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Mental Disorder:
A Proposal
Alfredo Gaete
Theory-Laden Concepts
and the Concept of Mental
Disorder
Any competent speaker of any given natural
language (e.g., English, Spanish, Chinese) possesses most of the concepts normally employed
in (nontechnical) everyday social interactions,
and also a repertory of ordinary terms for expressing them. Most of such concepts and terms
are acquired simply by being involved in such
everyday interactions. In particular, speakers are
not required to learn any special theory to acquire
them. But some scientific concepts are a different
story. For instance, there is no way of acquiring
the concept of neutrino without learning some
physics; and for a person to grasp the concept
of countertransference, she must learn a bit (or
perhaps a lot) of psychoanalysis. Concepts of this
sort are, unlike ordinary concepts, theory-laden
concepts (see Quine [1992] for the notion of the
theory-ladenalthough he talks of theory-laden
terms rather than concepts). They are born as part
of certain theories and, therefore, for us to acquire
them we have to learn such theories at least to
some extent. Moreover, for us to use these con-
but I also think that unlike the concept of countertransference, and more like the concept of syntax,
its use does not require the endorsement of any
particular theory. If the fact that many (perhaps
most) mental health professionals are happy to
construe the concept in question in this way is
not enough to justify this choice, let us consider
another good reason for it (which is very plausibly the reason many or most professionals have
this stance). Because one of the characteristics of
theory-laden concepts is that for one to use them
one has to endorse the theory from which they
stem, a theory-laden concept of mental disorder
stemming from (for example) psychoanalysis
would leave any mental health professional who
does not endorse such a theory without the possibility of using the concept of mental disorder.
Just as it is the case with, for example, the psychoanalytical concept of countertransference, the
use of the concept of mental disorder would be the
privilege of those who endorse (at least partially)
the psychoanalytical approach. Or, if you want,
every particular theory would have its own concept of mental disorder, that is, the term mental
disorder would express different concepts within
different theories. This, of course, could perfectly
be the case, although the existence of a dialogue
between professionals of different theoretical orientations would become impossible. The reason
is that a dialogue is possible only when there is a
common language, and for a common language to
exist between professionals of different theoretical orientations, such a language cannot rely on
the endorsement of any of the particular theories
they happen to endorse. Now, the existence of this
dialogue is required for specialists to assess and
(when appropriate) combine different explanatory
theories of any particular mental disorder, and
also for them to assess and (when appropriate)
combine different theory-oriented treatments of
any particular mental disorder. So if things like
these are desirable, and here I will assume they
are, a theory-laden concept of mental disorder is
not helpful.
In consequence, the concept of mental disorder
I propose in this paper is not theory laden. Thus
construed, such a concept is available to be used
by any mental health professional regardless of her
A Theory-Neutral Concept of
Mental Disorder
The concept of intelligence is definitively an
ordinary concept. On the other hand, the terms
intentionality and phenomenal consciousness
are definitively technical terms. But do they express
technical concepts? If I am not wrong, the former
does not. As I see it, everyday utterances such as
his belief is about you and you are the one she
loves might be respectively rephrased as you are
the intentional object of his belief and her love is
directed toward you. With regard to the concept
of phenomenal consciousness, I cannot see any
ordinary, nontechnical use of it. Fortunately, it is
indisputable that it is not a theory-laden concept.
We do not acquire it by merely being involved in
everyday conversation, but we are not required to
endorse any particular theory to use it. Like (for
example) the concepts of syntax, ceteris paribus,
and mitochondria, it is a technical concept the use
of which does not involve any commitment to any
particular theory. Hence, its being part of the concept of the mental does not constitute a threat to
the account of mental disorder presented here.
Now a certain capacity can be classified as
mental either (directly) in virtue of its being an
intelligent capacity or (derivatively) in virtue of
its involving either intentional or phenomenally
conscious states. For example, the capacity of
reasoning is mental in virtue of its being intelligent;
the capacity to effectively cope with a certain unconscious desire is mental in virtue of its involving
a particular intentional state; and the capacity of
having qualia is mental in virtue of its involving
certain phenomenally conscious states. So now I
can offer a more complete account of the concept
of mental disorder. A person has a mental disorder
if, and only if,
perceive the world, and delusions can be understood as manifestations of a lack of the mental
capacity to correctly interpret some episodes of
the world. Thus, disorders like schizophrenia and
paranoia also involve the lack of certain mental
capacities (a) and all of the suffering normally
stemming from such a lack (b). To consider a last
case, depressive disorders consist in the lack of
either the capacity to feel good or the capacity to
enjoy things (anhedonia), both of which involve
intentional states and phenomenally conscious
states and, therefore, are mental capacities (a).
The harmful effects of the lack of such capacities
are well known (b).
An objection might be raised. What about
those exceptional cases like illiteracy, where even
though there certainly is a lack of certain mental
capacities, and even though some harmful factors
may be said to stem from such a lack, the latter
is not considered to be a disorder but rather, to
use Wakefields (1992a) expression, a normal disability? My answer to this is simply that it should
not be considered to be a normal disability. Indeed,
nowadays in most cultural contexts an adults being unable to read and write is not normal in any
of the normal uses of normal. True, the claim that
illiteracy is a mental disorder may seem somewhat
counterintuitive. But the reason of that is simply
that the term mental disorder is frequently construed as a synonym for mental illness. Thus, the
claim that illiteracy is a mental disorder is taken to
imply the claim that illiteracy is an illnesswhich
is certainly a very counterintuitive claim. However,
according to the account of the concept of disorder
here presented, there is no reason for the term
mental disorder to be construed as a synonym
for mental illness, as I argue below. If I am right
about this, then the claim that illiteracy is a mental
disorder by no means entails the (false) claim that
illiteracy is an illness and, in consequence, nothing counterintuitive results from the claim that
illiteracy is a mental disorderjust as nothing
counterintuitive results from the analytical truth
that illiteracy is the lack of the capacities to read
and write. But before referring to this issue I will
tackle question (2.2).
the effect (or one of the effects) of a certain mental disorder. Few theorists would be committed
to these sorts of claims. What I am saying is that
whatever empirical connections scientists may
find between certain mental disorders and certain
illnesses, according to most accounts of mental
disorder there is no conceptual or semantic link
between them. The concepts of mental disorder
and illness are independent concepts.
Henceforth, I talk of a mental disorder as a
medical mental disorder if it is either (i) identical
with an illness or (ii) caused by an illness or (iii) the
cause of an illness; and, conversely, I will talk of a
mental disorder as a nonmedical mental disorder
if it is neither (i), (ii), nor (iii).
As I see it, because not only nonmedical mental
disorders, but also those medical disorders that are
not (i), are not illnesses, the use of mental illness
as a synonym for mental disorder is (at best)
highly misleading. True, in the light of a very wide,
nonmedical concept of illness (like that proposed
by Nordenfelt [1995], for example) a case might
be made for a synonymy between those two expressions. However, given that the term illness is
normally used to refer to somatic disorders, many
mental health professionals tend to assume that
mental disorders are somatic disorders. Thus, at
least to avoid this confusion the use of the expression mental illness to refer to mental disorders
might be eschewed.
Two very interesting things follow if (in line
with most accounts of mental disorder) one accepts that mental disorders are not necessarily
illnesses:
1. For any particular case of medical mental
disorder, it seems to be appropriate to provide
a medical explanation. However, if we do not
have any empirical evidence that a certain mental
disorder is actually a medical one there would be
no point in asking for a medical explanation. In
other words, no medical knowledge is relevant
to explain a nonmedical mental disorder. Consequently, the disciplines concerned with explaining
nonmedical mental disorders are not branches of
medicine.
2. Because nonmedical mental disorders are not
associated with any illness, the treatment of the
former is not necessarily a matter of medical or
Acknowledgment
I am indebted to Harry Lesser for comments
on a draft of this paper and several discussions on
it; and to Graham Stevens for very helpful discussions on meaning.
Conclusion
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