by Chuck Ruby, PhD

I'd like to coin a new term, diffunction, as part of our efforts to demedicalize our language about so-called mental disorder. This term reflects the incredible variation of our world perspectives, our value systems, and our choices as we navigate throughout life. In short, it refers to our different and individualized forms of functioning. This presents us with the difficult challenges of negotiating the conflicts among us that  are generated by those differences.

In contrast to diffunction, the conventional construct of mental disorder is an arcane and constantly shifting groupthink about good and bad ways of living. Moreover, the bad ways are deemed matters of objective illnesses to be assessed and treated with a medical approach "just like heart disease or diabetes."¹ This is how the mental health orthodoxy deals with the differences -- by claiming some are illnesses and others are healthy. As such, the DSM states:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.² [italics added for emphasis]

The first glaring problem with this definition is that mental disorder is said to be a "clinically significant disturbance" of an otherwise tranquil state. In plain words, we're talking about distress. Yet, we immediately have a quandary: How much and what kinds of deviations from tranquility surpass this clinical threshold, and why?

I'll save you the time and cut to the chase. We're talking about our familiar but elusive dichotomy of normality and abnormality -- abnormality is clinical; normality is non-clinical. But this forces us into the circular reasoning that the clinical is abnormal and the abnormal is clinical. It is impossible to determine abnormal vs. normal, as well as clinical vs. nonclinical, distress in an empirical or logical way. There will always be a judgment, whether based on social mores, moral codes, or individual preferences, as to how much and what kinds of things are abnormal. It is not a scientific or medical conclusion. This is the basis of the exalted yet indeterminate claim of professionals' "clinical judgment." For more on this, see Chapter 4, The Essence of Abnormality, in my book Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers.

A second problem with the DSM definition of mental disorder seems like a repeat of the first one. It says mental disorder reflects a "dysfunction in the...processes underlying mental functioning." Look up any dictionary definition of the prefix "dys" and you'll find synonyms such as "bad" and "abnormal." So, a dys-function is the same as bad/abnormal functioning. Does this sound familiar? We're back again with that same quandary but regarding how it applies to the processes underlying the disturbance, not just the disturbance itself. How do we determine bad/abnormal vs. good/normal functioning of those processes?

If I become fearful and confused, what are the processes underlying this disturbance. Even if we could operationally define those processes (which I don't think we can because they do not exist separate from the disturbance itself), how do we determine if those processes are bad or abnormal other than through clinical judgment fiat?

What the foregoing suggests is that the construct of mental disorder, as stated in the incredibly convoluted DSM definition above, reflects a clumsy semantic synthesis of social standards and medicine that enables the exercise of moral authority over others who are not really suffering from illness, but who are upsetting the social order of things (in a later section of the above DSM definition, it excludes "expectable or culturally approved response[s]" as mental disorders). This allows unfettered yet unfounded judgments of goodness/normality and badness/abnormality, and it falsely cloaks these moral pronouncements in a medical shroud that excuses the abandonment of due process of law while presenting it as altruistic care.

There is one sure way to resolve this dilemma. It is to abandon our moral authority position and recognize that there are differences among each of us in terms of our past and present experiences, our hopes for the future, the development of our values, preferences, and desires and, the difficult choices we make in life, even if those choices reap painful consequences. These are the things that observers might classify as dysfunction. But, in fact, they are diffunction. The difference in functioning is empirical and logical; the abnormality in functioning is not.

Besides, observers' assessments of abnormality is not what really counts. What counts is each of our assessments about ourselves --  we don't need to call it "disorder" (for those insistent on coming up with a label, try "order" instead). We simply can assess whether or not we are satisfied with our thoughts, feelings, and behaviors, given the consequences of those things. When we are not satisfied and not willing to put up with the consequences (e.g., law enforcement response, social isolation, health risks), we have the option of of doing otherwise or we might choose to reach out for help of various kinds -- professional, peer, self-study, Grandma, or our favorite AI app. Why are professionals so intent on corralling others into compliance with these social/medical standards?

When we are satisfied, we wish for the mental health industry to leave us alone. We aren't dealing with dysfunction like how physicians deal with bodily dysfunction. Bodily systems have good ways of functioning in terms of their ongoing support of biological viability, so there can be disturbances of those systems in a state of dysfunction. But when it comes to all things mental, we're not dealing with dysfunction. Instead, there is diffunction -- the many different, yet legitimate and self-determined, ways that people live.

¹ https://www.psychiatry.org/patients-families/what-is-mental-illness.

² DSM-5, p. 20.

Chuck Ruby, PhD, is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.