In an article titled “The Roots of Mental Illness,” the author, Kirsten Weir, tells us about Eric Kandel, MD, who believes that the experiences that doctors refer to as mental illnesses are brain diseases. Dr. Kandel defends his belief with the following statement: “All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases. The brain is the organ of the mind.”
The article also indicates that Dr. Kandel believes one important value of recognizing that these types of experiences are brain diseases is that it helps minimize the shame often associated with them. For example, Dr. Kandel is quoted as saying, “Schizophrenia is a disease like pneumonia. Seeing it as a brain disorder destigmatizes it immediately.”
Dr. Kandel’s credentials are pretty impressive–he’s a Nobel Prize laureate and professor of brain science at Columbia University. Therefore, if you are among those who believe a person’s credentials should determine who is right and who is wrong, you need not read any further. You must simply conclude that what is referred to as mental illnesses are indeed brain diseases because you would be hard pressed to find someone with better credentials disagreeing with Dr. Kandel.
However, if you are among those of us who believe that regardless of someone’s credentials, the reasonableness of the argument should sway your judgments, then I encourage you to read on. In brief, you will find that the phrase, “disorders of mental functioning” is way too vague for a science of disease, and that Dr. Kandel’s conclusion that seeing these types of experiences as brain diseases immediately destigmatizes it, is at the very least, questionable.
Are Disorders of Mental Functioning Properly Viewed as Brain Diseases?
Colony of pathogen bacterias
Physical pathologists, who are trained in the principles of science, determine if a pathological condition is present by looking for a set of objectively observable body conditions such as tumors, microbe infections, tissue tears, bone fractures, and blocked arteries. None of these have been identified by pathologists as causing the conditions typically labelled by psychiatrists as mental illnesses. If they were to find the physical pathology that causes any of the behavior patterns referred to as mental illnesses, that pattern would no longer be referred to as a mental illness. Instead, the pattern would be viewed as the symptoms of the physical pathology, and the disease would be referred to either as the type of pathology (tumor, microbe infection, etc.) or the name of the person who discovered the relationship between the behavior pattern and the physical pathology.
Dr. Kandel, when trying to make the case that mental illnesses are real brain diseases has, at times, cited articles that show some correlation of a brain difference with some of the concerns that lead to a mental illness label. But these correlations are far too weak to demonstrate they are causing these types of concerns. For example, people labeled as having schizophrenia have, on average, some larger brain ventricles. However, there are many people who have the same size ventricles, or even larger ones, who show no signs of schizophrenia. Moreover, numerous people who have smaller than average size ventricles are regularly classified as having schizophrenia. Thus, quite clearly, it is not the size of the ventricles that are causing the schizophrenic behavior pattern. It is for this reason that the size of one’s brain ventricles is not used to make the so called diagnosis of schizophrenia. Instead, doctors rely on a conversation with the designated patient to make these types of so called diagnoses.
Are such conversations properly viewed as objective criteria for determining a disease state and equivalent to observing the type of pathologies that physical pathologists look for in identifying a disease state? Numerous critics of psychiatry say no. They point to what highly credentialed doctors have, over the course of history, claimed are mental illnesses.
Dr. Samuel Cartwright
For example, in 1851 American physician Samuel A. Cartwright labelled black slaves who tried to flee captivity as having the mental illness of drapetomania. For people who hold the value judgment that the function of healthy blacks is to be slaves, then it certainly makes sense to say that blacks seeking to flee captivity were being dysfunctional.
Freud Practicing the Dysfunctional Habit of Smoking
If you are religious, many highly credentialed medical doctors, including Sigmund Freud, who, like Dr. Kandel, won a Nobel Prize, have claimed this meant you had a mental illness. People who are gay were declared as having a mental disease here in the US. In the former Soviet Union, if you were opposed to communism it warranted a mental illness label by their psychiatrists. In each of these societies, a case was made that the behavior pattern labelled as a mental illness was dysfunctional.
The argument that such labeling practices are not scientific, but, rather, value judgments, was intelligently made by William James when he defended the religious sentiment. He explained that pathologizing these sentiments as mental diseases was superficial medical talk. He called the reasoning doctors used to declare religious beliefs a type of mental illness, “medical materialism.”
Medical materialism seems indeed a good appellation for the too simple-minded system of thought which we are considering. Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic.
Woman of Religious Faith
It snuffs out Saint Teresa as an hysteric, Saint Francis of Assisi as an hereditary degenerate. George Fox’s discontent with the shams of his age, and his pining for spiritual veracity, it treats as a symptom of a disordered colon. Carlyle’s organ-tones of misery it accounts for by a gastro-duodenal catarrh. All such mental overtensions, it says, are, when you come to the bottom of the matter, mere affairs of diathesis (auto-intoxications most probably), due to the perverted action of various glands which physiology will yet discover.
James goes on from here to point out that it is true, of course, that psychology has found that there are definite psychophysical connections that “hold good.” Psychology, therefore:
assumes as a convenient hypothesis that the dependence of mental states on bodily conditions must be thoroughgoing and complete. If we adopt the assumption, then of course what medical materialism insists on must be true in a general way, if not every detail…. But now, I ask you, how can such an existential account of facts of mental history decide in one way or another on their spiritual significance? According to the general postulate of psychology just referred to, there is not a single one of our states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditioned just as much as religious emotions are; and if we only knew the facts intimatelyenough, we should doubtless see “the liver” determining the dicta of the sturdy atheist as decisively as it does those of the Methodist under conviction anxious about his soul. When it alters one way the blood that percolates it, we get the Methodist, when in another way, we get the atheist form of mind. So of all our raptures and our drynesses, our longings and pantings, our questions and beliefs. They are equally organically founded, be they religious or of non-religious content.
James points out that in the natural sciences it never occurs to anyone to refute opinions by putting down their authors’ neurological constitutions. Value is determined by “judgments based on our own immediate feelings primarily; and secondarily on what we can ascertain of their experiential relations to our moral needs and to the rest of what we hold as true.”
All states of mind are related in extremely complex ways to neural functions. There is a crucial distinction to be made between a brain difference and a brain pathology. The significance of each state of mind must be tested, not by some neurological difference, but by the value of its fruits. When the term “pathological” is applied to an experience, rather than an identified physiological pathology, it wrongly implies a neutral science classification.
In my view, what William James says about the religious sentiment and disease states hold just as true for people who are currently declared as having a mental illness by Dr. Kandel and many other doctors. They declare, in a very subjective manner, patterns of behavior are due to a brain disease without objective proof that there is a physical pathological condition causing the pattern. They don’t make a distinction between a brain difference and a brain disease. And they don’t deal effectively with the fact that there are numerous people who display patterns that have been viewed by the psychopathologizing doctors who have brought forth some of the greatest fruits known to the human race.
Calling Mental Illness a Brain Disease: Does It Stop Stigma?
In the above Aldous Huxley quote, apparently it was his opinion that all the normal people in our society are dysfunctional, and thus psychiatry might want to declare all normal people as having a brain disease. I wonder if all normal people might feel less stigmatized upon hearing about this pathologizing of their experiences. Hmmm.
Anyway, if you will, let us turn to Dr. Kandel’s declaration that by getting people to see that mental illnesses are brain diseases it destigmatizes them immediately. He offered no scientific evidence for this. When we actually look at the evidence bearing on his statement, we get a very different impression.
Lincoln, sufferer of depression
Very modest evidence exists indicating people who have become convinced that mental illnesses are brain diseases are somewhat less likely to blame labeled persons for their behavior. However, at the same time, overall stigma actually increases. Biological explanations, for many, imply that people with mental illness are fundamentally different or less human.
Research has also shown, that disease explanations for mental illness provoked harsher behavior toward labeled persons. It is worthwhile keeping in mind that in the not-so-distant past, biological and genetic explanations for stigmatized conditions were linked to a range of harsh policies, including marriage restrictions, sterilization, lobotomies, and even extermination.
Painter who has been said to suffer from mental illness
The biological explanation may also exacerbate yet another key stereotype of mental illness, the belief that people with mental illness are dangerous. Many researchers believe that the stereotype that people with mental illness are violent ranks among the most prejudicial and discriminating of attitudes. Unfortunately, there is evidence that biological arguments may actually strengthen dangerousness stereotypes, suggesting that people with mental illness have no control over their behavior and therefore are unpredictable and violent.
In contrast to biological arguments, psychosocial explanations of mental health concerns have been found to effectively improve images of people who are now being labeled as having a mental illness. It also appears to reduce fear.
Instead of arguing that mental illness is like any other medical illness, psychosocial explanations of mental health concerns focus on environmental stressors and trauma as causal factors. These may include childhood abuse, poverty, and job stress. The idea is to reframe mental health concerns as understandable reactions to life events.
Conclusion
Socrates heard voices in his head that he referred to as guiding demons and was condemned to death by society leaders.
The mental health concerns that most modern day doctors refer to as mental illnesses, have not been shown to be caused by a physiological pathological condition. There are undoubtedly some brain differences that have been correlated with a few types of concerns, but it is way too simplistic to say that such differences are the cause of any of these concerns. It is very possible that environmental and cultural factors may lead to the observed correlations. Despite the fact that a person might be said by some that he or she is functioning below average in some ways under some societal situation, numerous examples can be easily provided that people labeled mentally ill have often produced valued fruits in the fields of science, arts, and philosophy. Finally, labeling someone experiencing a mental health concern as having a brain disease does not automatically decrease stigma, and could actually increase it.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
Today, if your behavior, thoughts, or feelings begin to concern you or a family member, for a fee many doctors will translate your experiences into mental illness terminology. Synonyms for mental illness, are mental disease, mental sickness, mental disorder, and psychopathology. These terms, as metaphors for experiences someone doesn’t like, have been with us for centuries. When used in this way, it can communicate something about an experience that others relate to. However, when we move from using these types of concepts as metaphors to believing wholeheartedly that they are proper scientific terms, we begin to lose the respect of those well grounded in the principles of science.
Illness and its Synonyms as Metaphor
Let’s consider The Tragedy of Hamlet, Prince of Denmark, which William Shakespeare wrote in about 1604. This play offers its audience a magnificent tale of adultery, fratricide, revenge, and feigned madness by a protagonist. When reading Hamlet, we see how Shakespeare uses metaphors to vividly evoke in us the experiences of his characters. Thus, when Hamlet becomes dissatisfied that his mind keeps identifying flaws in his plans for action, he describes these plans as becoming “all sicklied o’er with pale cast of thought.” By extension, the reader senses that when Hamlet’s plans become “all sicklied o’er,” he, too, becomes in a sense, “sicklied o’er” with feelings of frustration, anguish, and helplessness.
Literature regularly uses this type of metaphor. Ralph Waldo Emerson, to take another example, once wrote:
Our young people are diseased with the theological problems of original sin, origin of evil, predestination, and the like. These never presented a practical difficulty to any man–never darkened across any man’s road, who did not go out of his way to seek them. These are the soul’s mumps, and measles, and whooping coughs.
I actually like Emerson’s disease terminology here because the context in which he uses it so obviously reveals that he is using it metaphorically. Notice how he cleverly uses diseases associated with childhood to evoke the feeling that individuals who worry themselves over problems of original sin and so on are acting, in his view, childishly. In this context, disease, to Emerson, was a metaphor for immaturity. If he were a man of science, in contrast to a literary personality, we would expect that he would use terms with clearly defined, objective meaning, that avoid value judgements.
In the science of physiological pathology, a pathologist identifying a tumor is not making a value judgement. The tumor can be seen, measured in size, and its cells observed and described objectively. When pathologists look at a sample of blood to see if a person has a microbe infection, the microbes can be described objectively, and the number present in the blood sample can be counted in a clear, precise manner.
Psychology as a Science
In the late 1800s, William James decided to begin a lengthy project of treating psychology as a science, hoping this would lead to new insights about how the mind works. A few years into this project, he published his Principles of Psychology. There, he laid out his scientific aims, and then he described the sources of error in a scientific psychology, the very first of which “arises from the misleading influence of speech.”
At the time, medical writers were already heavily pathologizing a great number of experiences. Thus, James cited W. Griesinger, the author of The Pathology and Therapy of Psychological Illnesses, and T. S. Clouston, author of Clinical Lectures on Mental Diseases. As James delved further and further into the experiences being pathologized in this way, he came to believe such terminology was “simple minded” and “superficial medical talk.”
The terms pathology, disorder, disease, and illness, when applied to the types of experiences that get classified as mental illnesses by the psychopathologizers of today, often are meant to suggest suffering, dysfunction, and abnormality. Let’s take a look to see why using pathologizing terms in this way is really way too imprecise for scientific purposes.
Suffering
Does it make sense to say that when people are suffering, they have a “mental disorder?” Well, consider the experience of giving birth. It is typically accompanied by suffering, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.
When writers receive rejections from publishers, or a loved one dies, suffering often accompanies these experiences. Yet, we do not typically describe them with pathological terms.
In the Buddhist teachings, the first of the four noble truths is that pretty much all of us will be experiencing suffering as we go through our lives. It has been theorized that in some extremely rare persons a state may be reached at which there is no more suffering, but that is far from the norm.
How much suffering, beyond the “normal” amount that one experiences during life’s parade of disappointments, is required to ascribe a diagnosis of some mental disorder? That is left to the subjective view of the pathologizers, rather than by employing sound principles of science.
There are science minded individuals who have been working on the task of providing objective measures of suffering for decades. Such people have used principles of science to measure short term and long term stress within an individual. For example, cortisol levels in saliva and heart rate variability has some connection with a person’s self-reports of how much stress they have experienced in recent days, while hair cortisol levels have some connection with longer term exposure to stressful experience. Other measures of stress utilize a list of stressors, such as the recent death of a loved one, living in poverty, etc. The person being assessed places a check mark next to each of the stressors on the list that applies to him or her. These check marks are then used to calculate how much stress the person has been experiencing.
Such measures, which are normed on large samples of people that are somewhat representative of the general population, can give us some objective estimate of someone’s level of suffering. But make no mistake, these types of scientific measures of the constructs of suffering are almost never used by the psychopathologizers. In today’s world, if you are a licensed mental health professional, you typically must declare that a person has a mental disorder to permit the person to access mental health services, and this must be done in one visit typically lasting less than an hour using the professional’s subjective judgement.
Dysfunction
Having indicated some of the problems of unambiguously, and non-subjectively applying the descriptors of suffering to the concept of mental disorder, we now turn our attention to the descriptor, “dysfunction.” As with the notion of suffering, the pathologizers almost never use the various scientifically validated measures of functioning to determine if someone has a mental disorder. A pretty good such measure is the Scales of Independent Behavior-Revised. It has norms for functioning in such areas as social interaction (communication skills, language comprehension, language expression), personal living skills (eating and meal preparation, toileting, dressing, personal self-care, domestic skills), community living skills (time and punctuality, money and value, work skills), and gross and fine motor skills. Rather than using measures of this type, pathologizers rely on their professional privilege to make a subjective estimate of dysfunction.
Abnormality
In the most current edition of the DSM, someone who is experiencing abnormal levels of distress might be considered to have a mental disorder. But the issue of the boundary between normal and abnormal experiences lies at the heart of the most contentious disputes in the field of psychopathology today. A major problem with using the term abnormal as one of the defining attributes of mental illness is that it leads us to forget the fact that natural to all organisms is substantial variability across individuals and within individuals. Having above average or below average functioning in various areas of our many areas of functioning is normal. Displaying rare behavior patterns that are highly valued, such as the great altruism of Mother Teresa, are not viewed as mental disorders. Psychopathology is applied when someone does not like a particular experience. Thus, a term that masquerades as a scientific term is really a value judgment masquerading as a scientific term.
Conclusion
Although there are some fairly well developed scientific measures of the three major factors (suffering, functioning, and abnormality) that the psychopatholgizers tend to claim are usually part of the mental illness experience, these measures are almost never used in their “diagnostic” determination. Instead, subjective indicators of these three factors are combined into an even more subjective abstraction called “mental illness.” This process is not scientific despite claims to the contrary.
Rather than a scientific concept, the mental illness concept has been very useful as part of a highly lucrative business plan for the pharmaceutical industry and medical doctors, which includes psychiatrists. This plan has doctors first convincing people that the experiences referred to as mental illnesses are scientifically real illnesses just like physiological pathologies. It then provides license for doctors, in as little as fifteen minutes, to declare that they have provided their patients a diagnosis, and to send them on their way with a prescription for pills. With this plan, billions of dollars flow their way.
It is my sincere hope that this post will lead to more people understanding what is going on here. It is also crucially important that more and more people come to understand that there is an alternative to the mental illness labeling process that would be easy to develop–one based on a “mental health concern” construct (see HERE for a more complete discussion of this alternative). A mental health concern approach would not only be more scientific, but also jargon free and less stigmatizing. Moreover, the research that it would generate would lead to dramatically improved services for people struggling with anguish, sadness, and tears.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
Dr. Kandel’s credentials are pretty impressive–he’s a Nobel Prize laureate and professor of brain science at Columbia University. Therefore, if you are among those who believe a person’s credentials should determine who is right and who is wrong, you need not read any further. You must simply conclude that what is referred to as mental illnesses are indeed brain diseases because you would be hard pressed to find someone with better credentials disagreeing with Dr. Kandel.
The argument that such labeling practices are not scientific, but, rather, value judgments, was intelligently made by William James when he defended the religious sentiment. He explained that pathologizing these sentiments as mental diseases was superficial medical talk. He called the reasoning doctors used to declare religious beliefs a type of mental illness, “medical materialism.”
assumes as a convenient hypothesis that the dependence of mental states on bodily conditions must be thoroughgoing and complete. If we adopt the assumption, then of course what medical materialism insists on must be true in a general way, if not every detail…. But now, I ask you, how can such an existential account of facts of mental history decide in one way or another on their spiritual significance? According to the general postulate of psychology just referred to, there is not a single one of our states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditioned just as much as religious emotions are; and if we only knew the facts intimately enough, we should doubtless see “the liver” determining the dicta of the sturdy atheist as decisively as it does those of the Methodist under conviction anxious about his soul. When it alters one way the blood that percolates it, we get the Methodist, when in another way, we get the atheist form of mind. So of all our raptures and our drynesses, our longings and pantings, our questions and beliefs. They are equally organically founded, be they religious or of non-religious content.
All states of mind are related in extremely complex ways to neural functions. There is a crucial distinction to be made between a brain difference and a brain pathology. The significance of each state of mind must be tested, not by some neurological difference, but by the value of its fruits. When the term “pathological” is applied to an experience, rather than an identified physiological pathology, it wrongly implies a neutral science classification.
In contrast to biological arguments, psychosocial explanations of mental health concerns have been found to effectively improve images of people who are now being labeled as having a mental illness. It also appears to reduce fear.
Today, if your behavior, thoughts, or feelings begin to concern you or a family member, for a fee many doctors will translate your experiences into mental illness terminology. Synonyms for mental illness, are mental disease, mental sickness, mental disorder, and psychopathology. These terms, as metaphors for experiences someone doesn’t like, have been with us for centuries. When used in this way, it can communicate something about an experience that others relate to. However, when we move from using these types of concepts as metaphors to believing wholeheartedly that they are proper scientific terms, we begin to lose the respect of those well grounded in the principles of science.
Let’s consider The Tragedy of Hamlet, Prince of Denmark, which William Shakespeare wrote in about 1604. This play offers its audience a magnificent tale of adultery, fratricide, revenge, and feigned madness by a protagonist. When reading Hamlet, we see how Shakespeare uses metaphors to vividly evoke in us the experiences of his characters. Thus, when Hamlet becomes dissatisfied that his mind keeps identifying flaws in his plans for action, he describes these plans as becoming “all sicklied o’er with pale cast of thought.” By extension, the reader senses that when Hamlet’s plans become “all sicklied o’er,” he, too, becomes in a sense, “sicklied o’er” with feelings of frustration, anguish, and helplessness.
Literature regularly uses this type of metaphor. Ralph Waldo Emerson, to take another example, once wrote:
I actually like Emerson’s disease terminology here because the context in which he uses it so obviously reveals that he is using it metaphorically. Notice how he cleverly uses diseases associated with childhood to evoke the feeling that individuals who worry themselves over problems of original sin and so on are acting, in his view, childishly. In this context, disease, to Emerson, was a metaphor for immaturity. If he were a man of science, in contrast to a literary personality, we would expect that he would use terms with clearly defined, objective meaning, that avoid value judgements.
At the time, medical writers were already heavily pathologizing a great number of experiences. Thus, James cited W. Griesinger, the author of The Pathology and Therapy of Psychological Illnesses, and T. S. Clouston, author of Clinical Lectures on Mental Diseases. As James delved further and further into the experiences being pathologized in this way, he came to believe such terminology was “simple minded” and “superficial medical talk.”
Does it make sense to say that when people are suffering, they have a “mental disorder?” Well, consider the experience of giving birth. It is typically accompanied by suffering, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.
When writers receive rejections from publishers, or a loved one dies, suffering often accompanies these experiences. Yet, we do not typically describe them with pathological terms.
For example, cortisol levels in saliva and heart rate variability has some connection with a person’s self-reports of how much stress they have experienced in recent days, while hair cortisol levels have some connection with longer term exposure to stressful experience. Other measures of stress utilize a list of stressors, such as the recent death of a loved one, living in poverty, etc. The person being assessed places a check mark next to each of the stressors on the list that applies to him or her. These check marks are then used to calculate how much stress the person has been experiencing.
Having indicated some of the problems of unambiguously, and non-subjectively applying the descriptors of suffering to the concept of mental disorder, we now turn our attention to the descriptor, “dysfunction.” As with the notion of suffering, the pathologizers almost never use the various scientifically validated measures of functioning to determine if someone has a mental disorder. A pretty good such measure is the Scales of Independent Behavior-Revised. It has norms for functioning in such areas as social interaction (communication skills, language comprehension, language expression), personal living skills (eating and meal preparation, toileting, dressing, personal self-care, domestic skills), community living skills (time and punctuality, money and value, work skills), and gross and fine motor skills. Rather than using measures of this type, pathologizers rely on their professional privilege to make a subjective estimate of dysfunction.
In the most current edition of the DSM, someone who is experiencing abnormal levels of distress might be considered to have a mental disorder. But the issue of the boundary between normal and abnormal experiences lies at the heart of the most contentious disputes in the field of psychopathology today. A major problem with using the term abnormal as one of the defining attributes of mental illness is that it leads us to forget the fact that natural to all organisms is substantial variability across individuals and within individuals. Having above average or below average functioning in various areas of our many areas of functioning is normal. Displaying rare behavior patterns that are highly valued, such as the great altruism of Mother Teresa, are not viewed as mental disorders. Psychopathology is applied when someone does not like a particular experience. Thus, a term that masquerades as a scientific term is really a value judgment masquerading as a scientific term.
Although there are some fairly well developed scientific measures of the three major factors (suffering, functioning, and abnormality) that the psychopatholgizers tend to claim are usually part of the mental illness experience, these measures are almost never used in their “diagnostic” determination. Instead, subjective indicators of these three factors are combined into an even more subjective abstraction called “mental illness.” This process is not scientific despite claims to the contrary.
Rather than a scientific concept, the mental illness concept has been very useful as part of a highly lucrative business plan for the pharmaceutical industry and medical doctors, which includes psychiatrists. This plan has doctors first convincing people that the experiences referred to as mental illnesses are scientifically real illnesses just like physiological pathologies. It then provides license for doctors, in as little as fifteen minutes, to declare that they have provided their patients a diagnosis, and to send them on their way with a prescription for pills. With this plan, billions of dollars flow their way.