Why Philosophy Matters?

Joanna Moncrieff, MD
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This is the first of a series of blogs presenting a philosophical analysis of the modern mental health system and what it is concerned with.

20th century philosopher, Ludwig Wittgenstein, much of whose later work concerns our thinking about the ‘mind,’ suggested that the role of philosophy is to identify and clear up conceptual confusions. Many of these confusions have been introduced by philosophers, asking the wrong questions in the wrong way. Wittgenstein hoped to show that by understanding the nature of language more accurately, many of the most complex dilemmas of philosophy just melt away.

This idea of tidying up our language might sound like a rather modest activity, of little practical importance, but it is not just philosophers who have been beguiled by muddled uses of language and led astray by fruitless debates. These confusions have permeated everyday thought. They influence our behaviour as individuals, and structure the social institutions we build. Nowhere is this more apparent than in the system we now call ‘mental health.’

Thomas Szasz is, of course, the most well-known person to have called attention to the conceptual confusion embedded in the term ‘mental illness.’1 For Szasz, illness and disease are concepts that are inextricably bound to the body, hence a non-bodily, non-material concept such as the mind cannot be ‘ill.’2 Situations that are referred to as ‘mental illness’ are defined by certain sorts of problematic behaviour, not by the biological dysfunction that is characteristic of regular illness. Szasz also understood that the confusion inherent in the concept of ‘mental illness’ did not simply arise because people were misguided, it is what he called ‘strategic.’ Designating certain problems as ‘mental illness’ justifies particular social arrangements and it does so because the terms ‘illness’ and ‘disease’ derive their meaning from being a condition of the body.

I will return to the crucial issue of whether or not an illness is necessarily a bodily characteristic in later blogs, but now I just want to illustrate how important this question is. Whole social systems depend on the assumption that what we call ‘mental illness’ or ‘mental disorder’ (a piggy-back term) originates in the body. In particular, this notion is fundamental to the current social response to certain forms of behaviour, and to processes for allocating resources for assistance or welfare.

In modern societies, the use of force by some individuals against others is considered unacceptable and is illegal. The state reserves a right to use force in some situations, but only against those who have broken the nationally agreed code of conduct — the law. However, if someone’s thinking and behaviour are thought to be the result of an aberrant biological process taking place within the body or brain, a process that has nothing to do with the personality or agency of the individual (which is what I will argue is the usual understanding of the term ‘disease’), then the individual logically forfeits the right to be regarded as an autonomously-acting being. What she does and says in these circumstances can legitimately be disregarded. Efforts to change her behaviour, which may involve the use of force, can be conceived of as a medical ‘treatment’ that is aimed not at the individual per se, but at the underlying disease.

Think of the contrast between compulsory community treatment orders or outpatient commitment for people diagnosed with mental disorders and the use of libido-suppressing agents for sex offenders (sometimes referred to as chemical castration). Although these drugs can be imposed on convicted offenders as part of sentencing in some parts of the world, in most of Europe, sex offenders have to give their consent, and in the United Kingdom, a second opinion is also required for the drugs to be administered by injection. Under out-patient commitment laws, someone who has a diagnosis of mental disorder, but has never harmed anyone, can have her body chemically altered against her will for the rest of her life, despite having the capacity to make a perfectly rational decision about this for herself. This is not imposed as a punishment for misbehaviour (at least not explicitly), and would not be acceptable in modern, western society without the implicit assumption that having a ‘mental disorder’ is equivalent to having a bodily disease. This enables the expressed wishes of the individual to be disregarded since she is no longer viewed as an autonomous agent, but as an object that is driven by the biological process taking place in her brain.

The idea that mental disorder is a disease is also the basis of modern welfare systems and crucially important for enforcing the modern work ethic. The characteristics of the ‘sick role,’ described by Talcott Parsons, derive from the nature of diseases as biological processes. People who have a disease have exemptions from normal social expectations and entitlements to care and support because of the recognition that biological events are not (often) under human control.3

Modern society has no other way of excusing people of their social obligations. Although we recognise that numerous common life events (relationship breakdown, loss of a job) can make it difficult for people to cope with their daily duties, only a medical certificate verifying that someone is ‘sick’ (the ‘sick note’) entitles them to time off work, or financial assistance without the obligation to seek work.

I am not claiming to say anything new here. Szasz has made these points for decades.4 There is a tendency within mental health circles to fudge or avoid the issue, however. Proponents of the ‘biopsychosocial’ model appear to suggest that mental disorders can be both a biologically-driven process and a behavioural condition at the same time. Others claim that mental mechanisms and biological processes are the same thing, and hence can be sick or diseased in the same way.5 Although the term ‘mental disorder’ appears to avoid criticisms of the concept of mental illness, in reality it serves the same purpose, and hence ‘piggy-backs’ on the concept of mental illness.

I simply want to stress that fundamental aspects of western society depend on the equation of certain social problems with bodily conditions or illnesses. Without this, the concepts of mental illness or mental disorder cannot do the work they currently do. They cannot form the basis of the social systems they currently sustain.

What disease or illness is rightfully thought to be, and whether these concepts should, or should not, include the problems we refer to as ‘mental illness,’ has hugely significant consequences. It turns out that clarifying conceptual confusions may have a profound impact on modern society.

In the next blog in this series, I will look at the philosophy of Wittgenstein in more detail, and how it relates to our understanding of the ‘mind’ or the ‘mental.’

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32 COMMENTS

  1. This is a good start. Good article. Like most philosophers, Ludwig was a troubled man, but he was also an early critic of scientism.

    Why not start with Socrates? The Socrates of psychiatry, Thomas Szasz, wrote a book called “The Meaning of Mind” that is worth reading. See here: https://psychiatricsurvivors.wordpress.com/2015/03/31/the-meaning-of-mind/

    Wittgenstein and Szasz come at the tail end of a very long discussion concerning the human “mind.” You might need to get back to Heidegger and Nietzsche to discover why human beings are frequently regarded as objects rather than autonomous agents, or to Hobbes and Machiavelli to understand why life as we know it is merely matter in motion. Or maybe we moderns are all Lucretians. Are Plato and Aristotle too quaint?

    It is good to resurrect Szasz, so to speak, but he would certainly take exception to assumptions that there is any such a thing as a “mental disorder” that is connected to observable biological reality. Szasz was right. “Mental illness” IS a myth. One criticism that I have of your excellent book about “The Bitterest Pills” is that you still seem to cling doggedly to the false notion that psychotropic drugs help certain people who suffer with a “mental illness.” Perhaps Wittgenstein will help you to see through that lie, although Szsasz and Socrates could also help. See here:
    https://psychiatricsurvivors.wordpress.com/2017/08/26/the-bitterest-pills/

    You make an important point, however, about the “fundamental aspects of western society” that “depend on the equation of certain social problems with bodily conditions or illnesses.” This was a very important topic in 18th century France, particularly in the writings of Jean-Jacques Rousseau.

    All of this is simply to agree with your point that philosophy matters, and that we need to ask the right questions in the right way.

  2. “someone who has a diagnosis of mental disorder, but has never harmed anyone, can have her body chemically altered against her will for the rest of her life, despite having the capacity to make a perfectly rational decision about this for herself. This is not imposed as a punishment for misbehaviour (at least not explicitly), and would not be acceptable in modern, western society without the implicit assumption that having a ‘mental disorder’ is equivalent to having a bodily disease. ”

    It is what motivates me.

    Wish you all the best with the RADA program, very important indeed, very difficult, but doable. It was almost shocking to me, that there was no help coming off these drugs – what so ever – from psychiatrists. They seemed to think it had nothing to do with them.

    • “This is not imposed as a punishment for misbehaviour (at least not explicitly), and would not be acceptable in modern, western society without the implicit assumption that having a ‘mental disorder’ is equivalent to having a bodily disease.”

      Since the psychiatric industry has spent decades and billions trying to prove their “mental disorders” are real “genetic” bodily diseases, and failed. Whitaker pointed out the ADHD and antidepressant, iatrogenic pathway to the “bipolar” diagnosis. And the “schizophrenia” treatments, the antipsychotics/neuroleptics, can create the positive symptoms of “schizophrenia,” via what is actually anticholinergic toxidrome, and the negative symptoms of “schizophrenia,” via what is actually neuroleptic induced deficit syndrome. Which means the DSM “disorders” have an iatrogenic etiology, not a “genetic” or biological one, as the psychiatric industry assumed – and assuming is never wise.

      Nontheless, since the psychiatric industry’s assumptions were incorrect, their behavior of forcing, and coercing with “chemical imbalance” lies, their iatrogenic illness creating drugs onto innocent other human beings has NOT been acceptable human behavior in our modern, western society. Quite to the contrary, the psychiatrists have been, and still are, behaving in a completely unacceptable manner. They have very literally been behaving like brutish, deluded, insane lunatics, because that is what they are. And the psychiatrists behaved like this in Nazi Germany and Bolshevik Russia, too.

      When will today’s psychiatric holocaust, primarily against child abuse victims today according to the medical literature, end? The right of psychiatrists, or any doctors, to force, or coerce with lies, the iatrogenic illness creating psychiatric drugs onto innocent humans needs to be criminalized immediately.

      I do not see the logic in this belief system either, “if someone’s thinking and behaviour are thought to be the result of an aberrant biological process taking place within the body or brain, a process that has nothing to do with the personality or agency of the individual (which is what I will argue is the usual understanding of the term ‘disease’), then the individual logically forfeits the right to be regarded as an autonomously-acting being.”

      Why is it logical to believe that one who is supposedly “diseased” automatically “forfeits the right to be regarded as an autonomously-acting being”? This kind of thinking would imply anyone who gets a cold or the flu automatically “forfeits the right to be regarded as an autonomously-acting being.” That’s psychopathic psychiatric “logic” in my opinion.

      Streetphotobeing, “It was almost shocking to me, that there was no help coming off these drugs – what so ever – from psychiatrists.” An excellent point that needs to be repeated, as this is shameful. And my experience was psychiatrists actually go to the point of breaking HIPPA and other laws to try to keep people medicated.

      • Yes, they sit back and watch in the belief that you will go into mania or depression and go running back to them. In my case – not only did that not happen – I fired off significant complaints to which the trust lied in reply, even giving the complaint to the very psychiatrist who subjected me to polypharmacy to investigate, of-course they concluded that I had never been subject to polypharmacy. I just proved all this to be lies in the form of crisis team discharge letters, listing all the drugs. Which qualified another complaint on NHS Choices. Right now, I just love it. However it is extremely serious and very invidious, what I went through was horrific; the only true justice would be prosecution.

  3. Logic is the method, coupled with science, by which we arrive at the truth. There are so many inconsistencies in psychiatry that a good dose of logic is called for to get beyond them. Ludwig Wittgenstein, being the major impetus behind positivist logic, certainly deserves a place in any series of blogs that would look at psychiatry from a philosophical standpoint. Self-deception and deception seem to be so pronounced in the field that, indeed, separating fact from fiction must become a pressing issue for anybody taking a good hard look at the matter.

    I, following Thomas Szasz, don’t think “mental disorder” is any improvement over “mental illness”, but that said, I am very curious to see where this philosophical trek of yours might lead, and I see it, in so far as the illusions put forward by the field are concerned, as something that can’t be a bad thing. Of course, given your profession, conventional language is required for reasons that go beyond medicine–bureaucratic, legal, and financial, for instance–and this presents us with another reason for recourse to philosophy when looking more closely at it.

    • Logic and science are two methods by which we arrive at truth, but any able epistemologist or metaphysician can show you that they are by no means exclusive. However, it is true that good philosophy ought to suffice to dissect and dissolve the lies inherent in psychiatry. Your point about Szasz is spot on. “Mental disorder” is hardly an improvement over “mental illness,” and Szasz would have recognized that. I too am concerned that it will be difficult for a psychiatrist to get behind the conventional language of the so-called “profession,” but I think that Joanna is making a concerted effort to do that very thing. Szasz paved the way. It will take a lot of work, but more importantly, it will take a lot of courage.

      • I love the logic in Szasz. I’m not saying there aren’t flaws in his thinking. I’m just saying that one thing follows another the way it doesn’t with so many of his colleagues. His thought, in that regard, is pretty consistent.

        I think logic reinforces science. This is the problem with much work in the human sciences. Illogical science is ‘bad science’.

        Dr. Montcrieff is right to focus on language here, and our discourse on the subject here indicates why. Wittgenstein and Szasz had that concern in common.

        I take the view that rationalism is my salvation. Doing so, I can defend myself as “sane” against accusations of “insanity”. I can also, in good faith, be held responsible for my actions. I realize this is an atypical approach to the matter, especially for a person who has done time in the Loony Bin, but, given that matters are getting worse for us, as in the recent passage of the 21st Century Cures Act, I see no other recourse for such as myself. If a lawyer (or anybody else for that matter) should ask, then, no Insanity Defense for me, please. Thank you.

  4. Good article.

    This [forced drugging] is not imposed as a punishment for misbehaviour (at least not explicitly), and would not be acceptable in modern, western society without the implicit assumption that having a ‘mental disorder’ is equivalent to having a bodily disease.

    Yes, however if a fully conscious person has a bodily disease they are not forced to undergo treatment, so the further question becomes why, if both mental “illnesses” and physical illnesses are equivalent, only the “mental” ones justify force. No one over 18 can be forced to accept treatment for cancer or even HIV.

    Part of the answer of course is that psychiatric “treatment” is a form of punishment, sometimes subtle, sometimes glaring.

    Although we recognise that numerous common life events (relationship breakdown, loss of a job) can make it difficult for people to cope with their daily duties, only a medical certificate verifying that someone is ‘sick’ (the ‘sick note’) entitles them to time off work, or financial assistance…

    And why is that — perhaps because anything more would constitute an admission by “society” (i.e. government) that it cannot adequately address human needs and should maybe be replaced?

    There is a tendency within mental health circles to fudge or avoid the issue, however.

    You think? 🙂

    Although the term ‘mental disorder’ appears to avoid criticisms of the concept of mental illness, in reality it serves the same purpose, and hence ‘piggy-backs’ on the concept of mental illness.

    Yes, absolutely. I think Frank would call these “weasel words.” (No offense to weasels.)

    To summarize, nothing really “new” here it’s true, but that doesn’t make the debate unnecessary. Capitalism or any other oppressive ruling system stands much to gain by redefining the destructiveness of its rule as individual pathology and unrelated to society at large. It’s much easier to deal with a collection of individuals, each with a “me against the word” (or “me against myself”) mentality, than with a united group of people who recognize and fight their collective oppression collectively.

    • Well, Szasz pegged them ‘weasel words’ or ‘weasel terms’, and so they are. As if people had “disordered” thoughts because doctors (and everybody else) had “ordered” thoughts, and not because the doctors were looking for a useful word to use that didn’t directly (the weasel part) infer “illness”. (They’re doctors, remember.) “Schizophrenia”, too. There you’ve got a term that purports to be the proper name of a medical disease like pneumonia, cancer, or psoriasis. Like, I don’t think so.

      I think you have to look at them from another perspective though, too, and that’s from the perspective of ‘health’ insurance. Also, legality. “Sanity” and “insane” are legal terms. Bureaucracy needs words for the disability pie it doles out to it’s ‘dependents’. If “mental illness” doesn’t have a literal reality, it sure as heck has a paper reality. A paper and a social reality, given the prejudice of people that catch loony birds. People are bound to language, lying language, and often by law.

      This makes looking at the words we use very important indeed. Liberation from specialist terms? That’s not so hard to achieve, I would think. Still, the illusions need to be shown up for what they are, and that’s where philosophy comes in.

      • Frank,
        “Schizophtenia” is a deadly term. “Has a Diagnosis of Schizophrenia” is like a death sentence even though a person might have recovered many years before.

        A doctor wouldn’t say “has a Diagnosis of diabetes” about someone that had recovered many years before and stopped consuming drugs suitable for diabetes. The doctor would present the person in proportion.

    • “The question becomes why, if both mental ‘illnesses’ and physical illnesses are equivalent, only the ‘mental’ ones justify force.” Your answer (and Szasz’ answer) has a great deal of truth to it (psychiatry plays a major role of social control) but it is not the most understandable answer. “Mental illnesses” are believed to cause a lack of “normal, healthy” judgment; thus, society (led by psychiatry) protects patients (and society) from themselves. This is consistent with the “insanity” defense against criminal prosecution and how we portend to treat children. “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive (C.S. Lewis).”

      • That’s a pretty judgmental thing though, isn’t it? Judging people to be ‘lacking in judgment’. You can go over the scene of the “affliction” with a fine toothed comb, and ultimately you still get to, ‘he who is without fault, cast the first stone’. Throwing people away, or designating them ‘throw away people’, is not an example of the best exercise of judgment. How do they put it? That ‘karma’ thing, oh yeah! ‘What goes around, comes around.’ ‘Judge not lest ye be judged.’ Still, miss out on that first chance, and some might confuse it for a third chance, and life for one inning at a baseball game. The judged are going to judge the judges, and the judges have their own arrogance and paternalism to account for.

    • Makes me think of a book by some German eugenicists before Hitler came to power. “Life Unworthy of Living.” I believe the pro-psychiatry people, at least the “well-informed” ones, view us as unworthy of life. They will not actively kill us—yet. That would be too obviously inhumane, since most of us aren’t enclosed in institutions where murdering us could be carried out in secret. Plus they can make a lot more money using us to sell drugs they can bill to Medicaid.

      In the end how much we suffer, sustain crippling from said treatments, or die prematurely don’t matter to anyone. Including the NAMI mommies and other folks out to help us into early graves.

  5. Joanna: I applaud you for taking up this issue.
    I also really like Thomas Szasz’s writings – he was instrumental in raising these issues and getting people contemplating/discussing these important matters. However, I have something to add to this discussion and I hope you will read the rest of this comment with an open mind.

    I too have done quite a bit of reading on this subject area and as a result, I agree with “Slaying_the_Dragon” regarding that logic/science are limited means to arrive at the truth. In other words, we need to consider other epistemologies. Here, I like to direct your attention to how ancient people understood the mind – especially how Buddhist teachings (from some 2600 years ago) describe the mind. I know that some people simply discard these types of considerations thinking that “it is religion and therefore it must be irrational.” However, if someone can go beyond that negativity, then one can see how comprehensively these teachings have described the mind.

    First, when talking of different epistemologies, it is useful to think in terms of two levels of analyses. One is the conventional level – almost all of the analyses we do on a day-to-day level happen at the conventional level (e.g. analyses on how trees grow, how digestion happen, about evolution, how the brain works, etc.). The other level of analysis is the moment-to-moment manifestation of the “stream of consciousness” (i.e., this takes into consideration the past, present and the future, how the past can condition the future, etc.).

    Buddhist teachings comprehensively describe this “stream of consciousness” in terms of continuously changing sense impressions and mental phenomena, and also describe factors that moderate the flow of consciousness. When you understand these explanations, it is possible to comprehend that there is no such thing as “mental illness,” and that there are only issues in life that can be dealt with through understanding (by the way, this relates to the practice of ‘mindfulness’). Commentaries of Buddhist teachings describe that the “stream of consciousness” is affected by physical laws, biological laws, psychological laws, volitional laws, and universal laws. The following academic article is a good start read about this:

    Karunamuni, N., and Weerasekera, R. (2017). Theoretical Foundations to Guide Mindfulness Meditation: A Path to Wisdom. Current Psychology. doi:10.1007/s12144-017-9631-7

  6. They would not use these “safe and effective” treatments on convicted felons as a form of punishment, because that would be cruel and unusual yet parents and spouses gladly force them on “loved ones” and gullible patsies (like me) submit to this torture because doctors claim they will help them. Or kill them. Or both. Whatever.

  7. Joanna: I think language matters, and words matter. 2 words I think are very relevant here are “subjective”, and “objective”. I’d say that so-called “mental illnesses” may have a *subjective* reality, but they have NO OBJECTIVE reality. It’s true that some people do believe in the “reality” of so-called “mental illnesses”, and that belief gives them subjective reality only. (It’s an objective reality that they hold that belief, but that’s a higher order of example.) Some people do believe in Santa Claus. So I say that so-called “mental illnesses” are exactly as *REAL* as presents from Santa Claus, but not more real. They may have subjective reality, but not objective reality. That’s what makes psychiatry a pseudoscience, and not a true medical science. EVERYTHING psychiatry does is subjective, including assessing the effects of drugs. (Yes, blood levels of a given drug can be measured objectively, but that’s all…. whatever “effect(s)”/”side effects” they have are all subjective.) Comments? RSVP? Thanks, excellent article, BTW….
    (c)2017, Tom Clancy, Jr., *NON-fiction

  8. The sound bite “an illness like any other” is obviously bovine excrement. Do the NAMI folks (the people who run NAMI, not the “consumer” mascots) encourage locking up diabetics and having teams of 6 burly orderlies pile on top of them for insulin injections? Do they force people with cancer to take chemotherapy against their better judgment simply so the doctor can make more money selling the treatments? If someone has a reaction to penicillin do they say that means they are biologically inferior and must atone by taking a cocktail of penicillin plus a few other drugs for the rest of their lives?

    They don’t? Then I guess it’s NOT like any other illness. Not like any real illness anyhow.

    And the pro-psychiatry people are telling lies even they don’t believe when they tout this bovine excrement. They need to be called out on their hypocrisy!