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 ------------------------------------------- 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.