Do Mental Health Conditions Exist? A Response

~o~

 

A while back, Max. J. Lewy asked me to review his latest book Gas Lit By A Madman; On Philosophy, Madness and Society. The book looks at multiple themes around mental health, such as its existence, it’s treatment and the idea of responsibility when with a mental health condition. On reading it, this book greatly disturbed me due to the various ideas the author appeared to be promoting. Therefore, I decided to investigate these issues myself and demonstrate my reasoning on why I reject his book. This blog post will be rejecting Lewy’s loose claim that mental health conditions don’t exist.

Trying to interpret Lewy’s attitude towards mental health conditions and their existence is incredibly difficult; the book jumps from problem to problem with not much guidance or organisation. Often, there are contradictory points. For instance, he claims he does believe mental health problems are real but then proceeds to give arguments to their non-existence. I believe what Lewy is trying to argue is that the way psychiatrists view mental health disorders is incorrect. Therefore, I will proceed on this assumption.

Lewy lists multiple reasons as to why we may experience feelings of anxiety, depression and despair, such as the political shambles of current world governments. He argues that such causes justify such feelings. Therefore, he argues that such feelings should not be labelled as a mental illness or “problems” as they have sufficient causes. Therefore, mental illness does not exist.

The first issue with this argument is that it confuses the multiple meanings behind the word anxiety, despair and depression. For instance, anxiety as a feeling and anxiety as a disorder are two separate concepts. Anxiety as a feeling is referring to the inner sensation of nervousness we feel in stressful situations. Anxiety as a disorder includes this, but also other behaviours or symptoms, such as a racing heart or being unable to get out of bed in the morning due to fear.  I feel Lewy is making the point that feelings of anxiety don’t mean you have an anxiety disorder, particularly if they are “justified”. However, looking at the sensation of anxiety alone cannot lead to the conclusion of whether mental health conditions exist or not. Therefore, his argument is inconclusive.

This limited interpretation of the topic also leads to another error. Lewy looks purely at what would justify an anxious response. Therefore, he is “pulling a rabbit out of the hat” and concluding something trivial; that justified responses aren’t an anomaly or illness. However, in reality, there are times when people have an unjustified anxious response. For instance, having to talk to a loved one or cooking. To be anxious in these situations is unjustified and therefore, by Lewy’s same logic (though I don’t agree with it) it would prove the existence of mental health conditions, disproving Lewy’s argument.

The basic issue with Lewy’s first argument is that he fails to acknowledge the full complexity of mental illness. Mental illness can include the incorrect triggering of certain feelings as examined above but it also includes the regularity of such feelings, the thought processes behind these feelings, the behaviours that they lead to and how these behaviours impact on the ability to lead the life that an individual wants to lead. Even if Lewy concluded that all anxious feelings were justified, it would not be able to comment on whether mental health conditions existed as a whole. Because of this, how justified an emotion is cannot be used to determine whether mental illness exists.

Lewy also attempts to use a similar argument for paranoia. Lewy doesn’t provide a set definition for paranoia which makes interpreting his argument problematic, but he does explore the issue of the government maltreating patients in secret government experiment. I think his fundamental point is that we have justification to be suspicious and therefore it should not be considered a problem. As a result, paired with the argument above, it cannot be used as a sign to highlight a mental illness.

This argument fails due to the misunderstanding of paranoia. Part of my understanding of paranoia and what makes it different to an entity such as doubt is that there is a lack of evidence for the belief that is being held. This can be demonstrated by the example of a person who believes their partner is cheating. This belief would be described as doubt if the person had some basis for this belief. For instance, his partner had cheated on him in the past. However, this belief would be paranoia if they had no evidence their partner was cheating. In the case of the government it would not in fact be paranoia but scepticism as it is founded in past evidence. Therefore, the example of the government cannot be used to comment on the existence of paranoia and hence the existence of mental health conditions.

Lewy also argues that because we cannot know for certain if a person has a mental illness, then mental illnesses are not real. He uses the example of someone pretending to be the queen of England.  It could be concluded that the person is mentally ill, or it could be that they are pretending to have one or there is a rational explanation for their behaviour. From this, he proceeds to conclude that mental illness is merely an appearance which is used to construct social norms and defame eccentric individuals.

The major problem with this part of the argument is that it confuses two different areas of philosophy that cannot be used to prove one another. The existence or essence of an object is a different issue to one of having knowledge. It is a very subtle difference but still an important one. In this case, there is a difference between whether we can know someone has a mental health condition and whether mental health conditions exist. This creates an issue, as raising into question if someone has a mental health condition cannot be used to challenge the existence of mental health conditions in general because it is still possible for other people to have mental health conditions even if the person in question does not. It is also possible that mental health conditions exist without knowing for certain that they do or do not exist. This means Lewy’s method of using knowledge becomes invalid and cannot disprove the existence of mental health conditions.

Lewy does attempt to use knowledge in a different way to create another argument. He looks at the phrase “I didn’t know I was depressed”. I assume he imagines this being used when someone has gone to the doctors and has received the diagnosis of depression which is the knowledge being gained. However, for Lewy this is a contradiction. How can we not know that we are experiencing a specific sensation? We are the only ones immediately aware of our feelings. If we were depressed, we would be the first to know. Certainly, a doctor would not be aware of this sensation before us. For Lewy it seems, by doctors giving us this label, they are telling us to feel a certain way and are making us more unhappy than we were originally. Therefore, the condition not only doesn’t exist but the label is causing damage to those in a vulnerable position.

However, I reject this argument due to the practicality of the phrase. If someone has received the diagnosis of depression, it would be highly unlikely that they were not aware they were depressed. They would have noticed that they were not happy or not enjoying the activities that they used to. They would have picked up on the fact they were struggling to get out of bed or were constantly tired. Therefore, the phrase can be accepted as contradictory but that is because it is a phrase that would never be used.

However, a better refutation of the argument lies with the multiple interpretation of the sentence . It would be illogical to not know you were depressed in terms of sensation, demonstrated in the argument above. However, it is logical to not know you were depressed in terms of a diagnosis. This is due to the change in the nature of the knowledge being examined. The feeling of depression is an internal knowledge that we directly perceive. However, the diagnosis of depression is a factual one. This is a piece of information we gain from the outside world which we gain via our senses which is a name that is given to various behaviours and sensations. While it is illogical to not know about a sensation, it is logical to not know that these sensations have a collective name. Therefore, there is no contradiction within the statement and Lewy cannot conclude that depression is merely a label that makes people feel worse via this method.

Lewy’s dismissal of mental health problems can be reduced to the final argument I am going to discuss; he argues that, to diagnose someone with an illness, there needs to be a set of specific causes of specific ailments in order to separate the atypical and the typical. Psychiatry cannot do this and therefore cannot assert that the mental health conditions that they label are real.

This argument is difficult to disprove, not because it is a good argument, but due to the lack of evidence it stands on. The only reasonable stance to take is to deny that psychiatry can’t do this. It has the DSM manual which has a specific breakdown of each mental health condition and the symptoms that each condition has. While Lewy does insult the DSM, he provides no real solid arguments for why we should reject this, particularly when many psychiatrists who have spent many years studying mental health abide by this guide. Therefore, his argument cannot disprove the existence of mental health conditions by arguing that the symptoms are not detailed.

Lewy has a number of flaws in his argument, mostly due to his lack of identifying nuances, defining the terms he is using in a systematic and clear manor and providing sufficient evidence for his points. If he had done this, many problems that he faced would have been avoided; lack of clarification between sensations and conditions, defining paranoia, asserting clearly what he is arguing against etc. Because of this, Lewy’s argument that mental health conditions do not exist cannot be maintained against the rigorous philosophical method.