These are very apt existential questions which I was confronted by by my experience of neuroleptic drugs. What is it which makes us human, normal, meaningful; and what identifies us individually and collectively. I—although I hate the current psychiatric paradigms—believe that the treatment of mental conditions is, in principle, a medical matter. I also believe that the mind is physical, by analogue to renal filtration. The kidney is the anatomic entity; the filtration the physiologic. Brain: anatomic; mind: physiologic. I completely agree with you that nosologists of the mind need especial caution in unyieldingly making clinical that which is not clinical. I would say that that which is clinical is ‘that which does not best accord *our* purposes out of the available options of alternative bodily states’: i.e.: I broadly agree with Hacker. It is biologists’ modus operandi to find generalities (I suppose nomothetically) manifesting within nosology’s insistence on trying to find an absolute rulebook of what are diseases and what is health. In non-mental medicine, there is greater consensus upon what bodily states are not conducive to our purposes. However, as you so exactingly identify, the mind is part of our unique identity. Therefore, unforgivingly insisting on a list of ‘good’ and ‘bad’ mental states/traits is dangerous and duplicitous. I think the future of nosology should rather than rule upon what is a diseasing condition and what is an easing condition; it should list each condition with what the prognoses of each are; and what treatments can be deployed to cause a potential condition, maintain a condition, or reverse a condition. In non-mental nosology, this might seem pedantic because of broad consensus. But, potentially, someone might want, say, mild osteoporosis or osteopenia if being lighter would help with his/her occupation (maybe needing to be carried/lifted). As long as ability to consider this fully is demonstrated, this is his/her right, in my opinion. It is in mental nosology where this subtler difference in definition is manifest more clearly. If someone wishes to decrease his/her anxiousness, because the person himself/herself has identified it as not purposeful for his/her identified plans, then it is legitimate, I believe, to seek advice on how we know, as a species, to reduce anxiousness. Conversely, an, e.g., disinhibited person might seek to increase anxiousness as an inhibitory process. If someone cannot consider whether his/her mental state is problematic, then, I believe that it is legitimate to enforce treatment. But the Mental Health Act does not recourse to what is currently referred to as ‘mental capacity’. Just severity and ‘appropriacy of treatment’. A nonconsenting even-capacitous patient with a severe-enough condition loses his decision’s being honoured by doctors. Even if the person has capacitously opted against identifying the condition as diseasing or against treatment for another reason. The other legitimate justification is risk to others publicly, e.g. infectiousness or dangerous behaviour. You quite incisively identify the conundrum ‘is disease the person or separate from him/her?’ If the person has sought help in modifying his/her mentality, then, one can separate it from himself/herself as an ego-dystonic trait. If the person cannot consider this fully, then, once the incapacitating factor (e.g., drug, psychotic episode, delerium, unconciousness) abates, even the person might dissociate his/her identity with the beliefs (or in the case of unconsciousness: not consenting, because unconscious) which stopped the person consenting to treatment. Where a person able to fully consider whether his/her mental or otherwise state is how he/she wants his/her body (and I include the mind with the rest of the body) to be and is not directly affecting others adversely (i.e., without consent or unlawfully), then that bodily state is not diseasing him/her, so cannot be separated from him/her. This is the case, I opine; however extreme/severe it may indeed be So, in summary, I do include the mind as part of the body, and psychiatry as a legitimate branch of medicine; but only with the qualification that the medical model be adapted to put the person the lead purposive determiner of what he/she regards as a diseasing/easing state. As Hacker opines, disease undermines the beholders purposes, but I would say, as a person rather than of the person’s kind, from a moral perspective (of how things ought to be [normally])—although spotting nomothetic universalities in how people identify different conditions as easing or disrasing is legitimate as a describing scientist, not prescribing individually these labels onto individuals. Thank you for the thoughtful, thought inspiring article. I suspect I might still further think about, contemplate about, and consider its compelling topics over the next few days.