Human kind has always been interested in way they behave. They are especially drawn to understanding their puzzling often eccentric even bizarre actions called abnormal behavior. Historically two dominant theories have emerged explaining why people engage in such behavior. These two are demonology and disease: the devil caused your behavior or your actions were due to an illness. Each explanation was replaced by the other several times in man’s history with the disease interpretation, mental illness, currently dominating the scene.
The current proposition that mental illness is a biological disease, often called the medical model, has held sway for several centuries. Despite its endurance, which is due to its exhaustive promulgation by medicine and kindred thinkers, cracks in its foundation as a valid enterprise have begun to appear.
In the early 1900’s physicians, themselves, began questioning the treatment of those called mentally ill, thus giving rise to, what was and still is, the Anti-psychiatry movement. (1) In more recent times the movement has shifted from physicians only to organizations comprised of those including the mentally ill; such organizations as MAD In America(2). The movement has gained in such popularity that it has evolved in a worldwide enterprise.
In the mid 1950’s criticism of the medical model took an abrupt change. Instead of dwelling on the treatment afforded the mentally ill, the validity of mental illness as a biological disease became the focus of the change. Thomas Szasz, a physician, in his landmark book, The Myth of Mental Illness, laid the ground work for the premise that mental illness was more a subject of problems encountered in everyday living than a disease and that mental illness was a myth based on a metaphor. (3)
In support of that contention, Szasz suggested that those advocating the medical model have yet to convince pathologists, those who study disease, that mental illness is a disease.(4) Evidence of that can be found in the pathology textbooks that are used to train physicians: Mental illnesses are not listed as diseases.
Mental illness as a disease.
It should be noted that neither explanation, demonology or disease, offered a precise definition of what it is and how it operated. To illustrate this when I went searching for a definition of mental illness, I consulted the National Institute of Mental Illness which is the governmental agency charged with addressing issues of mental illness. What I found was not so much a definition but a description of mental illness. They described mental illness as being comprised of “two broad categories”: Any Mental Illness(AMI) and Serious Mental Illness(SMI.)
I quote: “AMI is defined as a mental, behavioral or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderated and even severe impairment. SMI is defined as a mental, behavioral, or emotional disorder resulting in serious function impairment, which substantially interferes with or limits one or more major life activities.” (5)
They further state and I paraphrase, that to be included in the estimates of mental illness these disorders must meet the diagnostic criteria specified in the Diagnostic and Statistical Manual (DSM.)
All of this appears to be a roundabout way of saying that mental illness is that which is contained in the DSM. It should be noted that there are over three hundred mental illnesses listed in the current version of the manual called DSM-5-TR.(6)
Mental illness as a disease of what?
Macular degeneration is a disease of the eye. Crohn’s is a disease of the digestive tract. Glomerulonephritis is a disease of the kidneys. What is mental illness a disease of?
Some have suggested that mental illness is a disease of the brain. If that were the case then neurology, the branch of medicine that studies such diseases, would have declared it so. Others have suggested that mental illness is a disease of the mind. The problem here is that the mind is not a physical structure or organ of the body.
Unlike the eye, stomach and kidneys, the mind does not have a physical presence in the body that a disease might attack. It lacks a physical composition and location unlike these other three organs. In fact, the mind is not a biological entity, but rather something created by man. It is what those in psychology call a hypothetical construct, something that operates as though it were real. (7) A hypothetical concept presents things that, if they truly existed, could explain the occurrence of something else. That is, if the mind truly existed it could explain mental illness.
Mental illness as a metaphor
As mentioned earlier Dr. Szasz asserted that mental illness was a metaphor and not a disease. The term mental illness is more a figure of speech than a statement of fact. There are two frequently used figures of speech often used to describe mental illness. These two explanatory aides are simile and metaphor.
To refresh your memory: “A simile is a figure of speech that compares two otherwise dissimilar things, often employing the words like or as. A metaphor is a figure of speech in which a word or phrase that has one literal meaning is applied to another thing in order to suggest a likeness or similarity between the two.” (8) For example, “mental illness is like a disease” is a simile, “mental illness is a disease” is a metaphor. When the medical model and its like-thinking associates such as the media, present the topic of mental illness to the public it is usually expressed as a metaphor.
It is not uncommon when watching a TV discussion involving mental health that the panelists will allude to specific mental disorders such as depression or schizophrenia as a mental illness not like a mental illness. The metaphorical use of mental illness may seem harmless, but its continued use has created a problem. What was intended to be used as a descriptive figure of speech ends up as a statement of fact. Said often enough and by many, such as those supporting the medical model and the news media, the metaphor “mental illness is a disease” achieves the status of truth. However, if science has anything to say about it, the truth appears to be considerably different than what the metaphor declares.
What science says about mental illness as a disease
For the past century or more scientific inquiry has attempted to find the biological base of what medicine calls mental illness. These studies have included investigations involving family, twins and adoptive studies, genetic, chemical imbalance and impaired brain structures. Despite thousands of studies involving billions of dollars, as of now, there are no reliable, consistent scientific findings that have surfaced supporting the position that mental illnesses, is a biological disease. (9)
Some have suggested that because certain mental illnesses are treated by biological means such as drugs, these mental illnesses must be biological diseases. The fact that mental illnesses are treated by drugs is true. However, whether or not these drugs do so effectively is another issue.
Dr. Thomas Insel, ex-director of the National Institute of Mental Health, attests to the lack of scientific evidence for the medical model and its treatment efforts at correcting mental illness when he says and I paraphrase, there are twenty anti-psychotics, thirty different antidepressants, seven mood stabilizers and six drugs for ADHD. In addition there are increasing numbers of people who now are on these drugs than in previous years. Given all of this he concludes: “With nearly 500 million prescriptions for antidepressants and anti-psychotics in the U.S. and no sign of better outcomes, it seems preposterous to claim that medications are effective.” (10)
Added to that, other research reviews, over the past several decades, have shown that the treatments offered by the medical model are questionably effective and indeed harmful to one’s well-being. A complete discussion of this and other similar concerns is contained in a Robert Whitaker article. (11)
What does mental illness consist of?
The DSM-5-TR lists various “symptoms” that are to be considered when making a diagnosis of mental illness. When one thinks of symptoms of a disease, one thinks of simple, involuntary acts like reflexive or other built-in biological stimulus-response actions that are the result of a disease process. Among such actions are, coughing, sweating, headaches, nausea and the like.
With mental illness there are no such involuntary behaviors. Rather the symptoms listed in the DSM-5-TR and associated with the various mental illnesses are learned, complex, social behaviors and not involuntary stimulus-response actions.
These behaviors are learned, consistent with the principles associated with classical, operant and observational learning. The behaviors are complex because they are learned under a wide variety of circumstances and situations. And finally, they are social because they are acquired through interactions we have within the context of our relationships with others. For a detailed explanation of learning one can consult Baldwin & Baldwin. (12)
Again, complex social behaviors are not involuntary They are under the control of the person who is behaving. A person acts in a certain way because it does something for him or her to behave in that manner. We may not always be consciously aware of our complex social behaviors when enacting them. We may not know why and how we are behaving, but nonetheless, we are behaving albeit unwittingly yet in a manner that is under our control.
Conclusion
As it stands, mental illness could be described as a collection of ersatz disorders (those contained in the DSM) affecting a hypothetical organ (the mind) commonly expressed as a metaphor (a biological disease.) with complex social behaviors masquerading as symptoms. All of which is not much better than asserting that “the devil made me do it.”
If the above statement is correct, and evidence suggests that it is, then treating behavior as a physical disease is and will continue to be ineffective and in some instances harmful. What is needed is an alternative perspective concerning what is currently called mental illness; a perspective that treats the problem as one involving learned behavior rather than a biological induced disease.
This is not to suggest that we should cease research on the influence biology has on our behavior. Rather we should invest as much money and time investigating alternative explanations as we currently do on the medical model’s interpretation.
References
1. https:/en.wikipedia.org/wiki/Anti-psychiatry Accessed 3/12/25. 2:54 PM.
2. http://www.madinamerica.com/mission-statement/ Accessed 3/12/25. 2:04 PM.
3. Szasz, T. S. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New
York: Hoeber-Harper 1961
4. Szasz, T. S. Insanity: The Idea and Its Consequences. First Syracuse University Edition 1997.
5. https://www.nimh.nih.gov/health/statistics/mental-illness#part_2538 accessed 3/6/25. 11:02AM
6. American Psychiatric Association: Desk Reference to the Diagnostic Criteria From DSM-5-TR.
Washington, D. C. American Psychiatric Association, 2022
7. https://www.sciencedirect.com/science /article/pii/S0732118X11000146 accepted 3/11/25, 11:18 AM
8. (https://www.merriam-webster.com/grammar/metaphor-vs-simile Accessed 3//13/25. 11:35 AM
9. Houle, T. A. Why We Behave The Way We Do: The Houle Relationship Approach. 2nd Edition.
Tomar House Publishing, Vero Beach, FL 2023
10. Insel, Thomas, Healing: Our path from mental illness to mental health. Penguin Press New
York, NY. 2022)
11. Answering Awais Aftab: When it Comes to Misleading the Public, Who is the Culprit? (Robert
Whitaker, madinamerica.com/2023/04/answering-awais-aftab/)
12. Baldwin, J. D. & Baldwin, J. I. Behavior Principles In Everyday Life. Prentice Hall Upper
Saddle River, New Jersey 4th Edition, 2001.
Thanks for reading.
