Talk of 'mental illness' is commonplace. But what does it actually mean to have an 'illness of the mind'? Is it, for example, to have an illness which happens to affect mental function? Does it make use of an existing concept of illness and specify merely the domain of that illness's effects? Such a thought encourages the suggestion that mental illnesses might after all be bodily illnesses - i.e. illnesses of the brain. Yet there seem to be ways in which mental and physical illness differ rather fundamentally. For example the paradigmatic physically ill subject complains of feeling ill; not so the paradigmatic mentally ill subject.
 |
| Happy Michel Foucault |
Perhaps, then, physical and mental illnesses are both species of a more general unitary genus of illness, one which can be understood, for example, in terms of disturbances to action or agency (Fulford). Yet whilst we can clearly specify what counts as 'action failure' in physical illness, it's hard to fathom a sense in which mental illnesses similarly involve a failure of action. Or perhaps mental illnesses are forms of illness which are caused by mental rather than physical disturbance? What this misses, however, is the sense in which mental illnesses are not simply causally, but constitutively, of the mind. (It also overlooks the very real possibility of mental causes of physical illness and vice versa.) So perhaps the concept of 'mental illness' is invalid - perhaps it is simply an illegitimate medicalising of what are actually moral problems (Szasz), or a power play by doctors to legitimise their involvement in the segregation and treatment of cases of insanity (Foucault). Then again, perhaps people only have mental illnesses in a metaphorical sense (Pickering)?
 |
| Content Thomas Szasz |
The suggestion I take up here is that the concept of 'mental illness' is formed by secondary sense (Wittgenstein), and stands to the concept of 'physical illness' somewhat like the literary concept of a 'rhyme for the eye' stands to that of a 'rhyme for the ear' (Champlin). The concept is formed, that is, by a projection of patterns of significance from an old (bodily) into a new (psychological) context, yet
no rationale for the projection is available which is intelligible prior to grasping how to talk of 'mental illness'. (The approach accordingly dissolves a host of questions about the legitimacy of 'mental illness'.) This unprincipled conceptual extrapolation is in a sense also a
radicalisation of 'illness', a spread of it from figure (body) into ground (personhood), and since this abrogates the framing conditions for ordinary talk of (physical) illness, we're once again brought up against the senselessness of attempting justification for our extrapolation. This provides the most important feature of our concept of 'mental illness', intuitively recognised by all yet often unacknowledged by theorists: that mental illness essentially involves being unable to hold it together, breaking down, being unable to tolerate the emotional experience of one's predicaments, a breakdown of personhood more fundamental than what is met with in physical illness.
Yet, even so, what are the mental analogues of the physical? Mentally ill people need not look ill, and they may not need or benefit from treatment or even from care (contra Champlin). In this seminar I suggest: that both 'illnesses' essentially involve
suffering (
necessarily conscious in the bodily case,
necessarily unconscious (whilst often contingently conscious) in the mental case); that both involve
drive dysregulation, in the different ways in which 'mind' and 'body' may be said to instantiate drives that can be dysregulated (i.e. disturbance of reality contact vs loss of get-up-and-go); that the dysregulation throws up what we will call
symptoms in both;
and that both essentially offer
exculpation. That (talk of exculpation) is to say: the ill
 |
| Peeved Maurice Merleau-Ponty |
person is someone some of whose behaviour is no longer to be judged according to moral standards. Illness, like moral failure, involves failures in work, care, and allocentric attention, yet is not to be judged according to otherwise appropriate moral standards. The suggestion, in other words, is that moral judgement enters essentially into our understanding of illness by way of the latter's defeating of the former. This sheds light not only on the grammar of mental and physical illness in general, but also on that of hysteria in particular.
If there's time I'll look further into the nature of hysterical illness. Traditionally this has been understood in terms of a 'conversion' of mental into physical distress (Freud). The term 'conversion' invites us to understand the hysteric as converting one kind of extant issue into another; we may however see it instead as a failure of 'symbolisation' - a failure within the lived body (Merleau-Ponty) in the ontogenesis of articulate emotional experience
 |
| Quietly Pleased Susan Langer |
(Langer). By 'articulate' I do not here simply mean 'speakable' - although since discourse is constitutive of selfhood (i.e. is an existentiale - Heidegger) that is important! - but rather I'm talking of the development of a more refined and determinate shape which connects with action and thought and desire in particular, intelligible and manageable ways and contexts which make for what we call 'reality contact'. Having a lived body which is unable to take articulate meaningful shape - e.g. by forming, as modes of itself, distinct emotions with distinct objects and distinct expressions - leaves one with a 'primitive', or 'merely somatic', form of experience. Perhaps we do not meet here with anything worth calling 'conversion', but instead with a blockage of self-becoming due to lack of ego capacity (lack of ability to form, tolerate and maintain powerful emotional experience) (Frederickson). The exculpatory comforts of the physical illness role provide secondary gain; the apt therapy involves containment, regulation, and support of symbolisation.
Reading
T S Champlin (1996).
To mental illness via a rhyme for the eye.
Royal Institute of Philosophy Supplements, vol 41, pp. 165-189.
M Foucault (1967).
Madness and Civilization: A History of Insanity in the Age of Reason. Tavistock Publications.
J Frederickson (2013).
Co-Creating Change: Effective Dynamic Therapy Techniques. Seven Leaves Press. chs 7&8.
S Freud (1974).
Studies on Hysteria. Penguin.
K W M Fulford (1989).
Moral Theory and Medical Practice. Cambridge University Press. chs 7&8.
M Heidegger (1962).
Being and Time. Blackwell. ch 34.
S Langer (1957).
Philosophy in a New Key: A Study in the Symbolism of Reason, Rite, and Art. Harvard University Press.
M Merleau-Ponty (1962).
Phenomenology of Perception. Routledge & Kegan Paul. Part 1.
N Pickering (2006).
The Metaphor of Mental Illness. Oxford University Press.
T Szasz (1972).
The Myth of Mental Illness. Paladin.
