dopamine. The very idea of imbalance is almost pure conjecture. In fact, we do not know precisely what these medications do in the human brain-body.

Back to my original question. If you accept all the above caveats as given and want to stay inside the system of mental illness, then you can diagnose accordingly. According to the very system, these shooters are not mentally ill. That is, the problem is not theirs alone, but it is a cultural one, a societal one, which I have called STDs (socially transmitted diseases). It is highly contagious and is thus far totally the behavior of young, white men who express racism and misogyny. Hatred is not a “mental illness.”

We either change the paradigm or we recognize that these are not individual disorders, but are being intentionally perpetrated by those who have the cultural power to do so. Until that time, they are ethical, moral and cultural disorders and we should, therefore, look to cultural interventions as the “cure.”


Bell, C. Racism: A Mental Illness? (2004), Psychiatric Serv, 55:1343.

White, K. (2002). An introduction to the sociology of health and illness. SAGE. pp. 41-42.

Chesler, P. (1972), Women and Madness, New York

Kaschak, E. (1992). Engendered Lives: A New Psychology of Women’s Problems, Basic Books, New York.

This article was originally published in Psychology Today.

Ellyn Kaschak

Ellyn Kaschak

Ellyn Kaschak, Ph.D. is an internationally acclaimed and award-winning psychologist, author and teacher. She is well-known as a speaker, workshop leader, human rights advocate and a public intellectual.