Reflections on the Nature of Mental Disorder

Abstract

There is debate over what the proper scope of psychiatry is and what the nature of the conditions it treats are. The Psychiatrist Maurice Drury has described a number of cases of patients of his who came to him with what appeared to be psychiatric conditions that could also be understood in spiritual or religious terms. Is there a principle of differentiation between madness and religion?

I look at Thomas Szasz who has argued that Psychiatry, in applying the medical model, which is said to be free of any particular values, inevitably misunderstands the nature of the kind of problems people have that come to them as such problems are inherently ethical and defined against social values. Mental illness, as such, is a myth. Christopher Boorse and Jerome Wakefield have both produced theories that propose to offer a definition of mental disorder that is independent of any particular social order, that is, is objective and value free, construing mental disorder as biological or scientific fact. Such a theory is said to delineate the proper scope of psychiatric practice.

Such definitions however rely on a distinction being drawn between human nature and culture. The human subject is a union of the two meaning that such a distinction is not viable. In addition, the motivation for such a strict definition, making a definite distinction between the mentally unwell and the rest of the population has become less pressing given developments in our understanding both of ourselves and of the nature of mental disorder that have broken down and blurred the lines between normality and abnormality.

I argue that mental disorder should not be understood as representing a complete break from the world of truth and goodness. A shift that in a sense makes redundant the attempts to offer a definitive definition of the boundary between madness and sanity. In so far as there is a question over what the proper domain of psychiatry is, it is not to be found by discovering the true nature of mental disorder for the concept itself covers a myriad of different kinds of human trials and tribulations. I explore Wittgenstein's notion of form of life and his reflections on language to argue that attempts at a final definition of mental disorder is not necessarily going to offer a satisfactory answer to questions such as Drury's. The application of the concept of 'mental disorder' is something that is related to a whole slew of clinical judgements to do with social and ethical norms, harm to the individual, contextual factors, the potential benefits of treatment and so on, all reflecting judgements that reflect our own manner of life. Psychiatry offers one particular avenue of understanding and healing amongst others.