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Steve Stankevicius M.D.
Steve Stankevicius M.D.

The Illusion of Free Will and Mental Illness Stigma

We don't like hearing "it's all in your mind."

Source: Bs0u10e0/flickr

The idea of free will, the illusion that our minds are free to wander, independent of the brain, is problematic for psychiatry. Libertarian free will is the notion that we are free to choose our thoughts and actions at any given moment; that we could have acted differently than we did in the past, because we as the conscious authors chose otherwise. However, our subjective experience of free will is an illusion. There is nothing in physics, chemistry, neuroscience or psychology that could even begin to offer a valid explanation of free will (other than changing the definition).

A colleague recently told me a story of a 65-year-old female patient she attended to whilst working in the emergency department. Tearful, anxious and confused, she simply stated, “Something’s wrong with me.” This poor woman had recently developed confusion, hallucinations, irritability, and poor coordination. In her diagnostic workup, a CT head scan unveiled the presence of a large brain tumour that had all the tell-tale signs of a glioblastoma multiforme; brain cancer with an average survival of around 13 months following diagnosis.

When the woman was informed of these cruel findings, the response was not expected: she shed tears of relief as she said, “Thank god, I thought I was going crazy.” In the following days she described her comfort in knowing there was something “physically” wrong with her. Let this sink in for a moment: Despite the fact that this diagnosis meant she would likely die in a few short months, and the symptoms were nonetheless the same, this woman went from being distressed by the thought she was going “crazy”—that she had a mental illness—to relief that there was something physically wrong with her, a lethal brain tumour.

A study headed by the neurologist Jon Stone presented people with a hypothetical case of a person attending their doctor with limb weakness and asked them what they thought different diagnoses meant. Diagnoses that implied that the mind was at fault (e.g., psychosomatic weakness, depression associated weakness), rather than the brain or otherwise (e.g., functional weakness, multiple sclerosis), were commonly seen as putting it on, imagining the symptoms, not a medical condition and not a good reason to be off sick from work.

Sundara Ramaswamy/flickr
Source: Sundara Ramaswamy/flickr

Ingeniously, the authors of the study expressed the results as “number needed to offend,” borrowed from the commonly used phrase “number needed to treat.” For example, whilst three people would have to be diagnosed with psychosomatic weakness for one to be offended, 22 would have to be diagnosed with multiple sclerosis for the same backlash. Why is this? Why do we have to constantly try to convince people that mental illnesses are indeed real?

A significant reason, I believe, is free will. If the mind is truly free, it is only logical to extrapolate that illness of the mind must also be free; free to change on a whim, or at least free to change if one chose to do so. In a free and immaterial mind, it appears there is nothing for mental illness to be truly grounded in, so establishing a psychiatric diagnosis can seem like trying to plant a flag in a cloud. What is to blame for my mental illness? If there is no physical pathology, it must be my mind; it must be ‘me.’

The dangerous illusion of free will is imparting notions of choice into mental illness. Only the idea of free will could compel one to feel a true ownership and shame for their mental illness. Only the idea of free will could compel us to intuitively feel that if we were another person, atom for atom, we would handle our mental illness better, or prevent it from occurring in the first place. Sentiments such as “Well if I had depression, I’d snap out of it.” This type of thinking is toxic. The illusion of free will compels us to treat mental illness differently to all other illnesses known to the medical profession.

About the Author
Steve Stankevicius M.D.

Steve Stankevicius, M.D., is a medical doctor undergoing his psychiatric specialty training. He is currently working in neuropsychiatry in Brisbane, Australia.