Seonsam  Na

Thomas Szaz some decades ago explicitly declared in his controversial book ‘The myth of mental illness’[1]that there is no such thing as mental illness, and it’s a case of pure fabrication by psychiatrists, arguing that the notion of the mentally ill being cured by physicians is a ‘myth.’This idea spawned a series of intense debates on the state of psychiatric medicine for decades. Especially the lines of argument seemingly against or in a diagonal position from the ranks of psychiatric profession were collectively called ‘anti-psychiatry’movements, and those in this side of the debate characteristically focused on the misuse of power by psychiatrists[2]and impingement of human rights under the guise of licensed public approval.[3]

The emergence of critical or social or community psychiatry is one of the reactions on the psychiatrist part to the charges against them. They see that the failings of the conventional psychiatry ultimately lie in the misconception of mental illness and thus ill-guided dealings with those human conditions. Shying way from the exclusive biological orientations from its conventional psycho-pathology,[4]critical psychiatry inculcates as a cause a network of elements surrounding the patient’s mental illness in the personal and community context, arguing that the history of individual suffering should also be taken into account.[5]As a natural consequence following from this contextual conceptualization of the illness, those in this part of the psychiatric field prefer to give help to the patients in the community settings, patients including not only ‘soft’ones but also ‘hard’ones such as schizophrenics who were formerly admitted to the hospitals against their will.[6]

The main stream, however, reacts in a slightly different way. It moves instead in the direction of the physicalism, surmising that all those charges directed against the profession stem from the lack of solid physical foundation of the subject of their discipline itself, namely the mental. To vindicate themselves of any blame of pseudo-scientificity, it should go in the direction of hard-core tactile and visual science, locating the areas in the brain that are responsible for specific mental illnesses, and more microscopically, pinpointing the molecular causal structures in the neural network. It is only through this route, they argue, that the entity of mental illness will gain same epistemological status as that of bodily illness, and thus psychiatry could now gain respect from the public as a decent branch of medicine.[7]As for the scientific status of the profession, efforts in the analytical psychiatric field at its scientificity through the adoption of statistical tools of clinical research for the purpose of proving the efficacy of its treatment could be added.[8]

Closely intertwined with the epistemological status of psychiatry are the debates on the nature of mental illness. J. L. Austin rightfully said that it is a very strange thing for the philosophers who are experts in rationality not to give any significant concern to the matter of irrationality. For patients with delusion, their words[9]and the behavior following his/her conviction make perfect sense, even though for others their acts seem to show an absolute crumbling of rationality. Irrationality here becomes relativistic. Isn’t it possible that some of the connotations of the words which were spoken by the deluded patients, or some of their acts are just outside of our ‘acceptable’area of social conduct, thus unconsciously pushed away from the boundaries of our cognitive sphere? In a nutshell, the person in question simply could be ‘Bad’without being ‘Mad.’[10]

The objectivity in the diagnosis and classification of mental illness also present serious philosophical problems. The analysis of the DSM and ICD entries including the diagnostic criteria of the illness shows that many of their purely ‘descriptive’terms are heavily theory-charged, and neutral words are never value-free, thus significantly hampering their original intention of making an absolutely objective manual of psychiatric practice.[11]

In the cases of individual illnesses, there are an ample number of philosophical issues that could be raised and be positively re-directed in the care of those with that illness. In the obsessional neurosis, the agency is in the issue. As Freud’s Rat Man case explicitly shows, the patient keeps invoking a series of unpleasant thought against his will.[12]Philosophically, this is a puzzling situation. First, it’s the person himself who is in charge of his thought that reports his inability to block off his reappearing ‘unwanted’thoughts. Then again, it is also ‘his’thought that keep appearing with very frightful contents. Does that mean that there is a different mind or agency at work, switching its place as an agency of his thought at its whim? And where’s the part of mind showing the strong urge not to think the unpleasant thought?[13]Though Akrasia, the lack of will, is commonly related with this ailment, it could be asked the lack of which one’s will except the person’s who wants to block the process of unwanted thoughts emerging is being necessary to solve this problem? Maybe multiple-personality disorders or cases of thought insertion could cast a clinically significant light on our understanding of this compartmentalized or seemingly populous mind.

Apart from the issue of criminal liability in the area of forensic psychiatry, the involuntary commitment of the mentally ill would be the single most debated issue in the area of psychiatric ethics. The criteria for the justification of the involuntary commitment is chosen usually on paternalistic ground, the important point considered being whether he poses harm to others and most importantly, to him/herself. The value judgment of an extremely subjective kind here plays a role, though the slight misuse of power could result in a terrible humanitarian consequence as in the Donaldson case.