The ex-chief executive of the British Medical Journal has an amusing blog post where he notes how a Phillip Roth novel Sabbath’s Theater brilliantly ‘mimics’ a BMJ Group article on how happiness is a disease, seemingly unaware that his journal genuinely published the article in question.
At one point in the book Mickey is visiting his alcoholic wife in a clinic and after betting on the blood pressure of various patients he encounters a young woman with “a scar on her wrist” who has been in the library of the clinic reading medical journals. She reports “word for word” on what she has read in the Journal of Medical Ethics.
I was stopped short when I read this—because the Journal of Medical Ethics is published by the BMJ Group, and I was responsible for it when I was the chief executive of the group. For a moment I wondered if the piece was really from the Journal of Medical Ethics…
Roth mimics well the stilted prose of medical journals with their heavy emphasis on the passive voice. He also mimics the science that leads to problems becoming diseases. The “relevant literature” has been reviewed. This made me think immediately of Stephen Lock, my predecessor as editor of the BMJ, who always struck out “medical literature” and substituted “published reports.” “This stuff is not literature” he used to protest.
In fact, the article was genuinely published in the Journal of Medical Ethics and is titled ‘A proposal to classify happiness as a psychiatric disorder’.
It was written by British psychologist Richard Bentall who, although was clearly having some fun, was also making a serious point about the criteria we use to define mental illness.
Bentall is a long-time psychosis researcher and at the time it was not widely acknowledged that it was possible to have experiences common in diagnoses like schizophrenia, such as hearing voices, without any distress or impairment.
This is why he focuses on the statistical abnormality of the happiness state, its possible neurobiological underpinnings and it cognitive effects, often (over)used to justify why a condition is a ‘real disorder’, and then finishes with “One possible objection to this proposal remains – that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant.”
At the time, the satire was widely missed by the British press who ran lots of ‘barmy boffin’ type stories with headlines lines like “Top Doc Talks Through Hat”.
Despite its history of being misunderstood and misremembered, it remains a cutting critique of psychiatric classification and is well worth a read.