Some Thoughts About Understanding Mental Illness
Understanding the concept of depression as answerable to the actions that a person performs, is like saying a rat has depression because it does not function as we would expect in relation to things that normally stimulate it in certain ways (or, at a stretch, finds pleasurable); conditions that we may have simulated in a laboratory. What’s wrong with that?
Well, to speak of depression purely in terms of the actions a person performs – what they do or do not do regardless of reasons – is to reduce the concept in ways that ignore much of the behavioural landscape upon which it gains traction. For instance, on this reduced conception of depression, one could ascribe it to someone merely on the grounds of reduced (or different) functionality caused by them taking some drug or other. Saying that rats can be depressed merely on the grounds of their behaviour is to use the concept in an attenuated sense – on credit, so to speak, from the criteria that amount to the grammatical foundations which govern fully fledged and appropriate applications of the concept.
When someone becomes depressed, different things start acting as reasons for them - things that were never considered as reasons become reasons in the depressed person’s rationalization of their behaviour; the authority of existing reasons in their rationalisations also changes. This results in their actions being understood as consistent with someone suffering from depression. Put another way: the kinds of reasons given (and the changed emphasis on already existing reasons) provide many of the criteria required to say of someone that they are suffering from depression or another form of related mental illness.
People don’t just self-harm, lose interest in their friends and become sexually promiscuous for absolutely no reason; there will always be a cause (or causes) of one kind or another. Such causes can, in some cases, be addressed by the use of drugs, psychotherapy and, more controversially, electroconvulsive therapy (ECT). One problem however, is that physical causes of many forms of mental illness are not yet anywhere near fully understood, which is why identical treatments for similar (if not identical) symptoms can be effective for one individual but ineffective for another.
In treating depression, there therefore needs to be an awareness of what kinds of things are functioning as reasons for the sufferer. And it also needs to be understood that the reasons by which a person rationalises their actions are not the causes of their actions; indeed, reason-giving (of this kind) is as much a form of behaviour as the actions of the behaviour that it is intended to justify or rationalise.
However, without such supplied reasons, the behaviour of someone who is not mentally ill can look identical to that of a person who is suffering from mental illness. Indeed, it is not uncommon for such mental illness to go unrecognised, even when the sufferer supplies reasons for their behaviour. This is particularly apparent in cases where the mental illness is of a kind that goes largely unrecognised except by those who specialise in mental health. An example is a form of depression that finds its expression in sexual promiscuity.
The example is difficult because sexual promiscuity is a culturally relative concept. In terms of mental illness, some attempt has been made to distinguish sexual promiscuity from indiscriminate sexual behaviour – however, sometimes this merely amounts to a distinction without a difference. And, of course, for good or ill, there can be moral dimensions which obscure clarity. One obvious way in which they do so is the culturally entrenched attitude that promiscuity in men is largely seen as morally acceptable and, indeed, sometimes lauded (although not, perhaps, morally speaking), whereas the opposite is almost always true for women. This has the very real potential to distort how we think about sexual promiscuity and mental illness – with such a cultural background it is difficult to see how one can avoid the conclusion that compulsive sexual behaviour, which is expressive of mental illness, is more common in women than in men. (Because with men, it goes largely unnoticed, whereas this is not so with women.)
We are then faced with the question (which I will only gesture at answering here): to what extent are the moral dimensions of our thinking interwoven with our ability to recognise mental illness? Do moral aspects of our thought shape what we consider to be pathological behaviour in cases such as these? It seems difficult to avoid this conclusion if one accepts that sexual promiscuity is culturally far more acceptable for men than it is for women. In other words, what counts as pathological in such cases runs the risk of being defined by the different levels of cultural (and moral) acceptability of promiscuous behaviour in relation to the social expectations of each gender.
Be that as it may, it is certainly the case that sexual promiscuity can be an expression of forms of mental illness (e.g. bipolar disorder), in spite of the fact that clarity of recognition in relation to diagnosis is frequently obscured by moral dimensions. But, of course, it is, by no means, always so.
Indeed, both men and women can (and do) delight in the pleasures of the flesh to a high degree, (to that extent such delight is not, in any sense, expressive of mental illness); sexual enjoyment of the human body is, after all, a human need like any other and, as with anything, some people take more delight in it than others. This, too, can make it difficult to distinguish from cases in which promiscuity is a symptom of mental illness – especially when, as has been mentioned, a self-righteous moralism comes into play. But when such promiscuity is expressed in ways that show a propensity for self-destruction on the part of the promiscuous individual – a self-destructiveness that may, for example, be manifest in a despair about the inevitability of their own behaviour that leads to drug and alcohol abuse or, in some cases, suicide (or attempts at it) – then there is good reason to believe that person to be mentally ill.
However, matters are seldom this clear-cut and, even when they are, there is the ever-present possibility of blindness to mental affliction of this kind – both on the part of the afflicted and those who observe it. There are many other forms of mental illness that also suffer from similar levels of obfuscation – some for similar reasons to those specified above and some for different reasons.
--------------------------Part II: Further Thoughts-----------------------------
Another difficulty involving the recognition of mental illness is that those who suffer from it, frequently do not (and cannot) recognise it in themselves. The reasons that they give for their actions are, by definition, reasonable to them; granted, if they suffer from forms of bipolar disorder – or other forms of less severe but, nonetheless, ‘cyclical’ varieties of depression – they may think that at one end of their cycle the reasons that rationalised their behaviour when they were at the other end of it were those of a deluded individual. But at any point during such a cycle, the things that function as reasons for an individual and the weight that those reasons carry in their decision-making will be an expression of that individual’s cognitive orientation; they cannot be mistaken about what their reasons are at any given point.
There are two important points to make here. The first is that for someone suffering from mental illness, it is almost impossible to assess (and distinguish between) which reasons have their origin in the mental illness from those that do not because it is the mind that is sick – the very thing with which one is trying to make one’s assessments. Indeed, it is interesting to note that the philosopher Epicurus described mental sickness as the worst kind of sickness for precisely this reason, thus becoming one f the first people to recognise the existence of mental illness.
The second is that we do not understand a person who is depressed any better by looking at neurological function or the chemical changes that are physically related to such neurological function. To be sure, these phenomena are concomitant with behaviour that is consistent with depression and, as such, they can tell us more about the physical causes of it. However, they cannot tell us about what depression is or how we should understand those afflicted by the illness; neither can they be diagnostic.
Take as a clarifier, the following example of a different kind (it is an adapted and modified version of an example provided by the philosopher Ludwig Wittgenstein in his Blue and Brown Books).
Imagine a scientist claims to have disproved the concept of solidity using an electron microscope. The scientist asserts, quite correctly, that all solid objects are, in fact, full of gaps (insofar as there are gaps between the atoms); moreover, the atoms are actually moving. On the back of this, the scientist claims, the concept of solidity has been proved redundant, as there are no objects without gaps in them and, therefore, no solid objects. But this is a false inference from legitimate science. The scientist has not made the concept of solidity redundant (or proved it false); rather, they have told us more about the nature of solidity (and, as such, solid objects). Nothing about these discoveries has altered the fact that my desk needs to be solid for me to write on it, or that my mug needs to be solid to hold my hot chocolate.
Correspondingly, purely biological processes do not make extant or redundant (or define) the concepts of either depression or sex; rather, they tell us more about such phenomena.
What gives us as much as the idea that we are sexual creatures, depressed or, indeed, living creatures? (That we are taught that this is the case?) It’s not just the act or process; the act has to have some meaning that allows others to recognise and distinguish it from other acts (and other things around us more generally). In the first instance, that involves acknowledging the interdependence of recognition and understanding – I do not recognise a smile but, simultaneously, fail to understand it as a smile. Similarly, if I recognise my friend in a crowd of people there is not something that I have, as yet, to understand; my recognition of my friend is interdependent with my understanding that it is my friend that I see.
Similarly, the concept of depression is answerable to particular forms of human responsiveness with all their subtle moral and psychological inflections that are accountable to more than differences in function. Only in the light of these forms of acknowledgement are we able to apply such concepts to one another and, in attenuated ways, other animals.
Epicurus. The Philosophy of Epicurus (trans. Strodach). Northwestern University Press. 1963.
Gaita, R. The Philosopher’s Dog. Routledge. London. 2003
Wittgenstein. L. The Blue and Brown Books: Preliminary Studies for the Philosophical Investigations. Blackwell Publishing Ltd. Second edition. Oxford. 1969.
Coleman, E. ‘Is Your Patient Suffering from Compulsive Sexual Behavior?’ in Psychiatric Annals. June 1992 - Volume 22 · Issue 6: pp.320-325
Gaita, R. Romulus, My Father. The Text Publishing Company. Melbourne. 1999
Gaita, R. After Romulus. The Text Publishing Company. Melbourne. 2011
Spalt, L. ‘Sexual Behavior and Affective Disorders’ in Diseases of the Nervous System, Vol 36(12), Dec 1975, pp.644-647