Friday, November 25, 2016

Problem with the term 'mental illness'?

As I have said before (eg. see previous post), I don't have a problem with the term 'mental illness'. In a recent comment in The Lancet Psychiatry, Dinesh Bhugra et al make a case for what they call reclaiming the term. They suggest that psychiatrists have given up using the concept. Part of their argument is that "A large number of psychiatric disorders ... are ... socially elaborated states of pathology or disease, with neurophysiological or chemical alterations in brain or body functions". But are they brain dysfunctions? No evidence is offered to support this conjecture and, as I keep saying in this blog, such a belief is mere conjecture.

Actually, perhaps I do have a problem with the term 'mental illness' if this is what it is supposed to imply, although I don't think it necessarily does. Better to stick to terms that Dinesh et al tend not to like, such as 'mental health problems', which don't have this ideological implication.

I think Dinesh et al are right that mental illness does imply a major or more serious rather than minor mental health problem. Before the 2007 revision, the Mental Health Act (MHA) used the term 'mental illness', although it was never defined. This has now been replaced by the more generic term 'mental disorder'. In principle, people should only be detained under the MHA for mental health problems of a nature or degree that warrant this intervention and psychiatrists would have generally understood the term mental illness to mean functional psychosis. And, as I've said several times before (eg. see previous post), there may be potential advantages in seeing mental health problems as illness as it integrates the medical perspective. Illness can be mental and not purely physical. The problem with Dinesh at al's view is that they may appear to regard mental illness as physical in origin.


Eric Setz said...

A more fundamental problem is the lack of a definition for the mind.

Diana Rose said...

It does imply that Duncan. They also seems to say "mental distress" does not convey the "distress" involved. Pardon?

Duncan Double said...

I agree, Diana, that it tends to imply that. Perhaps I'm trying to reclaim the term 'mental illness' for what it really means, not what Dinesh and Kam say.

cobweb said...

At the ECAP Madrid Conference, Peter Fonagy who is promoting neuropsychological investigations of children and adolescents diagnosed with personality disorder and who is on a mission to convince other practitioners across Europe of his firm belief that 'mental disorder is a disorder of the brain' said that although 63% of psychiatrists do not share his views - he is right .Those who do not share his views do young people a disservice. (see web site) He has been called 'the father of mentalisation based treatment' and a' missionary of evidence based practice'. This sort of nonsense alone should raise concerns. P.F. says 'we need the therapies other people do not seem to want..ultimately we will persuade them'.
At the same time although he claims that the advice he gives has been included in NICE guidelines which have reached reached 60% of CAMS - it is uncontroversial that in reality there are numerous holes in the services available to young people or adults.

he has also been committed psychoanalysis and attCHMENT THEORY through his positions at the Freud Centre and UCL (He is involved with numerous orgs and has gained millions of pounds to spread therapy and mindfulness). yet the college of psychiatrist which supports his and his teams work state that the choice of psychoanalytic therapy for young people is at risk of being supported only for another two years. (See web site). The Association of Child Psychotherapists has stated on their web site that their organisation is under threat. The College of psychiatrists has published an interactive map showing that negligible amounts of funds are being put into mental health (se interactive map How much money is your CCG spending on CAMS')
P.Fonagay states that he would pay his own fare and hotel bill to attend any conference to promote European guidelines on neuropsychiatry for children and adolescents. Maybe tax payers should be concerned about the amount of funds already being poured into research/conference/events by charismatic men with personal histories which decide their choice of careers and who have the backgrounds which enable contacts in political circles and access to funds - while more and more youngsters are suffering from lack of any care.

cobweb said...

Why does the Lancet not have a way for people to make responses to articles...or am I missing something?

Dr. med. Hans Bangen said...

Maybe we should use the term "Psychiatric Disorder" (Psychiatrische Störung).

Dr. med. Hans Bangen

Yewtree said...

As the mind is an epiphenomenon of the brain, and the brain exists inside the body, and people have a complex relationship with their environment and other people, it has always seemed erroneous to me to try to pin mental health issues down to any one of these factors.

I had seasonal affective disorder caused by a severe lack of daylight (I only get it if I'm completely deprived of daylight all day) and the resulting symptoms were anxiety and depression. However there were no other environmental factors or underlying issues; it felt to me like the whole thing was down to brain chemistry. On other occasions when I've been depressed, it has been emotional and environmental issues. However, these affect brain chemistry.

That's why I think a range of approaches are needed.

Yewtree said...

Letters page?