Is "mental illness" really a disease, an illness?

Question

Or is it more like a character flaw we're not responsible for.

I have read a bit on this, Szasz, some of the critical people, who I do not claim to be be representing except with the broadest strokes.

And I have been diagnosed with quite a few of the major psyhiatric disorders over the past ten years. So basically, I'm curious if we know the answer to the topic title, either way

IMO Szasz would be very foolish to say or think that everyone who claims bizarre beliefs believes they are not the case, whether or not all psychotics constantly believe what they claim...

Answer 1

I am not a specialist in the philosophy of medicine, but I know it is a controversial issue. Diseases can be classified by symptoms, or by causes. There are arguments in the philosophy of language (by Kripke and Putnam) to the effect that natural kinds terms do not refer to collections of symptoms. For example the manifestations covered by the term "acid" have change during the history of science, but arguably the term was refering to the hypothetical cause of the manifestations, not to a set of symptoms (taste and so on), and its meaning did not really change. We only got to know better what an acid is. Today there is a precise definition of acid in atomic structural term. The problem is that contrarily to "acid", our terms do not necessarily "cut nature at its joints", they do not always refer to natural kind. So a relevant question would be: do mental diseases refer to natural kinds? For most of them, they are classified by their symptoms by contemporary psychiatrists (we don't really know the causes, even though in some cases genetic factors are identified). This behavioral approach is a sign that psychiatry is not yet a full fledged science (just as alchemy was classifying natural elements by their aspects, while chemistry has structural definitions). So the question remains open. The question is particularly difficult for bipolarity, schyzophrenia and depression: it's not clear whether these are really different diseases or different aspects of the same type of problem, or not even unified diseases.

Another related question is whether they are actually diseases, or social constructs. Psychological and social phenomena are interrelated in a complex way (think of sects or religious fanatism for example: they are kinds of delusions). This is probably not the case for autism (where genetic factors and brain structural causes have been identified) but again things are more complex for bipolarity schyzophrenia and depression. In any case, if they are diseases, their nature is different from biological diseases: the sense in which an organism is healthy is much more clear than the sense in which a mental is healthy. Definitions of mental health can vary in time and social contexts, and there is probably a continuity with "character flaws" as you mention, or fanatism, etc. Mental diseases are generally defined in terms of suffering by modern psychiatry, but mental suffering is different from physical pain: it is much more subjective (it is controversial whether there is a consistent notion of "pain" covering mental and physical pain) and, again, it is interrelated with social aspects. There are also different non orthodox schools (again a sign that the field is not mature) for example approaches inspired by existantialism and phenomenology which pretend to be less reductive (proposal include relating psychosis to attitudes toward time: depression lives too much in the past, schyzophrenia in the present, bipolarity in the future. E.g. Maldiney).

Concerning the question of responsability in your question: I am not sure it is relevant. In any case we are not responsible for a disease. Diseases, biological or mental, can be innate or acquired (or prevalence can be innate), so the question of whether it is intrinsic to us or can be change is irrelevant too. Perhaps we are more responsible of our character flaws: it's up to us to change our behaviour. To some extent, people can recover from mental diseases too. That does not mean they can be held responsible for their disease in any case.

Here are some more ressources (SEP entries):

http://plato.stanford.edu/entries/health-disease/

http://plato.stanford.edu/entries/psychiatry/

http://plato.stanford.edu/entries/mental-illness/

If your question is more on the illness/disease distinction: both words have the same translation in many languages ("maladie" in french). The distinction is probably minor and unrelated to the physical/mental distinction. I found this link, where it is argued that disease refers to a precise cause, whereas illness refers to an unspecified state: http://www.anglaisfacile.com/forum/archives2/forum-anglais-2383.php In which case the question amounts to whether mental illness can be further specified. My answer below is that it is controversial, in that the field of psychiatry is not yet a mature science.

Answer 2

A Few Thoughts:

Mental "health" or "illness is, to a significant degree, a social construct, a product of a certain consensus, which I often find dubious. i.e., many people in my society who would surely object to being labeled mentally ill are nevertheless engaging in behaviors which they know to be degrading the biosphere of the Earth. The biosphere is something that neither they nor their children can live without. To continue acting in a manner that is unsustainable is, quite simply, suicidal, and yet we see this tragedy being played out before our eyes each and every day. Who gets to define health and illness for you? Who is so qualified?

This quote is from R.D. Laing's, Politics of Experience read excerpts here: There are forms of alienation that are relatively strange to statistically "normal" forms of alienation. The "normally" alienated person, by reason of the fact that he acts more or less like everyone else, is taken to be sane. Other forms of alienation that are out of step with the prevailing state of alienation are those that are labeled by the "normal" majority as bad or mad.

While, as with most other things, there's a good deal of subjectivity involved related to individual value-judgments, this is my model--physical or mental--of Disease/Health. As I see it, perfect health is a correct or accurate (optimal) orientation (+10) between the internal entity and their environment or larger external reality (Reality) while grave illness is the diametrical opposite e.g., an incorrect and inaccurate (pessimal) orientation (-10) to their environment/Reality.

These states--Optimal (+10) and Pessimal (-10)--are idealized, perfectly static, conceptual states which do not actually exist in the Reality. In the Reality we have instead a continuum with (-10) Pessimal as the far left terminus and (+10) Optimal as the far right terminus. Our hypothetical entity occupies various positions on this continuum. As the Reality exerts force upon its various components they in turn adapt and re-orient, which in turn exerts force upon, and to some degree alters, the larger Reality, and so on, and so on. Death (or, perfect illness) is characterized by stillness or homeostasis and health by motion and dynamic equilibrium, i.e., oscillation (the Wobble).

Each species and each individual has a tolerance range within which they will endure and prosper. Health displays a slight Wobble. Illness a wide Wobble. To the degree that an entity exceeds its tolerance range to that same degree will that entity suffer debilitation. An entity that strays too far past its tolerance range will first display a wide Wobble (attempting to regain equilibrium) and then dis-integrate and revert to back to its constituent components. Traditional Wisdom encourages the Middle Way and advises Balance in All Things, i.e., stay within your tolerance range and you will not only endure but, in the long-term, prosper. To stay within your tolerance range you must accommodate and harmonize your internal and external Realities.

Again, in closing, R.D. Laing: Society highly values its normal man. It educates children to lose themselves and to become absurd, and thus to be normal. Normal men have killed perhaps 100,000,000 of their fellow normal men in the last fifty years.

Hope this provides some useful information to your query.

Answer 3

You say the issue is whether mental illness is a disease or "a character flaw we're not responsible for".

This does not accurately represent the state of the controversy. Szasz does not take either position. Rather, Szasz views mental illness as a strategy for dealing with a problem in living. When people have a disagreement they don't know how to resolve and don't want to discuss they attribute it to mental illness. For example, if a grown man stops doing his job because he finds in unsatisfying, moves back in with his parents and then starts to act in a violent or unpleasant manner, he may be diagnosed with schizophrenia. He isn't ill, rather his parents don't want to deal with him and would like to get rid of him, but they don't want to admit this. Nor does the man in question want to admit that he has made a hash of his life. So it suits them both better to pretend he is ill and thereby obscure their moral problems instead of dealing with them. See "Psychiatric Slavery" by Szasz for a description of such a case.

Another problem with your question is that you lump critics of psychiatry together. This is misleading. Many people described as critics of psychiatry should not be given that label and should not be treated as the same as Szasz. For example, R. D. Laing supported involuntary commitment and forced drugging. His only substantive moral difference with most psychiatrists was the identity of the people he wants to imprison and/or drug without trial and with no hope of appeal, and what drugs he wanted to use. Laing also endorsed the reality of mental illness but said that mentally ill people understand the world better than people deemed sane. By contrast, Szasz is totally opposed to forced drugging and involuntary commitment. Szasz also would not say a person diagnosed as mentally ill understands the world better than other people. See "Schizophrenia: The Sacred Symbol of Psychiatry" and "Antipsychiatry: Quackery Squared" by Szasz for detailed discussion of the differences.

You ask whether the reality of mental illness has been settled. I have not seen much serious discussion of the issue. Critics of Szasz are usually unable even to state his position let alone refute it, see "Szasz Under Fire" edited by Schaler for many examples. Also, it's a mistake to ask whether "we" have settled an issue. What matters is not whether somebody thinks the issue has been settled. The relevant issue is the state of the discussion: what arguments have been offered and what replies have been made and that sort of thing.

Answer 4

I'm going to try and answer my own question.

Diseases are visceral and tangible failures of an organism, and assuming mental illness is not a misnomer, and the term has been around long enough to warrant the claim it is part of what we actually mean by illness, then progressively worsening mental illness is a disease.

This is also a good definition of disease, because it seems to me that mental illness can be but isn't always reversible without treatment, but if some mental illnesses are so it makes them "real" because even if the sufferer is responsible for their creation, it being a weakness which is a product of their choices and vices, they cannot help their own suffering once it has begun.

And yes, it is, partly, a social construction, but it will be even we have a mature psychiatry. This is because psychosis IMHO is a loss of reality which is replaced by language which is not understood by its bearer, both in its bearing to themselves and consensual reality. That's one way of looking at it anyway, if we take Szasz seriously and agree that delusions cannot be held in the face of an actual extant dis-confirmation by real things.

Answer 5

It most definitely isn't a disease.

I am diagnosed with dyslexia and I feel like it's a real disorder. I can barely write a sentence without a typo. I don't know what mental disorders/illnesses you are diagnosed with, but there are very real ones. For example people who have PTSD (ex. shell shock, after WW1). These people had traumas that literally destroyed their lives.