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The Concept of Disease and its Implications for Psychiatry

Published online by Cambridge University Press:  29 January 2018

R. E. Kendell*
Affiliation:
University Department of Psychiatry, Royal Edinburgh Hospital, Morningside Park, Edinburgh, EH10 5HF

Extract

It has often been suggested in recent years that there is no such thing as mental illness; that the conditions psychiatrists spend their time trying to treat ought not, properly speaking, to be regarded as illness at all, or even to be the concern of physicians. Szasz is the best-known exponent of this viewpoint, and the core of his argument is essentially this: that as prolonged search has never demonstrated any consistent physical abnormality in those regarded as mentally ill, and as their ‘illness' consists simply in behaving in ways that alarm or affront other people, or in believing things which other people do not believe, there is no justification for labelling them as ill, and to do so is to use the word illness in a purely metaphorical sense (Szasz, 1960). Schneider had previously been led by the same reasoning to the conclusion that neurotic illness and personality disorders were ‘abnormal varieties of sane mental life’ rather than disease, but he took care to exempt schizophrenia and cyclothymia by assuming that both would in time prove to possess an organic basis (Schneider, 1950). The argument Eysenck puts forward in the first edition of his textbook, though written from the quite different standpoint of academic psychology, is a similar one. After observing that ‘the term psychiatry does not denote any meaningful grouping of problems or subjects of study’ he went on to suggest that the traditional subject-matter of psychiatry should be divided into a small medical part ‘dealing with the effects of tumours, lesions, infections and other physical conditions' and a much larger behavioural part ‘dealing with disorders of behaviour acquired through the ordinary processes of learning’, thereby implying that most of what doctors regarded as mental illness was really learnt behaviour rather than disease, and therefore much better understood, and dealt with, by psychologists than by physicians (Eysenck, 1960). A third line of attack is provided by R. D. Laing, and a fourth is exemplified by the sociologist Scheff. Laing argues that schizophrenia, far from being a disease or a form of insanity, is really the only sane or rational way adolescents have of coping with the intolerable emotional pressures placed on them by society and their families (Laing, 1967). Scheff has developed the somewhat similar argument that what psychiatrists call mental illness is largely a response to the shock of being labelled and treated as insane and the expectations this produces; in other words that schizophrenia is created by the people and institutions that purport to treat it (Scheff, 1963).

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1975 

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References

Alström, C. H. (1942) Mortality in mental hospitals. Acta Psychiatrica et Neurologica Scandinavica, Suppl. 24.Google Scholar
Babigian, H. M. & Odoroff, G. L. (1969) The mortality experience of a population with psychiatric illness. American Journal of Psychiatry, 126, 470–80.CrossRefGoogle ScholarPubMed
Cohen, H. (1943) The Nature, Method and Purpose of Diagnosis. Cambridge.Google Scholar
Dahlbero, G. (1933) Die Fruchtbarkeit der Geisteskranken, Zeitschrift für die gesamte Neurologie und Psychiatrie, 144, 427.CrossRefGoogle Scholar
Engle, R. L. & Davis, B. J. (1963) Medical diagnosis: past, present and future. I. Present concepts of the meaning and limitations of medical diagnosis. Archives of Internal Medicine, 112, 512–19.Google Scholar
Essen-Möller, E. (1935) Untersuchungen über die Fruchtbarkeit gewisser Gruppen von Geisteskranken. Acta Psychiatrica et Neurologica Scandinavica, Suppl. 8.Google Scholar
Eysenck, H. j. (1960) Classification and the problem of diagnosis. In Handbook of Abnormal Psychology (ed. Eysenck). London.Google Scholar
Eysenck, H. j. (1971) Personality and sexual adjustment. British Journal of Psychiatry, 118, 593608.Google Scholar
Hopkinson, G. (1963) Celibacy and marital fertility in manic-depressive patients. Acta Psychiatrica Scandinavica, 39, 473–6.CrossRefGoogle ScholarPubMed
Innes, G. & Millar, W. M. (1970) Mortality among psychiatric patients. Scottish Medical Journal, 15, 143–8.Google Scholar
Kräupl Taylor, F. (1971) A logical analysis of the medico-psychological concept of disease. Psychological Medicine, 1, 356–64.Google Scholar
Laing, R. D. (1967) The Politics of Experience. Penguin Books.Google Scholar
Larsson, T. & Sjögren, T. (1954) A methodological, psychiatric and statistical study of a large Swedish rural population. Acta Psychiatrica et Neurologica Scandinavica, Suppl. 89.Google Scholar
Lewis, A. (1958) Fertility and mental illness. Eugenics Review, 50, 91106.Google Scholar
Linder, R. (1965) Diagnosis: description or prescription? A case study in the psychology of diagnosis. Perceptual and Motor Skills, 20, 1081–92.CrossRefGoogle ScholarPubMed
Macsorley, K. (1964) An investigation into the fertility rates of mentally ill patients. Annals of Human Genetics, 27, 247–56.Google Scholar
Malzberg, B. (1953) Rates of discharge and rates of mortality among first admissions to the New York civil state hospitals. Mental Hygiene, 37, 619–54.Google Scholar
Ødegaard, Ø. (1951) Mortality in Norwegian mental hospitals, 1926–41. Acta Genetica, 2, 141–73.Google Scholar
Oldham, P. D., Pickering, G., Fraser Roberts, J. A. & Sowry, G. S. G. (1960) The nature of essential hypertension. Lancet, i, 1085–93.Google Scholar
Rosenthal, D. (1970) Genetic Theory and Abnormal Behavior. New York.Google Scholar
Sainsbury, P. (1968) Suicide and depression. In Recent Developments in Affective Disorders (ed. Coppen and Walk). London.Google Scholar
Scadding, J. G. (1967) Diagnosis: the clinician and the computer. Lancet, ii, 877–82.Google Scholar
Scheff, T. J. (1963) The role of the mentally ill and the dynamics of mental disorder: a research framework. Sociometry, 26, 436–53.Google Scholar
Schneider, K. (1950) Systematic psychiatry. American Journal of Psychiatry, 107, 334–5.Google Scholar
Slater, E. (1945) Neurosis and sexuality. Journal of Neurology and Psychiatry, 8, 1214.Google Scholar
Stevens, B. G. (1969) Marriage and Fertility of Women Suffering from Schizophrenia or Affective Disorders (Maudsley Monograph No. 19.) London.Google Scholar
Szasz, T. S. (1960) The myth of mental illness. American Psychologist, 15, 113–8; or book of same title. London: Seeker and Warburg, 1961.Google Scholar
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