Are Mental Disorders Diseases?

“Do not neglect medical treatment when it is necessary, but leave it off when health has been restored. Treat disease through diet, by preference, refraining from the use of drugs; and if you find what is required in a single herb, do not resort to a compound medicament. … Abstain from drugs when the health is good, but administer them when necessary.” — Tablet to a Physician, Bahá’u’llàh  (Source)

Are mental disorders diseases? I am of the opinion that they are not, and, in fact, I would argue that treating mental disorders as diseases disempowers the individual being treated and takes him/her out of the treatment process.

I had a very difficult time trying to find a standard definition of the term “disease.” In Szasz’s (2000) article a number of definitions from both the core medical and psychiatric paradigms were discussed. Szasz makes the argument that the psychiatric definition of disease is based on a metaphorical interpretation of the medical concept, which regards disease as a physical abnormality. He states that since the mind is not a physical object, the medical definition of “disease” cannot be applied to it in a literal sense. I tried to find a more neutral source, so I looked up the word “disease” in the Oxford Dictionary of Science (2003) and found this definition:

Disease: A condition in which the normal function of some part of the body (cells, tissues, or organs) is disturbed. A variety of microorganisms and environmental agents are capable of causing disease. The functional disturbances are often accompanied by structural changes in tissue.

Using the above definition, it would still be quite difficult to refer to a mental disorder as a disease because, to my knowledge, no mental disorder has been causality linked to any specific physical abnormality. So, I decided to pursue a psychiatric source to help define the term. I found another Oxford reference, Campbell’s “Pyschiatric Dictionary” (1996). The entry for “disease” began by explaining how unsatisfactory definitions have been for words such as disease, disorder, illness, condition, and abnormality. Then Campbell cited Culver and Gert (1982) who argued that diseases “are regarded as entities having characteristic signs and symptoms with known or discoverable underlying ‘mechanisms’ and ultimately, known or discoverable etiologies.”

Based on these definitions alone, all three paradigms regard disease as a condition resulting from physical abnormalities.  Therefore, from a purely semantic perspective, mental disorders cannot be qualified as diseases unless one interprets the term in a metaphorical sense. Now that we’ve established our definition, let us look at how treating mental disorders as diseases can disempower individuals by turning them into passive recipients of treatment.

In 1991, Nesse argued that the negative feelings associated with anxiety, depression, phobia, and distress are useful in that they are associated with the body’s defenses and carry out protective functions. Positive feelings (and we’re not talking about positive feelings induced by drugs) are obviously useful in that they signal and contribute to emotional well-being (Seligman & Csikszentmihalyi, 2000), and reinforce adaptive behaviours (Sheldon, 2011). Nesse’s overarching argument is that, in general, fluctuations in mood serve evolutionary functions, i.e., negative and positive emotions help us to survive in our environments. For example, Nesse cites Swedish psychiatrist, Emily Gut, who argues that depression often arises when primary life strategies fail and no alternatives seem available. Further, Gut posits that the characteristic withdrawal and harshly realistic introspection associated with depression is necessary for reevaluating life goals and strategies. This position was later reinforced by a review published by Andrews and Thompson (2009) who argue that depression is an evolved response to complex problems, which encourages rumination and withdrawal from distracting activities and stimuli. In light of Nesse’s argument, interrupting the emotional fluctuations associated with mental illness could actually be disturbing an important element of the healing process.

If we approach depression like a disease than we are assuming it has a physical cause. So we prescribe selective serotonin reuptake inhibitors (SSRIs: a form of antidepressant) to maintain and increase serotonin levels dancing around the synaptic cleft. Now, there are two problems with this approach. First, in a major meta-analysis conducted by researcher Irving Kirsch, it was convincingly demonstrated that antidepressants are no more effective than placebos (Kirsch, 2009). Now the argument can be made that if it works than who cares if it’s a placebo? Well, the problem is that SSRI’s such as Prozac have way too many side effects. You can find a list of these side-effects on Prozacs website. They include suicidal thoughts, new or worse depression, agitation, hallucinations, respiratory problems, and excessive happiness, which will eventually have to be treated with other medications that have other side effects, so on and so forth.

Personally, this approach to treating mental disorders is like taking Malox for an upset stomach after eating a donair. The problem isn’t with the upset stomach, but we must also be careful not to present the individual as totally responsible because, often, individuals with mental disorders lack control over their condition. Rather, there are a number of psychological and social factors involved. By relieving the upset stomach, which is communicating to us “you shouldn’t eat any more donairs,” we’re actually disturbing the opportunity to make fundamental cognitive and behavioural changes. Unfortunately, our society has developed a collective aversion to systematic approaches for adjusting maladaptive behaviours and attitudes. We want the quick fix – we’ll deal with the long-term effects, later.

I find psychiatric medication to be a lot like fast food. Fast food fills you up, is time sensitive, and, in the short term, is very pleasurable. However, the long-term effects of eating too much fast food are less positive such as excessive weight gain, gastro-intestinal problems, and nutritional deficiencies. Psychiatric medication, in the absence of other treatment approaches such as talk therapy and cognitive behavioural therapy (CBT), is analogous to fast food. Cooking a wholesome dinner takes time, is demanding and, at first, can seem difficult and hopeless; however, the long-term effects of such a lifestyle change are positive, lasting, and sustainable. Approaches to mental health that focus on lifestyle, attitude, and behaviour such as CBT and talk therapy are analogous to healthy eating.

In conclusion, I’d like to emphasize that there are always exceptions to the rule, and an integrative approach that considers both the physical and psychosocial aspects of mental disorders would be ideal. If we allow ourselves to get caught up in the idea that mental disorders are physical diseases in the absence of root causes then we’ll end up treating symptoms such as emotional lows – symptoms, which may in fact be a necessary part of the healing process. Approaches that emphasize process and empower the individual to be actively involved in their own well-being should be encouraged. Regarding mental disorders as diseases gives us the false impression that our physician is fully responsible for our treatment, which steals away whatever control we have left over our well-being.

 

References

Andrews, P. W., & Thomson, J. r. (2009). The bright side of being blue: Depression as an adaptation for analyzing complex problems. Psychological Review, 116(3), 620-654. doi:10.1037/a0016242

Kirsch, I. (2009). The emperor’s new drugs: Exploding the antidepressant myth. London: The Bodley Head.

Nesse, R. M. (1991). What good is feeling bad?. Sciences, 31(6), 30. Retrieved from EBSCOhost.

Oxford dictionary of Science (4th ed.). (2003). New York, NY: Oxford University Press.

Psychiatric dictionary (7th ed.). (1996). New York, NY: Oxford University Press.

Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5-14. Doi: 10.1037//0003-066X.55.1.5

Sheldon, K. M. (2011). Integrating behavioral-motive and experiential-requirement perspectives on psychological needs: A two process model. Psychological Review, doi:10.1037/a0024758

Szasz, T. S. (2000, January 20).  Mental disorders are not diseases. USA Today, 128, 30.

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