The Metaphor of Mental Illness

by Neil Pickering

Despite the currency of the notion of mental illness, its legal and medical legitimacy, and the panoply of psychiatric and other mental health services claiming to treat it, there are those who take the radical sceptical line that mental illness is a fabrication. This is a book that takes this sceptical line seriously-perhaps more seriously than almost any other book not written by sceptics themselves. The Metaphor of Mental Illness is a revaluation of the traditional philosophical disputes about the existence and nature of mental illness. Sceptics and apologists have generally focused on the legitimacy of extending illness from the physical to the mental, by means of the likeness argument. This says that claimed mental illnesses, from ADHD to schizophrenia, really are illnesses providing they are sufficiently similar to agreed physical illnesses. This book proposes that this argument is the likenesses to which the argument appeals appear when these examples have been categorized as illnesses, rather than the categorization being evidenced by, or derived from, the likenesses. The categorization of ADHD, schizophrenia, and so on, as illnesses is a matter of an imaginative shift into the illness category. The book puts forward a new view and resolution of the issues, to which it carefully guides the reader. It is a book that engages with many styles of analysis, but is accessible to anyone not familiar with these. It is full of examples, both historical and modern. It is a book for the postgraduate student coming to grips with the issues for the first time, for the researcher who is interested in a new approach to the issues, and for mental health workers such as psychiatrists who are interested in the fundamental assumptions of their field of work.

Genres: Psychology

208 pages, Hardcover

First published December 8, 2005

Reviews

[Mark · Rating 5 out of 5]

Recently, I independently came to the conclusion that "mental illness" is a metaphor. Though the phrase is so common as to border on cliche, it makes two important assumptions about the things it describes; first off, it assumes a mental source for the discomfort, not a bodily or spiritual, and secondly, it assumes a medical approach to alleviating said discomfort. Why emotions must be located in the mind is beyond me, as is their need for scientific validation, but I understand the strategy: mental Illness, though not literally "true" (oh, what does that even mean?) is a very helpful and sometimes very accurate label. It's one framework among many, and it just so happens to be the trendiest one right now. Prior to that it was the "humors," and prior even to that it was spirits and demons.

To get hung up on metaphors by thinking they're inherently duplicitous, as Thomas Szasz does, is to radically misunderstand language. As I've argued in other reviews, the poets are the ones who stretch and twist langauge until it's unrecognizable, thus new, thus useful; and as Nietzsche says, "truth" is just an old metaphor that has solidified into cliche, thereby bypassing the fresh shock of newer, more radical metaphors. Since all of science is mediated by language, signs, symbols, and unproveable assumptions, all of it leaves these uncomfortable "gaps", no matter how rigidly it's reasoned: "Brain evidence cannot be taken to dictate to the observer what it means." As I argued in my Master's thesis, these gaps, far from being problematic, are precisely the source of beauty (in art) and originality (i.e. scientific discovery).

Contrary to some people's oversimplistic ideas of how truth and science work, there is nothing truly self-evident, no 1:1 correlation between language and reality. Things are always fluid, and there's always squishiness left over. This doesn't mean that our science is "unscientific;" far from it! It's a simple admission that science, like everything else we humans do, is tinged with anthropocentrism. This isn't a problem; in my opinion, it's just the most obvious thing about us: our humanity rubs off on all our endeavors.

I genuinely think that people who are uncomfortable with admitting that Mental Health is a metaphor are people who are overly literal and timidly narrow in their thinking. To them, admitting that there are any other alternatives is tantamount to heresy, because it undermines their straining and striving after being respected by the scientific community. But all science requires the scientist to "look in a certain direction" in order to "see the thing;" in other words, of course the scientist's values will impact the science they do, so "skeptics" like Szasz shouldn't be surprised. You can only find a thing that you're looking for, since there are no self-evident "things" in themselves. There are only outlines as drawn by humans around undifferentiated matter. Pickering sums up the linguistic dilemma nicely: "Human knowledge cannot be expressed without recourse to categories of things, and the categories of things have an irreducibly social content."

Language thus is the most powerful tool ever invented, since it in turn invented everything else, and finally made possible any pretensions to truth and falsehood. All words carry with them assumptions, bias, blindspots; as do all languages, worldviews, theories, and dispositions. So much is obvious, but for some reason, people are so emotionally invested in this or that approach toward redressing emotional anguish. I for one have benefited and suffered in equal parts from the metaphor of "mental illness;" I've had both great and awful therapists; I've had both life-saving and potentially dangerous experiences with pharmaceuticals. As far as I can tell, the only real heresy is sticking dogmatically to any one approach concerning something as complex as the emotional well-being of a human.

As Pickering beautifully points out, our language actually shapes our experience, making the recognition of certain aspects of life more likely. Far from being neutral and descriptive, language influences our experience, which in turn influences our language. Thus the true relationship is reciprocal and cyclical, not linear and unidirectionally causal. Critics like Szasz, as much as his opponents in the APA, both are stuck in an intractable problem. As Pickering writes:

Even finding an example of something is not what shows the concept of that thing is coherent. We will have known before we found the example that we had a coherent concept, for if we had not we could not have been looking for an example of it.

This is somewhat repeating what I already wrote up above. But to return to the titular issue, Mental Illness is a metaphor much like "the body is a machine" is a metaphor. Of course, the body is not a machine, made by man out of wood or metal; but it IS a machine in many important ways. Though I often rail against scientific-minded people who turn a blind eye to the spiritual and ethical dimensions of life, any honest person has to admit the practical success of the "body as machine" metaphor. In other words, metaphors are important because they are a carryover from the premodern mindset; they're essentially paradoxes. It's both true and untrue that the body is a machine. It's equal parts useful and harmful. To refuse to acknowledge these basic aspects of the metaphor is to brutally misunderstand language.

Pickering is such an important writer, not just because of his thoroughly nuanced and well-researched arguments, but because he is comfortable enough to follow the argument where it leads. Skeptics like Szasz have some decent points at times, especially when they critically point out assumptions that are at risk of being lost within the calcifying metaphor of "mental illness"; among these are many moral assumptions (e.g. "good students sit still, fidgeting is a bad thing"). But I don't really have a problem with that, since psychiatry at its root is a conservative, normalizing force. Another sub-debate we should discuss but don't is precisely this: should people conform to society's whims, or should society conform to people's whims? In the case of almost every mental illness except for trans-ness, we answer the former; suddenly, when we get to the latter, the script flips. This is my own overly-simplistic and ill-informed observation. I don't know how to solve this tension, nor do I like the implications of calling trans-ness an "illness".

My proposal would be to give a more value-neutral term to the entire endeavor, probably some variation on the word "stress"; as far as I can tell, everything we label "mental illness" boils down to the feeling of stress (whether for the person themselves or the people around them) due to a disconnect or mismatch. For example, depression is the stress felt when things go wrong (assuming that things should go well) and the usual hopeful avenues feel cut off. Schizophrenia is the stress felt when sensory input is confusing and strange (hearing voices, paranoia, etc.). Transness is the stress felt when the body you live in doesn't match up with your desired body. To me, we need something more neutral than "illness" and more holistic than "mental" to describe what's going on. But in the meantime, I'm content to also use the metaphor of "mental illness" as an entry point into this complex topic. We can disagree about the specific language, but I think it's important to not lose sight of the basic "stress" response we're trying to alleviate. Sometimes, as in the case of Tourettes, other people are distressed by being around the person; in other cases, like autism, the person themselves is stressed out by being around loud noises. Perhaps the solution isn't always medication or therapy, but more open and honest conversations about the myriad ways people experience life? Then again, doesn't this just land me where so many leftists already are, i.e. expanding "normal" to include everything, to the point that the usefulness of the word becomes null? I'll definitely have to keep thinking and reading about this...