Mental health, pathology, clinical psychology.

How do you define “mental health”? Where does disease start and where does it end?

We extrapolate the idea of health from medical science. There is a “map” of the human body, and depending on how deviant you are from this map, you get the label “healthy” or “sick”. Too few limbs or too much hemoglobin? You’re sick.

There exists an Archimedean point from which to draw the map and judge the deviations: Death.
In general, deviations that don’t propel the body deathwards are given the OK, like being slightly taller or having 6 fingers in one hand, while deviations that tend to kill you or...

messing your survival/reproduction are considered “diseases” or “conditions”, meant to be eliminated, e.g. being tall is OK, but acromegalia increases your chances of heart failure, so it's deemed a disease.

Psychologists don’t get no map, but we pretend we do: the APA spends years burnin cash and circle-jerking over statistics to build a bed of Procrustes called the DSM. Yes, it’s kinda useful as a Schelling point, but in the end it’s the same thing as a crystal ball or a Tarot deck

A superstitious, expensive fetish employed by the gypsy/shrink to bootstrap a conclusion he already reached through sheer skillz.
Essentially, every school in psychology's got their own taxonomy and diagnostic methods, but you should never 100% trust any taxonomy of the psyche.

“How about utilitarianism then? You can at least call it 'mental disease' and try to cure it if the patient tells you he’s suffering b/c of it”
The DSM says something like that: if a pattern of behavior disturbs your normal functioning, if it affects your work, social life,

personal growth, etc., and that of those around you, then you have green light to call that “mental disease” -more specifically, a personality disorder- according to the DSM

Medical health map is drawn regarding the ded/not ded line, & the mental health map is drawn regarding social/not social line. If the society around you (and inside you <=zis is important) deems a behavior not-ok, then it’s mental disease

So that means shrinks operate on a subjective, blurry map, unlike TROO SCIENTISTS? That’s not much of a problem, we can deal with an imprecise & shifting basis: it’s just a calibration problem, margin of error, maintain negative net suffering balance, optimize Procrustes, etc.

But no, there’s a much worse issue.
A guy goes to the psychiatrist: “Doctor, I’m screwed. I have a loving family, a well-paid job with a bright future, my friends love me & my boss says I’m a role model. Still, I’m full of anxiety, I can’t sleep at night and I get the feeling

there’s something deeply wrong with me. Can you give me a hand?”
Let’s imagine everything goes dandy, the therapist goes for a combo of CBT, vacations in Baden & a sprinkle of Veronal, and by 6 mo there’s no trace of the symptoms. All cool.

What if the guy’s job was at the Gestapo in 1938 Germany, marking jewish families and fine young poets week after week? He doesn't understand why, but he knows there's something wrong with "feelings of anxiety", so does his doctor, who goes ahead and cures him

The px. “knows” what he’s doing is "right", bc he’s a good man surrounded by good men doing good stuff: it just happens that the “disease” inside of him "attacked" and had to be “cured”.

The problem with the mental health map is that it's drawn from society’s current disease*. And all societies are diseased: all societies are aberrations from natural order.
*Let’s define 'disease' real quick as “deviation from balance” for convenience, but it’s more complex

The deep deal with mental disease is not “Am I sure this is a symptom? A deviation from health?”, but “Should I cure this? Should balance be restored?”

Back to the medic analogy: medic health works like a Perfect Dictatorship of the Body: a Transcendent Order guides the surgeon’s hand, deviations from it are to be deleted. A tumor can be defined as a rebel group of cells demanding freedom from apoptosis and a Lebensraum.

What you do is chop ‘em off and throw them in a garbage bin, then we run a mini-Pogrom that slaughters tons of innocents fucking up the entire body in the process just to make sure they don’t come back (chemo)

Can you imagine anyone thinking “hmm, maybe I should let this cancer alone, who am I to decide which cells live and which don’t? Cancer cells have rights, too”, no, bc there’s an Archimedean. Now you KNOW there is none for mental disease and there can never be one.

Furthermore, every symptom (though not personality disorders, only talking abt. symptoms here) is an adaptive response to a problem: it’s actually fixing some conflict, and what would have happened in the absence of the symptom is much worse

Fun fact: lacanians opt to leave symptoms alone, for this and other reasons

You can not pretend you’re not a 1938 Nazi because you ARE: both px. and doc. in the example honestly thought, at a conscious lv, that they were “doing the right thing”, based on “reality”, "holy books", "logos", "common sense". You and me are no different.

We've learned some stuff about society and how it’s fucked, but there are true blind spots that we can’t unveil: we’re already molded into them. Thinking you’ve got it figured out is just classic commie hubris, nothing more.

So what do you do with this knowledge, as a shrink? Fall into moral paralysis? Ofc not. You do what your ancestors did and shaman onwards.

You know your alleged expertise is permeated by social disease. You can’t even trust your px when he says “doc, this makes me suffer, fix it plz”, bc they’re also traversed by society. Again, you have no Archimedean point.

This doesn’t mean you should sit on your hands. You harness this knowledge about how deep you don’t know shit to a) remain as humble as possible, tie urself 2 the mast b) pry yourself from the trap of thinking you have it figured out, slowly bringing the px with you c) ?????

Example of b):
Px: “I sleep with strangers & do heavy drugs bc my dad’s beatings gave me borderline disorder”
Me, in my head: nice b8 m8 now stfu about taxonomies and tell me how you feel

It’s not that I doubt that his dad gave him “””BPD”””, it’s that if he’s telling this to me, this is the surface, i.e. worthless. The true “click” moment, the satori, is somewhere deeper.

Along the way we might discover another meaning of the noun “beatings”, and how sleeping with strangers and ketamine are an avatar of health.

“But Zwickau, , how d’ya know what’s DA TROOF? Your perception of ‘healthy-er’ is mediated by society”
Yes. That doesn’t mean you shouldn’t move towards it.

You don’t achieve that final goal of “mental health” bc there is none, there’s always some aberration lurking down below. All the same, there's healthier ways of living, there’s phenomenons we call “cure”, “closure”, and s o m e h o w therapy, done correctly, takes you there.

FIN
h/t to @nosilverv for the inspirational therapyposting