Lecture 27
      
                           Mental Illness and Mouse Traps
      
      
      Lecture Outline
      
      I.  Introduction
      II. The Lingering Myth of Mental Illness
      III.Definitions and Perspectives: Who's Right?
      IV. The Conceptual Status of Mental Illness
           A. Reductionism
           B. Myths and Hypothetical Constructs
           C. Perspectivism
      V.  Conclusion
      
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      I.  Introduction
      
           And so, we come to the end of the course.  Where are we left?  I
      want to draw your attention back to the beginning of the course.  There
      we discussed the meaning of psychological "abnormality" - the
      difficulties inherent in defining this concept.  Now that we have spent
      a semester looking at various disorders, let us return to this issue,
      but this time more informed about the nature of psychological
      abnormality.  Today, we will examine the status of many of the terms
      (e.g.: Schizophrenia, Anxiety, Mental Illness) we have been using this
      semester.  What is it that these terms mean?
      
      II. The Lingering Myth of Mental Illness
      
           Does the concept of mental illness even make sense?  It's been
      almost 30 years now since Thomas Szasz (1960) claimed it does not.  For
      him (and subsequent writers, eg: Sarbin & Mancuso, 1980; Scheff, 1966),
      mental illness is a myth.  There is no such thing.  The things that
      psychotherapists treat people for are not illnesses, but simply
      individual traits or behaviors that society deems unacceptable -
      immoral, deviant, etc.  Szasz believes labelling such people as ill
      harms them - they come to accept the label, and they are treated
      accordingly.  We are telling people that they must act in ways seen as
      normal by the psychiatric profession, rather that attacking the social
      factors that don't allow these people to use their own unique abilities,
      traits, etc.
           Twenty-eight years have passed, yet there has been no real progress
      in resolving this fundamental debate - whether mental illness truly
      exists.  Of course, to most investigators, mental illness and the
      various disorders are clearly a reality.  As one writer noted: "If
      schizophrenia is a myth, it is a myth with a strong genetic component!"
      (Kety, 1974, p.961). Perhaps one reason for the continuing debate is the
      failure of the various interested parties - medicine, psychology,
      biology, etc. - to recognize the limitations of their respective domains
      (Gorenstein, 1984).  
      
      III. Definitions and Perspectives: Who's Right?
      
           As we have seen illustrated so often in this course, mental illness
      can be viewed from numerous perspectives:  Biological, Psychological,
      Environmental, Social...  But as we have also seen, it is rare indeed
      that any one perspective completely explains a particular disorder - the
      full meaning of a disorder fails to be captured when we limit ourselves
      to just one perspective.  There is more to what we mean by
      "schizophrenia" than abnormal amounts of certain neurotransmitters. 
      Likewise, disturbed family environment does not fully capture what we
      mean by "schizophrenia".  No single perspective does the job.  As we've
      stated on numerous occasions, a unitary explanation of a disorder is
      unlikely indeed.
           Similarly, if you recall from the beginning of the course, we
      outlined various perspectives on how best to define "abnormality" 
      [briefly review]:
              statistical deviation
              social norm violation
              maladaptive behavior
              personal distress
              deviation form the ideal
              medical disorder
      
      Nevertheless, as we've seen, no single definition can completely or
      consistently capture what we mean when we talk about "abnormality" or
      "mental illness".  Example: A person may experience no personal
      distress, yet be seriously disturbed (Charles Manson's reactions to his
      participation in mass murders).
           It looks like no one perspective, and no single definition is right
      in the sense of being the whole story.  Let's look at this in some more
      detail.
      
      IV. The Conceptual Status of Mental Illness
      
           In contemporary discussions of different theories and models of
      mental illness, usually one is singled out as the only true model. 
      Other models are criticized as false, misleading, possibly resulting in
      harmful practices (Weckowicz, 1984).  
      
      So, some authors:
           advocate a purely medical model as the only appropriate approach to
           schizophrenia (eg: Siegler & Osmond, 1974)
      
      ...other authors:
           reject the medical model, and argue for, say, humanistic approaches
           (Rogers, 1961)
      
      ...and still others:
           deny the existence of mental illness, as we've seen (Szasz, 1960).
      
      What ever the model being proposed, it often is proposed in a "nothing-
      but" manner:  For example - that schizophrenia is nothing but an
      accumulation of faulty habits.  One point of view, or perspective is
      adopted, the others rejected (Weckowicz, 1984).  
           Perhaps the fundamental question here is: Is it possible to
      construct a unitary "supermodel" of mental illness? (Weckowicz, 1984) -
      a model superseding existing models and that fully accounts for mental
      illness.  Let's look at one attempt...
      
      A. Reductionism
      
           The reductionist approach was an early attempt, and is still
      quite popular in the scientific literature.  It advocates that we
      can completely understand more complex phenomena in terms of more
      basic phenomena.  So, social/cultural phenomena could be "reduced
      to" psychological phenomena.  Example: the effectiveness of an
      organization could be explained in terms of the psychological
      characteristics of the individuals in the organization.  But this
      approach goes further; it goes on to argue that psychological
      phenomena could in turn be reduced to biological phenomena, and so
      on down to subatomic physics (Weckowicz, 1984).  Thus, all these
      higher level variables (social-psychological phenomena) could be
      reduced to the natural sciences - it was this that was the great
      hope of many scientists: that all statements about social,
      psychological, biological, or physical events can be stated in
      purely physical terms (ie: observable, measurable... physical in
      the sense of being "real", "things", true "stuff" out there in the
      world).  
           If this approach is followed to its logical conclusion, then
      we would construct our supermodel of mental illness based solely on
      microlevel phenomena: biochemistry, physics, and the like.  There
      would be no need to use concepts such as "beliefs", "cognition",
      "affect" when all they really are is biochemical processes.
           Or we could stop the reduction at the level of overt behavior
      - psychological phenomena could be reduced to purely behavioral
      phenomena ("anger" is a set of facial and bodily responses).  This
      is what the original behaviorists attempted to do.
      
           In any event, a reductionistic model:
      1. makes the claim that one level or perspective is the
         correct level/perspective,
      
      2. that other levels are simply made up of this lower level
      
      3. that these higher levels are therefore unnecessary -
         they add nothing to our understanding of mental illness,
         so we should do away with them.
      
      Problem:  The reductionistic strategy fails, however.  Philosophers
      have long argued that it is impossible to translate higher-level
      phenomena into lower-level variables without losing the meaning of
      the higher level.  Psychologists are beginning to recognize this
      problem.  Let's look at this in more detail...
      
      B. Myths or Hypothetical Constructs?
      
           What is it that we mean when we talk about, say,
      schizophrenia?  It is clearly more than excessive dopamine activity
      in the brain.  We mean many things: biological, behavioral,
      psychological, social phenomena...and the manner in which these
      different factors interact, some are causes, some effects, certain
      effects become causes of subsequent events, and so on, in complex
      interactions.  "Reducing" schizophrenia to purely biochemical
      phenomena may be useful in certain research settings, but it does
      not help us explain what we mean by schizophrenia.
           The reductionistic strategy is trying to determine what X
      consists of - what are its parts.  But psychological phenomena
      (sensations, beliefs, emotions, psychological disorders) are not
      easily thought of as having parts.  A "pain" is a "pain" - it
      doesn't have any parts.  Brain cells are not parts of pain (Fodor,
      1968).  They may play a role in producing a pain, but they are not
      in and of themselves the pain.  Lets look at a simple and hopefully
      more concrete example of what I am talking about.  Instead of pain
      (or schizophrenia, mental illness, etc) let's look at mouse traps:
      What do we mean when we talk about a mouse trap?  Something
      that catches mice - right.  Now, lets "reduce" the mouse trap:
      clearly it's made up of a piece of wood, and here's the
      spring, the place to put the cheese, and so on.  There, we
      have successfully reduced the mouse trap into a more basic
      level.  BUT...what about a different sort of mouse trap, mouse
      trap II (a better one, no doubt)?  Trap II is a large box,
      with a light sensor at the open end that when triggered by the
      mouse entering the box and interrupting the light beam, causes
      a door to slide shut, trapping the mouse, where it is quickly
      disposed of with a painless but quite effective gas.  Still a
      mouse trap, yet utterly different in the reductive sense.  If
      all we pay attention to is the basic "stuff" that makes up the
      mouse traps of the world, then we have totally lost the
      meaning of "mouse trap".  There is nothing in principle that
      requires a pair of mouse traps to share the same physical
      properties (Fodor, 1968).  What we mean by "mouse trap" goes
      beyond its mere parts.  It seems tied up with function, not
      parts.  Its at a level not open to reduction. 
      So, are mouse traps myths?  Of course not.  What they are is a
      construct.  The "mouse trap" construct is a way of summarizing what
      we mean by something-that-catches-mice.  Its an abstraction.  This
      makes it no less "real" than a neuron, simply something that is
      defined at a level other than the purely physical.
           In psychology, terms such as schizophrenia, depression,
      anxiety, mental illness...are all similar to the mouse trap:  They
      are constructs - abstractions - terms that refer to things that go
      beyond mere physical variables (Gorenstein, 1984).  
           This does not mean physical phenomena (biochemistry,
      physiology, etc) don't play an important role.  Such physical
      events can certainly explain how a particular individual is
      experiencing certain symptoms.  Clearly, every mouse trap is
      associated with some physical mechanism.  
           But it does mean that such physical phenomena don't completely
      capture what we mean by schizophrenia, depression, and so on.  
      Similarly, there is an infinite set of physical properties that
      could make up a mouse trap.  But enumerating all these properties
      does not define "mouse trap".  We need the concept before we can
      decide what makes one up.  Thus, it is quite conceivable that two
      people with schizophrenia could have very different neurological
      events occurring inside them (cf Fodor, 1968).  This being the
      case, we cannot define schizophrenia (or any other psychological
      disorder) as merely being lower level processes such as biochemical
      events.
           So, where does that leave us?  How can we define schizophrenia
      (or any of the other psychological disorders, or "mental illness"
      itself)?
      
      C. Perspectivism
      
           It looks like things will be much more complex than a single,
      super-model explanation of psychopathology.  The alternative may be
      a form of scientific pluralism, what Weckowicz (1984) calls
      perspectivism - where no single theory or model will supersede
      other models.  Rather, knowledge in general, and in particular
      knowledge about humans, will always require several perspectives. 
      And the acquisition of that knowledge cannot be reduced to one
      perspective.  The goal will be establishing meaningful
      relationships between the different perspectives.  The different
      approaches to mental illness will not be replaced by a supermodel,
      but will need to be made compatible with one another.  
           We saw an example of this when we examined the "biopsycho-
      social model" of mental illness proposed by Engel.  In that model,
      the different perspectives on mental illness were arranged in an
      orderly hierarchy of systems, from the cell to society.  His model
      stresses "holism" - to truly understand human beings they must be
      seen from multiple vantage points: for example - human beings are
      both biological organisms as well as people interacting with other
      people.  Thus, a psychological disorder can not simply be reduced
      to the level of biology.  
      
           In short,
      there can be different perspectives, broader or narrower,
      dealing with particular aspects of people - the biological,
      psychodynamic, societal, and so on.  These perspectives,
      however are of limited scope and usefulness, although each
      serves a purpose.  Single perspectives do not present the
      complete view of human beings and do not tell the whole
      truth about them.  Each perspective abstracts certain
      aspects of the whole person.  Each perspective complements
      one another without exhausting the totality of knowledge
      about the full meaning of human existence (Weckowicz, 1984,
      pp 338-339).
      
      V. Conclusion
      
           To fully understand psychopathology, it will be necessary to pursue
      pluralistic goals, as it were.  The various disciplines and perspectives
      will need to integrate their efforts (including Szasz's perspective on
      the political nature of mental illness), rather than strive for perhaps
      the true myth in all of this: a unitary supermodel of mental illness.