Abstract
One conceptual dilemma which has had practical repercussions beyond the confines of scholarly debate in philosophy and the human sciences is that surrounding the notion of ‘mental illness’. A polarization of views has taken place, which, in this particular field, has been unproductive, confusing and politically consequential. In the ensuing discussion, I shall try to disentangle some of the contending claims and isolate what I argue to be the defensible positions. In so doing, I shall need to examine the notions of ‘illness’, ‘diagnosis’ and ‘definition’. Hopefully, such elucidation should cast some light upon the intelligibility of psychiatric praxis and its grounding in ordinary reasoning, but will leave open the question of how to resolve some of the better-informed disputes about its transformation as a social institution.
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Notes
This is the position first articulated in T. Szasz, The Myth of Mental Illness (Harper & Row, 1961).
See also T. R. Sarbin, ‘The Scientific Status of the Mental Illness Metaphor’ in S. Plog & R. Edgerton (eds.), Changing Perspectives in Mental Illness (Holt, Rinehart & Winston, 1971), and
T. J. Scheff, ‘Schizophrenia as Ideology’ in his edited collection, Labeling Madness (Spectrum, Prentice-Hall, 1975).
R. D. Laing, The Politics of Experience (and the Bird of Paradise) (Penguin, 1968) p. 87.
Ludwig Binswanger, ‘The Case of Ellen West: An Anthropological-Clinical Study’ (trans. W. M. Mendel & J. Lyons) in Rollo May, Ernest Angel & Henri F. Ellenberger (eds.), Existence: A New Dimension in Psychiatry and Psychology (Simon & Schuster ed., 1958) p. 331.
H. Tristram Engelhardt Jnr., ‘The Concepts of Health and Disease’ in H. T. Engelhardt Jr. & S. F. Spicker (eds.), Evaluation and Explanation in the Biomedical Sciences (D. Reidel Publishing Co., 1975) p. 136.
Michael S. Moore, ‘Some Myths about “Mental Illness”’, Inquiry, Vol. 18, No. 3, Autumn 1975.
Leonard Linsky, Referring (New York, 1967).
T. Szasz, Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man (Doubleday-Anchor, 1970) p. 19.
Alvan R. Feinstein has drawn attention to the existence of ‘diseases’ (e.g. carcinoma of the lung) which can be present prior to, independently of, a person’s being ‘ill’ (—his category for such conditions is lanthanic diseases: see his ‘Boolean Algebra and Clinical Taxonomy’, New England Journal of Medicine, Vol. 269, October 31, 1964, and
his Clinical Judgment (Williams & Wilkins Co., Baltimore, 1967), esp. pp. 145–8.) For further support of Moore’s contention, consider the following: ‘…in African communities when air travel did not exist and where malaria was common, having sickle cell trait was not a disvalue at all.
M. K. Temerlin, ‘Suggestion Effects in Psychiatric Diagnoses’, Journal of Nervous and Mental Disease, Vol. 147, 1968, p. 358.
For an excellent discussion of the history of various psychotropic drugs and the separation of psychopharmacology from organic-aetiological inquiry in psychopathology, see Leon Eisenberg, ‘Psychiatric Intervention’, Scientific American, Vol. 229, No. 3, September 1973.
Harold Garfinkel, ‘The Rational Properties of Scientific and Common Sense Activities’ in his Studies in Ethnomethodology (Prentice-Hall, 1967) p. 277.
Laurence Kolb, as quoted in Herbert Fingarette, The Meaning of Criminal Insanity (University of California Press, 1972) p. 99.
Simon Sobeloff, ‘Insanity and the Criminal Law: From McNaghten to Durham and Beyond’, American Bar Association Journal, Vol. 41, 1955, p. 877.
van den Berg, as quoted in R. D. Laing, The Divided Self (Pelican, 1965) p. 27.
T. J. Scheff, Being Mentally III: A Sociological Theory (Aldine, 1966) and
his ‘Introduction’ to his edited collection, Mental Illness and Social Processes (Harper & Row, 1967). See also
Arlene K. Daniels, ‘The Philosophy of Combat Psychiatry’ as reprinted in E. Rubington & M. S. Weinberg (eds.), Deviance: The Interactionist Perspective (Macmillan, 1973), from
‘Normal Mental Illness and Understandable Excuses: The Philosophy of Combat Psychiatry’, American Behavioral Scientist, Vol. 14, No. 2, Nov/Dec 1970, and
her ‘The Social Construction of Military Psychiatric Diagnoses’ in H. P. Dreitzel (ed.), Recent Sociology Vol. 2: Patterns of Communicative Behavior (Macmillan, 1970).
Anselm Strauss et al., Psychiatric Ideologies and Institutions (Free Press of Glencoe, 1964). See also
L. Schatzman & Anselm Strauss, ‘A Sociology of Psychiatry’, Social Problems, Vol. 14, No. 1, Summer 1966.
L. Phillips & J. G. Draguns in Annual Review of Psychology, Vol. 22, 1971.
B. M. Braginsky, D. D. Braginsky & K. Ring, Methods of Madness: The Mental Hospital as a Last Resort (Holt, Rinehart & Winston, 1969).
David L. Rosenhan, ‘On Being Sane in Insane Places’, Science, Vol. 179, 1973.
The referential comparability problem is a problem only for a limited range of theoretical, research purposes; see D. Bannister, ‘The Logical Requirements for Research into Schizophrenia’, British Journal of Psychiatry, Vol. 114, 1968.
See Waismann’s classic paper, ‘Verifiability’ in Anthony Flew (ed.), Logic and Language (Anchor Books, 1965).
Ludwig Wittgenstein, Philosophical Investigations (Basil Blackwell, 1968) para. 75.
Alan F. Blum, ‘The Sociology of Mental Illness’ in Jack D. Douglas (ed.), Deviance and Respectability: The Social Construction of Moral Meanings (Basic Books, 1970) p. 35.
For some documentation, see M. R. Yarrow et al., ‘The Psychological Meaning of Mental Illness in the Family’ in Rubington & Weinberg (eds.), Deviance: The Interactionist Perspective, op. cit., and Kathleen Smith et al., ‘The “Last Straw”; Decision Incidents Resulting in the Request for Hospitalization in One Hundred Schizophrenic Patients’, American Journal of Psychiatry, Vol. 120, 1963.
Peter Winch, ‘Understanding a Primitive Society’ in B. R. Wilson (ed.), Rationality (Basil Blackwell, 1974) p. 82.
See Zhores and Roy Medvedev, A Question of Madness (Penguin, 1971), and the excellent summary of more recent evidence by
Clayton Yeo, ‘The Abuse of Psychiatry in the USSR: The Evidence’, Index on Censorship, Vol. 4, No. 2, Summer 1975.
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© 1979 Jeff Coulter
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Coulter, J. (1979). The Metaphysics of Mental Illness. In: The Social Construction of Mind. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-09379-3_9
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DOI: https://doi.org/10.1007/978-1-349-09379-3_9
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