Medicine recognizes illnesses like hypertension and Cushing'sdisease that are the outcome of systems in a poorly regulated statethat is stable, albeit suboptimal. The idea of a specific pathogenicprocess in medicine includes dysregulation, but this may not accordwith folk thought.
Naturalists tend towards conceptual conservatism. They typicallyappeal to our intuitions about illness as support for their ownemphasis on underlying bodily malfunction. This assumes that ourcurrent concept is in good shape, that common sense and medicineshare a concept of disease, and that medicine should respect layintuitions about what is or is not a disease. Like manyphilosophers who think about other concepts with both scientific andcommon sense uses, conservative naturalists about disease think thatfolk concepts specify what counts as health and disease. The job ofmedicine is to look at the world and see if anything in nature fallsunder the concept as revealed by analysis (cf the “Canberraplan” of Jackson 1998) For revisionists, this understanding ofcommon sense's in its relation to science is needlessly submissive to folkintuitions.
So please, become a pioneer, and together let's drop the use of the phrase "mental illness," and search for more inclusive and creative phrases. This is a reminder that our words and even our whole social reality of what is called "normal," are not forced upon us God-given by the heavens, but are constructs that we mortals all co-create, in our imperfection, in our freedom, together.
If you need one more reason to stop saying "mental illness," observe that sometimes our opponents can inform us about what may be an effective strategy. In 2010, the annual federally-funded Alternatives Conference that gathers up to 1,000 mental health consumers and psychiatric together to discuss peer-run projects, was politically attacked afterwards primarily because organizers from their program and publicity materials.
We have arrived at a generic naturalism that says judgments ofillness are sensitive to causal antecedents of the right sort, as wellas to value judgments about the effects of those causes. What are theright causal antecedents? Culver and Gert's (1982) requirement thatthe antecedents be a “nondistinct sustaining cause” is abiologically noncommittal criterion. Culver and Gert analyze theconcept of a malady, which involves suffering evils, or increased riskof evil, due to “a condition not sustained by somethingdistinct” from oneself (1982, 72). The cause can be physical ormental, (p.87), provided it is a sustaining cause that is not distinctfrom the sufferer (p.88). A wrestler's hammerlock, because its effectscome and go with the presence or absence of the cause itself, is anexample of a sustaining cause. But because the wrestler is a distinctentity from the sufferer, someone in a hammerlock does not have amalady. If the cause is inside the body it is nondistinct just in caseit is difficult to remove (e.g. a surgical implement left behind inthe body) or it is biologically integrated in the body (e.g. aretrovirus). This is an attractively simple solution but it is tooinclusive. Culver and Gert (p.71) say that loss of freedom,opportunity or pleasure count as evils. But if that is so, then blackcitizens of South Africa and Mississippi (among many other places)used to suffer from maladies, since they were unfree, unhappy andoppressed. And they suffered these evils because of black skin, whichwas a nondistinct sustaining aspect of their nature. But it wasn't adisease. Of course, the presence of racism, backed up by coercivesocial structures, was also necessary, but aspects of the environmentare implicated in many maladies.
The mainstream view in the West is that the changes in our descriptionand treatment of mental illness are a result of our increasingknowledge and greater conceptual sophistication. On this view, we haveconquered our former ignorance and now know that mental illnessexists, even though there is a great deal of further research to bedone on the causes and treatment of mental illness. Evidence fromanthropological studies makes it clear that some mental illnesses areexpressed differently in different cultures and it is also clear thatnon-Western cultures often have a different way of thinking aboutmental illness. For example, some cultures may see trance-like statesas a form of possession. This has led some to argue that Westernpsychiatry also needs to change its approach to mentalillness. (Kleinman, 1988, Simons and Hughes, 1985) However, theanthropological research is not set in the same conceptual terms asphilosophy, and so it is unclear to what extent it implies that mentalillness is primarily a Western concept.
What we now call mental illness was not always treated as a medicalproblem. Descriptions of the behaviors now labeled as symptomatic ofmental illness or disorder were sometimes framed in quite differentterms, such as possession by supernatural forces. Anthropologicalwork in non-Western cultures suggests that there are many cases ofbehavior that Western psychiatry would classify as symptomatic ofmental disorder, which are not seen within their own cultures as signsof mental illness (Warner, 2004, p. 173). One may even raise thequestion whether all other cultures even have a concept of mentalillness that corresponds even approximately to the Western concept,although, as Kleinman (1988) points out, this question is closely tiedto that of adequately translating from other languages, and insocieties without equivalent medical technology to the west, it will behard to settle what counts as a concept of disease.
A more extreme view, most closely associated with the psychiatristThomas Szasz, is that there is no such thing as mental illness becausethe very notion is based on a fundamental set of mistakes. While it is not always easy to delineate the different arguments inSzasz's voluminous work, (Reznek, for instance, separatesout at least six different arguments within his work [Reznek, 1991,Chapter 5]), Szasz has compared psychiatry to alchemy or astrology(1974, pp. 1–2), contending that the continued belief in mental illnessby psychiatrists is the result of dogmatism and a pseudoscientificapproach using ad hoc defenses of their main claims. He hasalso argued that the concept of mental illness is based on aconfusion.
To understand why there are such conflicting opinions, one must first look at the available studies that have been conducted. Twin studies are conducted on the basis of comparing monozygotic (MZ) or identical twins and their rates of criminal behavior with the rates of criminal behavior of dizygotic (DZ) or fraternal twins.
More recent critics of psychiatry have been more focused onparticular purported mental illnesses. The most heatedcontroversies about the existence of particular mental illnesses areoften over ones that seem to involve culturally-specific or moraljudgments, such as homosexuality, pedophilia, antisocial personalitydisorder, and premenstrual dysphoric disorder. Othercontroversies exist over disorders that are milder in character and areon the borderline between normality and pathology, such as dysthymia, alow level chronic form of depression (Radden, 2009).
While there is debate over how to define mental illness, it isgenerally accepted that mental illnesses are real and involvedisturbances of thought, experience, and emotion serious enough tocause functional impairment in people, making it more difficult forthem to sustain interpersonal relationships and carry on their jobs,and sometimes leading to self-destructive behavior and evensuicide. The most serious mental illnesses, such asschizophrenia, bipolar disorder, major depression, and schizoaffectivedisorder are often chronic and can cause serious disability.