>Just a note on this: nobody has "psychoses" anymore. It's not in the
>DSM-IV; it's considered an obsolete term by most practicing clinicians
>nowadays (kinda like "melancholy" or "hysteria"). If a clinician
>wants to get reimbursed by HMOs for their work, they do not diagnose
>a person with a "psychotic condition". --Whether this is a good thing
>or a bad thing depends mostly on what you think of psychodynamic theory.
>
>Miles
I don't know about the baneful effect of HMO's on psychiatric diagnosis, but psychosis is very much alive and well in the DSM-IV. The term used is "psychotic condition." The basic definition is "delusions or prominent hallucinations." The narrower definition is that the afflicted individual doesn't realize the voices are hallucinations. The broader definition includes disorganized speech and behavior as well as catatonia. The DSM-IV also offers a "conceptual" definition of psychosis: "A loss of ego boundaries or a gross impairment in reality testing." Sounds like Ken's definition. But when Ken uses the term to refer to people who believe in God and country, that's a misuse of the term. It's not enough to believe God is telling you what to do. You have to actually hear his "voice." Most people who follow the word of God have perfectly clear ego boundaries and do not hallucinate. Yet these people are clearly nuts. Their impairment in reality testing is not "gross" but simple and commonplace. Psychosis is special. And that's what makes it a poor term to use the way Ken is using it.
I grew up in a house with a step-mother who was schizophrenic and a father who is pathologically narcissistic (Narcissistic Personality Disorder). I can tell you right now that my dad was the crazy one. In at least one sense, my step-mother became more sane when the schizophrenia emerged. Prior to that time, she was totally subservient. She let Dad yell at her and insult her and believed, like a total lunatic, that it was her duty to be a good wife and put up with it. After the psychosis emerged, she became powerful and assertive. She got in his face and yelled at him, often quite coherently, night and day. She moved her stuff out of their bedroom and took to the guest room. She would have left the house entirely, but it was her house, and she thought he should leave. But she was truly impaired and could not have negotiated the process of divorcing him and kicking him out of the house.
Depression is the same way. It certainly can signal a greater grasp of reality. To be depressed is, in part, to be unable to filter out the more painful aspects of life in this evil world. (Who says hell isn't real?) On the other hand, it can lead you to honestly believe that you're such an awful person that your friends would be relieved if only you would kill yourself.
People can be crazy with or without a specific mental illness, be it neurotic or psychotic. And even psychotic people can be far more sane, at least in certain ways, than most people. To be insane is to *project* reality instead of perceiving it. It's to believe what you want to believe rather than what you already know unconsciously. Furthermore, it requires total inflexibility. Anyone is capable of deluding themselves about one thing or another, but a truly insane person cannot be reasoned with. My dad, for instance, cannot ever be wrong about anything, because he is the most special and perfect person in the world, and you are automatically wrong for disagreeing with him.
To psychologize does not imply individualizing. Mental disorders and insanity are not merely functions of the individual mind. We see precisely the same disorders in groups as well as individuals. A group disorder can encompass any size group, from a family to a plattoon to a nation. Psychology can be very useful in political analysis. When I look at my dad's cognition and behavior and interpersonal relations, I see exactly the same pattern as I see with the United States. You think there's no pathology involved in the narcissistic mindset of America? Think again. Americans are far more sane as individuals than they are as a group.
Ted