By Joanna Moncrieff.

This blog was inspired by a talk I gave at the conference of the American Association for Philosophy and Psychiatry in May 2017. The title of this talk was: Many ways of being human: challenging the medical view of mental disorders and the implications for psychiatry.

The title is taken from a book by British psychiatrist, Alec Jenner, and three Portugese colleagues entitled: Schizophrenia: a disease or some ways of being human? The book sketches out an approach to the understanding of schizophrenia that challenges the idea that schizophrenia is understandable using the cause and effect paradigm of the natural sciences.

Whether some, or all, mental disorders are diseases in the medical sense is both a philosophical and empirical matter. I have addressed both of these areas in other blogs, looking in particular at the work of Thomas Szasz, but here I set out what I don’t like about the idea that mental disorders are diseases ‘just like any other’.

If mental illness is a brain disease, then the behaviour it is manifested in is irrelevant and uninteresting. It has nothing to do with being human in a general sense. There is no lesson to be learnt from it, and we may as well just eliminate it in whatever way we can. Indeed, we have an obligation under this way of thinking to liberate the ‘normal’ person that is buried somewhere behind the illness. The behaviours and experiences (or symptoms) have nothing to do with that person as a person, they are just an aberrant part of their physical body. Nothing is to be lost, no inherent cost incurred, by eradicating the condition without trace.

What attracted me to psychiatry, and I believe many others, is not that the symptoms of mental illness are bizarre curiosities arising from brain irregularities. If this was the case, I could have gone into neurology. What attracted me to psychiatry, and what still interests me, is the intuition that mental disorder has something profound to teach us about the nature of being human. And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.

The title of the talk was also meant to emphasise that mental disorders need to be understood in the same way that we understand other sorts of human behaviour. There is not a categorical distinction between normal behaviour and emotions, and what we might call mental disorder. This is not the same as saying that all mental disorder is on a continuum with normality. Depression and anxiety may be familiar to all of us to some degree, but despite the research saying we all hear voices, I think that true psychotic experiences are rare, and most people probably only get a glimmer of what these might be like when they are very tired, or have taken certain mind-altering drugs. Therefore I do not think it makes sense to suggest that psychosis is on a continuum with normal experience. However, it is not a different sort of thing either. As Luc Ciompi, founder of the Swiss Soteria project commented (as cited in Jenner and colleagues’ book), psychotic states, like that sometimes referred to as ‘schizophrenia,’ are better thought of as a life process than an illness.

As another Swiss psychiatrist, Manfred Bleuler, said (also cited in Jenner et al) people with ‘schizophrenia’ “flounder under the same difficulties with which all of us struggle all of our lives.”

What we need to try and understand these extreme and unusual states of being are not the specialised methods of natural science. In contrast, it is the ways in which we understand ordinary, everyday behaviour that can, if anything, help to reveal the nature and meaning of madness. Madness is an unusual way of being human, but a way of being human nonetheless!

First published on joannamoncrieff.com, WordPress, 27^th March 2017