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My ideas are constantly changing as I learn. Sometimes they even change midway through writing a post.

Tuesday, July 26

Comment - Mental Illness

Dear Kolya,

I really appreciate your comments although I think so far, I tentatively disagree with some of what you've said.

Debilitating behavioural syndromes such as schizophrenia, manic depression and eating disorders are real. But it's highly tendentious to call them illnesses, because the prevailing theories about their causes, their consequences and their remedies are all morally very controversial. By calling these syndromes "illnesses" we gloss over that controversy and hand over authority to adjudicate on these moral issues to a "priesthood" of psychiatrists who lack any special moral insights for dealing with them. While there exist some wise and humane psychiatrists and therapists, as an objective body of transmissible knowledge, psychiatry is, as Szasz rightly says, just like alchemy.

I think refusing to call mental problems(or controversies) "illness" has already led to a serious problem - moralists who heap blame, shame, and guilt on those who genuinely need medical or some type of help. At least when they're diagnosed with an illness, people with these difficulties can be treated as deserving of help and with some optimism about living better lives.

I'm not convinced that doctors and scientists aren't doing a better job than "moralists" have done so far. Sure they've made and will continue to make mistakes, but at least they're trying to find ways to test their theories and correct them.

Good moral knowledge could help with this, but I don't think it's enough. The record for helping such people outside of the medical community hasn't been very good.

I know people who seem to have been substantially helped by anti-depressants and therapy. I also know of people who actually seemed to be hurt by it. I think this could be a problem with fitting the best solution to the patient. In some cases, substantial life changes (moving, divorce, etc) seemed to bring about a lot of improvement.

It's hard to say whether it was the person who was particularly sensitive to the environment, the environment/interactions being particularly bad for him, or whether there was some brain difficulty. Sometimes change was suggested by a therapist and sometimes it wasn't. I wouldn't say this is a lack of good knowledge about it, just a particular difficulty or mistake with finding the best way to help the particular person. It could have been that for a person in a seemingly similar situation, drugs and therapy would have helped. I think knowledge about how to find the best way to help will improve.

However, it would be ridiculous to suggest that just because the prevailing psychiatric theories are wrong, serious mental disorders don't exist. They exist all right; it's just that they are not illnesses in any useful sense of the word. Having said that, we cannot entirely de-couple the management of these problems from the medical profession, because prescription-only medication has a legitimate role to play in the management of mental disorders. Moreover, as some behavioural disturbances are caused by genuine illnesses such as thyroid malfunction, brain tumours and Alzheimer's, it makes sense for doctors to be involved in the evaluation of certain kinds of mental/behavioural disorders.
Kolya | 07.17.05 - 8:28 am |


I think mental disorders do share some important characteristics with "medical illnesses" in that they're an "impairment to normal functioning". Personally, I think "healthy" would be a better term - as in "impairment to healthy functioning" (being different from "normal" might not actually be an impairment to health).

This doesn't mean a person can't manage to function well in spite of illness - physical or mental - at times. It doesn't mean there won't be mistakes made about what it means to actually be "impaired", what it means to be "normal" or "healthy" mentally, and whether a particular person is "healthy" and "normal".

If there are problems with the system for avoiding and correcting those mistakes, then those problems can and should be addressed and improved. I've been really impressed with the bits of medical history I've read so far. Yes, there have been plenty of big mistakes, but there have been some amazing improvements and breakthroughs.

Cheers,
Becky

2 comments:

Becky said...

(This comment has been copied over from the Haloscan system to the blogger system)
I think refusing to call mental problems(or controversies) "illness" has already led to a serious problem - moralists who heap blame, shame, and guilt on those who genuinely need medical or some type of help.

This is why the concept was invented, I think. Originally it was supposed to be a metaphor, I believe; we were being asked to treat people in such as situations as if they were ill. Then somewhere along the line, we lost the qualification (probably as a result of developments in neurology and genetics suggesting tenuous 'causes'). FWIW, I'm with Szasz.

I know people who seem to have been substantially helped by anti-depressants and therapy. I also know of people who actually seemed to be hurt by it. I think this could be a problem with fitting the best solution to the patient.

Many / most treatments seem to be about making people "better animals". I don't mean that pejoratively, just that for a lot of people physical survival, mate selection, breeding, and herd / pack membership seem to be their sole goals in life, and periods of mental illness can disrupt that. Other people are naturally not very good animals (I'm one), because they just don't care about that stuff — but they are interested in learning what makes the universe tick. ADs never worked on me.


I think mental disorders do share some important characteristics with "medical illnesses" in that they're an "impairment to normal functioning". Personally, I think "healthy" would be a better term - as in "impairment to healthy functioning" (being different from "normal" might not actually be an impairment to health).

I'm afraid 'healthy' gives me the creeps almost as much as 'normal' (or 'functioning' for that matter - are we robots?) .. the people who spend 40+ hours a week complying with their bosses demands at work, and the rest in an endless whirl of shopping and socializing are supposedly 'healthy'; those of us who spend hours on the net (because it's the only easily accessible source of interesting data) seem generally to be seen as not quite right in some way ..
acheron_hades | Homepage | 08.03.05 - 3:32 am | #

Leo said...

There is no such thing as mental illness or even mental disorder.

The powerful are sane, the powerless are mad. What else is to talk about?