OK, a http://members.aol.com/ahunter3/psych_inmates_libfront/vol_1/Hill/Hill_InadeqData.html]cite and some discussion.
The link goes to my own web site, where I have excerpted with the author’s permission some chapters from David Hill’s The Politics of Schizophrenia. It is somewhat out of date, but the situation with regards to empirical demonstrations of the existence of mental illness in the medical-model sense of the word had not changed. (Also, while Hill is focusing on schizophrenia specifically, his logical arguments apply equally well to other subforms of mental illness).
To pick up with Hill’s main arguments, let us consider the medical profession overall, and the notion that a diagnostic category has to meet some criteria in order to be useful. A diagnosis of “polio”, for example, is useful in large part because several doctors would independently arrive at that diagnosis after examining the same patient. The medical description of “polio”, and the ways in which you can test for it, the telltale signs of it, etc etc, are clear-cut enough that the same patient would receive the same diagnosis regardless of which doctor was doing the assessment. Also, and this is important, it is a sufficiently rarefied diagnosis that you could not attribute the concurrence of all those doctors to a tendency on the part of doctors to diagnose practically everyone who has a little bit of difficulty walking with “polio”. Polio can therefore be distinguished from what it is not. It can be distinguished from the ordinary healthy condition of people who don’t have polio, and it can be distinguished from a wide variety of other ailments that a person might have instead.
Not every medical diagnosis passes this test of diagnostic usefulness. Some diagnostic categories are considered controversial, e.g., Epstein-Barr and Multiple Chemical Sensitivity and fibromyalgia. Some doctors might say that it isn’t clear that the diagnostic criteria sufficiently differentiate the diagnosed person from a person who experienced subclinical degrees of tiredness and pain, and some doctors might say that the diagnostic criteria do not sufficiently differentiate the diagnosed person from people suffering from a different ailment instead. (In the case of fibromyalgia, for example, there is a Dr. Lowe who believes that most “fibromyalgia” is undiagnosed or undertreated thyroid conditions).
Now let us move on to mental health and mental illness. An extremely wide range of behavioral and emotional circumstances can cause an individual to be either unhappy themselves or disturbing to others, ranging from bad marriages to bad hormones, malignant bosses to malignant brain tumors, depressed neurotransmitter function to repressed political expression. The “mental illnesses” are of course among them.
Our species has entertained and continues to entertain a wide variety of theories about the causes and possible remedies for these things, ranging from religion to hobbies to involvement in the creative arts as an avenue of expression, but the best success stories came from the medical research laboratory. Understanding the causes of epilepsy, syphilis, brain tumors, and whatnot often led to cure or at least a notion of how to maintain the afflicted individual. In the 19th century, it was believed by early researchers that the remaining causes of these human malaises would similarly be known soon. But the ones that are still called “mental illness” are mainly the ones that didn’t yield up any specific secrets. The “mental illnesses” are still diagnosed on the basis of behaviors and self-reported mental and emotional experiences. Despite all the theories and optimistic assertions that schizophrenia or bipolar disorder or depression would soon be proven to be an inherited ailment of the neurotransmitter system, the research that would nail it down and cause them to yield their etiological secrets just hasn’t taken place yet.
Meanwhile, let’s look at those “mental illnesses”. First you’ve got your basic schizophrenia. Then there is bipolar disorder (the artist formerly known as manic-depressive psychosis). Finally we have clinical depression. Those are your big three. Can each of them be distinguished from the other two and from the normative healthy person’s array of emotional and psychological states? In order to be able to answer “yes”, it would have to be true that the same individual if seen by different doctors, each of whom had no awareness of any prior diagnoses for that particular individual, would receive the same diagnosis. David L. Rosenhan’s famous article, “On Being Sane in Insane Places”, is a typical indicator that such is not the case. Basically what you’ve got is one category for nuts who simply don’t make sense (schizophrenia), one category for miserable folks who wish they were dead (clinical depression) and one for people who have mood swings (bipolar disorder). The overlap of all three categories with what they are not is huge and frightening.
Does mental illness “exist”? Well, certainly there is something (or many somethings) from which many people suffer, much as the misery of people who have gone to their doctors and received diagnoses such as Epstein-Barr or fibromyalgia is real misery. But do we know what it is, what causes it, how it “works” to cause the suffering, and what, ideally, is to be done about it? No, not really. Some people do find blessed relief by taking psychiatric meds, but others find them worse than the sufferings they are supposed to help. And to be sure, most of the psychiatric treatments were adopted because of their efficacy at controlling symptoms for institutional convenience, and they are still widely used as immobilizing agents or punishments for unwanted behaviors. Does “mental illness” exist? Possibly. Lunacy exists. Madness exists. The only thing we know about them that we didn’t know in the 19th Century is that a century’s worth of attempts to find the etiology and dynamics of the “mental illness” yields damn few findings. To some folks’ way of thinking, that would tend to indicate that they are looking in the wrong place, and that lunacy and madness are caused by other things instead.