I'm going to have to disagree with you on this one.

I agree that psychiatry as a discipline has not made nearly as much progress as would be desirable, and that many of the drug treatments we currently have frankly suck.

However, claiming that because we haven't found consistent physical signs of mental illness makes them not diseases is ridiculous. To steal a point someone else made today (http://blogs.psychologytoday.com/blog/in-practice/200807/debunking-a-neu...), the exact physical cause of Parkinson's disease is still rather fuzzy, but no one is claiming that it's time to pitch the "disease model" for that disorder. There are many other diseases that we still don't understand the basis for, but that no one doubts are medical problems.

Secondly, it doesn't make sense to say that a problem with the mind is not a disease, disorder, syndrome, illness... pick your medical term. We know SOMETHING is wrong with how "mentally ill" people experience the world, we understand that our experience of reality arises from the mind... therefore there is something wrong with the mind, which means there is something wrong with the brain. When there is something wrong with a part of one's body, we call that an illness. I don't understand how that's debatable.

Third, I don't understand why you think calling mental illness is something else is going help anything. There will still a problem that people are having that we don't understand, and that problem will still need to be investigated in a systematic scientific way, considering all aspects of the problem, and as I've already stated, this problem occurs in the brain. And on a more practical note... I assume you still think people with mental illness should get some kind of help/treatment.. if this isn't disease, then where will that treatment come from. I assume, for instance, that health insurance doesn't cover non-disease related problems. Insurance already does a shitty enough job paying for therapy.

I also know that the failures of medical treatment for mental illness are frustrating, I entirely agree that treatment for most mental illnesses should involve a more comprehensive solution than drugs alone, and I agree that the reductionist simplistic models of mental illness that we have (chemical imbalance!) are crap. But the brain is a very complex thing that medicine as a whole is still working to understand, which is why many other brain disorders not traditionally called "mental illness" still stubbornly resist attempts at treatment/cures. And maybe it's too complicated for us to ever understand enough to make the tweaks we'd like to make with drugs. But that doesn't mean we should stop trying to understand the biological basis for these disorders... which means calling them what they are, disease.

I understand that the idea of calling something that we consider to be really the essence of who we are... our personalities, our experience of the world, our thoughts... diseased or disordered is difficult and unpleasant. Believe me, this is something I've struggled with personally, as I have spent about a third of the time since I started high school falling into, drowning in, or struggling out of a severe episode of depression. Even when out of it, the fear of it, the distrust of my own mind, became a big part of who I was. Figuring out how to deal with the fact that much of the experiences I've had in my "adult" life have been distorted by a disease isn't pleasant. And I do work hard to avoid a mindset of deterministic victimhood... but this is what it is to be human. We are physical beings. No part of us is exempt from the possibility of breaking, or at least getting a little screwed up, disregulated. Even our minds.

Honestly, I hear the "it's not an illness" thing a lot, and I think it is always either a 1) purely academic argument that is very disconnected from how changing what we call things like depression will change our rate of success with fixing it or 2) anti-psychiatry babbling. I'm all for change, open-minded-ness, new ideas, etc. in treating mental illness... no one has got me deluded into thinking we have all the answers. And there are some aspects of treating mental illness as a disease that are rather... dehumanizing and distressing for the person being treated. But whether or not you can put a brain scan up on the wall like an x-ray and say look, the problem is here, it's still an illness.

In fact, demanding that kind of visible proof in a brain illness completely disregards the complexity of the brain. Brains are a hell of a lot more complicated than broken bones.

I have trouble thinking depression is a disease. I just can't swallow it. Mind you it helps therapists anchor their therapy treatment because like patients going to see a family physican we want to be healed quickly and efficiently. Pigeon-holing depression as a disease does not effectively 'handle' whatever depression is. The failure rate is high. Calling it a disease is only a stop gap measure.

This post is comical and your lack of understanding extreme. Anyone interested in what depression IS should follow ""IN PRACTICE'' by Peter D Kramer.- William, try taking this argument to his post,he'll show you how much you really don't know,and have you crying for your momma out of embarrassment. Sincerely-David

Your article is on topic! I agree completely with what you say and it's a happy occurence that a mainstream magazine publishes such a nice critic! I was inspired to write an article of my own by your post, if you want check it out at http://encefalus.com/general/metaphor-mental-illness/

I think that language is important, so maybe "mental imbalances" or "mental disorders" sounds generic enough and not as confusing as illness. However, I think if we want to educate the public we must not be lazy about it. We should try to get news stories out on this topic.

For example, my cousin has schizophrenia and one time at Thanksgiving, he "snapped out of it" (That's probably not the technical term) for some reason he was completely lucid and friendly for the first time since I had known him. My older sister said that it was his "former self" before he developed his condition. I was shocked and I felt like I really knew the real him for the first time. If people could see what schizophrenics are or were like before they had their troubles, it would do much more for education than just shuffling names around. In my opinion.

Great topic, thanks!

Peter kramer's books are not to be liked they are to be admired. blaming people for unethical behavior is outdated thinking.FREUD is another great book. I'll wait for you to catch up on your reading so you can enter the 21st century with dignity. And if drugs don't work it's because the brain has been too badly damaged,or their not on enough of it. Sincerely, DAVID

Genius is Dissociation of the Night Kind: "asleep yet awake". Madness is Dissociation of the Day: Kind "awake yet asleep". Psychosis is Dissociation of the extreme kind!

I took The Hero's Journey and just got back thank you very much! The Daimonic called and I answered.

The DSM is wrong. One manic event should not make one Bipolar. One manic event could be the beginning of sanity (midlife crisis.)

"And if drugs don't work it's because the brain has been too badly damaged,or their not on enough of it."

they're*

"I'll wait for you to catch up on your reading so you can enter the 21st century with dignity."

I can't believe you're accusing William of not being "informed. In my experience, informed people rest on the laurels of their arguments. Their lack of cognitive dissonance allows them to feel secure with their arguments, and they are also constantly learning. They have no need for statements that prop themselves up as authorities on the given subject but contribute absolutely nothing to the discussion. I am aware that this is a correlation made on my part, and does not disprove your argument. I have had depressive/psychotic symptoms for the past 5 years (I'm 21 now).

I believe that part of what has kept me depressed, unmotivated, and paranoid are moralistic ways of thinking. I was raised Catholic and seeing my problems as moral failures have never done a lick of good, in fact it's toxic to my mental health and I believe contributed to my abandonment of self in the first place. I make progress when I am able to forgive myself which results from an understanding that is based not on moralistic authoritarianism but empathy and compassion.

Personal responsibility is certainly lacking in the mentally interesting, but developing it need not be based on fear and guilt. It is those emotions and the associated ideas that have prevented me from cultivating a sense of self (and a personal history) I am comfortable enough with to lift the depression, feel that I can still be of worth to the world, and begin working on my real flaws with compassion. So you see, if I am going to continue on the path I'm on currently it's necessary to discredit arrogant moralizers such as yourself when I encounter them. I have not yet developed the inhibition necessary to emotionally ignore threatening stimuli such as yours, instead I magnify it.

Peace,
Brian

Dabrowski's Theory of Positive Disintegration is the "popcorn method" by which we are evolving. Take a bag of popcorn and place it in the microwave. Add the heat of a personal or world crisis. Open the bag. Some kernals refuse to pop. Some kernals get burned. Some popcorn pops. Some popcorn burns.

The shell that my ego built to keep out the allergens of "Parent", "Peers" and "Society" was rock hard. It was so rigid I couldn't change or grow.

The Defense Against Heat
A popcorn kernal hiding in a shell
The heat turned up and burned like hell
Destroyed by fire, the home I knew
But wouldn't you know it I grew and grew!

In everyone's life, at some time, our inner fire goes out. It is then we burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit. - Albert Schweitzer

A Smile can Change the World
When someone’s ego screams in pain
From internalized devils that tortured Cain

Choose not to engage them with yours
For those devils lead to illness and wars

Instead…

May your smile touch the depths of someone’s despair
And restore faith and hope in those found there

Courageous honesty, love, compassion and forgiveness - Pass these on!
Paradise, The Garden of Eden, exists and was here all along !

Its a nice article. I have to agree with your article. It is unclear what really the cause of mental disorder and all study conducted shows unclear explanation.

Mental illnesses are that: illnesses. The brain is not functioning like it should leading to immeasurable suffering as an illness does. It is folly to think the brain, an organ of the body, is immune to biological malfunctions. The complex array of interacting proteins involved in signaling between nerve cells is as prone to malfunction as the complex array of proteins involved in cell signaling that go array leading to cancer. As someone who has suffered from a psychotic and mood illness (and all the misery they bring), the biological approach (anti-psychotic medication) has freed me of those "demons" and allowed me to have real emotions (good and bad) after a 20 year hiatus. Maybe I am lucky that medication has worked considering how often it does not. But that doesn't negate the condition as an illness. Often people with Parkinsons do not respond to medication, as noted above. Or people with cancer fail to respond to treatment. Lack of response to medical treatment doesn't mean they are not "illnesses"! If it brings suffering beyond the normal pains of life, it is an illness.

I seem to be arriving a bit late to the conversation! (Aug, 09) so don't know this will be read - BUT - have a comment in any case. I believe at least some forms of 'depression' are based in logic and rationality of certain - perhaps 'personality types' is a useful descriptor.(Read: "The Highly Sensitive Person", Elaine Aaron.) I believe some are born with inclination of sensitivity, inclined to experience empathy, for instance. And we live in a world which tries its best to coach us out of this - to point out to us that it is more 'pragmatic' to 'balance' our awareness of others with need to 'get ahead'. We simply can't easily go there! I believe a huge amount of personal, individual, discouragement (slumping into depression) is based in culturally held and taught perspectives that over-emphasize the long popularized "dog-eat-dog" nature of normal human events. Empathy is de-valued if it is too broad, too generalized, in application. Guys with strong inclination to empathize live in personal constant conflict due to romanticized stereotypes of "masculinity". Women have been taught there is something 'wrong' with them, based on their normal hormonally driven inclinations (and tendency to think globally). In many cases PMS is a diagnosis used by society to further dishonor the social/cultural position women have found themselves in. (Easier to blame their hormones, and treat them to distrust their own bodies, than to treat our wondrous bodies and processes with deep respect.) It should not take rocket science to discover why individuals end up experiencing depression! (Some forms of depression, at least.) All it takes is constant hammering away at ones own deeper inclinations to experience, and express, compassion. Logical and rational to become deeply discouraged. Ones mind takes strange twists and turns in an attempt to restore balance and/or find refuge. :) - my thoughts.

I agree with virtually everything the article says, but as the author states at the end what next? Nature abhors a vacuum, and I for one have wracked my brains but never been able to come up with a better term for "it". Having said that maybe all we really need is truth in advertising, in other words, imagine if psychiatrists prescribed medication to people by saying something along the lines of "well you appear to be suffering from something we in the psychiatric profession call a mental illness...we are not sure of its cause, and relationship to brain chemistry, but many people with similar symptomology have benefitted from certain drugs which seem to stabilize and/or help the person feel better, although again we are not exactly sure why. with other kinds of "rehabilitation" [i.e. psychotherapy, family therapy] you may be able to some day live without the drugs and any of the overwhelming thoughts/feelings, but it's a long struggle for most."

now of course this sounds unrealistic but is it any more realistic to pump people's brain full of drugs you don't understand, and expect them to "recover"? or to hide reams of clinical data about the safety and/or efficacy of drugs without ever getting caught and/or sued? (count the number of settled class action suits against big pharma for psych meds, it's more than a few)

unfortunately like so many things i think it comes down to questions of fear and power. who profits from the current system, who has the power to change it, what are the interests of the great mass of people who have no personal connection to any mentally ill person, and don't have the time and/or energy to research these issues personally? the list goes on...

p.s. i also found the contempt and condescension of critics of the article depressing. i hate to come across like a snarky oh-those-unenlightened heathens type, but it really seemed like an overreaction to me, especially when you consider that none of these people *by definition* have done the research despite the ferocity of their assertions--because if they did they would realize the emperor has no clothes! "metaphorically", of course ;-)