Multiplying the categories of mental illness isn't just a game; it has effects in the real world.

By Jerry Adler

No one really wants to be labeled sick, but there are times when it may be better than the alternatives. Men caught groping their secretaries plead guilty to alcoholism or bipolar disorder, not to being sleazeballs. Parents of children who can't sit still in school naturally prefer to think of them as having attention-deficit disorder, rather than being monsters. Those conditions really exist, of course, and defining them is the first step to treating them. But labeling them "disorders" is also a way to compartmentalize them, to locate the source of trouble at one remove from our real, true selves. It's a form of thinking that dates from the days when witches were assumed to be possessed by demons. It was the witches' bad luck that they had to be killed to be cured, but the same powerful impulse still works to explain away our failings by some agency other than free will--all the more so since the treatment of choice has evolved from burning at the stake to Prozac.

The explosion of diagnostic categories of mental illness isn't just a game therapists play; it has consequences in the real world, mostly growing out of the Americans With Disabilities Act. This law essentially extended civil-rights protections to the disabled, requiring employees, public facilities and schools to accommodate their special needs. Apart from some quibbling over the cost, not many people object to the principle that, say, public buildings should be accessible to people in wheelchairs. But what about someone--the person at the next desk, perhaps--whose disability consists of Antisocial Personality Disorder (DSM 301.7), characterized by "disregard for, and violation of the rights of others"? The short answer, according to Walter Olson, a senior fellow at the Manhattan Institute and author of "The Excuse Factory," is that his official disability gives him legal protection against being fired--unlike someone who has the misfortune to be simply an undiagnosed pain in the butt.

Olson's book is part of a conservative backlash against the expansive interpretations some judges have given ADA. Pundits warn of a world in which pilots with narcolepsy fall asleep on takeoffs, while waiters with Histrionic Personality Disorder (DSM 301.50) collapse in sobs if you don't order the special. A careful reading of these tracts suggests that some of these dangers are still largely hypothetical. (An employee who claimed to have extremely low self-esteem sued his employer, seeking a court order to spare him "the slightest hint of rejection or criticism," Olson writes indignantly. But the man lost.)

The fastest-growing category of disability is "learning disability," especially the variants of attention-deficit disorder. The number of students requesting "accommodations" on SAT tests--the great majority involving claims for a learning disability--has doubled in five years. Even so, last year they amounted to less than 2 percent of all test takers. A typical accommodation would be additional time to finish the exam. Obviously many people would like to have that, so there was some editorial hand-wringing last year about the possibility that the Educational Testing Service would abandon its policy of "flagging" the scores of students who received such special treatment. But after a review, it decided to continue flagging "where we feel the accommodation changes the nature of the test score," according to ETS officials (although not, say, for students who took a large-type test because of a vision problem). Sid Wolinsky, director of litigation for California-based Disability Rights Advocates, says the group is considering a lawsuit to end flagging, which he calls "an invitation to discriminate."

But the larger question posed by the revolution in neurobiology has to do with how people view themselves. There is a striking asymmetry in how we assign diagnoses to undesirable traits but not to positive ones such as prudence, kindness or intelligence. These are not thought of as "conditions," but as essential features of one's personality; we integrate what we like into our self-image and isolate what we dislike by designating it as a disease. Yet logic and research suggest that one, no less than the other, will turn out to be the expression of specific physical conditions. And individuals will always be nothing more than the sum of their traits. Someday "there will be a biological basis for everything," predicts Gerald Zuriff, a psychologist at Wheaton College. "Some people will be courageous, some shy, some vandals. But people will still be responsible for what they do."

Newsweek 1/26/98 Lifestyle/My Brain Made Me Do It