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Mental and physical illness

Institute of Epileptology, Weston Education Centre, King's College, Denmark Hill Campus, Cutcombe Road, London SE5 9PJ, UK

EDITED BY MATTHEW HOTOPF

The editorial by Kendell (2001) independently reflects the view of Baker & Menken (2001) that it is time to abandon the term ‘mental illness’. All three authors emphasise that an important reason for so doing is that the term is stigmatising and undermining of the care and treatment of millions of psychiatric (Kendell) and neurological patients (Baker & Menken). Interestingly, Kendell suggests that the term ‘psychiatric illness’ is more acceptable, whereas Baker & Menken propose instead ‘brain illness’. The former seems to replace the mind by the psyche and the latter by the brain.

Like Kendell, I have reviewed the historical processes that have led to the evolution and divergence of psychiatry and neurology as separate disciplines with all the ensuing confusing theoretical and practical uncertainties and complications for professionals and patients alike, including stigma (Reynolds, 1990). Modern neuroscience, which has demonstrated how brain function is profoundly influenced by psychological and social as well as biological factors, has opened the way for resolving some of these uncertainties and divisions. I share the view that one way forward is to build practical bridges between neurology and psychiatry (Reynolds & Trimble, 1989). For example, it does not make sense for neurologists and psychiatrists quite separately to tackle the problem of stigma towards brain and mental illnesses without some dialogue or coordination, especially as neurologists sometimes blame the stigma of brain disease on misunderstandings created by inappropriate application of the term ‘mental’.

I do not, however, share the possibly unrealistic and impractical view that the term ‘mental illness’ should be abandoned. Brain/mind issues have been debated by professionals, philosophers, patients and the public for centuries, and this will continue for some time to come. It is reminiscent of proposals to abolish the word ‘epilepsy’ because this neurological condition is so stigmatised. Similar suggestions have been made in the past for the words ‘cancer’ and ‘leprosy’, which together with ‘epilepsy’ were three great unmentionables for much of the 20th century (Reynolds, 2000).

Stigma results from ignorance, misunderstanding, fear and prejudice, and the way to combat it is by education and raising public awareness. Rather than abandon the word ‘epilepsy’ the International League Against Epilepsy (professional), the International Bureau for Epilepsy (patients/public) and the World Health Organization (political) have jointly initiated a global campaign to bring epilepsy ‘out of the shadows’ (Reynolds, 2000).

REFERENCES

Baker, M. & Menken, M. (2001) Time to abandon the term mental illness. BMJ, 322, 937.[Free Full Text]

Kendell, R. E. (2001) The distinction between mental and physical illness. British Journal of Psychiatry, 178, 490-493.[Free Full Text]

Reynolds, E. H. (1990) Structure and function in neurology and psychiatry. British Journal of Psychiatry, 157, 481-490.[Abstract/Free Full Text]

Reynolds, E. H. (2000) The ILAE/IBE/WHO Global Campaign against Epilepsy: bringing epilepsy "out of the shadows". Epilepsy and Behaviour, 1 (suppl.), S3-S8.

Reynolds, E. H. & Trimble, M. R. (eds) (1989) The Bridge between Neurology and Psychiatry. Edinburgh: Churchill Livingstone.

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Reynolds, E. H. Search for Related Content PubMed PubMed Citation Articles by Reynolds, E. H.