In the first session we highlighted two important distinctions for understanding the very idea of the social aetiology of mental illness. The connection between social factors might be brutely causal (sessions 1, 2) or understandable (session 3). And the connection might be causal (sessions 1, 2) or constitutive. In this session, we will begin to consider this stronger claim.
The claim is stronger because unlike a causal claim it is inconsistent with a bio-medical model according to which illness is constituted by factors within the body (whether or not caused from without). But it is therefore harder to motivate.
One way to begin is to consider the argument offered by Thomas Szasz in his paper ‘The myth of mental illness’. This contains an argument against the existence of mental illness. Schematically, Szasz attempts to establish features that mental illness is supposed to have but then argue that nothing could possibly have those features. Hence mental illness is a myth.
Whether or not that argument is successful, however, one of its premises is important. It is the claim that mental illness is essentially connected to the idea of deviation from a norm which has to be characterised in psychological, ethical, and legal terms. That is, it seems to be a complex evaluative notion. That raises the question: if mental illness answers to societal values, does that mean that what counts as an illness (at a time and a place) is determined merely by what a society, contingently, values? Is the decision to count some conditions as life-style choices (eg. sexual orientation) and others as illnesses (eg. anorexia) simply a value-choice?
The connection between societal norms or values which Szasz highlights is merely suggestive of a constructionist view of social factors, though. To get a clearer picture of what is involved it is helpful to look at a different debate between constructionism and its objectivist opposition: not about values but about meanings. Are meanings constructed socially? Thus the reading for this session combines both.
Essential reading
Fulford, K.W.M., Thornton, T. and Graham, G. The Oxford Textbook of Philosophy and Psychiatry Oxford: Oxford University Press chapter 2 session 2.
Szasz, T. (1960) ‘The myth of mental illness’ American Psychologist, 15 : 113-118
Thornton, T. (2007) Essential Philosophy of Psychiatry, Oxford: Oxford University Press chapter 4 section 2
Further reading
Fulford, K.W.M., Thornton, T. and Graham, G. The Oxford Textbook of Philosophy and Psychiatry Oxford: Oxford University Press pp687-95
Sabat, S.R. and Harre, R. (1994) ‘The Alzheimer’s disease sufferer as a semiotic subject’ Philosophy Psychiatry and Psychology 1: 145-160
This session’s lecture slides are here.
Reflections on this session are here.