Author’s Note: This two-part article is an edited combination of two essays which I wrote for an undergraduate seminar on mental health. My position was controversial because I directly sought to challenge the prevailing “anti-functionalist” attitude which was widely accepted by the class. The uninitiated reader may find some of this informative prima facie. The keen Evolians in my readership may be able to read between the lines and see the more obscure point being made about collectivism and daemonic possession. Either way, I hope you find something useful.
In this essay I intend to define the term “disease” and justify what it would mean for an organism to have a disease. I intend to do this by utilizing an argument which appeals to functionality and/or nonfunctionality of the organism’s various systems, in part or in whole, which are detrimental to the overall health or wellbeing of the organism. I think this definition can be applied to mental health concerns, to the effect that certain mental illnesses can be accurately called “diseases” as well. I consider this an adequate definition because I consider all counterarguments to hinge on some supposition of relativism in functionality, either to the effect that “proper functioning” is too vague a term, or even more extreme, that there can be no proper functionality because demarcating an average range would be to create arbitrary boundaries of “function” and “dysfunction”.
Disease implies a non-functionality or an improper functionality of the organism in parts or as a whole. It is simple enough to speak of “kidney disease” or “liver disease” because we can intuitively understand what a dysfunction in these systems would do to the organism’s overall health or quality of life. Some diseases may be so specific or acute that it isn’t intuitive to the layman what the effect would be, but this need not be an obstacle to our definition. A failure of the uninitiated to comprehend the intricacies of diagnostic medicine says nothing about the validity of diagnostic medicine as a school of medicine.
Additionally, improper functionality should be understood to be something which impinges upon the health or wellbeing of the organism. A liver disease such as cirrhosis is more detrimental to the organism’s health than a simple kidney infection. But the wellbeing of the organism may very well be impinged by the side effects of the kidney infection more than the cirrhosis. Many conditions, though painful, inconvenient, or otherwise welfare-reducing do not specifically threaten the health of the organism, but should still be considered diseases for reducing the organism’s overall functioning to below an optimal level (which I will take care to define below). Part of this is necessarily the organism’s individual tolerance of this reduction, such that organisms with a higher pain threshold may find very uncomfortable conditions to be less serious than organisms with lower tolerance for pain (or discomfort, or disruption of their everyday life).
This should translate to issues of mental health fairly cleanly. Some conditions, though not life threatening, can be deeply inconvenient and painful, reducing the wellbeing of an organism intolerably. Examples may include some variants of bipolar disorder, or disthymia. Other conditions are more clearly health-damaging and reduce the functioning or life-expectancy of the organism directly, such as psychosis or more serious forms of depression.
Depression is an apt example because it also shows how lifestyle can lead to diseases both physical and mental. Depression has strong correlation with lifestyle choices and affects several organisms in the same way: sedentary lifestyle, lack of socialization, overcrowding, and substance abuse are all behaviours which invite depression. Additionally, fewer than 5% of depression sufferers see improvements with medication alone. Depression is a disease that affects the affluent and inactive above and beyond, and is unheard of in many poorer nations (outside of large cities) where the lifestyle choices which are simple or defaulted-to in the first world are too detrimental or too culturally reviled.
Counterarguments to this argument generally hinge on some criticism of “functionalism” as a premise. They usually take the form of a NAXALT fallacy (short for “Not All X Are Like That”) in which an exception to the normal presentation, progression, or prognosis (in the face of or in absence of a disease) is taken to disprove the idea of “normal function” or a “normal range of function” in a system or in an organism more broadly. For example, claiming that the fact that <5% of people with depression are cured with medication alone does not mean that depression is not a lifestyle disease, and to suggest that it does would be a NAXALT fallacy. In short, to commit a NAXALT fallacy is to suggest that the statistical outliers disprove or complicate the vast majority of cases.
NAXALT is not a formal fallacy, but rather an emergent form of invalid reasoning which is gaining both popularity and notoriety (depending on whether you use it or hate it) in recent philosophical discourse. I theorize that NAXALT stems from the peculiarly Anglo-American approach to science and philosophy: the desire to understand a system by rationalizing and sorting all available information into neat categories. The world, however, does not always fit into such discrete boxes, but the children of the Enlightenment believe that, since it should, NAXALT represents a serious challenge to any system as a whole which fails to account for statistical outliers. The system does not fail to account for statistical outliers at all, but the idea that the system does not give the intended result for every data point fed into it is taken to be a failure.
It is also worth considering the peculiarly North-American sense of exceptionalism which skews the individual’s perception of treatment and illness. In my personal life, some thirty young people with depression, who I have helped mentor, have all without fail assumed that they were all part of the <5% who just had an illness and would be helped by medication alone. There’s a peculiar capitalist-consumerist angle to this problem too; a sense that health can be bought by taking medication, and that it is a doctor’s job (which, implicitly, they are being paid to do) to find the right medication and “fix” the patient. However, to discuss this in detail would take us too far afield from the topic of this paper.
One of the major issues which results from this is a widespread and cultural misunderstanding of mental illnesses, their causes, their presentation, and their treatment. The mixture of NAXALT and this widespread misunderstanding is a major factor in the diagnostic relativism that seems to hold sway in much of the Western world. For example, the sweeping epidemic of ADHD diagnoses among young boys (especially since the diagnostic guidelines changed in 2013) has met vocal challenge from professionals and laymen alike for being disproportionately likely to flag personality traits endemic to young boys as symptoms of ADHD worth medicating. Much of the blame for this is generally laid at the feet of pharmaceutical companies who hold great political power in the West, whereas European and Asian countries with less corporate interference have significantly lower rates of ADHD diagnosis. It is also possible that the Western lifestyle contributes to the symptoms of ADHD, which may affect the subject on an individual basis but which are generally taken to have an underlying, unifying disease, and I am inclined to lay a reasonable portion of the blame there as well.
At this point, the reader may be skeptical of some of the claims I have made in this paper. Particularly, the claim that cultural misunderstanding and diagnostic relativism run rampant throughout the West is a claim which is contested very often, but it is also one of the simplest to justify. The very existence of the Healthy at Every Size movement is one obvious and widespread example. HAES activists claim that weight has no correlation to health and that it is entirely possible to weigh in excess of three-hundred pounds with no tangible detriments to health or wellbeing. At the most extreme end, HAES activists claim that the BMI scale is a tool of oppression which normalizes unrealistic and dangerous body compositions and weights when it declares them “normal” or “average”.
This is the kind of relativism which we should rightfully fear and detest, because it attempts to describe the human organism on a spectrum with no boundaries and no true “average” range of functionality. With these descriptors out the window, diagnostic medicine becomes a matter of opinion rather than a pursuit of truth and health. Surely, we do not take the psychotic’s word for it when he claims he is not mentally ill. Surely, we don’t take the lung cancer patient seriously when she says her continued smoking has nothing to do with it. Surely, there has to be a degree of specificity, and we can’t allow rare and unlikely cases to rule the day or to undermine faith in the carefully constructed medical systems of classification and diagnostics which we have painstakingly built over the centuries.
End of Part 1