Value judgments and power in the diagnosis of mental disorders When I first started working in the psychiatric clinic after graduating from college, I often asked questions that my supervisors did not know how to answer. I remember that when I was studying neurology, my supervisors often told us that we must “localize first, then characterize” when diagnosing neurological disorders. Following this diagnostic principle, I asked my supervising teacher after I started working in the psychiatric department: Where are the delusions located in the center? The question made my supervisor stare. During a mental status examination of a schizophrenic patient, the patient complained that he was hearing someone’s voice cursing him, but none of us doctors doing the examination could hear it. At this point, the senior doctor told us that such a symptom is called “hallucinations”, which are hallucinations and are standard psychotic symptoms, just like delusions. If a person has hallucinations or delusions, he or she is definitely in a psychotic state. I asked my teacher: How do you know that the voice he heard was a hallucination? Is it only because we can’t hear them? If they can hear and we can’t, it only means that there is a difference between us and him, but what is the reason to say that we are normal and they are psychopathic? The teacher said: Of course they are not normal, because they could not hear, only after they had schizophrenia, they became this way, and, in a thousand people, only two or three people like him can hear “phantom hearing”. I’m puzzled: does the fact that he didn’t hear people scolding him in the past, but he can hear them now, mean that he was normal in the past, but now he is psychopathic? Why can’t we say that he is normal now and he was abnormal only when he couldn’t hear the voice originally? If, to judge whether a person is mentally disturbed, it depends on the percentage of the population he is in, wouldn’t that be a voting election, the majority bullying the minority? If the majority is always right, then doctors are only a minority in the ward, and the majority are schizophrenic patients who can hear voices, but the doctors who are a minority cannot, so why are they said to be pathological and we doctors are normal? Who gave us the power to rule that others are sick? Later, I discovered that there are more “truths” that are questionable. For example, we say the world is in color, but people with red-green colorblindness see the world in black and white, with only shades of gray, no color changes. At that time, I thought: If everyone in the world were color-blind, would the world still be perceived as having color? Patients sometimes have visual hallucinations: they see a glass of water on the table and we can’t see it, so we say they are hallucinating because of that. At this point, I take a glass and put it on the table, then close my eyes, and of course I can’t see the glass. Then I asked the teacher: What do you see on the table? He said: There is a cup. I said: I don’t see it, only you see it, so you’re hallucinating! Why can’t you say you are hallucinating? Because you are a teacher, I am a student, you are a senior doctor, I am a new graduate doctor, I can’t tell that you are “hallucinating”? Reluctantly, the teacher took my hand to touch the cup and asked me: What did you feel? I said: I felt a cool, hard thing, …… he asked: What is it? I said: I don’t know what it is. He said: This is the cup, the one you just put up yourself, the one you just saw. I said: I only touched a cold, hard thing, why should I believe that what I touched is the same cup I saw before I closed my eyes? You see, when you meet a student as obstinate and unteachable as me, it’s a wonder the teacher doesn’t get mad at me! I continued: If my sense of touch is numb, how can you let me know that something cool and hard is there? If my proprioceptive and kinesthetic senses are also lost, how can you let me know how far away that cool, hard thing is? If I was blind to begin with, how could you let me know that a cup existed on the table in the first place? If you are blind, and everyone in the world is blind, who can know that there was a cup on the table in the first place? We all live in our own “psychological reality”! Human beings live in the world of human “psychological reality”! Everyone has the right to live in his or her own “psychological reality”! Who is mentally ill? Who has the right to say that someone is mentally ill?