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.