WHAT IS 'MENTAL ILLNESS' ?
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"When
I use a word," Humpty Dumpty said, in a rather scornful tone,
"it means just what I choose it to mean - neither more nor
less."
"The question is," said Alice, "whether you can make
words mean so many different things."
"The question is," said Humpty Dumpty, "which is to
be master - that's all."
(Lewis Carroll: Through the Looking Glass)
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The cost of mental illness
*The
national Service Framework for Mental Health: modernising
mental health services.
**Happiness: Lessons from a
new science. 2006
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'One adult in six
suffers from one or other form of mental illness.' (Department
of Health, 1998)*
Richard
Lord Layard
has estimated that depression costs the United Kingdom between
£17 and £21 billion a year, i.e. between 1.5 and
2 % of Gross Domestic Product. This includes lost production,
incapacity benefits and mental health services, but not the
cost of individual suffering.**
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Distinguishing mental
from physical Illness
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We
mostly use the word 'illness' in connection with pathogens or
lesions, but
all it really means is lack of health! Perhaps the
best definition is an inability to do what we would otherwise be able
to do. Health
and illness are a continuum; they 'shade into' each other and there is no clear division
between them. The dividing line is a matter for
personal judgement, and we often rely on medical practitioners to decide
for us.
We also find It helpful to distinguish between physical and mental
illness. In physical
illness, the presence or absence of objectively
measurable causes, such as pathogens or lesions, makes it relatively easy to decide
if
someone is ill. But identifying a mental illness
and its causes is more difficult.
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What is mental
illness?
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Is mental illness the same as a
nervous breakdown? Is it imagined, 'all in the mind', reluctance to
'pull oneself together', a form of malingering? Or is it
something that requires medical treatment?
We may be tempted to
assume that the suffering involved in mental
illness is not as real, and not as intense, as the suffering that accompanies
physical illness. But it is very real and can be
equally, if not more, distressing. At the very
least, it involves extreme
anxiety, or nervousness. Hence the
term 'nervous breakdown'.
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'Organic' and 'functional' mental illness
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Mental
illness caused by brain impairment is 'organic', or physical,
because the brain is a physical organ . Examples are the dementias that
result from Alzheimer's, Pick's, Creutzfeldt-Jakob's and Huntingdon's
diseases, Acquired Immune Deficiency Syndrome (AIDS) and
those that result from dependence on
mood-altering substances.
But the organic mental illnesses are relatively few.
Most mental illnesses are not organic. They are prolonged,
acute emotional disturbances
capable of affecting thoughts and behaviour. They are usually
called 'functional' because they relate to mental malfunctioning
that is not caused by brain
impairment.
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Mind and brain
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Because
our minds are mediated by our brains, many people do not
distinguish between mind and brain and they assume that mental disorder is caused by abnormal brain
chemistry. But the fact that brains are the physical organs
we use to facilitate mental
activity does not mean that they are the cause of the
activity.
A musical instrument, for instance, does not play
itself. Although brain lesions can adversely affect
mental activity, it does not follow
that mental disorder is invariably caused by brain deterioration or
impairment.
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Words
and their meanings
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As Humpty Dumpty was trying to explain to Alice,
abstract words like 'illness' and 'mental' mean different things
to different people. The words 'mental' and
'mind' both come from the same Latin word and they describe
our invisible behaviour; our thoughts and feelings,
such as wondering, remembering, calculating,
judging, planning, learning, knowing,
understanding, fearing, hoping, wanting, imagining ... So
perhaps 'mental disorder' is a more accurate description than 'mental illness'.
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Brain chemistry
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When we fall in – or
out – of love, or become frightened or
exhilarated, there are undoubtedly changes to our
brain chemistry. Can there be any thought or
feeling that does not involve such changes? Is
post-natal depression, for example, caused by a
hormonal imbalance? If so, what prevents hormonal imbalance in those women who give birth
without becoming depressed?
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Cause and effects of
functional mental disorders
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Confusion
sometimes arises because many of the symptoms of functional
mental disorders (FMDs) are the same as the symptoms of organic
mental disorders! Also, there is
sometimes a reciprocal relationship between the FMDs and physical illness,
making it difficult to distinguish cause from effect.
Consequently, we may be tempted to regard the FMDs as
illnesses that require medical treatment, even though they are
not.
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Schizophrenia
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Although the
FMDs are by definition not caused by any detectable
brain impairment, does it mean that there really is no
impairment or simply that none has so far been
detected? Is the absence of evidence the same as evidence of
absence?
The diagnosis of schizophrenia is an example. Is there a genetic factor, as some
studies have suggested? Are the brain
abnormalities that have been detected in some
people diagnosed as suffering from schizophrenia the cause or
the effect?
The answer is that there are probably several different kinds of
mental disorder diagnosed as
schizophrenia, some of them organic and some functional!
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Diagnosing FMDs
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The most
important difference between the FMDs and
physical illness is that the categories medical practitioners use
to diagnose the FMDs are of a very different kind
from those used to diagnose physical illness. A physical
illness category suggests a likely cause. For
example, a diagnosis of influenza suggests that a virus is
exploiting a weakened immune system, that byssinosis (a lung allergy)
is caused by dust in a cotton factory, malaria by a mosquito-borne
parasite and so
on.
A FMD diagnosis, on the other hand, consists of groups of symptoms whose causes
are indeterminate, perhaps physical, perhaps mental.
Mental 'stress' (meaning a surfeit of perceptions, or 'information
overload') is usually the main cause, but the word means
little without a detailed explanation.
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Diagnoses are
'conjectural'
*Reported
in The Times 12th April 2000
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When people suffering from a
FMD consult a medical practitioner, they are likely to be told
that they are suffering from a particular category of
mental disorder. These categories are
'conjectural'. In other words, they are
'clusters' of symptoms
that, although they have no
scientific basis, enable the practitioner to
select particular forms of treatment and reassure their patients that their condition
is a medically recognised one. The conjectural
nature of the diagnosis is typified by the fact
that, until 1974, homosexuality was categorised as a mental
disorder; and apparently is still so regarded by the
Italian Court of Cassation (Supreme Court) and
the Vatican's Sacra Rosa.*
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Pathological beliefs
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In the USSR a
number of political dissidents were compelled to
accept psychiatric treatment because it was clear
from their behaviour that their minds were
unbalanced. Were the government ministers duplicitous, or were
they too motivated by sincerely-held
belief?
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Malingering
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Is there a clear
dividing line between illness and malingering? In
what category is the litigant who raises his arm only to shoulder
level when asked how far he can, but then raises
it above his head when asked how far he
could before the accident? Are children who suffer from
'Attention Deficit, Hyperactivity Disorder' (ADHD) tempted to think it is
the illness that causes them to misbehave? People in responsible positions
have been known to avoid criminal
charges because a psychiatrist has opined that they
are too ill to plead. There are even cases in which patients qualify for
cosmetic surgery because the surgeon has to decide between
their physical need and their psychiatric diagnosis.
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'Social
and political assumptions sometimes lie at the heart of what
we regard as mental pathology ...' [Michael King, Glenn Smith
& Annie Bartlett Treatment of Homosexuality in Britain
since the 1950s — an oral history: the experience of
professionals. [British Medical Journal, 21st February 2004]
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Personality
disorders
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Yet 'psychopathic' behaviour, such as pyromania, kleptomania, paedophilia and
sadomasochism is not categorised as a mental illness
because there is no recognised
medical treatment for it!
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Causes
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When the causes of
FMDs are thoroughly examined with the help of
someone who specialises in such work, they are
invariably found to consist of difficulty coping
with the demands of living, such as: the
experience of puberty; marital breakdown;
unsatisfactory relationships; parenthood and the
eventual 'empty nest'; bereavement; loss of
financial or social status; unemployment; adverse
working conditions; involvement in a serious accident or heavy or prolonged bombardment;
neighbourhood crime; violence; intrusive noise; a
sense of being completely isolated or abandoned
... Even though the sufferer's brain is not defective, it may
become defective simply because it cannot keep up with
the demands made of it!
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Controlling the
causes
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Mostly, we react to
such events in ways that enable us to cope
without becoming ill. Such reactions as
headaches, depression, anxiety, panic attacks,
listlessness, shortness of temper and nightmares
are warnings that we may need to withdraw
temporarily from the situation in order to
determine what is really troubling us and the
best way of dealing with it. But, if too many
adverse events occur within a limited period or
if we are ill-prepared for them, the information overload may
swamp or
mental capacity. Our minds become 'unbalanced'. We are unable to 'see the wood for the trees'.
Thoughts may become so jumbled or disordered that
we tend to behave irrationally and even
bizarrely.
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The long-term solution?
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Reducing the incidence of
mental illness and the suffering of those who do succumb will
not be easy, simple or swift, but a good starting point might
be to question, more rigorously than we have until now, the real nature of the
FMDs and their most likely causes.
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LINKS:
Suggested Reading:
Illusion and Reality: The Meaning of Anxiety by David
Smail. J.M. Dent & Sons, London 1984.
Making Us Crazy by Herb Kutchins & Stuart A.
Kirk. The Free Press, New York 1997
Recent advances in understanding mental illness and
psychotic experiences: a report by the British
Psychological Division of Clinical Psychology June 2000.
Post Traumatic Stress Disorder: Issues and Controversies
ed. Gerald
M. Rosen. Wiley 2004
Violence
and Society: Making Sense of Madness and Badness by Elie Godsi.
PCCS Books 2004
Sick and Tired:
healing the illnesses doctors cannot cure by Nick Read. Weidenfeld &
Nicolson 2005
'The Limits of BIomedical Models of Distress' by Lucy
Johnstone; and
'Critical Child Psychiatry' by Sami Timimi in Critical Psychiatry
ed.
Duncan Double. Palgrave Macmillan 2006
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