In a comment discussion last month, we touched on the question of whether religion could ever be considered a mental disorder. This is a common idea among atheists, sometimes expressed as a joke, or sometimes claimed seriously. I am not mentally ill, so I would defer to other people to explain why it is wrong to compare religion and mental illness even as a joke. Here I will ignore the jokes and consider only the serious question: Why isn’t religion a mental disorder?
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’ s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. [emphasis mine]
There you go. Religious behavior isn’t a mental disorder because the DSM-5, an authoritative document, says so. However, you could be forgiven for not taking the DSM’s word for it. Let’s dig deeper.
Look at what else has been excluded from mental disorders: socially deviant sexual behavior. This exclusion arises from a famous controversy, which led to the declassification of homosexuality as a mental disorder in the DSM in 1973. And until 1987, homosexuality remained as a mental disorder (“Sexual Orientation Disturbance” and later “Ego-dystonic Homosexuality”) as long as the patient was distressed about their orientation. The architect of these decisions was psychiatrist Robert Spitzer. I believe that Spitzer himself offers the best insight into the definition of mental disorders.
The Diagnostic Status of Homosexuality in DSM-III: A Reformulation of the Issues, is a paper by Robert Spitzer, published in 1981, in the midst of arguments over Ego-dystonic Homosexuality. He says,
The concept of disorder is man-made. Over the course of time, all cultures have evolved concepts of illness or disease in order to identify certain conditions that, because of their negative consequences, implicitly have a call to action to a special group of caretakers (in our society, the health professions to provide treatment), to the person with the condition (to assume the sick or patient role), and to society (to provide a means for delivery of health care and in some instances to exempt the sick individual from certain responsibilities). The advantage of identifying such conditions is that it makes it easier for individuals with those conditions to receive care that may be helpful to them.
This is the core of the definition of a disorder. A disorder is something that is useful to treat as such. When we call something a disorder, we are calling for the intervention of health professionals, and sometimes for public accommodations.
When the DSM tries to define a mental disorder, its task is to identify the situations where it would be helpful for mental health professionals to intervene. When you disagree with the DSM, and claim that homosexuality or religion is a mental disorder, you are essentially saying that those conditions are best addressed by mental health professionals. I highly doubt that most atheist activists truly believe that religion is best addressed by mental healthcare–clearly their preferred method is to address religion through social critique!
Now that we understand what the definition of a mental disorder is for, we can discuss the definition’s contents. There are two major elements to the definition: the consequences of a condition, and its etiology (i.e. its cause).
It makes sense that we only call something a disorder if it has negative consequences. After all, why bring in health professionals if there’s no problem to be solved? One common negative consequence is the distress of the patient. However, the DSM also considers it a negative consequence if the condition causes impairment in an important social or occupational function. For instance, a patient suffering from hallucinations isn’t necessarily distressed by these hallucinations, but they still interfere with basic functioning.
Spitzer argues that there is necessarily a value judgment involved in identifying “important” functions. For example, we make the (obvious) value judgment that life is an important function, thus consider things that cause death to be disorders. But what makes heterosexuality so important? If everyone were homosexual, humans might die out, but Spitzer points out that if everyone were a psychiatrist, we’d also be in trouble. And why don’t we consider heterosexuals to be disordered for their impaired ability to have homosexual relationships? Why don’t we consider the inability to fly to be a disability?
We could get around the subjective judgment by considering the etiology of the condition. But this solution is hardly satisfactory, after all, many neutral and positive conditions are also caused by childhood conflicts, and should not necessarily be considered disorders. What etiology really does, is inform whether an problem is best addressed in a mental health setting, as opposed to some other setting. For example, we consider AIDS to be a disease and an abusive relationship to be a social ill, rather than calling these mental disorders.
In this discussion of mental disorders, there is one aspect I’ve omitted. Many people believe that mental illnesses should be stigmatized. For instance, it is commonly argued that people with PTSD should stay out of school, see a doctor, and halt all interaction with normal people until cured. I emphatically assert that stigmatization should play no part in the definition of a disorder.
One of the reasons that gay activists wanted homosexuality declassified as a mental disorder is because of the stigma of having a mental disorder. That is, they didn’t want the American Psychiatric Association saying there was something wrong with them. I do not consider this to be a valid reason to declassify homosexuality as a mental disorder; the correct reason is that homosexuality simply isn’t something that should be “treated”. When I’ve argued that asexuality should be declassified as a mental disorder, I’ve been careful not to rely on stigmatization.
In contrast, I think there is a much stronger argument to be made in favor of gender dysphoria being called a disorder (mental or otherwise). After all, many people with gender dysphoria would like to be treated (e.g. hormonal replacement therapy, electrolysis, surgery), and would like their health insurance to cover that treatment. Of course, I also know plenty of non-binary people who do not want to be treated in a medical setting, and a mental disorder diagnosis does not seem to help them. For the most part, I would rather defer this issue to trans and non-binary people themselves.
When atheists argue draw parallels between religion and mental disorders, they often appear to be (ineptly) using mental disorders as a tool to stigmatize religion. I take issue with this, and you should too.
Part of my problem with considering dysphoria a mental illness is that it is entirely possible to receive a diagnosis of gender dysphoria without necessarily having physical dysphoria.
The diagnosis guidelines can be sufficiently met by wanting to be read and treated as a member of the desired gender. This more or less describes my situation as an agender person (I do have physical dysphoria, but it’s not constant nor does it prevent normal functioning in any way.)
The thing is, this social dysphoria is a purely social matter – in a world where people treated me as I feel is correct for my gender, there would be no issue. There’s nothing to cure, not any more than drapetomania actually exists independent of a racist slave-owning society.
Now, if one wanted to consider physical dysphoria a mental illness, I might agree. But as it stands, I absolutely don’t as long as social dysphoria is rolled into the overall “gender dysphoria” category.
First, I like your take on gender dysphoria – because the desires of the people being diagnosed with the condition are taken into account. If the condition is taken seriously, then their treatments are not ‘elective’ but necessary. It’s the opposite for homosexuality or asexuality, in which people simply seek to exist without judgment.
On religion and mental illness, this is my take, as someone who both has a diagnosed mental illness (schizo-affective disorder) which involved hallucinations and delusions, and someone who studied (for a while) cognitive psychology.
Most religious people are simply falling victim to cognitive biases. These affect everybody. A charismatic Christian is prayed over and has an ‘anointing’ and feels better, a person in rural China feels better after receiving some “Traditional Chinese Medicine” and an alt-med type in the USA feels better after a juice cleanse, all with the absence of any evidence these practices cause any tangible improvement in their conditions. Christians see answered prayers everywhere (particularly for trivial matters, which they are encouraged to pray for) and unanswered prayers are not evidence that their god isn’t listening – confirmation bias all the way. Even people who ‘hear’ from god are often not really hearing anything; they’ve just been taught that any random impulsive thing that jumps into their head has to be god telling them what to do.
In some cases, accepting biases of your society can make you function better within it, even when they hold your society back. But as you said, it’s not really mental health professionals who can help there. If you go to a doctor and say ‘I feel dirty and sinful because of homosexual urges, and everybody I know tells me to pray them away’ – a doctor, counselor or such has limited power to help, particularly if that viewpoint is dominant. And they don’t tend to second guess the professed beliefs of clients.
This is not necessarily the case; see my post above. My social dysphoria would not exist in a society that didn’t insist on treating me as a gender I don’t identify as.
… their preferred method is to address religion through social critique!
What other method do we have available?
“Dysfunctionality” always seems to boil down to a matter of degree: an odd behavior once in a while is an idiosyncrasy; done repeatedly, it becomes Obsessive-Compulsive Disorder™. I don’t have a citation to hand, but many say that social workers’ second-most urgent red flag in assessing family problems (after heavy use of alcohol &/or other mind-altering drugs) is hardcore religiosity.
Psychology reminds me of Theodore Sturgeon’s description of quantum mechanics: “… all the micrometers are made of rubber and the tapemeasures are printed on wet macaroni.” Except that QM can produce consistently reliable results.
@smrnda
I would say that gender dysphoric people, too, would like to exist without judgment, but this is unrelated to the question of whether they want treatment.
@Pierce R Butler,
Perhaps certain kinds of religiosity can be addressed by social workers. I couldn’t say, being unfamiliar with social work.
It’s worth noting that the question, “Why isn’t religion a mental disorder?” is about as old as psychology (as a self-described “scientific” discipline) itself. William James’s Varieties of Religious Experience is an interesting read: one of the most interesting minds of the 19th century trying to deal head-on with the fact that most of his friends “believed” manifestly untrue things, while trying avoid conceptualizing them as simply delusional. James’s ultimate solution wasn’t entirely satisfactory (it involved re-defining “true”), but he did point the way toward taking religious experience seriously as an authentic element of human experience generally.
And that’s more or less where we are today: the mechanisms underlying the religious impulse seem to be sufficiently near-universal as to constitute “just how the mind works,” rather than a disorder. A bit like cognitive biases, really. We know they’re there, we know they distort our perception of reality, but they’re just part of normal functioning. And the “treatments” are intellectual — you learn some statistics and some evolutionary biology and get by as best you can.
Interestingly enough, a mutual follower of mine on tumblr just reblogged a post saying that vocal atheism is ableist, because mentally ill people use religion to cope.
@Vivec,
Even granting that were true, telling activists to shut up clearly goes above and beyond the reasonable accommodations that should be made for disabilities. While trigger warnings are often falsely accused of being censorship, getting people to shut up is actually censorship.
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’ s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities.”
This is exactly what I was saying on that other post — that a behavior or belief that interferes with one’s ability to function is a mental illness. If one believes so strongly in God and demons that they cannot function, they ARE, by the DSM’s own standards, mentally ill.
Carving out exceptions for religious beliefs is a form of religious privilege that should absolutely be removed.
@WMDKitty,
Selectively quoting the DSM doesn’t work too well when everyone can see the full quote in the OP just fine.
Yes I know that you think mental illness refers to anything that interferes with ability to function, that is the precisely the idea I rebutted?
Siggy, read it again. I quoted the exact same passage you did. Everyone can see the quote in the OP fine, and can see that I’m right. Are you going to continue to debate the official definition of mental illness when the DSM’s definition is right there in front of you?
(PS: I find the tactic you’re using to be highly dishonest. You quoted a thing that means precisely what I said it meant, and then claimed it DOESN’T say what it clearly says in black and fucking white. Don’t try to pull the wool over my eyes.)
The religious exemption is nothing more than Christian Privilege, and should be removed.
“Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities.” =/= “a behavior or belief that interferes with one’s ability to function is a mental illness”
You’re treating a necessary condition as a sufficient condition. The DSM quote says that x’s are usually also y’s, while you’re claiming that all y’s are x’s.
@WMDKitty,
Yeah I honestly can’t tell if you really think you’re agreeing with the DSM, or if you’re just agreeing with part of the DSM and then rejecting the other part as Christian Privilege.
Also, at best you have only stated your position. You’re missing the part where you argue in favor of your position.
All dogs are furry mammals. If I tell you that I have a furry mammal, does it therefore follow that I have a dog?
No. I might, but there are more qualifiers to a dog than just “furry mammal”, and there are more qualifiers to a mental illness than “impedes normal functioning”.
I see I can write Vivec off as another dishonest asshole who has NO CLUE what they’re talking about. I LIVE WITH MENTAL ILLNESS.
As for you, Siggy, just stop. I have been using the official DSM definition the entire time. Your failure to understand is not my fault. Your moving of goalposts is dishonest.
So do I? I don’t accept that dysphoria is a mental illness, but I have clinically diagnosed Attention Deficit and Depression.
Your entire argument, as of yet, is literally affirming the consequent. From the same quote you like to spam everywhere, it merely says that ‘most x’s are y’s’. You cannot therefore infer that something is an x just because it is a y.
While my attention deficit, depression, and dysphoria all impede my normal functioning, my dysphoria ceases to exist when I’m gendered correctly. It’s no different than drapetomania ceasing to exist in a society that doesn’t keep slaves.
I don’t have the time to provide the moderation that this discussion apparently needs, so if I see more comments like #15 I’m going to block the offending commenter.
People should use your preferred pronouns when made aware of your preference. It’s a simple matter of courtesy — you refer to people the way they would like to be referred to.
At the same time, you can’t expect people to automatically just know what your pronouns are. I’m the type of person who just asks what pronouns you’d like me to use — I’d rather just embarrass myself up front than spend an entire conversation using the wrong pronoun and then feeling like a total ass.
So, for future reference, what are your pronouns? If you’d prefer not to answer, I can default to “they”. No big.
I think a lot of the “dis” in “disability” — this applies equally well to mental illness — a lot of the negative effects, a lot of the “dis-ability” is in how society treats us. Lack of understanding, lack of physical accessibility, half-assed not-up-to-code “accommodations” that just… don’t accommodate your needs at all. Lack of thinking on the part of planners and architects. I could slap the people who decide where to put in curb cuts (and how to design and implement them) because so many are just plain dangerous. The lack of accommodations for the blind or Deaf. The way mental illnesses are played off as either a big joke (at the expense of those suffering) or the Worst Possible Thing Ever (again at the expense of those suffering.) Society has a long way to go before there’s anything approaching equality and inclusion, let alone universal accessibility.
At the same time, I recognize that my physical limitations are very real. Fixing society and advocating for universal design is not going to get me up and walking. Cerebral Palsy is kind of a pain in the ass to live with. I may never run a marathon or play a professional sport or what have you, but there’s no reason to block me out of things I can do just ‘cuz someone wasn’t thinking during the planning stage.
I go by they pronouns, but that wasn’t the point of my post.
Social dysphoria, as defined in the DSM, refers to “wanting to be treated like and adopt the social role of some other gender” (i’m paraphrasing from memory).
My dysphoria is non-existent in spaces where I am indeed treated like the gender I identify as, and would not exist in a world that treated me like the gender I identify as.
It’s completely different to, say, my depression or my attention deficit, which would exist regardless of how society treats me. In a world that perfectly accommodated my mental illnesses, I’d still have them. In a world that perfectly accommodated my gender identity, I’d have no dysphoria.
Clearly, there’s more to a mental illness than impeding normal functioning – under that standard, social dysphoria, homosexuality, and drapetomania are all perfectly valid mental illnesses, and I don’t think you think the latter two are.