A Mental Health Epidemic

Great Debates
61

dis·ease
1 obsolete : TROUBLE
2 : a condition of the living animal or plant body or of one of its parts that impairs normal functioning : SICKNESS, MALADY
3 : a harmful development (as in a social institution)

Is manic-depressiveness normal functioning? Is schizophrenia? Is talking to people who aren’t there? These may not cause pain, but they impair normal functioning enough to be classed as a disease. We have a range of what is considered normal in both body and mind, and sufficient deviation from that is considered a disease. The definition of normal itself, whether body or mind, cannot exist without society. Being born with a syndrome that progressively (yet painlessly) cripples your legs would be considered normal if 99% of people were always born this way. You claim it is society based as if that negates it, but I am referring to deviance that would result in an inability to adapt in the vast majority of societies; the only society it would be acceptable in is one that happens to exactly accomodate the mental disorder, just as a person whose legs progressively became crippled would be perfectly suited to a society consisting solely of progressively-leg-crippled people but considered to have a disease that impairs normal functioning in every other one.

If you are uncomfortable with the term “disease” for deviance in mind rather than body, make up another, but I believe I am using it correctly.

62

No. Physical medicine can define a disease even when it’s endemic. 99% of the population has tooth decay, but it’s still a disease. If you are going to define anything in relation to society, it is a humanity, not a science. Disprove me.

63

I suppose I would say tooth decay is a disease because it impairs functioning, and it is desirable and possible to do without it, or to amerliorate the effects. Would the fact that someone enjoys tooth decay mean it is not a disease? But by your defintion of disease, it would, and tooth decay would simply be a social convention, since while most people think it’s doing harm, if you really enjoy it it’s not a disease, even if it interferes with your ability to function “normally”. I do think that we can toss your defintion of a disease as necessarily causing pain; think of someone who gets a syndrome that causes a painless purple splotch to appear on his face. Now according to you, if this bothered him, it’s a disease; if it didn’t, it’s not. How can we tell what is “normal functioning” without other people (society) to compare it to?

You like to refer to mental illness as merely a social convention, but many mental illnesses do genuinely interfere with successful functioning in all but a society that happens to be perfectly tailored to their exact illness (nor can I think off offhand a society where schizophrenia allows you to function well). For many of them humanity itself would have to be significantly different to allow them to function well. I do not think you can legitimately claim that it is wholly a matter of taste or social preference; currently they do indeed study brain chemistry and makeup, and try to correlate it to behavior. I admit we do not know as much about the brain as we do the body, but we can hardly do a great deal of exploratory surgery. If a person with a deficiency in Brain Chemical A is manic-depressive, but they can be given a drug that “stabilizes” them and allows them to function better, why is this a “humanity” rather than a “science”? Are you saying the manic-depressiveness or schizophrenia is the way our bodies and minds are supposed to function, and it is simply a social convention that says that people who cannot hold a job or who talk to people who aren’t there are not functioning the way they should, just as when a person’s leg painlessly falls off that his body is not functioning the way it should? Do you think that every single aspect the human brain comes in is properly functioning, and the fact that it can radically impair functioning is simply society’s fault? Why is “proper mental functioning” simply a social convention, but “proper physical functioning” is not? I suppose my qualification for a disease would be: Does it significantly impair normal functioning? Is it beneficial to do without it or ameliorate its detrimental effects? Is it not the result of trauma? (i.e. a bonk to the head can cause you to lose your menory, but that’s not the same as Alzheimer’s.) Quite frankly, the way “disease” is defined specifically includes mental as well as physical impairment of functioning; this is the way the word is used.

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Whether or not a brain chemical is the cause is not an issue, as AHunter pointed out. And I’m sure that there are mental illnesses which can be shown to be the same without appeal to society. That is what the science of neurology is for.

Psychiatry, on the other hand, is an attempt to make an objective science out of a subjective view of humanity. It was thus when drapetomania was a mental illness, and I don’t see how it’s improved.

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I’m not sure that we just haven’t figured out exactly what brain chemical/brain setup does cause mental illnesses. It’s not as easy to crack open the head as it is to do exploratory surgery, and people are even less keen about experimental messing with their brain than they are with their body (can’t say I blame them). I see psychology more as “we don’t know exactly what causes this yet, but it is impairing normal functioning, so we will try to fix it.” We don’t know what causes cancer yet, but we try to treat it.

Now, as to psychology being a humanity or a science, I’m going to have to ask why you are making such a point to call it a “humanity” here. As I see it, psychology makes observations, formulates a falsifiable theory, and tests it out. Ex: a person who exhibits behavior A as a child will almost certainly manifest behavior B as an adult. Behavior B can be treated sucessfully with treatment A. Now, this is a “soft science”; it is not as 100% accurate as, say, physics; people are not ping-pong balls and are far more unpredictable. Heck, we can’t even predict the weather reasonably accurately, and medicine is reasonably accurate but not 100% either. There is also a “hard science” aspect to psychology: Alzheimer’s seems to result in stripping of the nerve ends; this process can be halted or slowed by use of nicotine. Or: Depression is a result of improper production of serotonin; Zoloft can get this back to “normal”. Is the “soft science” aspect of predictions and theories of psychology what you are identifying as a “humanity”? If so, does this mean that the treatments for mental disorders should not be used since they are not “hard” science? I’m not sure where you’re going by making such a point to refer to it as a “humanity”.

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I’ve been watching this back and forth for a while, and I have pretty much had to concede that both of you are scoring points.

Gaudere: You simply cannot define an illness as being characterized, in part or in whole, as being bound up with the individual’s functioning in society and then claim that there is no element of social convention in determining what constitutes an illness. The societal norms are part of your definition, and therefore must be applicable. Mental illnesses have been redefined or even discarded due to societal changes, homosexuality being the most widely known example.

Matt: Just because societal norms are mutable does not mean that mental diseases are all arbitrary or completely subjective. Plenty of mental illnesses impair an individual to the point where he does himself or others real, measurable harm. Others may be less obvious, but that doesn’t mean they are fictional. Even if all mental illness was societally based, they would still have validity when you consider that you must function in that society. You could make a case that your disease is merely a social convention if you like (I don’t have any experience with it, so I won’t debate the point with you.) but you cannot logically extend that indictment to the whole discipline of psychology.

Personally, I don’t care much for psychology, because its definitions are imprecise, its language open to interpretation, and yes, it’s far too subjective. I much prefer disciplines where things are more measurable and falsifiable. That doesn’t mean that it isn’t a worthwhile endeavor. It does seem to help plenty of people, even if some are harmed by it as well. It’s the same with physical medicine.

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I know this, as I believe I pointed out.

The reason I think it’s important to keep in mind that some mental illnesses are based on the conventions of society is that since individuals are more real than systems, it is the systems which ought to change to accomodate individuals and not vice versa.

68

I think the problem I have with the “social convention” statement is that I think, even in the absence of a society, if you have inherently insufficient social skills you have inherently insufficient social skills. Just as if in you live in a dark cave, you still have cataracts even if they are no impediment to you. “Disease” I think refers to something that is an impediment under “normal” circumstances; not in a dark cave, not on a island with no one else around. It is still a disease whether or not you’re happy with it, or whether or not it might not be an impediment under certain specialized circumstances.

I think Matt and I have been going back and forth because he thinks a “disease” must mean that it has to be treated (correct me if I’m mistaken, Matt). Therefore, classing autism as a disease means it has to be treated. I don’t agree that a disease needs to be treated, whether or not it is mental or physical. If it is not a serious impediment and the person is content, no treatment is needed. Even if it is a serious impediment, if the person can function marginally adequately (can somehow prevent self from dying, even if this requires begging, handouts, shelters) and does not want treatment, treatment is not required. If a child is sick (but not fatally) and the cure appears to do more harm than the disease, the treatment should be discontinued. Hell, I have eczema, which is considered a disease, I think (it’s an allergic reaction). Do I get any treatment for it? Not usually, only when it becomes a problem. Do I think anyone has a right to tell me to get treatment when it’s not bothering me? No. When I was a child, did my mom treat me for it? Yes; but if it hadn’t bothered me and I didn’t want treatment, she wouldn’t have done so. If I go someplace where the eczema is never a problem for me, do I still have a disease? Yes. Would it be ridiculous to get treatment for something that doesn’t bother me and doesn’t do me serious harm? Yes. I think it should be the same way for mental illnesses. Comments?

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That’s fine, Gaudere. At this point my problems are twain:

  1. You cannot scientifically posit something which is a disease in one society and not-a-disease in another society. If sutteeism is a disease in America, but not in India, that means that a woman could instantly be cured of that disease by choosing to immolate herself in India rather than America.

  2. You cannot define as a disease a personal condition which causes you to chafe against established systems, simply because the systems are less real than the persons. It is more humane (if more difficult) to change the systems rather than the persons.

  3. Whether or not it ought to be cured, calling my autism a disease (rather than a personal flaw) is exactly the same as calling my homosexuality a disease (rather than a personal flaw). It’s like saying, it isn’t his fault, poor thing, he can’t help it. What if I said it isn’t a fault, I’m not a poor thing, and I don’t need to help it?

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Can you scientifically posit something that is a disease in one situation, but not in another? Cataracts are an impediment to normal functioning, a “disease” in normal life. But if you live underground in the dark all the time, they’re not an impediment. Therefore are they not a disease?

It’s not the suteeism per se, I think; it’s the inability to adapt to current society. By a coincidence, the woman went to a place where her inability to adapt to most societies was not an impediment, like our cataract sufferer who went underground.

??? Changing the system requires changing people, lots of 'em. As I said, lack of mental illness seems to be a certain degree of ability to adapt to most societies well enough to function fairly well. Should you be unable to adapt well, but coincidentally are living in a society where the way you are is not an impedient, it may never be known if that you have a mental disorder. A person with dyslexia living in a place where no one reads or writes will never know that they are dyslexic. Nevertheless, I would still consider them dyslexic.

I went over the difference between homosexuality and a mental quirk that may cause you to do repetitive motions, impair social skills, or hear things that aren’t there, previously. I don’t think that you can make a case that homosexuality in and of itself inherently and significantly impairs your ability to function in most societies. I don’t think you need to “help” your autism if you are content the way you are, and any problems it causes you (if it does) are in your opinion not worth bothering to do anything about. If it did bother you, then you would probably go get treatment on your own. I don’t think your autism makes you a “poor thing” any more than my eczema makes me a “poor thing”. It means we’re not perfect, that we both have a disease (in my opinion, not in yours, I recognize), and I don’t feel the slightest bit inferior for not being perfect. Nevertheless, the fact that your autism doesn’t bother you doesn’t change the fact that you have autism any more than the fact that my eczema doesn’t bother me mean that I don’t have it, or it isn’t a disease.

I think we have hashed this out quite a bit, and our positions appear to be irreconcilable; perhaps our definitions are simply too far out of sync. ::shrug:: Good arguments, Matt. :slight_smile: I’m going to bow out since we seem to be going over the same points again and again and getting nowhere. Just a final note: I think that there is a very negative view of mental illness in our society; a view that is not as evident for physical illnesses. You have a physical illness? No big whup, get it fixed if it bugs you. But people don’t have the same attitude toward mental illnesses. I’d like there to be the same attitude towards both. I, personally, don’t think that will be accomplished by denying that they “really” are illnesses, and I am extremely hesitant to classify manic-depressiveness or schizophrenia as a “personal flaw” or the result of “social convention”. YMMV.