[Article updated on 11 September 2017]
‘Mental disorder’ is difficult to define. Generally speaking, mental disorders are conditions that involve either loss of contact with reality or distress and impairment. These experiences lie on a continuum of normal human experience, and so it is impossible to define the precise point at which they become pathological. Furthermore, concepts such as borderline personality disorder, schizophrenia, and depression listed in classifications of mental disorders may not map onto any real or distinct disease entities; even if they do, the symptoms and clinical manifestations that define them are open to subjective interpretation.
In an attempt to address these problems, classifications of mental disorders adopt a ‘menu of symptoms’ approach, and rigidly define each symptom in technical terms that are often far removed from a person’s felt experience. This encourages health professionals to focus too closely on validating and treating an abstract diagnosis, and not enough on the person’s distress, its context, and its significance or meaning.
Despite using complex aetiological models, health professionals tend to overlook that a person’s felt experience often has a meaning in and of itself, even if it is broad, complex, or hard to fathom. By being helped to discover this meaning, the person may be able to identify and address the source of his distress, and so to make a faster, more complete, and more durable recovery. Beyond even this, he may gain important insights into himself, and a more refined and nuanced perspective over his life and life in general. These are rare and precious opportunities, and not to be squandered.
A more fundamental problem with labelling human distress and deviance as mental disorder is that it reduces a complex, important, and distinct part of human life to nothing more than a biological illness or defect, not to be processed or understood, or in some cases even embraced, but to be ‘treated’ and ‘cured’ by any means possible—often with drugs that may be doing much more harm than good. This biological reductiveness, along with the stigma that it attracts, shapes the person’s interpretation and experience of his distress or deviance, and, ultimately, his relation to himself, to others, and to the world.
Moreover, to call out every difference and deviance as mental disorder is also to circumscribe normality and define sanity, not as tranquillity or possibility, which are the products of the wisdom that is being denied, but as conformity, placidity, and a kind of mediocrity.
Other pressing problems with the current medical model is that it encourages false epidemics, most glaringly in bipolar disorder and ADHD, and the wholesale exportation of Western mental disorders and Western accounts of mental disorder. Taken together, this is leading to a pandemic of Western disease categories and treatments, while undermining the variety and richness of the human experience.
Many critics question the scientific evidence underpinning such a robust biological approach and call for a radical rethink of mental disorders, not as detached disease processes that can be cut up into diagnostic labels, but as subjective and meaningful experiences grounded in personal and larger sociocultural narratives.
Unlike ‘mere’ medical or physical disorders, mental disorders are not just problems. If successfully navigated, they can also present opportunities. Simply acknowledging this can empower people to heal themselves and, much more than that, to grow from their experiences.
At the same time, mental disorders should not be romanticized or left unattended simply because they may or may not predispose to problem solving, personal development, or creativity. Some mental disorders undeniably have a strong biological basis, and all mental disorders are drab and intensely painful. In some cases, mental disorder can lead to serious harm and even to death by accident, self-neglect, or self-harm.
Rather than being medicalized or romanticized, mental disorders, or mental dis-eases, should be understood as nothing less or more than what they are, an expression of our deepest human nature. By recognizing their traits in ourselves and reflecting upon them, we may be able both to contain them and to put them to good use.
This is, no doubt, the highest form of genius.
The most beautiful things are those that are whispered by madness and written down by reason. We must steer a course between the two, close to madness in our dreams, but close to reason in our writing.
Neel Burton is author of The Meaning of Madness, Growing from Depression, and other books.