Mental illness has ravaged many a life, ruined many a family, and has dramatically increased during the pandemic. Most of us probably know someone—a loved one, family member, friend, or colleague—who has been afflicted.
Hidden within all this suffering is a long standing, seemingly intractable, philosophical quandary residing at the center of Western philosophy since the 17th century: The mind-body problem. This Gordian knot was prompted by the rise of science, which permits only physical causes and effects. The problem is this: How can a material, biological entity that obeys the laws of the physical world (our body) give rise to our rich, subjective, deeply personal experience of the world (our mind)? The debate ranges and rages across a wide landscape. Are we, for example, only body and our mind is, at best, an epiphenomenon? Or, alternatively, can we only be sure of our immediate phenomenological experience—our mind—and our body, as a physical entity, is a mirage?
This debate appears to have little to do with our everyday lives; simply another pointless intellectual game played by philosophers.1 This debate, however, cannot be so easily dismissed. Many will likely make decisions that have life consequences, sometimes life and death consequences, without realizing that they are determined by unexamined assumptions about the mind-body problem.
Mental illness. The mind-body problem adheres in its very name. The term, mental illness, is a concatenation of mind (mental) and body (illness). The term also encodes a presumed resolution to the mind-body problem. Illness is the subject, the noun. Mental is the descriptor of the subject, an adjective. It identifies the type of illness. To reverse the order, “illness mental”, makes no sense. Illness is not an adjective. Because human distress, anguish, and dysfunction are defined as an illness, a physical affliction of the body, then the identification, diagnosis, cause, and cure must be treated as all illnesses are; as a medical condition.
Pills and Power
The illness approach to mental suffering gives “ownership” to MD’s; to psychiatrists. The manual for identifying and diagnosing mental illness (the DSM) is issued, and frequently updated, by psychiatrists; new illnesses are identified, some deleted, and diagnostic criteria added and amended.
Understanding and treating mental illness underwent a revolution in the 1960’s. Prior to this time, identification, diagnosis, cause, and cure were predominately determined by Freudian trained psychiatrists. The revolution was sparked by the discovery of medications that ameliorate symptoms associated with profoundly disabling types of mental illness; neuroleptics to treat psychosis, antidepressants for depression, and mood stabilizers for bipolar disorder.
The chemical actions of these drugs were investigated with the aim of uncovering the pathophysiology responsible for the illness that the medications address. This research led to “chemical imbalance” causal models of mental illness. So, for example, neuroleptics, which contain dopamine, was hypothesized to offset an imbalance in dopamine presumed to cause psychosis. Similarly, antidepressants, which inhibit the uptake of serotonin, was hypothesized to prevent an imbalance of that neurotransmitter presumed to cause depression.
Given the severity of impairment of these illnesses, and the prolonged Freudian treatments using medically dubious means (talk) with uncertain results, these discoveries flashed on the scene as miracle drugs. Psychiatry was upended. The Freudian-based approach was replaced by a medical model anchored in physical causality, symptom-based diagnosis, and treatment by medication.
In addition to the obvious and profound benefits of relief of suffering, other important consequences followed from the positioning of mental illness within the body-causes-illness medical model. Insurance coverage is now routine, lifting the huge financial burden of treating these illnesses, and billions of federal dollars are now dedicated to research investigating the bio-medical causes and cures of mental illness. Medication is the default option typically used to treat mental illness.2 While philosophers debate the mind-body problem, it appears to have been solved in the laboratory.
Flies in the Ointment
Despite the success of medication and its widespread use, however, a host of troubling difficulties plague foundational aspects of the medical model of mental illness. Three are especially noteworthy.
Causality. Decades of research has failed to support the premise that specific biochemical deviations in the brain correspond to particular mental illnesses. Furthermore, symptom amelioration can be accomplished with drugs that do not contain the hypothesized chemical causal agent.3
It also has become clear that psychological stress and trauma can precipitate all manner of mental illness, from PTSD and anxiety disorders to schizophrenia and depression. Both body (biology) and mind (psycho-social) can predispose, prompt, or give rise to mental illness. Causality is a complex entanglement of body-to-mind and mind-to-body interactions. The nature of the entanglements are fuzzy, vary among mental disorders, and even vary among individuals sharing the same illness.
Diagnosis and Cure. Mental illness does not share essential diagnostic attributes of physical illness. Question: How many mental illnesses can be diagnosed using biomedical indices, including brain scans, genetic markers, blood tests, body scans, laboratory assays of bodily fluids and functions, identification of pathogens, etc.? Answer: None. Not one. Furthermore, the illnesses themselves are not identified by medical or biological symptoms. The symptoms are all psycho-behavioral. And cures consist of the reduction of the listed psycho-behavioral symptoms. Diagnosis and cure fall entirely within the circumference of “mind,” not body.
Treatment. The treatment of mental illness is a much researched area and the complications are head spinning. The best practice, empirically supported treatments vary for types and severity of illnesses, and can differ between individuals and circumstances. Medications can certainly be effective, but they are not a panacea. Indeed, for many, if not most, of the 157 mental disorders listed in the recent diagnostic manual, medications are not the most effective treatment. Instead, behavioral and psychological interventions often are, and they come with the added benefit of no long-term side effects.4
Mind-Body and You
The debate about the mind-body solution to mental illness ranges widely and rages on. It has not been solved. Confusion, dispute, and debate about all aspects of mental illness, from identification, to diagnosis, to cause, to cure, indeed, to the very legitimacy of the term “mental illness” itself, highlight the intractable nature of the issue. This is not simply a philosophical debate, and cannot be waved off as irrelevant to our daily lives. It is a dispute with life-altering consequences. Should you find yourself in need of treatment, you must choose your solution, and the stakes couldn’t be higher. Be informed. Choose wisely.
- See https://decembersongs.com/pandemic-truths/ for an essay about another apparently pointless philosophical dispute that can also have mortal consequences. Indeed, while the general public regards philosophy as academic masturbation that only benefits the participants, and philosophers themselves typically don’t help their cause, many knotty philosophical issues have vital practical consequences.
- Unfortunately, it is primary care physicians, who have not been trained to treat mental illness, who typically prescribe psychiatric medications, not psychiatrists.
- Dr. Joanna Moncrieff has written extensively about these issues in a way that is accessible to the lay public.
- Medications can be especially helpful for some particularly debilitating illnesses, like schizophrenia. Tragically, these illnesses are mis and over diagnosed to an almost criminal extent, and over-prescribing is rampant. Furthermore, when medications are needed or helpful, psycho-behavioral therapies, in conjunction with medication, can help afflicted individuals move beyond symptom amelioration to developing skills and habits to cope with their illness and live a rewarding life.