Is illness a biological fact?

One way to block Szasz’ argument against mental illness is to try to say what all illnesses have in common and show that mental illnesses also fit that condition or definition. Two such defences of the idea of mental illness were offered by Christopher Boorse and Robert Kendell. If either are right, then we can know what illness in general - the target of much healthcare - is.Like Thomas Szasz, RE Kendell (pictured) was a Professor of Psychiatry but unlike Szasz, Kendell was an establishment figure. In a paper called ‘The concept of disease and its implications for psychiatry’ he argues in defence of mental illnesses or diseases by suggesting that it is a matter of biological disadvantage which must involve increased mortality and reduced fertility.

The US philosopher Christopher Boorse also attempts to articulate a value-free, purely descriptive account of disease but using a conceptually richer notion: that of biological function in general. He claims that:

An organism is healthy at any moment in proportion as it is not diseased; and a disease is a type of internal state of the organism which:

i) interferes with the performance of some natural function—ie some species-typical contribution to survival and reproduction—characteristic of the organism’s age

ii) is not simply in the nature of the species, ie is either atypical of the species, or, if typical, mainly due to environmental causes. [Boorse 1998: 108]

So is it plausible to argue that illness is a matter, simply, of biological fact? Is either approach plausible?

Reading: extracts from

• • Boorse, C. (1998) ‘What a theory of mental health should be’ in Green, S.A. and Bloch, S. (eds) An Anthology of Psychiatric Ethics, Oxford: Oxford University Press: 108-115

  • Kendell, R.E. (1975) ‘The concept of disease and its implications for psychiatry’ British Journal of Psychiatry 127: 305-315

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