Editor's letter: 300 categories of crazy

last updated 8 January 2015

We are all, to some extent, crazy. If you come to know any human being well enough, you eventually gain access to the basement where the traumas and wounds and deprivations are stored; rummage in there for a while, and you begin to understand the neuroses and fixations that shape his or her personality. The successful, reasonably happy people I’ve known are nuts in a way that works for them. Those who struggle and suffer fail to turn their preoccupations to some meaningful use. Next week, the American Psychiatric Association releases the latest version of its bible of mental illnesses, the DSM-5, which catalogs about 300 categories of crazy. Critics of all kinds have lined up to assail this dictionary of disorders as subjective and lacking in scientific validity—assembled primarily to justify the prescribing of pills of dubious value (see Reviews: Books).

About 50 percent of the population, the APA admits, will have one of its listed disorders at some point in their lives. Shy, like Emily Dickinson? You have “avoidant personality disorder.’’ Obsessed with abstractions and numbers? You have “autistic spectrum disorder,’’ like Isaac Newton. Suffer from “narcissistic personality disorder,” with some hypersexuality thrown in? You must be a politician. To be skeptical of these neat categories isn’t to deny that minds get broken, stuck, or lost, and need help finding their way out of misery. But psychotherapy remains an art, not a science; there is no bright line between nuts and not. If you’re an old lady who lives amid piles of newspapers and personal treasures, you have “hoarding disorder.” If you’re a CEO who exploits sweatshop labor to pile up countless billions, you’re on the cover of Forbes.