The Philosophy of Mental Illness

My wife is getting her masters in philosophy and stumbled across a book she thought I should read.  She was right; it’s very interesting.  It’s called: The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness by George Graham.  I had never given this topic much thought, but it bears considering because the ramifications of which philosophy of mental illness we choose to believe are simply enormous.

We are all familiar with the mainstream philosophy of mental illness because we are all aware of the current methods of treating it.  We have drugs for depression;  drugs for psychosis; drugs for anxiety and so on.  Issuing prescriptions for drugs to treat mental illness is a demonstration of a mental health philosophy that views mental disorders as disorders of the brain.  This philosophy has roots both in capitalism and materialism.  The capitalistic part is simple: higher profits are made selling drugs than selling labor.  This also works well for insurance companies because therapy is more expensive than drugs.  The materialistic part of the argument holds that consciousness is an emergent property of the brain, and therefore the brain must be the root of all mental activities.

Graham does not get into the capitalist element, but I will, because I think it is pertinent to the discussion.  Capitalism is a monetary philosophy based on the acquisition of wealth, which buys material goods and services.  All value is measured with money.  States of mind, such as happiness, love, understanding and compassion have no value under this system and are not acknowledged at all, since they are neither goods nor services.  This is not merely hypothetical; it is codified in law.  In the case Dodge v. Ford Motor Company, 204 Mich. 459, 170 N.W. 668. (Mich. 1919),  the Michigan Supreme Court held that Henry Ford owed a duty to the shareholders of the Ford Motor Company to operate his business to profit his shareholders, rather than the community as a whole or employees. It is often cited as embodying the principle of “shareholder value” in companies.   (Wikipedia)

The Court held that a business corporation is organized primarily for the profit of the stockholders, as opposed to the community or its employees. The discretion of the directors is to be exercised in the choice of means to attain that end, and does not extend to the reduction of profits or the non-distribution of profits among stockholders in order to benefit the public, making the profits of the stockholders incidental thereto.

Because this company was in business for profit, Ford could not turn it into a charity. This was compared to a spoilation of the company’s assets. The court therefore upheld the order of the trial court requiring that directors declare an extra dividend of $39 million.

A company is required by law to place profits above all other considerations within the bounds of lawfulness.  In this way, we can see that the foundations of mental health philosophy are rooted in a system that treats our entire mental life as though it did not exist.  Small wonder then, that so much effort is focused on viewing mental health as the product of an unhealthy brain.  The attitudes of capitalism, which is intricately woven into our social structure, will carry over into psychology and psychiatry.  A mind that is unhealthy is viewed as broken and must be fixed.

As Graham points out, the philosophy that an unhealthy mind is the product of an unhealthy brain is severely flawed.  For example, a person who suffers depression because of a personal loss is not experiencing depression due to physical causes.  whatever changes that might occur in brain chemistry happen as a result of purely non physical thoughts, which activate the brain to behave in specific ways.  Consciousness is clearly the horse that is pulling the brain chemistry cart in this case.  It is a matter of a healthy brain with an unhealthy mind.

If viewed from a materialist perspective, depression is truly bizarre.  It has no symptoms that, when present, are always indicative of depression.  Rather, there is a constellation of possible symptoms.  What’s more, depression is not always considered unhealthy.  If you or I experience depression due to the loss of a companion animal or person who we were extremely close to, this is considered to be a healthy response.  In fact, if we were to display behavior after our loss that is normally considered to be healthy, we would be judged to have an unhealthy mind.  Furthermore, the healthy response of depression due to loss becomes unhealthy after about six months even though there is no change in symptoms.

But this is not the whole story.  In some cases, brain chemistry is the horse, pulling the cart of consciousness.  Take paranoid schizophrenia for example.  While the physical causes aren’t completely understood, the mental disorder certainly is.  It is relatively easy to diagnose in severe cases, as it is typically accompanied by predictable symptoms.

Schizophrenia is often described in terms of positive and negative (or deficit) symptoms. Positive symptoms are those that most individuals do not normally experience but are present in people with schizophrenia. They can include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis. Hallucinations are also typically related to the content of the delusional theme.Positive symptoms generally respond well to medication.  Negative symptoms are deficits of normal emotional responses or of other thought processes, and respond less well to medication. They commonly include flat or blunted affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), and lack of motivation (avolition). Research suggests that negative symptoms contribute more to poor quality of life, functional disability, and the burden on others than do positive symptoms.^[21] People with prominent negative symptoms often have a history of poor adjustment before the onset of illness, and response to medication is often limited.

This disorder is known to be genetic in origin and there is clear separation between schizophrenic and normal behavior.  Unlike depression, there is no healthy schizophrenia.  It is also not situationally dependent.  It typically starts at certain ages.  Schizophrenia is a case of an unhealthy brain making the mind unhealthy as well.  I will just add briefly, that situations exist where people have overcome their schizophrenia and gone on to live normal lives.  This creates a situation where the brain is unhealthy, but the mind is healthy.

However, this idea cannot be generalized into a class of genetically created mental disorders because there are some grey areas.  Asperger’s Syndrome and Schizotypal types can either be classified as disorders . . . or not . . . depending on who you ask.  Do they have symptoms of mental illness, or are they just different?  This is an important question because a healthy Asperger or Schizotypal mind is surely going to be different from the norm.

To get to the bottom of this, you have to ask the question, “what does a healthy mind look like?”  You probably intuited that this is not an easy question.  We can describe a healthy body fairly easily.  Many standards can be applied and scales can be created to accommodate different body types, but we cannot apply the same process to the mind because we have to rely solely on the subjective interpretation of the person who we are evaluating.  It has no physical form to be objectively evaluated.

To complicate matters, people have many different personalities and what is a healthy mind for one, may          not be healthy for another. If we take for example, a highly analytical person and a highly emotional one, either of them can be said to have a mind disorder if they start behaving like the other personality type.  A highly analytical person who suddenly becomes highly emotional, or a highly emotional person who suddenly becomes highly analytical are said to be mentally ill because they are not behaving according to their “true nature.”  To a certain extent then, you have to know a person’s true nature to know whether they are mentally healthy or not, but who decides what this “true nature” is?  What if the person who is said to be mentally ill has no idea what sort of personality they have?  How do we decide when they are mentally healthy if we require foreknowledge of their “true nature” to determine this?

And this brings up an interesting question: does this definition of a healthy mind for a particular individual change over time?  I think so.

Age is a factor in ways that are entirely different from  the body.  After a certain age, the body undergoes progressive deterioration.  The mind undergoes a transformation as well, but of an entirely different sort.  An accumulation of understanding, experience and wisdom conspire to make the mind more healthy and resilient over time.  Younger bodies are generally healthier than older bodies, but older minds are generally healthier than young minds.

And yet for all this uncertainty, we seem to know when a mind is ill, and when it is not. There are obvious cases, such as schizophrenia, and less obvious, such as depression, but we still know it when we see it.  An encompassing philosophy of mental illness should necessarily be dualistic.  Brain based mental illness will be relatively easy to identify with a clear set of symptoms, and mind based mental illness will be variable with a constellation of possible symptoms.  Both have to be recognized on their own terms and both are valid in their own ways.  It is simply impossible to view all mental illness one way or the other.