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Joel Bowman's avatar

Fascinating topic! Thanks for another excellent and thought provoking post, as usual...

I notice that Thomas Szasz (author of the controversial book "The Myth of Mental Illness") has lately been exonerated for many of his views. A psychiatrist and academic himself, Szasz argued that what we call "mental illness" is really closer to a metaphor, a way of explaining particular patterns of behavior, rather than a physiological "illness" or "disease" as we more commonly use the terms.

Szasz cited the since discarded "illnesses" of drapetomania and hysteria as examples of when society, disapproving of a particular behavior (slaves fleeing their owners and women not bending to a man's will, in the above cases) were not really "illnesses" at all, but simply a way for society to label and diminish one's individual agency and, thereby, better control them. (If you assign a runaway slave a mental "illness," it's easier for society to invoke "civil commitment," for example, to claim that their behavior is driven by some kind of aberrant condition that needs to be treated, even by involuntary hospitalization.)

Nowadays, we generally consider the desire for freedom (from slavery) and individual expression (even if it means - gulp - going against one's partner's desires) as perfectly natural. It's interesting to think of the way society shapes our perceptions of what is and is not acceptable, and the labels used to stigmatize those society disapproves of in order to victimize and control them.

Also interesting to consider the kinds of societies we build, and what types of behavior they incentivize and reward. If we build a society around the ancient Greek concepts of arete (excellence), isonomia (equality before the law) and xenia (hospitality) for example, we might expect an entirely different outcome than if we build one incentivizing other types of behavior... blind obedience, for example, in place of individual virtue and character... or one prizing victimhood in lieu of eudaimonia (the concept of happiness and human flourishing).

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Dr. B's avatar

Evocative question with many volumes devoted to its answer. I’ll attempt a short one.

“REAL” (especially in capital letters 😉) is a tough case to make for any object or idea much less one as inky and controversial as “mental illness”. Nevertheless, after much thought - and 30 years as a practicing psychoanalyst - I will give it a go with the confidence I might be at the level of “justified belief” instead of simply “opinion”.

I’m my view, mental illness is real and can be manifested and known in the subjective experience of unnecessary suffering in a person and/or the others in interaction with that person. When the suffering is mostly located within the person (perhaps like Anya’s new college friend with an apparently unspeakable collection of hallucinations) we see mental illness. In Caligula’s instability and cruelty we more easily see the unnecessary suffering inflicted upon others. Most times it’s a mixture (i.e. agoraphobic terror which torments the individual and gives pain to loved ones). This definition leaves aside all questions of etiology.

Freud described mental health as the ability to “love and work” with only the “misery of everyday life” remaining after a successful treatment. I believe that definition also implies that it is the presence of phenomena which lead to unnecessary suffering which ought to qualify as mental illness.

I believe this definition also marries well with the interests and goals of most schools of philosophy. After all, it’s hard to make a case for the good life or optimal happiness and well being for individuals or groups including any measure of unnecessary suffering.

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