Gender Ideology the Modern Mental Illness
The history of mental illness, how it parallels the pride movements recent trajectory and why this new mechanism should be stripped of its law making power
In 1961 author and psychiatrist Thomas Szasz published a book challenging the preconceptions of his field at the time. It was titled "The Myth of Mental Illness" and argued that it (mental illness) was at its core more of a creation than a discovery and that attempting to fit it into the medical model was an egregious mistake. He argues that what we contemporarily define as mental illness is actually the result of "problems in living.” Szasz begins building his thesis by deconstructing what in the medical field traditionally defined illness. Pathology, the appendage of medicine concerned with identifying and studying disease has traditionally defined it as a defect or deficiency of the bio-chemical machine that is the body. As Szasz himself states the established definition was as follows “…illness meant a bodily disorder whose typical manifestation was an alteration of bodily structure. That is a visible deformity, disease or lesion such as a misshapen extremity, ulcerated skin or a fracture or wound. Since in this original meaning illness was identified by altered bodily structure, physicians distinguished diseases from non-diseases according to whether or not they could detect an abnormal change in the structure of a person’s body. This is why after dissection of the body was permitted anatomy became the basis of medical science.”[1] Therefore the tools and methods or epistemology of pathology was centred around the main goal of being able to measure and detect changes within the body that would be indicative of disease or illness. A disease by these methods and procedures would than manifest in an undesirable variance from normal baseline measurements or the presence of a foreign or alien chemical, bacteria, etc. Either way the disease or illness would be detectable by empirical standards and measures. Using this definition Szasz continues with solidifying the fact that mental illness did not fit this established definition of illness nor was discovered using pathologies reputable procedures. “It is important to understand clearly that modern psychiatry and the identification of new psychiatric diseases began not by identifying such diseases by means of the established methods of pathology but by creating a new criterion of what constitutes disease.”[2] In other words the definition of disease or illness was changed in order to fit this new concept rather than it turning up organically by the established procedures of discovery.
Before continuing, I want to acknowledge the fact that during its history it has been attempted to fit mental illness into the traditional model of pathology. This was attempted by using the “chemical imbalance” theory to explain it. In general, the theory stated that depression, anxiety and other mental health conditions were due to an “imbalance” of neurochemicals in the patients brain. However, this theory has since been proven false and is no longer widely accepted as an explanation for mental illness.[3],[4] The theory was backed with scientific evidence and studies mostly funded by the pharmaceutical industry; the same industry who stood to and did benefit immensely from pushing the “chemical imbalance” narrative. The book “Anatomy of an Epidemic” explains in detail the pharmaceutical industries influence and its relationship with the practitioners of mental health care. It is also important to note that this theory was proposed and put forth decades after the concept of mental illness made it’s inception into the medical field. This means that when the concept was introduced the field of medicine was willing to bend the definition of illness to accommodate it and again that it didn’t fit the traditional model of pathology.
In the book Szasz separates the definitions of brain and mind, brain is defined as an objective physical structure whereas mind is explained as a metaphysical formless entity. Using this definition of mind and to paraphrase Szasz; he essentially states that "It [the mind] can only be sick in the same sense that an economy can be sick."[5] Meaning that it can only be perceived ill against pre-conceived or "normal" social standards. In essence the minds metrics for health can only be compared to ones fabricated through society and culture by humans rather than through empirical observation of physical phenomena. This runs in contradiction to all other branches of the medical practice. Medicine is a natural science based on empirical observation and experimentation of the physical and chemical structure of the human body. What mental illness really is then is what is contemporarily called "a social construct." This is because it cannot exist independently outside of human social cultural norms and rules. In summary, Szasz's idea of mental illness as "problems in living" essentially boils down to an individual’s inability to exist within the rules or boundaries of their inhabited society.
To further clarify his point Szasz uses the idea of "game theory", a hypothesis put forth by neuroscientist Jacques Piaget. The summarization of Jacques’s theory is that the neural and social development of a person is tied to their ability to play ever increasingly complicated games; eventually advancing to the role of adult within a sophisticated society. In Piaget’s game model the explicit and non explicit rules of society or a given entity of it are likened to the rules of a game in which the individual plays within. In this analogy the mentally ill are simply people who are unable to "play" this social game.
These rules of society that people play within are based on its values which are then based on its morality which if you go deeper are usually based on its primary religion. In secular societies such as the Soviet Union or North Korea the state replaces religion, and it becomes the base for all rule making and morality. Either way in the Szasz, Piaget model psychiatrists, psychologists and other mental health professionals do not belong in the medical role since they are not healing objectively sick patients. Instead in this model what they're actually doing is educating people in the rules of the game and helping them play accordingly within those rules. Since as already mentioned the rules are based on the given societies morality it would be more appropriate for the psychiatrist or psychotherapist to be viewed in the same light as a priest, clergyman, author, or other type of moralist. Szasz views the role as being somewhat of a moral arbiter whose job it is to educate the client in the workings of the mind, social rules or "games" played within the culture. The education provided by the arbiter in this model grants the client the ability to make much more informed decisions regarding self or interpersonal conflict and general life choices. As a side note in the Szasian model because "the mental health" professional is not within the medical field it eliminates the requirement of the individual to be "sick" before requesting or receiving help. Anyone at any point could justifiably access the arbiters’ services.
In his book Szasz not only states and argues his view of mental illness but he also outlines the history and trajectory of it, beginning with a physician named Charcot. Charcot was a doctor who was concerned with ailments of the mind but at first followed the traditional medical path. That path being to look for physical or chemical changes in the body or brain to explain symptoms. An example of which would be a brain tumor being the cause of "psychotic" behavior. Patients who displayed off kilter behavior or complained of pain but had no physical or chemical ailments during Charcot's time were often viewed in a negative light and deemed as malingerers. However, at some point during Charcot's career his interest drifted from the traditional path of medicine to the condition of hysteria. Before his interest in the condition, the study of hysteria was a fringe field. When Charcot decided to dedicate his energies to it, he brought with him his reputation and prestige which gave the field and therefore the syndrome a certain amount of legitimacy. In the book Szasz likens Charcot's authority to that of a reputable art critic or dealer. If such an individual was brought a painting and deemed it a masterpiece even if the artist responsible for it was previously unknown the work would suddenly be viewed as valuable. That work along with any other paintings yet to be discovered by this new artist would be deemed treasured and in no small part this would be due to the weight of the critic’s opinion. Charcot validating hysteria as a legitimate illness is like this art critic analogy. With his (Charcot's) blessing suddenly people who were previously viewed as malingerers were now deemed hysterics suffering from genuine illness.
What Charcot and his prestige did was begin to change the rules of "the medical game." He eliminated the need for objective evidence of a physical or chemical deficiency as a required pre-requisite to being deemed legitimately ill. Thus, by Charcot validating hysteria he not only cast a portion of society previously known as malingerers as hysterics but also consequently changed their status from impostors to legitimate players in the medical game. Charcot's rule change than opened the gates for other conditions void of physical evidence to be classified as sickness.
Charcot trained and influenced Sigmund Freud, who ushered in the practice of psychoanalysis. Which not only became a prevalent method of treatment but contained overarching theories of the mind. Psychoanalysis contributed to and greatly influenced the field of psychology which at the time was only in its infancy. Freud and his colleagues in a large part helped lay the foundations of modern psychology. Through it (psychology) a plethora of rule changes from the Charcot, Freud foundation have been introduced. After the original definition of illness was altered by conditions like hysteria, a myriad of mental illnesses and symptoms have since been codified within the psychological rule set. Psychology as a whole has now become its own fully formed "game" within the medical field with its own set of rules. More accurately psychology has not only become its own independent “game” but has advanced to a mechanism that can change and influence the greater or meta social game. Anyone and everyone now makes use of the discoveries and theories created by psychology from actual practitioners to advertising companies, to the judicial system, etc.
Whether or not you occupy as hard line of a position as Szasz and believe mental illness is a “myth” or choose to recognize it as a legitimate form of sickness; it is undeniable that in its history the concept of mental illness has changed the traditional pathological definition of it and that psychology the field surrounding mental illness has had a large impact on society. The rule set ushered in by Charcot, Freud and psychology as a whole has in modern times been manipulated and played illegitimately for different types of gains.
As mentioned, the idea of mental illness began with hysteria but has since come to include a myriad of ailments under its umbrella. Today a large amount of human behavior and emotional states regarded as a deviation from normal can be neatly fit into a category of mental illness. Therefore, because of the ever-expanding vastness of its definition and with the major rule change that was ushered in by the concept of it; that one no longer has to "prove" they are ill as a precondition to being considered sick it has become increasingly easier to be considered mentally ill. The now established conduit of mental illness has made it easier than ever to be cast into the sick role. Once an individual is classified as mentally ill a new social rule set is bestowed upon them. Although ostensibly being considered sick would be thought of as a bad thing the role does have some advantages. This includes not having to meet certain social obligations such as work; it also grants the person a ready scapegoat to blame disruptive or other undesirable behavior on. This same scapegoat could also be used as a way for an individual to not have to deal with or face personal/interpersonal conflicts or take responsibility for negative character traits. For example, forgetfulness can be blamed on ADHD, not having the discipline or energy to adhere to an exercise routine can be blamed on depression, even behaviors such as theft can be blamed on conditions like kleptomania. Although there are cases where these conditions are true it is easy to see how somebody who doesn't want to take responsibility for negative behaviors can easily use a mental illness or the "sick role" to accomplish these ends. In fact scapegoating behavior on mental illness has become so socially accepted that a person can claim insanity in a court of law to displace personal responsibility for murder successfully.
Either way the point is that the introduction and expansion of mental illness has greatly influenced the rules of the overall or meta "social game" and these changes have given people an easy path to inhabit the sick role which as mentioned comes with certain social advantages.
Historically, being viewed as mentally ill was more rare and the negative social consequences outweighed the positive. In large part mental illness was rarer because at that time the definition only covered a minute amount of human behaviors. Secondly being cast into the sick role via mental illness had possible dire socially driven negative consequences. Being deemed mentally ill in the past would have and sometimes did lead to such things as forced institution and or un-pleasurable treatments such as shock therapy and lobotomy. These types of treatments and therapies either infringed on the individual’s autonomy or had large and lasting damaging consequences. This made the occupation of the mentally sick role undesirable. However, as the years have gone on most of the negative social consequences surrounding mental illness have been removed and the criteria for admittance into the category has greatly expanded. This has allowed a lot of wiggle room for people to illegitimately "play the game." The job of the psychiatrist or other mental health professional is to distinguish the legitimate from illegitimate player. They're role is to act as gatekeepers, however they're judgement can unfortunately be convoluted and swayed by a number of factors.
Diagnosis in the first place becomes difficult because of the subjective metaphysical nature of the mind and consequently of mental illness. The lack of objective scales and measures fosters a diagnosis based on interpretive and sometimes arbitrary thresholds. Because of the factors discussed (the subjective nature of mental illness, the ever expanding definition and the social forces harboring the belief that emotional distress is a form of sickness) an individual in our culture can easily conflate themselves as mentally ill. Once they’ve instilled this belief in themselves, they would typically seek the aid of a mental health professional for official diagnosis or dismissal. However, again because of the attributes listed it becomes very easy to validate the patients claims. The problem again arises in the fact the illness is rooted in the patients’ subjective complaints and not detectable physical alterations. Couple this with the fact that the mental health professional may have a disposition of assuming sickness, meaning they operate from a presumption that anyone seeking their services is most likely ill, essentially a guilty until proven innocent viewpoint. When they operate from this disposition they act as an audience would in validating an actor in their role. It’d be like if after the premiere of “Walk the Line” society began to acknowledge Joaquin Phoenix as Johnny Cash. This means in this example Joaquin would no longer be able to rely on society for a corrective definition of reality and his own identity. Actors and their audience however know blatantly that the actor is performing an impersonation so after the credit’s roll both drop the suspended reality. But on the metaphorical stage of real-life things are a lot less deliberate and if someone who believes that they are ill is met with a validating family, friends or other social network as well a representative of the mental health industry who inhabits the guilty until innocent disposition they collectively act as the delusional and un-corrective audience in the Joaquin analogy.
Another influence that aids in producing a positive diagnosis of a mental health condition is the financial benefit. In modern medicine after a patient is deemed mentally ill their treatment typically begins with a pharmaceutical intervention. The benefit to the pharmaceutical industry as a result of this arrangement is obvious since now an entirely new market of "sick people" has been opened up. It also further benefits the corporations because a lot of the prescriptions given for mental illness are life long. This has entrenched a new market for the pharmaceutical companies. It would clearly be in these powerful entities best interest to have the gatekeepers of the field recommend and prescribe their products. Again, the book "Anatomy of an Epidemic" covers the pharmaceutical industries influence on the field of mental health extensively. As a further note the psychiatrist also benefits from this arrangement since the writing of prescriptions further validates them as a medical professional or legitimate player in the "medical game". Regardless, the pharmaceutical industries participation has further skewed the diagnostic procedure for mental illness.
So, in synopsis, the concept of mental illness introduced a mechanism that influences rule changes in the "social game." This mechanism is psychology. Mental illness in its modern form is extremely expansive and now covers a large amount of human behavior and emotional states. The sick role which can be obtained by being considered mentally ill has some social advantages. Access to this role requires no objective proof just the rubber stamp of a mental health professional who can be swayed by influences such as the pharmaceutical industry. A majority of the socially driven negative consequences associated with being part of the group have been for the most part removed, leaving only the social benefits.
What does this all have to do with gender ideology? Well, the recent trajectory of the LGBTQ community’s history has followed an almost identical path as that of the history of mental illness. As with mental illness admittance into the group was at first more stringent and came with grave negative social consequences. As the years have gone on, in the West anyways the community has come to be more accepted and even celebrated. Thus, just like mental illness a large portion of the socially driven negative consequences for being associated with the group have been removed. At this point its debatable that membership comes with positive social consequences now. Also similar to mental illness the criteria for entry have been ever expanding and now simply subjective self identification grants admittance.
Now to be clear, I'm not arguing that this social progress is wrong nor am I implying that there should be negative social consequences for being a member of the community, the point I'm trying to make is that the social forces that drove the trajectory of mental illness seem to be the same or like the ones at the wheel of this movement.
The watershed moment for acceptance of the community was when they were granted the equal right to marry. What has been lost or at least convoluted since this right was granted is that the main argument for it was that sexuality was an innate biological characteristic. Scientific studies have proved this hypothesis to a certain degree. A study performed by neuroscientist Simon LeVay showed that a tiny part of the hypothalamus formally called the third interstitial nucleus of the anterior hypothalamus abbreviated to INAH-3 was twice as large in straight men as opposed to gay men; in gay men it was closer in size to that of straight women. This portion of the brain is believed to govern the four "F's" (Fleeing, fighting, feeding and uh fornicating)[6]
Another study, this one performed by sexologist and psychiatrist Ray Blanchard provided more evidence for the biological foundation for sexuality. He developed a theory called the “fraternal birth order effect” which stated in essence that as a mother gave birth to sons with each subsequent one the likelihood of them being gay would increase:
“The work of Ray Blanchard, a world-renowned sexologist and professor of psychiatry at the University of Toronto, speaks to the biology of being gay. His theory of the fraternal birth order effect offered an explanation, establishing that gay men were more likely than heterosexual men or lesbian women to have a greater number of older brothers. An estimated 15 to 29 percent of gay men owe their sexual orientation to this effect.[7]
According to Blanchard’s research, the fraternal birth order stems from the prenatal environment. When a woman becomes pregnant with a male fetus, her body interprets it as a foreign substance due to antigens produced by the Y-chromosome. This sets off an immune response in her body, with antibodies rendering the masculinizing process inoperative, a response that strengthens with each subsequent male child. Blanchard believed this maternal immune response increased the chances that younger-born sons would be gay.
Over the years, study after study has confirmed the link between the fraternal birth order effect and male sexual orientation. In one study, Blanchard and a team of scientists, led by Anthony Bogaert at Brock University in Canada, demonstrated that the effect is indeed immunological.
In the study, mothers who had gay sons – particularly those with gay sons with older brothers – had higher levels of antibodies against NLGN4Y (a protein involved in brain development in males) than did mothers who had heterosexual sons or no male offspring. This led to differences in the way the baby’s brain is masculinized in the womb.”[8]
If the theory of sexuality being biologically driven and innate were true as these studies and several others suggest, that would mean not awarding an equal right to the community would be no different than discriminating by race. Therefore, in this context what gay marriage becomes is access to an equal right by a previously oppressed group. The result of awarding it does what the civil rights movement led by Martin Luther King did and gives the community equal access to opportunity. Equality of marriage fits in with Western principles because again it awards equality of opportunity, it raises up an oppressed class to a level playing field.
However, at some point just as in the history of mental illness the “pride” movement abandoned these biological/genetic roots and instead began favouring idiosyncratic criteria. This took the movement from the objective realm into the subjective. Szasz separated mental illness from physical by highlighting the fundamental difference between mind and brain; explaining that brain defines a physical structure whereas mind describes a metaphysical formless entity. The pride movement started with rooting sexuality and gender in biological phenomena however it has since shifted its foundation to metaphysical abstract principles. After the biological or empirical explanations for sexuality were vacated, just as with mental illness its definition (that of “abnormal” sexuality) went from narrow to ever-expanding, hence the reason why letters have been continually added to the acronym. Mental illness started its journey in the subjective realm with hysteria, now nearly a century later it can be defined as anything from depression to mania and almost everything in-between. Society over the decades accepted the idea of mental illness and subsequently the community, this caused the stripping away of the socially driven negative consequences. Mental illness gave birth to the field of modern psychology which then became a mechanism with the ability to influence society or change the rules of the meta “social game”. Similarly, the socially driven negative consequences of being gay or another type of sexuality have for the most part been removed and the original movement that formed with the objective of obtaining marriage equality has since like psychology evolved and expanded into a mechanism capable of changing the rules of the overall “social game”.
The problem with this is that both mechanisms (psychology and the pride movement) ostensibly claim to be rooted in science, however because of the metaphysical nature both fields cover (human behavior and emotion or human sexuality and social gender roles) they tend to act more as religions. Szasz acknowledges this for psychology/psychiatry in his book. “…contemporary psychiatry is characterized by a multitude of diverse, competing and often mutually exclusive beliefs and practices. In this respect and indeed not only in this respect psychiatry resembles religion rather than science, politics rather than medicine. In religion and politics, we expect to find conflicting systems or ideologies, broad consensus concerning the practical management of human affairs and the ethical systems utilized in governing and justifying particular types of group formations are regarded merely as measure of the political success of the dominant ideology. In contrast scientific theories do not as a rule concern vast populations, hence broad consensus concerning such matters are not an issue. At the same time, it is not unusual for scientists to widely and persistently disagree among themselves concerning the ideas and actions appropriate to their special areas of competence. However, there is for instance relatively little disagreement among scientists concerning basic physiological, bio chemical or physical theories, even though individual scientists may believe in different religions or no religion and maybe members of different national groups. “[9]
Outside of competing ideologies and reliance on consensus, one only needs to look at the structure of these mechanisms to see their parallels with religion. Practices are a good example, Christianity includes the practice of prayer, prayer is rooted in a belief. The belief being that it allows for communication with God. If you zoom out that belief is further couched in the concept of there actually being a God. Large overarching concepts form the basis of the religion, the concepts than facilitate several beliefs then the beliefs lead to practices which are actual actions, changes to speech, etc., that a person performs. A parallel example in psychology would be the concept of the unconscious. One of the beliefs stemmed from this concept is that dreams are your unconscious mind attempting to relay information from it into your consciousness. This leads to the practice of logging and interpreting dreams. This exact same structure is repeated within the pride movement. An example would be the practice of “preferred pronouns”. The use of preferred pronouns is rooted in the belief that one can change their gender based on personal and subjective criteria. This is further contained in the concept of “gender identity” which is an intangible thing that allows for someone to separate their perception of self from biological foundations. Without the concept the belief would not be possible and thus the practice would not and could not be executed. Why would you pray if you didn’t believe in God? Why would you log dreams if you didn’t believe they contained pertinent information? Why would you use preferred pronouns if you didn’t believe the concept of gender could be separated from inherent biology?
The fact that these mechanisms are structured as religions doesn't mean they should necessarily be cast aside as invaluable. Psychology is still an excellent tool for understanding and explaining human behavior and the pride movement offers people a sense of belonging and community. However, just as Szasz's book argues that how attempting to forcibly fit mental illness and consequently psychology within the medical model was an egregious mistake; so to is claiming the pride movement is based in objective science and purports unbiased truth. The fact is the pride movement walked away from its underpinnings in the natural sciences like biology and genetics years ago. Since then its spiraled into a subjective ideology.
Coercing the general public into its belief system by law is assimilation and impedes on the freedom of the individual and fundamental western principles, like those of freedom of speech and religion. By superseding people's personal belief systems and values with its own they're propagating the antithesis of what they claim their fundamental values are. Coercion through law or corporate policies is intolerant, insensitive and un-inclusive. What we in the present day are witnessing is nothing short of the beginning of re-amalgamating the church and state. Centuries ago we persecuted heretics and burnt witches at the stake. Today we cancel dissenting voices and strip the livelihood from "unbelievers" propagating "radical" or "hateful" viewpoints. This mechanism should be classified as what it is; an ideology. Like existing religions in the western world people should have the right to practice and adhere to it on a voluntary basis, however it's law making/changing power should be stripped or at least scaled back to the point where it only affects consenting individual adults. If we continue down this road and let this now established mechanism continue to create and change laws, it'll only be a matter of time before the guy who dared to say "there's only two genders" is set ablaze in the name of tolerance while an angry mob gathers around him waving rainbow flags celebrating his demise.
[1] Thomas Szasz, “The Myth of Mental Illness: Foundations of a Theory of Personal Conduct”, Harper Collins Publishing, 1960
[2] Ibid
[3] Benjamin Ang, Mark Horowitz, Joanna Moncrieff, “Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the scientific literature”, ScienceDirect, December 2022, https://www.sciencedirect.com/science/article/pii/S266656032200038X#sec4
[4] Ronald W. Pies, MD “Debunking the Two Chemical Imbalance Myths, Again” Psychiatric Times, August 2nd 2019, https://www.psychiatrictimes.com/view/debunking-two-chemical-imbalance-myths-again
[5] Ibid
[6] LeVay, S. (1991). A difference in hypothalamic structure between heterosexual and homosexual men. Science, 253, 1034 - 1037
[7] Blanchard, R. (2004). Quantitative and theoretical analyses of the relation between older brothers and homosexuality in men. Journal of Theoretical Biology, 230, 173 - 197
[8] Dr. Debra Soh, “The End of Gender”, Threshold Editions, August 4th 2020, https://www.amazon.ca/End-Gender-Debunking-Identity-Society/dp/1982132515?ref=d6k_applink_bb_dls&dplnkId=f008c46d-643e-469a-a667-6416736af7d9
[9] Ibid