What Is "Illness"?
And what does it mean for the concept of "mental illness"?
It is no secret that in my own work is have focused on reframing psychological distress away from medicalised concepts of “illness” and toward an understanding of such experiences as acquired neurodivergence.
This may seem a peculiar thing for a Schizophrenic man such as myself to do. I take medication, I see a psychiatrist. I’ve had more courses of psychotherapy than most NHS bosses would consider a sensible use of resources.
And yet still I am drawn to the notion that I am not “unwell”, rather I have a mind that performs differently to others.
I have just started reading Psychopolitics by Peter Sedgwick and I am intrigued to admit that I feel somewhat challenged by his thoughts. Not in a way that triggers my cognitive biases to disregard his writing, but in a way that compels me to explore the thoughts that arise from my reading of this book.
Now, full disclaimer; the thoughts I am about to type are still in formation, and may well evolve and shift as I continue reading. However, I am keen to address the first question that Sedgwick poses in his book.
How do we define illness?
Sedgwick asserts, quite correctly in my opinion, that one of the most fundamental flaws of the anti-psychiatry movement is it’s delineation between physical and mental health. He further asserts that accepting the positivist methodology of biomedical research while rejecting it within mental health research is an inherently contradictory and critical error to make.
The core of Sedgwick's thesis on this point is that to establish if mental illness is truly an illness, we first have to establish a somewhat universal definition of illness at large.
Contemporary definitions of illness have their roots in statistical averages and pseudomechanical models of the human body. Think, for example, of Quetelet's “Average Man” or Descarte's “Ghost In The Machine”. The problem with these approaches to illness is that humans often deviate from statistical averages, and human bodies are more complex than machinery.
It would seem to me that the starting point with an inquiry into the nature of illness is whether or not it causes suffering. This in itself is not enough for an entire definition as one could, for example, stub their toe and suffer immensely for a brief moment; most would agree that a stubbed toe does not constitute an illness.
So, if we have suffering as the outward observation and the internal experience, what more do we require?
Perhaps we could then ask if that suffering arises from some kind of infection, toxin, or corporeal dysfunction. This raises some interesting thoughts.
Human beings, to my knowledge, are the only species that view the impact of these things as illness. While interesting to ponder, I doubt that a dog with kennel-cough would consider itself ill, and as we have already mentioned, suffering alone does not empirically define illness.
Illness As Construction
Sedgwick further asserts that much of what medicine considers to be illness has been driven by the needs and values of society. When a bodily (bodymindily?) state does not fulfill the needs or values of it’s culture, it then becomes an illness.
In this sense, illness becomes a somewhat constructed idea that forms a foundation for medicine as an industrial institution. Illness as a contemporary concept has been defined by the priorities of systemic powers, and then a medical industry has been built around it.
Illness, then, is not a single concept, but a collection of states of being that reduce a person’s ability to participate in society at large.
What Does This Mean For The Concept Of Mental Illness?
To satisfy the criteria of illness above, mental illness would have to be the convergence of states of being that reduce a persons ability to participate in society.
It is reasonable that following would be things that converge to do such a thing:
Multiple Marginalisation:
Many who are labelled as "mentally ill” have experienced marginalisation at the intersection of multiple cultural and sociopolitical identities.
Environmental Harm & Trauma:
One is likely to have experienced harm or traumatic events within the environment(s) they exist within.
Systemic Harm &Trauma:
We are likely to have experienced harm or systemic violence from systems both within and beyond our power horizon.
Genetic or Neurological Predisposition:
We can assume the likelihood that genetics and brain development or injury play roles in mental health based on the available research literature.
Within this model, which I would consider to paint an image of an ecosystem rather than isolated environments, the most stubborn aspects of converging states is the final one; genetics and neurology.
“Mental Illness” as a concept then does not fit into biomedical models of illness easily. It would seem that ecosystem and the power within it is the variable one can most easily alter to change the path toward psychological distress.
It is for this reason that I feel a framing of acquired neurodivergence is a more emancipating framing of these experiences. Our brains neurocognitive style has been altered by the ecosystem in such a way that it is now harder to perform neuronormativity.
In future writing it would be pertinent for me to expand further on my ecosystemic model of neurocognition, and I will do so.
For now, whether you agree or disagree with the concept of “mental illness”, I hope we can agree that our wider ecosystem is the pipeline to our outcome, and not a broken brain.
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