Philosophy of Medicine: On Mental Illness

Last year, during my final term at university studying philosophy, I was taking a class in Philosophy of Medicine. We covered mental health for a couple of weeks and the final essay I chose to write was called ‘Can I Be Ill and Happy?’

Here I have written a few excerpts from my essay, since it is relevant to the nature of this blog.

‘Can I Be Ill and Happy?’

On the one hand, the disabled individual can be ill in the sense of their lack of ability to achieve the same goals as other more able bodied people, such as participating in sports, joining in with work related activities and going on trips.

Disabled individuals may sometimes feel themselves detaching from the social world for these reasons. Also, they often lack autonomy and so relationships can become a strain- a lack of independence can be a huge factor.

Mental illness usually comes with a stigma attached to it and so, whether or not the mentally ill person wills it, social situations can be very difficult. Finding a job may also become a problem due to judgments being made based on the grounds that the ill person cannot fulfil the role in the same way as a ‘healthy’ person could.

As noted by Charmaz, people experiencing chronic illness are actually able to embark on a journey of self-discovery and possess the tools to develop themselves a great deal.

It must also be noted that- as studies show- chronic illness and disability is a purely subjective matter. For example, for one person it marks the end of their world as they once knew it (or, if born with chronic illness or disability, wished to know). But for another it is, as highlighted above, a tool for self-development.

On this view, we may discard our idea of health and illness being mutually distinct and embrace the idea that we can achieve a blend of the two.

On the other hand, limitations can be viewed in different ways. In one sense a limitation in the way one’s body functions can be experienced as alienation and loss of self-worth, in another, making progress and completing difficult tasks can merit a sense of achievement and gratitude. For example taking physiotherapy and improving one’s abilities, or walking up a steep hill without becoming breathless (for a person suffering from lung cancer, for example).

Another creative element of the chronically ill is that one learns (or has no choice but to) to live in the present, understanding the transience and fragility of life in the way that the healthy often cannot. Since the ill person is limited in what plans they can make for the future, one must learn to appreciate the here and now. This rare insight is available through the experience of illness.

In my essay, I also wrote about the conflicting views of some philosophers that mental illnesses are different from physical ones; whereas other philosophers believe they are conceptually the same.

One philosopher, Szasz , denied that mental health was a real illness. He argued this on the basis that the word ‘illness’ literally means a physiological illness, and mental health does not fall under that umbrella, as such. In fact he took physical illness to be ‘…well-defined, objective, and reducible to physiological phenomenon.’

Taking this into account, mental illness fails to match up to these premises- it is not objective, nor is it ‘…reducible to a physiological basis.’ And so Szasz rejects some strongly held claims. He has two metaphysical reasons for this. Firstly, his claim is based on the assumption that, taking into consideration that medicine is a science, it is ‘…concerned only with the material realm.’

In addition to this theory, he rejects any materialism surrounding anything mental. In 1960, Szasz held that illness could be defined in physiological terms and that ‘…the concept of mental health cannot be reduced to such terms…’ He claimed that we cannot stretch this definition to mental health simply because- where the body is material- the mind is not and it therefore cannot be diseased in the same way in which the body can. We must mark a strong distinction between the two. He even went so far as to say that, if we were to broaden this criterion (for physiological illnesses) to include illnesses of the mind, we would be making a fatal mistake based on the materialist-medical definition.

But there are other philosophers that argue against Szasz’s theory.

We can oppose this view by stating that mental illness has observable symptoms. Persons suffering from mental illness seem to suffer to the same extent that people with a physical illness do. I can understand why mental illness is more difficult to diagnose (since we can’t see it), but- symptomatically- it does not differ that much from physical illnesses.

The view that mental and physical illness are completely separate derives from the old philosophy of the mind/body distinction, but I claim that- nowadays- we know much more about mental illness and the mind; in fact some doctors claim that chemical imbalances can be seen in the brain, showing evidence that mental illness exists.

Perhaps what is really needed is a better education about mental illness; one as extensive as that for physiological conditions.

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