tion, treated with talk. Every bit of research suggests that they’re both
right. This does not stop them from arguing over who is “righter.”
There’s no question that mental disorders have physiological com-
ponents, but whether they are causes or effects is still unclear. That’s only
one of many ways mental illnesses are different from other diseases. They
just don’t fit the model, but it’s not for lack of trying. Every few years the
American Psychiatric Association puts out a new diagnostic manual in
which the names and descriptions of disorders change according to the
latest medical theories. The Diagnostic and Statistical Manual of Men-
tal Disorders, widely referred to as DSM, is by far the best classification
system anybody has ever devised; the problem is with the diseases them-
selves.
Most of what we call mental disorders have two distinct elements:
their symptoms—such as anxiety, depression, or anger—and the patterns
of thoughts, feelings, and actions that cause those symptoms to mess up
people’s lives. In real life, the two are inextricable. In the DSM they are
divided into clinical disordersand personality disorders,as if they were sep-
arate, the general wisdom being that symptoms can be alleviated with
medical treatment but personalities can’t.
The Disease Model
Most physicians believe that mental illnesses are brain diseases—imbal-
ances among chemical neurotransmitters at the synaptic level. (We’ll dis-
cuss the nuts and bolts of brain function in later chapters.) Different
disorders are thought to relate to different neurotransmitters and/or dif-
fering structures within the brain. Treatment involves prescribing medi-
cations that enhance or inhibit the appropriate chemicals. Solid and
convincing as all this sounds, it is still theory rather than fact. Science is
not advanced enough to prove it with anything but circumstantial evi-
dence. There is no question that many medications have profound, posi-
tive effects on the symptoms of metal disorders, but why they have these
effects is still a matter of heated debate.
Perhaps one day biochemical causes and cures will be found for all
the symptoms in the DSM, but that day is not yet here. Mental disorders
are still more complex than any theory yet devised to explain them, and
What’s Wrong with These People? ❧ 35