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 recent history we have successfully destigmatized mental illness to a large degree, one of the unfortunate side-effects of this destigmatization has been the broad misunderstanding about what exactly a mental illness is. The widespread belief that mental illnesses can be treated or cured by medication has suggested to the general population that a mental illness, like a physical illness, can be anything from the equivalent of a “brain cold”, to a massive, untreatable system failure of something akin to a psychotic fracture. The use of the word “illness” bears the significant brunt of the responsibility for this misunderstanding, and I intend to argue here that, though it is morally right to prescribe something analagous to medical intervention in cases of “mental disorders” the key terms are “analagous to”, “disorder”, and perhaps even “intervention” rather than “medical” and “illness”. This crucial distinction makes a critical difference to the justification of intervention to treat the disorder at hand.
To begin, I feel it necessary to debunk the claim that it is immoral to consider a mental disorder to be something which does not require some analogue of medical intervention, which I will henceforth refer to simply as “treatment”. This argument hinges on a version of a functionalist theory of health, wherein there is an acceptable range of functions for any given bodily system, outside of which the system may be called defective, disordered, diseased, or damaged. I am not interested in claims that mental disorders are merely cases of “broken brains” because this is an abdication any present responsibility in light of what we currently know of these disorders because we may come to know something contradictory in the future, even though we may have no good reason to believe that will come to pass in the present.
If we believe we have any kind of duty to provide healthcare to our fellow citizens, it is a modest extension of the argument to claim that we should also promote the general health of our neighbours, and by extension the proper functioning of their various bodily systems. We already require some such infringements on the total bodily autonomy of our citizens for the good of all, such as mandatory vaccinations in public schools, so there is nothing wrong with the claim that we have the duty to promote our collective health in principle. Rather, I consider the position which claims we should not treat mental disorders to be a kind of dereliction of duty, abandoning our neighbours when, if their illness were more physical, we would have rushed to their aid.
If the reader is inclined to believe that what I have just presented is a valid line of argument, then I can ask nothing more. The coherence of my argument is the most critical feature, as the course of action which I will eventually suggest is not clear-cut and may not become feasible in any practical way for a significant amount of time, and I believe we will have to content ourselves with theoretical work until the scholarship around mental disorders matures to the point where it becomes more common knowledge.
Next, the delineation between the key terms. As I have already suggested, “mental illness” is a misleading term because of its suggestion that mental disorders are of a kind with physical illnesses. I glibly referred above to a “brain cold”, the suggestion being that mental disorders could even be classified like physical illnesses to the point that we might consider “catching the seasonal depression” to be as coherent a phrase as “catching the seasonal flu” (and indeed, some people currently do). This is a mistake both because it trivializes the often complex and immaterial causes and manifestations of mental disorders, and also because it suggests that treatment could be as simple as drinking your orange juice and getting some bed-rest.
In short, the term “mental illness” both minimizes the severity of mental disorders and suggests they are simpler and more straightforward to treat than they actually are. Thus, I propose that the term “mental disorder” be used instead to stress what the condition precisely is: the inability of the individual’s mental states to be properly ordered so as to function optimally. This accurately explains the issues of communication or proportionality which occur between mental states and which characterizes mental illnesses. For example, the inability to move past trauma and the constant reliving of traumatic moments which characterizes Shellshock, or the massively disproportional reactions which sufferers of anxiety experience to mundane situations, are both examples of poorly-ordered mental states, and treatment of such disorders is not so cut-and-dry.
Hopefully, the complexity of even common mental disorders has been represented well enough, and we can now speak of the complexity involved in treating them. Shellshock is a strong example of a trauma-related disorder because it exhibits many obvious symptoms, such as a cyclical reliving of the traumatic events, the inability to rationalize the events, survivor guilt, and a perpetual state of panicked arousal which leads to disproportionate reactions to mundane stimuli (such as soldiers who have fight-or-flight reactions to fireworks and slamming doors). There is no simple pharmaceutical solution to these various disorderly mental states, though the various symptoms may be treated this way. To work through Shellshock requires a significant investment of time and energy, intense cognitive behavioural therapy to break the various cycles of trauma, and a return to a normal state of arousal which may never be entirely successful at returning the sufferer to a baseline of proportional reaction to stressful stimuli and general tolerance for anxiety.
Depression is another broad category of mental disorder which is not simple to treat. A very small minority of depression sufferers merely have issues uptaking neurotransmitters into their brains, and can be effectively medicated to treat them. The vast majority of depression sufferers are urban, sedentary, secular, and without strong ethnic and family cultures. Their depression is variously treated with medication, exercise, forced socialization, and constant exposure to new experiences. Their depression, in short, is caused by a lack of identity which leaves them feeling purposeless, and as a reaction their bodies begin to shut down. The sense of isolation which characterizes these depression sufferers come from many different areas of their lives and cannot be treated uniformly, either with pharmaceutical interventions or otherwise, and the personal nature of each case of depression must be acknowledged to treat the individual effectively.
This brings us to why the term “analogous” is critical to our understanding of moral intervention and treatment. We have already established that the treatment of mental disorders is not, by and large, of the same kind as the treatment of physical illnesses. Because of the decreased prevalence of pharmaceutical solutions, I’d suggest that we should only loosely consider the treatment of mental disorders to be medicine at all. Rather, the treatment of mental disorders generally depends on striking a balance between the elements of the patient’s life which will keep them both healthy and sane. For this reason, intervention is only analogous to “treating the disease” because it is more accurately “re-teaching the individual how to live” in pursuit of an optimally functional (and therefore healthy) individual, in body and in mind.
Healthy minds and bodies are codependent entities, and frequently the symptoms of mental disorders are bodily (or neurological) reactions to cope with physical and psychological shortcomings: when the basic needs of the individual’s biological and psychological health aren’t met, the symptoms of these deficiencies manifest in the many odd and complex ways which characterize modern mental illnesses.
Understanding the individual’s health as a holistic entity which requires much more than just the basics of nutrition to function can be unintuitive to the average Western audience, but the rapidly increasing prevalence of mental illness in the West is a testament to the lack of something immaterial which exists in poorer, less developed, and more culturally uniform parts of the world. This is notably the case in Eastern Europe, which is geographically and was culturally close to Western Europe, but the two have diverged significantly and rapidly in the last hundred years.
In conclusion, this understanding of a “medical intervention” analogue is critical to the moral treatment of mental disorders because it is aimed at treating or even curing the individual’s disorder rather than merely dulling the symptoms with pharmaceuticals. To continue to allow mental disorders to be treated as “mental illnesses” is a dereliction of our duty to our neighbours and countrymen, and is immoral because it prolongs their suffering and deceives them as to the proper treatments for their disorders. However, it is clear that until the West matures enough as a society to admit that health is not a commodity which can be bought with medication, and that we must conduct our lives in healthy ways, physically, socially, and mentally, we are not ready to consider the paternalistic implication of a collective social duty to encourage healthy behaviour .