Monday, May 22nd, 2017
CHOICE, RESPONSIBILITY, AND PSYCHIATRY
While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist. Like the personal and social troubles which people had in the Middle Ages, they are real enough. It is the labels we give them that concerns us and, having labelled them, what we do about them. While I cannot go into the ramified implications of this problem here, it is worth noting that a demonologic conception of problems in living gave rise to therapy along theological lines. Today, a belief in mental illness implies — nay, requires–therapy along medical or psychotherapeutic lines.
What is implied in the line of thought set forth here is something quite different. I do not intend to offer a new conception of “psychiatric illness” nor a new form of “therapy.” My aim is more modest and yet also more ambitious. It is to suggest that the phenomena now called mental illnesses be looked at afresh and more simple, that they be removed from the category of illness, and that they be regarded as the expressions of man’s struggle with the problem of how he should live. The last mentioned problem is obviously a vast one, its enormity reflecting not only man’s inability to cope with his environment, but even more his increasing self-reflectiveness. Read the rest of this entry »
Monday, May 22nd, 2017
THE ROLE OF ETHICS IN PSYCHIATRY
Anything that people do — in contrast to things that happen to them (Peters, 1958) — takes place in a context of value. In this broad sense, no human activity is devoid of ethical implications. When the values underlying certain activities are widely shared, those who participate in their pursuit may lose sight of them altogether. The discipline of medicine, both as a pure science (for example, research) and as a technology (for example, therapy), contains many ethical considerations and judgments. Unfortunately, these are often denied, minimized, or merely kept out of focus; for the ideal of the medical profession as well as of the people whom it serves seems to be having a system of medicine (allegedly) free of ethical value. This sentimental notion is expressed by such things as the doctor’s willingness to treat and help patients irrespective of their religious or political beliefs, whether they are rich or poor, etc. While there may be some grounds for this belief — albeit it is a view that is not impressively true even in these regards — the fact remains that ethical considerations encompass a vast range of human affairs. By making the practice of medicine neutral in regard to some specific issues of value need not, and cannot, mean that it can be kept free from all such values. The practice of medicine is intimately tied to ethics; and the first thing that we must do, it seems to me, is to try to make this clear and explicit. I shall [p. 116] let this matter rest here, for it does not concern us specifically in this essay, Lest there be any vagueness, however, about how or where ethics and medicine meet, let me remind the reader of such issues as birth control, abortion, suicide, and euthanasia as only a few of the major areas of current ethicomedical controversy. Read the rest of this entry »
Monday, May 22nd, 2017
MENTAL ILLNESS AS A NAME FOR PROBLEMS IN LIVING
The term “mental illness” is widely used to describe something which is very different than a disease of the brain. Many people today take it· for granted that living is an arduous process. Its hardship for modern man, moreover, derives not so much from a struggle for biological survival as from the stresses and strains inherent in the social intercourse of complex human personalities. In this context, the notion of mental illness is used to identify or describe some feature of an individual’s so-called personality. Mental illness — as a deformity of the personality, so to speak — is then regarded as the cause of the human disharmony. It is implicit in this view that social intercourse between people is regarded as something inherently harmonious, its disturbance being due solely to the presence of “mental illness” in many people. This is obviously fallacious reasoning, for it makes the abstraction “mental illness” into a cause, even though this abstraction was created in the first place to serve only as a shorthand expression for certain types of human behavior. It now becomes necessary to ask: “What hinds of behavior are regarded as indicative of mental illness, and by whom?” Read the rest of this entry »
Saturday, May 20th, 2017
My aim in this essay is to raise the question “Is there such a thing as mental illness?” and to argue that there is not. Since the notion of mental illness is extremely widely used nowadays, inquiry into the ways in which this term is employed would seem to be especially indicated. Mental illness, of course, is not literally a “thing” — or physical object — and hence it can “exist” only in the same sort of way in which other theoretical concepts exist.
Yet, familiar theories are in the habit of posing, sooner or later — at least to those who come to believe in them — as “objective truths” (or “facts”). During certain historical periods, explanatory conceptions such as deities, witches, and microorganisms appeared not only as theories but as self-evident causes of a vast number of events. I submit that today mental illness is widely regarded in a somewhat similar fashion, that is, as the cause of innumerable diverse happenings.
As an antidote to the complacent use of the notion of mental illness — whether as a self-evident phenomenon, theory, or cause–let us ask this question: What is meant when it is asserted that someone is mentally ill? Read the rest of this entry »