Updated: Oct 26
Since “mental illness” refers to illness of the mind, it should go without saying that we must understand and define the mind to speak with authority about mental illness. We have not yet done this in medical science. Our medical understanding of the mind is not on par with our medical understanding of, for example, the heart.
Thomas Szasz was famous for saying “There is no such thing as mental illness.” I disagree with him. “Mental illness” has become part of our vernacular because it represents something real that we experience: suffering and difficulty, which touch the human soul like few other experiences can.
Specifically, “mental illness” represents suffering that is due to beliefs, thoughts, perceptions, and emotions. The problem is that many if not all people experience suffering due to their beliefs, thoughts, perceptions, or emotions. Some experience it for longer periods and some for shorter periods. Some experience it more frequently and some less frequently. Some experience it more intensely and some less intensely. Some experience a shift to a different state of mind relatively soon and some don’t. At what point on the range of these experiences do we set the threshold that qualifies as “mental illness” and “impairment?” Based on what criteria?
When we look at this question steadily, we see that the thresholds of “mental illness” and “impairment” are social determinations rather than medical determinations. Not being able to keep a job may be impairment in one family and acceptable in another. One community’s appropriate clothing may be another community’s inappropriate clothing. What one family accepts as sadness may be what another family teaches is an inability to cope with life. “Mental illness” is real, and we as a community determine where it begins.
Because the mind is traditionally linked with subjectivity, it is notoriously difficult to reach a consensus on what range it covers. Science, philosophy, spirituality, religion and direct personal experience have much to say about the mind, and all may be valid from their frames of reference. So perhaps the best place for us to start collectively is to simply say We don’t know what the mind is. What we know is only our range of the mind.
We don’t know what the mind is.
This is the starting point of all learning, and of all possibilities. This places great responsibility on you and me as members of an educated society. We are the ones who collectively determine where “mental illness” and “mental health” begin and end, based on our understanding of what is happening and what is possible. It is only once we agree on what qualifies as “mental illness” that clinical medicine has a potential role in treating it. Therefore, it is up to us to investigate and understand the mind.
What if we found that the mind is more than beliefs, thoughts, perceptions, and emotions? What if we found gateways in our subjective experience that lead to unseen fields of the mind not described in medical science? What if we found that certain avenues and patterns of suffering can be managed in new ways? What if the mind is both within and around the body? What if the mind is not limited to a lifetime? How might our explorations of these and other questions change how we interpret and assign words like delusion, hallucination, depression, mania, addiction, and impairment?
Rich, ancient, philosophical traditions around the world have investigated such questions in depth and left a trail of breadcrumbs that any diligent mind can follow, but we have so far failed to mine this knowledge to inform medicine and psychiatry. We have developed a medical culture that is reluctant to ask such questions - partly because they are difficult and partly because the very answers question our frameworks and expertise. We often rush to defend established notions of “mental illness” and “mental health” with the goal of helping others, assuming our definitions are benign and questioning them is somehow denying or minimizing the suffering of others. On the contrary, it is precisely because there is so much suffering that we must dare to investigate new questions and reconsider unexamined notions, even if it makes us unpopular. Otherwise, we allow our fears to shape us rather than our knowledge.
Investigating such philosophies is not enough. We also have to get the basics right, beginning from childhood. The basics include expressing and sharing our emotions, and recognizing that there is no such thing as a “normal person” apart from a mathematical average. If we do this effectively, starting with making an example of the way we live, we will find that our insight into the mind increases. This is how we open the door to the possibility of helping those who are suffering in deeper and greater ways.
So whether you’re an expert or a lay person, a person with an advanced degree or no degree, a person who meditates or doesn’t meditate, it is you who helps us define "mental health" and “mental illness” based on the range of your experience of mind.
We don’t know what the mind is. Let’s find out.