The present paper intends to clear the way to considering all psychopathology as responses to failures in the human environment by examining three common sources of error in scientific reasoning about psychopathology: the false identification of "biological considerations" with the sub-interest of organic pathology, the idea that a person could be genetically predisposed or vulnerable to psychopathology, the failure to distinguish between causal forms of explanation and explanation based upon connections of meaning and significance. For convenience, the omnibus term "environmental (...) failure-oppression" is introduced to refer to the totality of possible failures in the human environment. (shrink)

Although the “Introduction” to the DSM makes it clear that the presence of “clinical” distress or impairment is insufficient for a diagnosis of “mental disorder” , in practice the clinician is completely unshackled from the conceptual definition and is free to decide on a case-by-case basis if “enough” distress or impairment is present, regardless of circumstances, to judge that “mental disorder” can be diagnosed. It is argued that reference to a biological or psychological dysfunction cannot raise “mental disorder” from a (...) judgment quite like “This is pornography, not literature” to a technical–scientific term because “biological dysfunction” must be tied to an outcome that is itself less ambiguous than “mental disorder,” and “psychological dysfunction” erroneously assumes that how people are supposed to think, feel, and act, regardless of circumstances, can be as uncontentious as ideas about physical well being, and in addition erroneously assumes that human behavior can be causally explained. (shrink)

This afterword extends and refines the arguments presented in Cohen and Jacobs . The main point made by the authors is that the antidepressant randomized controlled trial world is a make-believe world in which researchers act as if a bona fide medical experiment is being conducted. From the assumed existence of the “disorder” and the assumed homogeneity of the treatment groups, through the validity of rating scales and the meaning of their scores, to the presentations of researchers’ ratings as the (...) genuine outcome of interest — all aspects of such trials are make-believe. The continued acceptance of randomized controlled trials as appropriate mechanisms to ascertain the actual effects of psychoactive drugs on human beings in distress confirms that researchers are inextricably dependent on large-scale organizational and financial interests that require the sustained production of make-believe results about psychoactive drugs. (shrink)