1. We don't insist on calling every condition in medicine an "illness"... we recognize that the concept has a certain prototype, and the farther we go from that prototype, we reach for other words... disorder, syndrome, condition, health problem, etc. But the application of the medical framework doesn't depend on calling *every* conditio…
1. We don't insist on calling every condition in medicine an "illness"... we recognize that the concept has a certain prototype, and the farther we go from that prototype, we reach for other words... disorder, syndrome, condition, health problem, etc. But the application of the medical framework doesn't depend on calling *every* condition an illness. It's the same in psychiatry, where the term mental illness applies better to some condition, but we use a patchwork of other terms to describe the whole domain.
2. I've told many people with anxiety disorders about the smoke detector principle over the years but I've yet to see that kind of response. I'm sure it happens sometimes, but it's also unlikely to resolve the most severe and entrenched set of problems. An overactive "threat" (anxiety/panic) system is like an overactive immune system. If someone is having a mild case of allergic rhinitis, they might be reassured by the explanation that the immune system by design over-reacts to benign things such as pollen, but someone with more severe symptoms will need symptom relief. For most people with severe anxiety, an explanation of the evolutionary role of anxiety is not enough.
And if we do wanna bring up Nesse's work, I think it's fair to point out that Nesse's evolutionary approach recognizes the existence of psychological conditions which result from failures of evolutionary design. For Nesse, psychological dysfunction is an evolutionary reality, responsible for conditions such as schizophrenia and severe mood disorders. Or do you want to simply acknowledge the existence of evolved mental functions without recognizing dysfunctions of evolved mental functions?
Framing matters, sure. I think much of literature on putative negative effects relies on problematic biological explanations. I'd also be very curious about the psychological consequences of telling people with severe distress and disability that they are NOT suffering from an illness, disorder, or even a "health problem." I imagine many will react quite negatively to that.
3. I honestly don't think that it makes sense to deny or reject that there is no such thing as "mental health." I think there is no satisfactory definition of health that doesn't extend to the psychological domain. And yes, once we recognize that there is such a thing as good mental health, we can recognize that there is also poor mental health and mental health problems.
The framings cannot be understood as being exclusive. Yes, people can get help outside the "mental health" realm, but if mental health problems were indeed so easily treatable by non-clinicians, we'd be operating in a very different landscape. It is still the case that many people do not find any relief from thing such as talking to friends, or elders, or clergy members, and for such people, there remains a role for professional help. I'd like to see an experiment in which we put "skilled, compassionate, wise Clergy member" in charge of people seeking help at a Mood Disorders Clinic, and let's see how well it turns out. While some people might indeed benefit more from a priest than a physician/psychotherapist, most people with chronic, recurrent, and severe problems will have better luck with a trained professional. At least that's what I think.
"we have to be very careful with confusing philosophical positions as being objective scientific truths." I agree, which is why I don't think that illness status, or disorder status, is an objective scientific truth, and I have written extensively on that. https://www.psychiatrymargins.com/p/the-social-construction-of-disease
4. There is nothing about a disorder concept that forces us to focus only on what's wrong. The focus on what's wrong is a bias introduced in clinical settings because of the nature of the work, and it is a bias that ought to be pointed out and addressed (which is being done by movements such as Positive Psychiatry). This also applies to all of medicine, not just psychiatry.
5. "For me, it’s more about what lens is most useful to approach the situation from." I think medical framing has a pretty good case when it comes to utility. I work with people every day who find this framing helpful. It's not the most helpful for everyone, but it is the most helpful for enough people that it has a claim to legitimacy based on utility alone.
6. Social isolation and pollution are indeed medically relevant phenomena. They are public health concerns. Pollution is not an individual characteristic at all, so it cannot be considered a dysfunction/disorder *in a person* or *of a person*. A person can be socially isolated, but given the interpersonal and contextual nature of isolation as a phenomenon, and its nonspecific health effects, arguably it is better considered a risk factor. Social isolation is also better addressed via non-medical means at present. But conceivably it could become a medical condition some day. (These are not quite gotcha issues, once you start looking into discussions around the status of aging, infertility, grief, etc.)
7. Illness is not an empirical hypothesis and I think it is a mistake to treat it as a hypothesis.
I’ve enjoyed a couple of videos of you on YouTube so far, with more to watch. You come across as a great guy; balanced, fair, empathetic, and passionate — and I find myself agreeing with you excessively ;)
I’m continually reminded how limited text-based conversations can be, lacking in the non-verbal dimension that is so important in relating to another person.
Given we agree on so much, I wonder if there are perhaps just two related points of difference:
1. I am totally on board with the Prototype Theory of categories. My question is how do you assess when a particular example is best considered to be a peripheral category member, vs being better served by placing it in an entirely different category, vs creating a fresh brand new category?
As you know, prototypes tend to play a dominant role in influencing the meaning of a concept. The concept of illness, for most people, is prototypically represented by what I might artificially call ‘physical illnesses’* (the common cold, flu, diabetes, cancer, multiple sclerosis, heart disease, etc.) (*Just a way of talking here as I can’t think of a better framing: biology obviously grounds every human experience.)
To the general public, and I’m sure also with most clinicians, I would bet that the frame of ‘mental illnesses’ inherits much of its implicit meaning from these prototypical ‘physical illnesses’.
What do we do about the fact that there is a dramatic difference between most ‘physical’ and ‘mental’ illnesses?
If, for example, someone closes their eyes and just listens to someone else talk, and their problem automatically vanishes, was their problem really best described by the term ‘illness’?
I’m reminded of the work of Michael Yapko who has several patients with depression (that medication hadn’t helped), on video, having their life utterly transformed just by one session with 20 or 30 minute of hypnosis. People's depression can often vanish when people get new perspectives, learn new skills, learn how to make better decisions, have a positive change in the social life, etc.
If someone learns a new social skill-set, and their ‘social anxiety disorder’ vanishes, is it best described as a disorder, or a lack of psychological and social skills, strategies, and understandings (i.e. a learning phenomenon)?
Do conditions that CAN—not always—vanish with powerful changes in ideas (about oneself, life, situations, etc) really belong in the same category as heart-disease, cancer, or diabetes? You’re sophisticated and so you understand that categories can have peripheral examples. But when is the phenomenon so different that it shouldn’t be in the same category with something else?
Tomatoes 'should' be vegetables. They look and taste like vegetables. Botanically, they’re not. One criteria can disqualify something from belong to a category.
Something like Schizophrenia, I presume, almost never vanishes just by mere talking. Is it, therefore, better conceptualised in a different category to a very painful problem that does change with a ‘mere’ change of ideas, in a supportive social context?
We could include Schizophrenia in the same category as most depression, albeit very distinct members. Or, maybe we could have a new category for ‘conditions’ that do readily change via the right learning processes (conditioning, changes in beliefs, thought processes, the development of new skills and capabilities, etc.) or social situations (e.g. financial relief, leaving an abusive relationship, etc.)
Then presents a problem though…
How does one assess whether a problem is solvable through mere ‘ideas’ in social context? We can’t say for certain that a specific person’s mental problem requires biological intervention, because the scientific literature can’t falsify such an idea. Inductive reasoning isn't proof (much like we knew all swans are white, until people travelled to Australia and found black swans).
My point is: Surely, if someone’s ‘mental illness’ vanishes through just listening and talking, without any conscious effort on their part, surely that belongs in a different category than diabetes, heart-disease or cancer? It’s not a quantitative difference, it’s a qualitative difference. That result isn't possible with most cancers (rare potential placebo cases excluded--I don't know the literature on whether or how often that happens with cancer).
This is not just about semantics for me. If the ideas of disease—for most people—precludes an appreciation that a particular mental problem could very well likely vanish by a change in ideas, I would think that the illness frame is highly distorting the territory that is being described.
NOTE: some ideas may only be able to be changed with biological intervention. Maybe the ideas involved in a certain psychosis are changeable by a social interaction, like therapy. Or maybe they will be best solved by precise biological intervention in the decades and centuries to come (e.g. AI and ultra precise neurological modification techniques. The same could be done though, with things we'd never want to call diseases. For example, one could imagine futuristic neurological interventions to help someone fall out of love with an abuser, or become more extraverted).
I think the map-territory distinction is so important. If people said ‘What you’re suffering could be thought of in many useful ways. Thinking of it as an illness is one way. Thinking of it as a disorder is another. Thinking of it as a sign that your life will likely improve dramatically when you learn certain, key psychological skills, is another.” Etc.
My concern is that a ‘illness’ lens presents a highly impoverished conceptualisation of the actual underlying territory.
‘Psychological problems’ is a much more neutral lens. ‘Psychiatric problems’ less so, because it implies the requirement of medical help, which is not always true.
Medicine, as you rightly state, CAN include it all. However, much of the time, when we frame something as belonging to one category, it implies a preclusion of other categories. Framing suffering as ‘Psychiatric conditions’ implicitly out-frames psychological, social, learning, societal, etc. etc. approaches (Not for you, but for most people I’d bet.)
I think that just as Psychiatrists may be fearful of losing their role if the frame of illness ceased to be used, I think other equally valid lenses are under threat when ‘illness’ is used.
We don’t need an illness frame to explain highly aversive, involuntary, suffering. There are other maps that explain this equally as well. Conditioning isn’t best conceptualised under an illness frame. It’s more usefully conceptualised under a learning frame. And yet involuntary conditioned responses are often core to most ‘mental illnesses’ (e.g. panic and interoceptive cues being conditioned to fear). And, conditioning responses are influenced by genetics and the rest of biology. So a learning frame could fit equally well to medicine (‘Medication could help your brain learn you’re safe more quickly, in addition to exposure’—an empirically testable claim, that some research suggests—e.g. by David Barlow— is not true, but used just as an example).
Back to the study of Tony Robbins’ seminar. Amazing results if that study is to be believed. Tremendous skills at helping people (based on empirical results), and yet he is dismissed by many in mainstream—who would learn so much from him, if open-minded—because he is ‘practicing without a licence’ or even a university degree. However, with a more balanced conceptualisation of the underlying phenomena—which we both care most about—Tony Robbins has an equally valid place in addition to all the other experts because of results (empirical data).
Meditation was once naively mocked as pseudoscience in many parts of academia. And yet how fast that has changed! This kind of narrow definition of what’s valid vs not, based on the current dominant model, doesn’t seem to serve anyone well as far as I can tell.
If we care about the territory most—which I think you do—then we want to make sure our maps don’t implicitly bias us to ignore important parts of that territory, bias who has a right to navigate through that territory, or get us lost etc. because only experts understand the right nuance to read the said map correctly.
Am I making any sense? Thank you. I appreciate you.
Thanks Michael. You bring up a lot of excellent and important points. There is a lot to discuss here, but I'll briefly say a few things.
You are right that different terms can bias people as well as clinicians in different ways. It is important to be mindful of that and to take that into account. We can also recognize that no single term will necessarily be suitable for all contexts, and we will have to be flexible in how we use them, and we may have to switch back and forth between different terms. In general, I think "mental health problems" and "mental disorders" are suitable for most purposes, and "mental illness" is fine in many contexts (provided it is not misunderstood).
I'm inclined to be rather deflationary about the emphasis on the terms. Here is what I think suitable candidate terms should be able to do:
a) Recognize the suffering, distress, disability, or harm associated with a condition
b) Recognize that clinical assessment is warranted
c) Recognize that many interventions are available that can help a person in such a state, and that these interventions include interventions typically used in medicine.
d) Despite all the differences, there are many important similarities between problems in mental health as well as problems in physical health
f) It is appropriate for healthcare resources to be used for the purposes of assessing and treating these problems.
I think terms such as “problems in living” and “mental distress” fare poorly in performing the above tasks. “Mental health problems,” “mental disorders,” and “mental illness” are much better. I think it is fine to prioritize “mental health problems” or “mental disorders” over “mental illness” due to association connotations, but it starts becoming a problem when people start insisting that mental health problems are *not* illnesses. It also starts becoming a problem when people take the view that whether we call a condition an "illness" or not *determines* whether some form of medical intervention is appropriate and whether healthcare resources can be used for that purpose.
“Mental illnesses” are indeed different than diabetes, heart-disease or cancer… which is why they have a category of their own, don’t they? We recognize that there are different types of illnesses and disorders, and we categorize them to facilitate the recognition of their differences.
Now for mental disorders, things like behavioral learning, personality development/personality traits, and life story are extremely important, way more than they are for most other areas of medicine. (Referring to McHugh and Slavney’s figure in the post above). Any account of mental illnesses/disorders/health problems that doesn’t recognize this is extremely problematic and indeed quite impoverished.
“This is not just about semantics for me. If the ideas of disease—for most people—precludes an appreciation that a particular mental problem could very well likely vanish by a change in ideas, I would think that the illness frame is highly distorting the territory that is being described.”
Well, that’s kind of the whole point of psychotherapy and other psychological interventions, that we can bring about change, at times powerful change, with psychological tools. Even in the case of things like psychedelics, it seems as if the experiential content of the experience – a change in ideas, so to speak – is an important driver of therapeutic benefit. So it is absolutely essential to convey this to people. Mental illnesses are illnesses that respond to psychological and behavioral interventions. And if conveying this point requires using other terms preferentially, then so be it.
Thank you Awais. You're a great role model for how controversial topics should be discussed. I admire your balance, fairness, and ability to talk about this topic so rationally!
1. We don't insist on calling every condition in medicine an "illness"... we recognize that the concept has a certain prototype, and the farther we go from that prototype, we reach for other words... disorder, syndrome, condition, health problem, etc. But the application of the medical framework doesn't depend on calling *every* condition an illness. It's the same in psychiatry, where the term mental illness applies better to some condition, but we use a patchwork of other terms to describe the whole domain.
2. I've told many people with anxiety disorders about the smoke detector principle over the years but I've yet to see that kind of response. I'm sure it happens sometimes, but it's also unlikely to resolve the most severe and entrenched set of problems. An overactive "threat" (anxiety/panic) system is like an overactive immune system. If someone is having a mild case of allergic rhinitis, they might be reassured by the explanation that the immune system by design over-reacts to benign things such as pollen, but someone with more severe symptoms will need symptom relief. For most people with severe anxiety, an explanation of the evolutionary role of anxiety is not enough.
And if we do wanna bring up Nesse's work, I think it's fair to point out that Nesse's evolutionary approach recognizes the existence of psychological conditions which result from failures of evolutionary design. For Nesse, psychological dysfunction is an evolutionary reality, responsible for conditions such as schizophrenia and severe mood disorders. Or do you want to simply acknowledge the existence of evolved mental functions without recognizing dysfunctions of evolved mental functions?
Framing matters, sure. I think much of literature on putative negative effects relies on problematic biological explanations. I'd also be very curious about the psychological consequences of telling people with severe distress and disability that they are NOT suffering from an illness, disorder, or even a "health problem." I imagine many will react quite negatively to that.
3. I honestly don't think that it makes sense to deny or reject that there is no such thing as "mental health." I think there is no satisfactory definition of health that doesn't extend to the psychological domain. And yes, once we recognize that there is such a thing as good mental health, we can recognize that there is also poor mental health and mental health problems.
The framings cannot be understood as being exclusive. Yes, people can get help outside the "mental health" realm, but if mental health problems were indeed so easily treatable by non-clinicians, we'd be operating in a very different landscape. It is still the case that many people do not find any relief from thing such as talking to friends, or elders, or clergy members, and for such people, there remains a role for professional help. I'd like to see an experiment in which we put "skilled, compassionate, wise Clergy member" in charge of people seeking help at a Mood Disorders Clinic, and let's see how well it turns out. While some people might indeed benefit more from a priest than a physician/psychotherapist, most people with chronic, recurrent, and severe problems will have better luck with a trained professional. At least that's what I think.
"we have to be very careful with confusing philosophical positions as being objective scientific truths." I agree, which is why I don't think that illness status, or disorder status, is an objective scientific truth, and I have written extensively on that. https://www.psychiatrymargins.com/p/the-social-construction-of-disease
4. There is nothing about a disorder concept that forces us to focus only on what's wrong. The focus on what's wrong is a bias introduced in clinical settings because of the nature of the work, and it is a bias that ought to be pointed out and addressed (which is being done by movements such as Positive Psychiatry). This also applies to all of medicine, not just psychiatry.
5. "For me, it’s more about what lens is most useful to approach the situation from." I think medical framing has a pretty good case when it comes to utility. I work with people every day who find this framing helpful. It's not the most helpful for everyone, but it is the most helpful for enough people that it has a claim to legitimacy based on utility alone.
6. Social isolation and pollution are indeed medically relevant phenomena. They are public health concerns. Pollution is not an individual characteristic at all, so it cannot be considered a dysfunction/disorder *in a person* or *of a person*. A person can be socially isolated, but given the interpersonal and contextual nature of isolation as a phenomenon, and its nonspecific health effects, arguably it is better considered a risk factor. Social isolation is also better addressed via non-medical means at present. But conceivably it could become a medical condition some day. (These are not quite gotcha issues, once you start looking into discussions around the status of aging, infertility, grief, etc.)
7. Illness is not an empirical hypothesis and I think it is a mistake to treat it as a hypothesis.
I also have many issues with Moncrieff's drug-centered model. https://www.psychiatrymargins.com/p/drug-centered-model-of-psychopharmacology
Hi Awais,
I’ve enjoyed a couple of videos of you on YouTube so far, with more to watch. You come across as a great guy; balanced, fair, empathetic, and passionate — and I find myself agreeing with you excessively ;)
I’m continually reminded how limited text-based conversations can be, lacking in the non-verbal dimension that is so important in relating to another person.
Given we agree on so much, I wonder if there are perhaps just two related points of difference:
1. I am totally on board with the Prototype Theory of categories. My question is how do you assess when a particular example is best considered to be a peripheral category member, vs being better served by placing it in an entirely different category, vs creating a fresh brand new category?
As you know, prototypes tend to play a dominant role in influencing the meaning of a concept. The concept of illness, for most people, is prototypically represented by what I might artificially call ‘physical illnesses’* (the common cold, flu, diabetes, cancer, multiple sclerosis, heart disease, etc.) (*Just a way of talking here as I can’t think of a better framing: biology obviously grounds every human experience.)
To the general public, and I’m sure also with most clinicians, I would bet that the frame of ‘mental illnesses’ inherits much of its implicit meaning from these prototypical ‘physical illnesses’.
What do we do about the fact that there is a dramatic difference between most ‘physical’ and ‘mental’ illnesses?
If, for example, someone closes their eyes and just listens to someone else talk, and their problem automatically vanishes, was their problem really best described by the term ‘illness’?
I’m reminded of the work of Michael Yapko who has several patients with depression (that medication hadn’t helped), on video, having their life utterly transformed just by one session with 20 or 30 minute of hypnosis. People's depression can often vanish when people get new perspectives, learn new skills, learn how to make better decisions, have a positive change in the social life, etc.
If someone learns a new social skill-set, and their ‘social anxiety disorder’ vanishes, is it best described as a disorder, or a lack of psychological and social skills, strategies, and understandings (i.e. a learning phenomenon)?
Do conditions that CAN—not always—vanish with powerful changes in ideas (about oneself, life, situations, etc) really belong in the same category as heart-disease, cancer, or diabetes? You’re sophisticated and so you understand that categories can have peripheral examples. But when is the phenomenon so different that it shouldn’t be in the same category with something else?
Tomatoes 'should' be vegetables. They look and taste like vegetables. Botanically, they’re not. One criteria can disqualify something from belong to a category.
Something like Schizophrenia, I presume, almost never vanishes just by mere talking. Is it, therefore, better conceptualised in a different category to a very painful problem that does change with a ‘mere’ change of ideas, in a supportive social context?
We could include Schizophrenia in the same category as most depression, albeit very distinct members. Or, maybe we could have a new category for ‘conditions’ that do readily change via the right learning processes (conditioning, changes in beliefs, thought processes, the development of new skills and capabilities, etc.) or social situations (e.g. financial relief, leaving an abusive relationship, etc.)
Then presents a problem though…
How does one assess whether a problem is solvable through mere ‘ideas’ in social context? We can’t say for certain that a specific person’s mental problem requires biological intervention, because the scientific literature can’t falsify such an idea. Inductive reasoning isn't proof (much like we knew all swans are white, until people travelled to Australia and found black swans).
My point is: Surely, if someone’s ‘mental illness’ vanishes through just listening and talking, without any conscious effort on their part, surely that belongs in a different category than diabetes, heart-disease or cancer? It’s not a quantitative difference, it’s a qualitative difference. That result isn't possible with most cancers (rare potential placebo cases excluded--I don't know the literature on whether or how often that happens with cancer).
This is not just about semantics for me. If the ideas of disease—for most people—precludes an appreciation that a particular mental problem could very well likely vanish by a change in ideas, I would think that the illness frame is highly distorting the territory that is being described.
NOTE: some ideas may only be able to be changed with biological intervention. Maybe the ideas involved in a certain psychosis are changeable by a social interaction, like therapy. Or maybe they will be best solved by precise biological intervention in the decades and centuries to come (e.g. AI and ultra precise neurological modification techniques. The same could be done though, with things we'd never want to call diseases. For example, one could imagine futuristic neurological interventions to help someone fall out of love with an abuser, or become more extraverted).
I think the map-territory distinction is so important. If people said ‘What you’re suffering could be thought of in many useful ways. Thinking of it as an illness is one way. Thinking of it as a disorder is another. Thinking of it as a sign that your life will likely improve dramatically when you learn certain, key psychological skills, is another.” Etc.
My concern is that a ‘illness’ lens presents a highly impoverished conceptualisation of the actual underlying territory.
‘Psychological problems’ is a much more neutral lens. ‘Psychiatric problems’ less so, because it implies the requirement of medical help, which is not always true.
Medicine, as you rightly state, CAN include it all. However, much of the time, when we frame something as belonging to one category, it implies a preclusion of other categories. Framing suffering as ‘Psychiatric conditions’ implicitly out-frames psychological, social, learning, societal, etc. etc. approaches (Not for you, but for most people I’d bet.)
I think that just as Psychiatrists may be fearful of losing their role if the frame of illness ceased to be used, I think other equally valid lenses are under threat when ‘illness’ is used.
We don’t need an illness frame to explain highly aversive, involuntary, suffering. There are other maps that explain this equally as well. Conditioning isn’t best conceptualised under an illness frame. It’s more usefully conceptualised under a learning frame. And yet involuntary conditioned responses are often core to most ‘mental illnesses’ (e.g. panic and interoceptive cues being conditioned to fear). And, conditioning responses are influenced by genetics and the rest of biology. So a learning frame could fit equally well to medicine (‘Medication could help your brain learn you’re safe more quickly, in addition to exposure’—an empirically testable claim, that some research suggests—e.g. by David Barlow— is not true, but used just as an example).
Back to the study of Tony Robbins’ seminar. Amazing results if that study is to be believed. Tremendous skills at helping people (based on empirical results), and yet he is dismissed by many in mainstream—who would learn so much from him, if open-minded—because he is ‘practicing without a licence’ or even a university degree. However, with a more balanced conceptualisation of the underlying phenomena—which we both care most about—Tony Robbins has an equally valid place in addition to all the other experts because of results (empirical data).
Meditation was once naively mocked as pseudoscience in many parts of academia. And yet how fast that has changed! This kind of narrow definition of what’s valid vs not, based on the current dominant model, doesn’t seem to serve anyone well as far as I can tell.
If we care about the territory most—which I think you do—then we want to make sure our maps don’t implicitly bias us to ignore important parts of that territory, bias who has a right to navigate through that territory, or get us lost etc. because only experts understand the right nuance to read the said map correctly.
Am I making any sense? Thank you. I appreciate you.
Thanks Michael. You bring up a lot of excellent and important points. There is a lot to discuss here, but I'll briefly say a few things.
You are right that different terms can bias people as well as clinicians in different ways. It is important to be mindful of that and to take that into account. We can also recognize that no single term will necessarily be suitable for all contexts, and we will have to be flexible in how we use them, and we may have to switch back and forth between different terms. In general, I think "mental health problems" and "mental disorders" are suitable for most purposes, and "mental illness" is fine in many contexts (provided it is not misunderstood).
I'm inclined to be rather deflationary about the emphasis on the terms. Here is what I think suitable candidate terms should be able to do:
a) Recognize the suffering, distress, disability, or harm associated with a condition
b) Recognize that clinical assessment is warranted
c) Recognize that many interventions are available that can help a person in such a state, and that these interventions include interventions typically used in medicine.
d) Despite all the differences, there are many important similarities between problems in mental health as well as problems in physical health
f) It is appropriate for healthcare resources to be used for the purposes of assessing and treating these problems.
I think terms such as “problems in living” and “mental distress” fare poorly in performing the above tasks. “Mental health problems,” “mental disorders,” and “mental illness” are much better. I think it is fine to prioritize “mental health problems” or “mental disorders” over “mental illness” due to association connotations, but it starts becoming a problem when people start insisting that mental health problems are *not* illnesses. It also starts becoming a problem when people take the view that whether we call a condition an "illness" or not *determines* whether some form of medical intervention is appropriate and whether healthcare resources can be used for that purpose.
“Mental illnesses” are indeed different than diabetes, heart-disease or cancer… which is why they have a category of their own, don’t they? We recognize that there are different types of illnesses and disorders, and we categorize them to facilitate the recognition of their differences.
Now for mental disorders, things like behavioral learning, personality development/personality traits, and life story are extremely important, way more than they are for most other areas of medicine. (Referring to McHugh and Slavney’s figure in the post above). Any account of mental illnesses/disorders/health problems that doesn’t recognize this is extremely problematic and indeed quite impoverished.
“This is not just about semantics for me. If the ideas of disease—for most people—precludes an appreciation that a particular mental problem could very well likely vanish by a change in ideas, I would think that the illness frame is highly distorting the territory that is being described.”
Well, that’s kind of the whole point of psychotherapy and other psychological interventions, that we can bring about change, at times powerful change, with psychological tools. Even in the case of things like psychedelics, it seems as if the experiential content of the experience – a change in ideas, so to speak – is an important driver of therapeutic benefit. So it is absolutely essential to convey this to people. Mental illnesses are illnesses that respond to psychological and behavioral interventions. And if conveying this point requires using other terms preferentially, then so be it.
P.S. This may also be of interest: https://www.psychiatrictimes.com/view/psychiatric-disorders-imperfect-community-peter-zachar-phd
Thank you Awais. You're a great role model for how controversial topics should be discussed. I admire your balance, fairness, and ability to talk about this topic so rationally!
I appreciate your kind words! Thank you for your comments and questions!
Thank you for a thought provoking response Awais. You make some good points here that have got me thinking. Thanks again!