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The danger, in my mind, in reducing the etiology of “mental illness” simply to biological causes, as Paul suggested, is that it depersonalizes the illness experience and may lead to an increased sense of alienation from one’s own mind (body), while also, potentially, overlooking elements that may contribute to perceptions, attitudes and behaviors of individuals. A systemic shortcoming of western biomedicine, in general, is a tendency to champion the organic genesis of disease as being the only valid measure of one’s health/wellness; the logical outgrowth of this tendency is to embrace diagnostic criteria that require increasingly technological interventions that do not take into account differences in individual experiences, ethnicity, education, etc. While imaging techniques, such as fMRI (http://www.fmri.org/fmri.htm ), have enabled incredible insights into the relationship between brain structure and function, does this information lead to a useful/constructive amelioration of mental distress for the patient or, once again, imply the need for a psychopharmacological agent to correct the brain “abnormalities”? While, certainly, psychopharmacological interventions have altered the delivery of care for people with mental illnesses, this seems to have been in some cases, a leap forward, and in other a disastrous step back. Perhaps it is more useful to treat every individual, in the context of mental health evaluations, as just that, individual. And while medications for some may well be the difference between slipping into a paralyzing depression and being able to lead a rich life, for others, medications may ignore the underlying source of distress and may mask, at best, and ignore, at worst, the real source of the problem. And what of illnesses that defy categorization and can be identified as a cluster of symptoms of unknown origin with diffuse clinical manifestations and great individual variation, such as fibromyalgia (http://www.fibromyalgia.com/) ? If we cannot determine an organic or biological root of mental “illness” does this make the experience of the individual less “real”?

I think I disagree with Martin, if I understand his point correctly. I think the stigma associated with mental illness seems to arise, in part, from a fear of that which we do not understand. As a society, if a certain finite range of behaviors is normative, that which strays from the prescribed norm is a source of fear, confusion and disbelief, amongst other things, leading to a view of those with somehow aberrant behavior as being pariahs, who should be imprisoned, medicated, or otherwise relegated to the margins of society. It is difficult to deduce which behaviors constitute “choice,” which can be attributed to biology and which are “illness” manifestations and I think it somewhat perilous to impose a culturally determined set of values on an individual as a means of evaluating whether their behaviors are the result of “choice” or impaired brain function. “Doing something you know you shouldn’t do” doesn’t imply weakness, moral inferiority or even choice; sometimes people either cannot or believe they cannot control their behavior and their thoughts. Either possibility may lead to the same result, and neither is necessarily indicative of “choice.” Ryan’s point about mental illness being seen as a “character flaw” is a salient one. And, I think, has some historical basis, in terms of attempts in recent history to correct the behaviors of those deemed to be social misfits or those who were mentally ill either through behavioral modifications or other means of molding behavior to conform to norms. I agree, too, that identifying causes of mental illnesses as being biological will not remove the stigma associated with mental illness. People with mental illnesses or limitations are seen to be less fit, therefore less able to participate in society. As a result, those people are marginalized because they are perceived as “weaker” and unfit for modern life. This is not to suggest that society, as a whole, lacks a collective unconscious, or that individual members do not care for the well-being of others; however, our culture is one that relishes the triumphs of the individual success story as much as we judge those whose “choices” we deem less worthy, thereby vilifying certain ranges of behavior.

Involving people who have dealt with mental illnesses, their families and friends in the call for dialogue that many of the above organizations have suggested, seems a potentially important component to a conversation that often involves various mental health professionals and politicians to the exclusion of those actually affected. One of the goals of the National Institute of Mental Health is to work towards “prevention, recovery and cure…” of mental illnesses. It seems more than anything, the voices left unheard are those of the patients themselves, to whom “cure” may be foreign and mitigation of suffering might be a more appropriate goal, or the ability to participate more fully in daily life. Regardless, the stated goal seems somewhat removed from the realities of mental illness for many, and more aligned with a biomedical paradigm that seeks to identify a problem and blot it out, where behavior is so often murky territory without finite bounds or convenient explanations/resolutions.