Defining mental illness may not be inseparable from the culture and society in which the definitions are being made:

This idea—that we might be able to strip away all subjectivity from the diagnosis of mental illness and render psychiatry truly scientific—is intuitively appealing. But there are a couple of problems with it. The first is that the science simply isn’t there yet. A functional neuroscientific understanding of mental suffering is years, perhaps generations, away from our grasp. What are clinicians and patients to do until then? But the second, more telling problem with Insel’s approach lies in its assumption that it is even possible to strip culture from the study of mental illness. Indeed, from where I sit, the trouble with the DSM— both this one and previous editions—is not so much that it is insufficiently grounded in biology, but that it ignores the inescapable relationship between social cues and the shifting manifestations of mental illness…

The trick is not to scrub culture from the study of mental illness but to understand how the unconscious takes cues from its social settings. This knowledge won’t make mental illnesses vanish (Americans, for some reason, find it particularly difficult to grasp that mental illnesses are absolutely real and culturally shaped at the same time). But it might discourage healers from leaping from one trendy diagnosis to the next. As things stand, we have little defense against such enthusiasms. “We are always just one blockbuster movie and some weekend therapist’s workshops away from a new fad,” Frances writes. “Look for another epidemic beginning in a decade or two as a new generation of therapists forgets the lessons of the past.” Given all the players stirring these cultural currents, I’d make a sizable bet that we won’t have to wait nearly that long.

Intriguing assessment of American society: unable to see how mental illness is both culturally influenced and real. This more complicated view may not fit as easily into American tendencies toward pragmatic approaches to issues, a belief in scientific progress, and a belief in individual effort and responsibility.