Psychiatry tends to believe that brain abnormalities will be established for mental illness. It will often admit that such abnormalities have not yet been established but many patients are led to believe by psychiatrists that their mental health problems are due to brain abnormalities when they are not. What they are told may even seem to make sense to them because it apparently gives them an explanation for their problems.
Of course brain abnormalities can cause organic mental illness, which is caused by a primary brain disease or may be secondary to a systemic illness. It can also result from an exogenous toxic agent, or may be due to withdrawal of a physically addictive substance. But the vast majority of psychiatric presentations are due to functional mental illness, which is not caused by brain disease. Organic and functional mental illness can usually be differentiated clinically. The typical symptoms of brain disease, particularly cognitive dysfunction, such as disorientation, are not present in functional mental illness. The reasons for functional mental illness are psychosocial in origin and there is no brain disease as such.
Mind and brain are integrated in the person. Functional mental illness is mediated by the brain but not caused by it, whereas organic mental illness is caused by the brain. Being able to visualise the structure and functioning of the brain by scanning over recent years has wrongly encouraged the abolition of the distinction between functional and organic mental illness.
We need to restore this differentiation. It is wrong for psychiatry to reduce people to their brains. It is treating patients as objects rather than people. This is a fundamental complaint about psychiatry by patients and means psychiatry needs to change. Patients shouldn’t be taken in by psychiatry defending its own interests.
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