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The reason I am inclined to dismiss the notion of mental “illness” as being too narrow a framework within which to understand mental states is not because I think there are not some biological factors that cause some peoples’ brains to create a “reality” that can be directly linked back to distinct, knowable physiological causes. As Sarah mentioned, it makes sense that the brain, too, can become “diseased” like other parts of the body. However, the illness/health paradigm does place mental “health” squarely in the realm of the medical, which may, in some ways, limit our ability to understand the complex, variable and sometimes inexplicable workings of the mind. More than anything, the health/illness dualistic paradigm seems to alienate the people who fall within the “norm” of non-diagnosable behavior. Such that, those who may have obsessive thoughts, or function with less severe depression or perhaps have features of disordered eating, but do not meet the DSM criteria for a diagnosis are left feeling alienated and stigmatized and, perhaps, helpless. As I posted before last weeks class, I believe that no matter one’s diagnosis, for all of us, mental “health” is an ongoing enterprise and not an endpoint. As such, the understanding of how to ameliorate or work with strengths of individuals and within limitations springs not from a disease category, but a holistic understanding and a commitment to work with, not against the mindset of the individual. That being said, what of people who do benefit, personally, from a paradigm that does empower them to see "illness" as being something they "have" and not who they are? I can see the the value of this in some instances and cannot, at this point, seem to reconcile what seem to be conflicting ideas...

Several years ago, I read a book by James Gordon, a psychiatrist, called Manifesto for a New Medicine. I found an interview with him, http://www.healthy.net/scr/interview.asp?ID=225,  in which he discusses the limitations of the healthy/sick paradigm. He says, “I was first attracted because I was made uncomfortable by conventional psychiatric treatment. I was working with psychotic people, who seemed not to be sick in the way that people with gall bladder disease or people with heart disease or cancer are sick, yet they were treated as if they were physically ill. They were put in pajamas, and given large doses of medication. I didn?t understand it. It seemed like they had certain difficulties; they were sometimes harder to understand or more erratic than most so-called normal people, but they certainly didn?t seem sick.

So I began to question the whole medical model. That is, that there was a specific disease entity that people had, and a specific kind of pharmacological or surgical treatment for them. I began to question whether for these psychotic people, if we regarded their experience as essentially a human experience, if we created a healing environment in which they would be fully respected, could change the nature of their illness? So I was questioning the whole notion of fixed diagnostic categories.”

JRLewis mentioned that discarding the health/illness paradigm seemed to draw an artificial distinction between mind and body. While, I agree the distinction is artificial, on the contrary, I think re-shaping the dialogue about mental states, along a continuum, with language that is less extreme (healthy vs. ill) creates an environment in which more voices can be heard in the conversation about these mental states and if they are to be shaped or changed, it is not, necessarily, with an end in mind. In my opinion, this is not, simply, an issue of semantics, but an issue of redefining the terrain of what we know as mental illness; and, in so doing, recognize that perhaps there is no destination where mental well-being is concerned, but rather it is the journey that is significant. In the Bipolar Puzzle article from this past Sunday, linked somewhere above, mentioned two instances in which the diagnosis of bipolar in children had been changed, and both were due to the influence of physicians. My question is, in the realm of “mental health” are physicians the people who determine normative behavior?

Ian Hacking, who works in the field of Philosophy of Science, has written widely on the phenomenon he calls “making people up.” (http://foucaultblog.wordpress.com/2007/06/15/ian-hacking-on-making-up-people/). The thrust of his argument is that the more we study, classify and define people, the better able we are to “control, help, change or emulate…” He then points out that all of our studying, probing and doctoring actually changes people, for we do not exist in a vacuum. In this view, people are who and what they may be; this is not an argument against medicine or against comprehensive treatment for those who present in a mental health practitioner’s office with troubling behavioral patterns. The point, in my mind, is to understand that just as health/illness do not exist unto themselves, without the coalescing of myriad factors (experience, cultural background, age, etc.), nor can we reduce behavior, the workings of the mind to a singular cause and effect. Moreover, in so doing, we create "illness" and categories of people, such as the outmoded category of hysteria, amongst others. To borrow Sarah’s analogy from above, two peoples’ kidneys, whether healthy or not, are a lot more similar than the mental states of those same two people, though their brains may also structurally be similar. Again, biology is essential and to borrow James Gordon’s words, we should attempt to work with the “transformative” powers of biology, but not see a biomedical framework as the "answer" to a “problem.”