Changing how mental health and illness are understood

Is there anything wrong with how we understand mental health and illness? Surely we know what these terms mean. After all, our brain can be healthy, and there may be something wrong with how it functions, amounting to a pathological abnormality which we call mental illness. Isn’t that obvious?

I agree this is the way we tend to think these days. It’s our cultural understanding that there has been major progress in understanding how the brain works and what can go wrong in its functioning. We tend to believe neuroscience has made considerable advances and we expect doctors who want to be psychiatrists and other mental health professionals to learn about these matters and apply this knowledge in their care and treatment of patients.

But it's not generally brains that become unhealthy; it's us! Please don't misunderstand me. Of course I'm not saying the brain has nothing to do with our state of mental health and illness. It mediates our thoughts, feelings and behaviour. But it's not us; it's only part of us. It's us that are alive and can be mentally healthy and unhealthy. Of course our brain can contribute to that state. But we need to understand ourselves as more than our brain. 

So, what does it mean to say we, rather than our brains, can be mentally ill? We're not necessarily making a statement about our brains. And we're not necessarily saying anything about our body, as such. Illness is something we experience. It may be caused by bodily dysfunction, and we can too often assume that there must be something wrong with our body when we feel ill. We may have all sorts of speculations about what's gone wrong with our body when we experience symptoms. But, quite commonly, these ideas do not prove to be the case. Actually, often, what can be reassuring is if the doctor indicates that our concerns are unlikely to be correct from the presenting symptoms and signs.

Modern psychiatry developed by identifying insanity, which we now call psychosis. However logical their private understanding may seem to a psychotic person, it is the loss of common sense viewed by most people that is characteristic of madness/insanity (see eg. previous post). Psychiatric treatment of course covers wider conditions than psychosis and there may be questions about what counts as a psychologically morbid state. Psychiatry could be said to have extended even further in its diagnostic reach, with such modern concepts as neurodiversity, which are not necessarily even seen as abnormal. Psychiatric diagnosis is not an exact science.

Clearly, though, psychiatric diagnosis does not necessarily imply bodily dysfunction. It is a statement primarily about psychological functioning. It is usually a description of a personal, not a brain, state. The brain may cause that mental state but it does not in the majority of cases. To talk about brain health, as we now often do (see eg. previous post) may well be a misnomer. It’s about time we moved on from the misguided hope that we can understand mental health and the majority of mental illness in terms of our brain.