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.