eXTReMe Tracker WARNING: The opinions expressed and linked to in this blog are not necessarily mine (anymore).

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

Friday, July 15

Mental llness

Below are my comments in reply to an article about Creationism Setting the World to Rights .

At first, I couldn't see much point in saying mental illness doesn't exist and that it was something that could be used interchangeably with brain disease. It finally occurred to me to look at it another way:

With physical symptoms, there's usually some idea of harm they are doing to the person's body. With "mental illness", a set of "symptoms" based on behavior is likely to be very biased by what people think of as "normal" and people might be very wrong about what should be normal.

With behavior/mental "symptoms", sometimes what is harming the patient are other people's reactions to it. For example, some people might consider being homosexual "abnormal" and think of it as something that should be "treated" to prevent the tendeny to behave in "self-harming" ways. In reality, I think such a person is likely healthy and trying to treat him or make him behave "normally" is likely harmful to him.

I can't be sure of this, but I think David's aversion toward using the term "mental illness" could actually be partly out of respect for individuals who are different but possibly not "diseased". Then again, once it is understood that a "mental illness" is actually normal, people could always recategorize it that way. This can be difficult for such people because the stigma of it being a mental illness can take a long time to go away within a culture. It still seems like there ought to be a term for labeling a set of behaviors/symptoms that we think are unhealthy/bad for the patient or could cause them to have bad interactions with people. I think illness offers the benefit of seeing it as something the person is working to have treated or overcome. I'm not sure what other term would be appropriate. I don't think being "mentally ill" would mean that a person has no responsibility or culpability. As David suggests, the person could be held responsible for harm he causes as a result of his failure to obtain and adhere to treatments.

As for deciding about culpability and responsibility, I think it's trickier than David has suggested, so it would be great if he'd expand on it a bit.

What if a person is unaware of the effects of a brain disease/difference when he does something harmful to someone else? David suggests such a person wouldn't be culpable but he should seek to get help.

What if getting help is also risky? A person admitting to a mental difficulty could be barred from employment and find themselves rejected socially.

How much risk is the individual's responsibility to take on? Doesn't society have some responsibility for creating an environment where admitting to and receiving treatment is so risky?

Suppose a person is aware of his condition and takes what he thinks are reasonable measures which turn out to be insufficient. For example, he only has noticeable altered state type symptoms when he eats a particular food. He doesn't take medication but is careful to read labels and ask about ingredients in dishes in order to avoid the food. Despite his care, he unknowingly ingests some one day and as a result is in a bad mental state and harms someone. What then? Is the person "culpable" or "responsible"? Should people err on the side of taking whatever drugs or therapies offered to avoid harm even if the treatments are risky? (some anti-depressants have been linked with higher rates of suicide and aggressiveness, from what I understand) Would such a person then be responsible for being even more selective about his food choices (say only eating specific things that he's tested on himself with someone to supervise him) or would it be sufficient to tell everyone he knows about this risk and help him keep a look out for symptoms? Is he cupluble for mistakes in treating his condition? Are treatment decisions something that should be assigned to another party?

What if part of a person's condition prevents him from being able to accurately assess the need for treatment? A person who is "manic" might feel "great" and not see any need to be treated and yet the person's behavior could become very harmful to himself and others. The same person might, in a different state, might be quite calm and non-violent and shocked by his own behavior in the past and not be able to understand how he could have done such things. How would one tell the difference between a "manic" person and a normal person who is simply making some bad choices because .. well why?

Becky Moon


Becky said...

(This comment has been copied over from the Haloscan system to the blogger system)
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.

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 | #

Becky said...

(This comment has been copied over from the Haloscan system to the blogger system)

On the subject of culpability, I think there exists a lot of confusion about what this really is. People tend to assume that culpability is a fundamental quality like right and wrong. I don't go along with that. I think that assigning culpability is basically a way of coming to feel OK about the degree of coercion against a culprit that we judge to be optimal from a societal point of view. In other words, we deem people culpable in proportion to how severely we want to punish them or deter them or others. And this is strongly influenced by social trends and changes in our factual knowledge.

For example, whereas once it was deemed exculpating to have been drunk when causing a traffic accident, more recently the trend has been to consider inebriation an inculpating factor. What this boils down to is that society has decided to increase the degree of deterrence against drunk driving, in order to exert a stronger influence on drivers to change their behaviour regarding drinking and driving.

It follows from this conception of culpability that a person's degree of culpability is a function of how susceptible that category of persons is to being deterred. That's why, generally speaking, the madder people are, and also the younger children are, the less culpable they are deemed to be. But culpability is not the only legitimate reason for coercing culprits. Sometimes we are justified in incarcerating people who are dangerous to others, even if we do not deem them culpable. But this kind of decision ought to be made by legislators and judges, not by psychiatrists and psychologists.
Kolya | 07.17.05 - 8:29 am | #