Which philosophers talked about mental retardation?

DOES MADNESS EXIST?
By Jud Evans
With an Addendum by
Richard Sansom


MADNESS

There are two sorts of insanity - a person can be judged insane when he is out of touch with reality, or when he is so mentally ill as to lack responsibility. The former is the medical concept and the latter a legal one. The earliest case illustrating the distinction arose when Edward Arnold known locally as 'Crazy Ned' for his bizarre behaviour, shot and wounded Lord Onslow in 1724. He was condemned to death, but an intervention by Lord Onslow led to his punishment being commuted to life imprisonment.
(1) Lawrie Reznek Evil or Ill? Justifying the Insanity Defence p. 16.

The word 'madness' is actually an umbrella-word which encompasses a wide spectrum of atypical behaviour patterns which are considered by the majority in a given society [but not all societies] to uncharacteristic of 'normal' behaviour.

In the seventeenth and eighteenth centuries it was not only criminals awaiting sentencing or execution who were incarcerated but often those considered to be madmen too. Criminality, unreason and disease were often seen as a corollary of madness. The doctors of the day were more guardians or jailors, and not so much the arbitrators of who was mad and who was sane. I should like to take a brief look at various types of 'madness' and create my own personal categories of such phenomena based upon my own knowledge with a few typical examples of what I consider to be the three main differing causes.

(a) THE CONGENITAL. Congenital physical defects at birth with accompanying neural disability. This typically would include such people who present physical and neurological conditions such as Downs Syndrome: - a chromosome syndrome causing physical effects and mental retardation, congenital hypothyroidism (Cretinism) and other such defects caused by imperfect genetic copying or prenatal DNA damage.

(b) THE DEGENERATIVE. Defects caused by tissue changes within the brain leading to partial or complete memory loss and behaviour considered by the majority to be bizarre. Alzheimer's patients, victims of Parkinson's disease, mad cow disease, cerebral stroke, metabolic disorders etc.

(c) THE EXPERIENTIAL. Those chronically or occasionally affected by chemical imbalance, shock or stress, or the trauma of physical damage due to accidents or self-harm, substance abuse etc., resulting in such classical symptoms such as: hallucination, paranoia, disorientation, dementia etc.

There is a lot of overlap and convergence, and elements of one classification can cause accompanying symptoms in others. It would seem to be that behaviour formerly described as madness no longer applies, and the word has in this sense lost its semantic currency as a descriptor of a definable human condition.

Does modern psychiatry really label some people mad? I have conducted extensive searches both in the library and on the Internet and not been able to discover any instances of members of the medical profession in Britain or western countries actually labelling people in their care as suffering from a condition called 'madness.'

What - if any - 'objective foundation' does modern psychiatry lack?

A principal formulation of psychiatric taxonomy is the "medical model." This posits the view that the classification of psychiatric disorder is capable of being both scientific and objective. The best-known contemporary defender of such an approach is Christopher Boorse.

Boorse, argues for the value-neutral view of classification, suggests that evolutionary theory can tell us what conditions are healthy. In one paper, he gives the following definition of health:

'An organism is healthy at any moment in proportion as it is not diseased; and a disease is a type of internal state of the organism which interferes with the performance of some natural function -- i. e., some species-typical contribution to survival and reproduction -- characteristic of the organism's age; and is not simply in the nature of the species, i. e. is either atypical of the species or, if typical, mainly due to environmental causes.'
(Boorse, 1976, page 62.)

The contemporary position of the majority of western psychology and psychiatry is that there exists a distinctive mental dimension that is not reducible to anything physical.

The eliminative materialist Prof. Patricia Smith Churchland whose work is in the forefront of deconstructing and reducing the whole concept of the nonmaterial 'mind' to that of a neurophysical brain comments that there is a additional variance of views amongst the current psychological and psychiatric establishment which can be represented as being roughly divided into two.

'Within this view there is a further division over whether this mental dimension harbours a separate mental substance such as the non-physical mind or the soul (substance dualism) or whether it is limited to non-physical properties of the physical brain (property dualism.)' P. S. Churchland. Neurophilosophy. Towards a Unified Science of the Mind/Brain. P. 317

The importance of comparing the eliminative position, which seeks to excise the non-physical 'mind' altogether, with the more traditional view which seeks to retain it is of course very important for any discussion of 'diseases of the mind' - for patently if 'mind' does not exist then the diseases of the mind cannot exist either.

Professor Churchland continues:
'An intractable problem confronting substance dualism is the nature of the interaction between the two radically different kinds of substance. Soul-stuff allegedly has none of the properties of material-stuff and is not spatially extended, and the question this concerns how and where the two substances interact. This problem stymied Descartes, and his completely inadequate solution was to suggest that the "animal spirits" functioned to mediate between the two types of substance and that the subtle interaction took place in the pineal gland. But his animal spirits were composed of material stuff, albeit very fine material stuff, so the problem stood its ground.'

In spite of their inability to explain the precise nature of the 'mind,' and although some of the terms employed by the current psychiatric community are vague, it appears that the modern practitioners believe themselves and their methodology to be objective and successful. They claim that patient-behaviour is observed and carefully monitored and in most cases, diagnoses successfully identify behaviour as falling into recognised text-book categories of 'mental illness.' They point to the many improvements in the treatment of the mentally ill, to the great strides in the development of new drugs and the consequent closing down of mental institutions and release of patients into society which these new medications have made possible. It is possible therefore that the anti-psychiatry movement are aware of this, and that in this case they are themselves guilty of employing the word 'madness' thoughtlessly? We will now look at their main criticisms which may throw some light on this.

Are the criticisms of the Anti-psychiatry movement justified?

One of the criticisms of the anti-psychiatric movement is that psychiatric classification depends solely on the whim or values of those doing the classification, who are seen as unwitting agents of social control, and that there is nothing objective about the often arbitrary decision-making at all, and that there are no scientific facts about what is normal. Critics point to the fact that homosexuality was until quite recently considered to be a mental-illness, and that behaviour such as suicide is considered in the west to be indicative of mental illness or madness, whilst in Japan it is considered socially acceptable in many cases. The defenders themselves are very conscious of the increasing disrepute in which psychiatry finds itself. Here Reznek himself admits that:

'The foundations of psychiatry art shaking. As a branch of medicine, it is firmly committed to the existence of mental illnesses, but there is little consensus as to their existence. As a branch of medical science, it presumes to discover the truth about the causes of abnormal human behaviour using scientific methodology, but there is a question mark against the scientific status of psychiatric knowledge. In short, as a theoretical enterprise, psychiatry is in a bad way.
(4) Reznek, L. The Philosophical Defence of Psychiatry

The techniques used by Western psychiatrists are, with few exceptions on exactly the same scientific plane as the techniques used by witchdoctors. If one is magic, then so is the other ... In order to be scientific a phenomenon must be explainable by underlying laws. These laws are arrived it by observation, measurement, experimentation, induction, hypothesis formation and testing. The rationale for most therapies used by witchdoctors and psychiatrists for therapies used by witchdoctors and psychiatrists is not arrived in this way - rather the techniques are used on sick clients, the clients get well, and therefore the techniques are thought to work. This is logical, empirical psychiatry and is found among witchdoctors and psychiatrists. And both witchdoctors and psychiatrists make the assumption that their clients get well because of the techniques.
(Torrey, 1986, pp. 11-12)

These scathing criticisms are generally proposed in a spirit of attacking or undermining psychiatry, and are often very sympathetic to the Szaszian view that there is really no such thing as mental illness, and so there could not be a legitimate objective classification of different kinds of mental illness. With Szasz the suggestion is that classification schemes are created to suit the needs of those in power.

Conventional psychiatry responds that this position does not take into consideration the current lack of understanding and the extent to which physical ill health in as a whole may not be comprehended. Additionally they defend themselves by responding that a rejection of 'the mental' does not allow 'mental illness' to be associated with the wider domain of psychological abnormality.

These critical views of psychiatry are most well known in the work of Thomas Szasz, though there are many other highly respected professionals in this area such as Franco Basaglia and the Scotsman R. D. Laing. Anti-psychiatry can be seen as having arisen as part of a general cultural critique of the 1960s. This is particularly the case with Laing, who was involved in left-wing politics, such as the Dialectics of Liberation Conference in 1967, whereas the phenomenon of anti-psychiatry's popular appeal and its later demise can probably be related to wider political and cultural developments.

A philosophical dualism of mind and body should obviously be avoided. Mental functioning is due to the brain, yet labelling someone as mentally ill is primarily a statement about psychological, not physical functioning. The extent to which illness in general, including physical illness, is an evaluative concept, may be underestimated.

A more extreme view is that there is no such thing as mental illness in any culture, and that there could not be, because the very notion of mental illness is based on a fundamental mistake or set of mistakes. This sort of view is most closely associated with the psychiatrist Thomas Szasz. I

Reznek, a critic of Szasz writes:
'Szasz separates out at least six main arguments against the existence of mental illness within his work. Sometimes he has compared psychiatry to alchemy or astrology (1974, pp. 1-2), and says they are all pseudo-sciences. On this criticism, it seems that the reason that mental illness does not exist is the same sort of reason that phlogiston or astral influences do not exist: it is an empirical mistake caused by flawed methodology. The continued belief in mental illness by psychiatrists is the result of dogmatism and a pseudoscientific approach using ad hoc defences of their main claims. He also accuses psychiatrists of secrecy and obfuscation. However, it seems that his most fundamental criticism is not of the scientific methodology of psychiatry, but of its concepts. His claim is that the concept of mental illness is based on confusion.
(4) LAWRIE REZNEK 1991, Chapter 5.

[The belief in mental illness] rests on a serious, albeit simple, error: it rests on mistaking or confusing what is real with what is imitation; literal meaning with metaphorical meaning; medicine with morals. (Ibid, p. x.)

Szasz says that there cannot be mental illness, literally speaking, because it is no more than a metaphor. He argues that by definition, "disease means bodily disease."
(Ibid, p. 74)

Conclusion

Like the eliminativist man and wife team Paul and Patricia Churchland many are now questioning whether madness or mental illness - or even the mind itself exists at all, and whether madness is a malfunction of the body like any other physical disorder? I believe that those of the anti-psychiatry movement who argue in this way are absolutely right to do so. On that basis, and to address the essay question strictly I am disposed to agree with the anti-psychiatrists that in the sense that the word 'madness' has been replaced with the euphemisms 'mental illness' and 'disease of the mind' etc., which imply that such a thing as 'mind' exists - that the concept of madness is simply a label used without any objective foundation.

The label 'madness' nowadays is more usually attributed to the reckless, impetuous or unthinking behaviour of persons who are otherwise considered sane and carries the unspoken implication that the person doesn't always behave in that fashion, but perhaps only in situations of heightened emotion. Self-styled 'psychologists' and 'mental therapists' proliferate - particularly in angst-ridden USA, where a visit to a 'my therapist' has been transformed into a social cachet to be offhandedly dropped into cocktail party conversation as if it were indicative of some personal accomplishment or social grace.



References:
(1) Lawrie Reznek Evil or Ill? Justifying the Insanity Defence p. 16.

(2) The Word Reference Dictionary http://www.wordreference.com/definition/psychopathy

(3) Stanford Encyclopaedia of Philosophy. http://plato.stanford.edu/entries/mental-illness

(4) Boorse C. What a theory of mental health should be. Journal of Theory Social Behaviour. 1976;6:61-84.

(5) Reznek, L. The Philosophical Defence of Psychiatry. 1991, Chapter 5. London: Routledge.

(6) Reznek. L Evil or Ill? Justifying the Insanity Defence (Philosophical Issues in Science)