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By John 'Birdman' Bryant-12-24-03
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Disease, like truth, is a matter of opinion. In particular, it is a matter of definition: Any condition can be defined as a disease, or not. Blacks, for example, call any drive for success among fellow blacks a disease which they name 'acting white'. The Soviets called political dissent a disease, which went by who-knows-what names. Psychiatrists used to call homosexuality a disease, but since redefining it as merely a human condition it seems to have developed into a sort of moral asset. Government-paid scientists call AIDS a disease, even tho its definition is a bizarrity: The presence of any of about 30 already-defined diseases plus infection with an ill-defined entity called HIV. And the tendency of boys to be boys is currently said to be a disease called ADD or AHAD for which a powerful and dangerous cocaine-like psychoactive drug is prescribed.
As should be apparent from the foregoing, the concept of 'disease' is a political football, and a powerful weapon when directed against enemies. If enemies can be labeled as 'sick', then this undermines their credibility, while making those who do such labeling seem not only superior, but actually helpful and sympathetic. The secret to pulling off this trick is to be in control of language: If one side can control what is accepted as a definition of 'sick', then that side can have significant control over who receives that label.
One factor which makes the concept of disease confusing is that it is intimately bound up with an ancient and troublesome philosophical paradox known as the free-will/determinism controversy. The essence of this controversy is that human behavior may be described in one of two seemingly-contradictory ways: It may be said to be a product of free will in which the individual makes choices and is morally responsible for them, OR it may be said to be the product of the physical operation of the brain which is merely a mechanism whose behavior is determined by the laws of physics, and whose actions are therefore not a matter of free will or choice, but only give the illusion of so being. While the free- will/determinism controversy does not come directly into play in the matter of disease, the controversy is surreptitiously slipped in in two different cases:
(1) When a person who is regarded favorably because of his politics, family connections, or the like, commits some outrageous act, this person's behavior can be said to be the consequence of a 'mental disease', hence he 'couldn't help' what he did, hence had no free will, hence is not morally responsible, hence should not be punished.
(2) When a person who is not regarded favorably commits some act that is disliked, he may be condemned as 'crazy' and said to need to be put away 'for his own good'.
By use of the above strategies, then, a person may either be exonerated or condemned by use of the determinist position of the free-will/determinism controversy by the simple claim of 'mental disease'. (He may also be condemned -- tho not exonerated -- by use of the free-willist position, by saying that he freely chose a wrong behavior.) It is little wonder therefore that the entire concept of mental disease has been attacked wholesale by hard-core free-willists like Dr Thomas Szasz, who have made a career of asserting that mental illness is a myth.
But if Szasz and his friends have gone after a very real bogey man, they have undermined their own credibility by studiously ignoring the fact -- and it is a fact -- that there are some people in this world that 99 and 44 one-hundredths percent of everybody else is going to label 'diseased' because of their weird behavior. In a way, of course, this makes no difference to Szasz's thesis, since he is merely against labels which give a pass to outrageous behavior or condemn the innocent, and wishes to hold everyone to the same standards of moral responsibility. From a purely practical standpoint, I think Szasz's way is the way to go, and that if we forced people to be self-responsible by removing the excuse of 'disease', they would much more often be so. For even in the paradigm case of innocence where a man blacks out and commits a murder of which he is supposedly unaware, the confinement or execution of such a person still meets the minimum standards of justice by protecting society from the chance that the individual in question will have another 'blackout' and commit another murder.
It is possible, however, to argue against Szasz by saying that 'genuine' mental diseases are real by virtue of the fact that they manifest themselves in physical pathology of the brain or nervous system. There is, of course, much to recommend this view, since mental disease caused by ingestion of ergotamine is well-established, as of course is disease by means of ergotamine's purer chemical cousins, the psychedelics. This however brings us back to the matter of definition: It would be aberrant to say that a psychedelic experience is a 'disease state', tho this perception might change if the state were extended beyond the time of a usual 'trip'. Furthermore, we are confronted with the fact that strange people who might by modern psychiatric definitions be diseased are often perceptive beyond the realms of ordinary experience, as attested to by religious ascetics, tribal shamans and psychic healers. But the real point about definitions of disease is that there need be no physical pathology, for as we pointed out earlier, normal behavior such as political dissent or 'acting white' can be defined as 'disease' just as easily as amyloid striations, brain worms, or aneurisms in the circle of Willis. Needless to say, unless you embrace the theory of dualism which holds that a soul is said to inhabit the body and animate it, you are committed to the proposition that every psychological state must have its corresponding brain state, so that whatever is defined as disease will a fortiori have a brain state 'pathology' that corresponds to it.
In conclusion, it is worthwhile to point out that, besides those trying to cover for their own or others' behavior or reduce the credibility of their opponents, the greatest pushers of the notion of psychological disease are the disease professionals themselves -- it is, after all, their major source of income. In a sense this is tragic, but it is also comedic; for those most seriously affected by psychological disease, as demonstrated by their suicide rate, are the headshrinkers themselves. Maybe the problem is that they are trying to solve their own problems by becoming the professionals they so desperately need to see.
This essay is posted at http://www.thebirdman.org/Index/Temp/Temp-BirdmansWeeklyLetter.html
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