Most people fail to realize how much the process of what we regard as normal, healthy, or sick is influenced by social, cultural, political, or financial factors.

Dr. Allan Horwitz joins Greg to talk about how the public’s perception of many common conditions, such as depression, anxiety or PTSD, has evolved over time and no longer involves the stigmatization they once had. Dr. Horwitz also shares how "psychiatry's bible," the Diagnostic and Statistical Manual of Mental Disorders or DSM, consciously or unconsciously shaped the general public’s view of many conditions.

Dr. Allan Horwitz is an American sociologist who is Board of Governors Professor in the Department of Sociology and Institute for Health, Health Care Policy, and Aging Research at Rutgers University. 

He was trained in psychiatric epidemiology at Yale and is the author of over one hundred books, articles, and chapters in the mental health area. Dr. Allan Horwitz has studied a variety of aspects of mental health and illness, including the social response to mental illness, family caretaking for dependent populations, the impact of social roles and statuses on mental health, and the social construction of mental disorders. 

Episode Quotes:

What makes something a mental disorder? 

33:51: To be a mental disorder, any condition has to have two components, not just one. And one would be dysfunction, which is analogous to a physical disease. That is: some psychic mechanism isn't working in the way that nature designed it to work. So that's a necessary but not sufficient condition. You also have to have the cultural judgment that dysfunction negatively harms the individual. Those definitions differ tremendously from culture to culture. A mental disorder requires both some dysfunction and a negative cultural judgment.

The distinction between psychiatry and medicine

3:29: There are some distinctions between medicine and psychiatry, and in particular, for most medical conditions, there are objective tests. You have X-rays and blood tests, and there certainly are judgments that are involved, but at least there are some biological baselines you can use. Psychiatry does not have any physical test for their condition, so psychiatry is completely reliant on the diagnostic criteria. 

Is there a way that we can objectively measure mental illness?

21:04: The purported increases in conditions like anxiety and depression, and PTSD are not entirely, but for the most part, artifacts of the way that we measure them. With these symptom-based questions that ask you, "Well, have you been anxious in the last two weeks?" Or "Have you been depressed?" or so on, as the meaning of the questions changed over time.

Show Links:Recommended Resources:

• Robert Spitzer
• Emil Kraepelin

Guest Profile:

• Faculty Profile on Rutgers University
• Professional Profile on Psychwire
• Allan Horwitz on LinkedIn

His Work:

• DSM: A History of Psychiatry's Bible
• Personality Disorders: A Short History of Narcissistic, Borderline, Antisocial, and Other Types 
• Creating Mental Illness
• Anxiety: A Short History (Johns Hopkins Biographies of Disease)
• All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders
• The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder