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The Concept of

Mental Disorder:
A Proposal
Alfredo Gaete

Abstract: During the last years, there has been an


important discussion on the concept of mental disorder.
Several accounts of such a concept have been offered by
theorists, although neither of these accounts seems to
have successfully answered both the question of what
it means for a certain mental condition to be a disorder
and the question of what it means for a certain disorder
to be mental. In this paper, I propose an account of the
concept of mental disorder that, if I am right, provides
satisfactory answers to both of these questions. Furthermore, this account (unlike other accounts presented in
the literature on the subject) meets the requirements for
achieving a crucial goal underlying the project of sorting
out the concept of mental disorder, namely the goal of
allowing the existence of a dialogue between mental
health professionals of different theoretical orientations.
To achieve this goal, the account herein proposed is not
based in any particular theoretical framework, but in
both ordinary and technical theory-neutral concepts. In
the last part of the paper, I argue that it follows from
most accounts of the concept of mental disorder that
the disciplines concerned with explaining some mental
disorders are not branches of medicine, and that the
treatment of some mental disorders is not a matter of
medical intervention.
Keywords: Mental health, mental health sciences,
ordinary concepts, scientific concepts, theory-laden
concepts, mental capacities

2009 by The Johns Hopkins University Press

uch has been said about the concept of


mental disorder during the last years. In
particular, given the extremely wide variety of conditions that mental health professionals
classify as mental disorders (e.g., mood disorders,
memory malfunctions, obsessive-compulsive
disorders, mental retardation, attention-deficit
hyperactivity disorder, alcohol dependence, male
erectile disorder, kleptomania, anorexia nervosa,
sleep disorders, exhibitionism, autism, pyromania, schizophrenia, learning disorders, phobias,
personality disorders, ludopathy, and dementia)
several attempts have been made to provide a
satisfactory answer to at least the following two
general questions:
(1) W
 hat does it mean for all of these conditions to be
disorders?
(2) W
 hat does it mean for all of these conditions to be
mental?

Question (2) has in turn been divided in two


subquestions:
(2.1) W
 hat does mental mean?
(2.2) W
 hat is mental about mental disorder?

Until now, no account of the concept of mental


disorder among those one can find in the literature
seems to provide satisfactory answers to either
of these two questions (certainly not to both of

328 PPP / Vol. 15, No. 4 / December 2008

them). Furthermore, most works have been almost


exclusively focused on question (1), as if the discussion on the issues raised by question (2) were
rather subsidiary (see Brlde and Radovic 2006a).
One aim of this paper is to offer an account of the
concept of mental disorder which, in my view,
provides satisfactory answers to both questions
(1) and (2). I argue that a crucial advantage of
such an account is that (unlike other accounts)
it meets the requirements for achieving a crucial
goal underlying the whole project of sorting out
the concept of mental disorder. Another aim of
this paper is to support the claim that mental disorders are not necessarily illnesses and draw some
conclusions concerning both the explanation and
the treatment of some mental disorders.
Because this work is mainly about the concept
of mental disorder, I start by referring to, and
applying to the case at issue, some important
distinctions that can be made in thinking about
concepts in general.

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-

cepts (i.e., to perform the job for which they have


been created) we have to endorse such theories.
For example, for a chemist to use the theory-laden
concept of phlogiston, say, for her to assert that
she has measured the amount of phlogiston involved in a certain combustion, she must endorse
the theory according to which phlogiston exists
(which is why no contemporary chemist uses the
concept of phlogiston); and for a psychologist to
use the concept of countertransference, say, for
her to assert that countertransference can be an
important therapeutic tool, she must endorse the
theory according to which countertransference
exists (which is why, for example, Skinner never
used such a concept). Naturally, one does not
need to endorse the theory of phlogiston to utter
sentences such as (i) The theory of phlogiston
was formulated during the seventeenth century
or (ii) Phlogiston does not exist. But in uttering
sentences like these, one is not using the concept
of phlogiston to perform the job for which it was
created. (Indeed, in uttering [ii] the concept is being used to reject the very need of such a job.)
Not all of the technical concepts used by scientists are, of course, theory laden. The concepts of
syntax, ceteris paribus, and mitochondria are all
scientific, technical concepts, the use of which does
not necessarily involve any commitment to any
particular theory. Furthermore, some terms could
be used to express both scientific and ordinary
concepts. For instance, the term white dwarf
would probably be expressing one concept when
appearing in a journal of astronomy and quite
another when used by a person to characterize another one as a diminutive Caucasian (the example
was taken from Bach [1987]). Likewise, the term
energy is very likely to express different concepts
in I feel full of energy and The total energy of
a system always remains constant. On the other
hand, many ordinary concepts are used in science,
and at least some of them can be expressed in both
technical and ordinary terms. Thus, a biologist
could normally use either the ordinary term dog
or the technical term Canis familiaris to express
the (ordinary) concept of dog.
Now, let us apply these distinctions to the
concept of mental disorder. It is clear that mental
disorder is a technical term, because people do not

Gaete / The Concept of Mental Disorder 329

normally use it in nontechnical, everyday social


interactions. It is a term coined by scientists to
serve a certain function in science. So the question
is whether specialists use it to express an ordinary
or a technical concept; and, if the latter is the case,
whether that concept is theory laden. But these are
quite difficult questions, for specialists happen to
disagree on what concept the technical term mental disorder should expresswhich, by the way,
is the reason the current discussion is being held.
In particular, there is no general agreement on
whether or not the term should express a theoryladen concept. On the one hand, many mental
health professionals (perhaps most of them, but of
this I am not sure) think that the concept of mental
disorder should not be theory laden. For instance,
as Wakefield (1992a) has noted, according to the
project underlying the DSM-III-R:
all theories of mental disorder presuppose a common
pretheoretical concept of mental disorder, as expressed
in DSM-III-Rs theory-neutral definition. The concept
specifies the domain of conditions that such theories
must explain if they are to be theories specifically of
mental disorder. The concept thus provides the glue
that holds together the mental health field. Because the
concept is theory neutral, it can serve as a basis for the
creation of an atheoretical manual. To accomplish this,
the set of criteria for each category of disorder listed in
the DSM-III-R must possess validity as an indicator of
disorder when judged by the shared concept of mental
disorder alone, independent of any additional theoretical assumptions. (p. 232)

On the other hand, there are those who think


that the concept in question must be theory-laden,
as (for example) Wakefields (1992a) own view
seems to be:
theory-guided psychological research into normal
mental mechanisms is critical to an understanding of
pathology. No matter how useful a descriptive atheoretical manual may be for now, the distinction between
disorder and nondisorder and the individuation of
disorders ultimately depends on empirically confirmed
theoretical inferences about the normal workings of
inner mechanisms. (p. 245)

In this paper, I side with the former view, that


is, the view that the concept of mental disorder
should not be a theory-laden concept. I do think
that it is a technical, scientific concept (i.e., a
concept used only in technical, scientific contexts);

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

330 PPP / Vol. 15, No. 4 / December 2008

particular theoretical preferencesin such a way


that it does not constitute an epistemological obstacle for the existence of a dialogue between professionals of different theoretical orientations.
One last preliminary consideration. In a recent
article, Gipps (2006) claims that, because the
expressions mental disorder, physical disorder,
and social disorder are used to refer to different
sorts of things, the term disorder has different
senses. In my view, the postulation of these alleged different senses of disorder is too rash. As
Kripke (1998) suggested, it is very much the lazy
mans approach in philosophy to posit ambiguities
when in trouble (p. 243). The fact that, say, good
person and good action are used to refer to different sorts of things, namely people and actions,
respectively, does not mean that good is being
employed in two different senses. Analogously, it
is perfectly possible, and plausible, for the mental,
the physical, and the social to be different sorts of
things without that implying that the term disorder is ambiguous. For instance, in either mental
disorder, physical disorder, or social disorder,
the term disorder can be construed as meaning
a condition in which things are not as they are
expected to be (which by the way is one of the
definitions given by the dictionary). Of course,
there are very different ways in which something
may not be as it is expected to be, but that does
not mean that there are different senses in which
one can say that something is not as it is expected
to be. (Gipps seems to be somewhat entangled
in what Matthews [1972] called the sense-way
confusion.)
I do think, however, that the three expressions
mental disorder, physical disorder, and social
disorder may be used to refer to different sorts
of conditions. But this is not because of an alleged ambiguity of disorder, but rather because
the adjectives mental, physical, and social
are normally employed to characterize different
sorts of conditions. Thus, although both physical disorder and mental disorder may be used
to refer to a certain condition in a person, social
disorder may be used to refer to a certain social
condition; and although physical disorder (or
somatic disorder) may be used to refer to a certain
condition at the level of a persons bodily states

and processes, mental disorder may be used to


refer to a certain condition at the level of a persons mental states and processes (see below for
the meaning of mental). A consequence of this is
that, even if the concept of disorder expressed by
physical disorder is the same as that expressed
by mental disorder (say, the concept of a condition in which things are not as they are expected
to be), the criterion or criteria in virtue of which
we establish whether or not there is a disorder can
be completely different in each case (as observed,
there are different ways in which something may
not be as it is expected to be). In the light of these
considerations, my discussion of the criteria of the
concept of disorder focuses on the criteria of such
a concept only when it is used as a constituent of
the concept of mental disorder. In other words, my
proposal is concerned exclusively with the criteria
in virtue of which a disorder should be diagnosed
in the sphere of the mental, regardless of whether
or not those criteria are appropriate to diagnose
physical (or somatic) disorders, social disorders,
or any other kind of disorder. With this important
point in mind, let us now tackle question (1).

The Concept of Disorder


In a recent paper on the concept of (mental)
disorder, Ross (2005) pointed out that any project
of sorting disorder from non-disorder requires for
at least two issues to be fully addressed, namely
(i) what the goal of the sorting is and (ii) what
criterion or criteria of the concept of disorder
will best meet that goal. She also noted that the
validity of the posited criterion or criteria relies
on the chosen goal. Thus, if (i) the goal (or one of
the goals) of a given account is to allow a dialogue
between mental health professionals of different
theoretical orientations then (ii) the criterion for
something to be a disorder cannot be such that
it renders the concept of disorder a theory-laden
one. In this section, I present an account of the
concept of disorder that does not rely on the use of
any theory-laden concept. But before that, I argue
that in the light of the goal of allowing a dialogue
between professionals of different theoretical preferences some accounts of disorder which have been
offerednamely, Wakefields (1992b), Megones

Gaete / The Concept of Mental Disorder 331

(2000), and Nordenfelts (1995)do not offer


valid criteria of the concept of disorder.
In Wakefields (1992b) view, a disorder is a
harmful failure of a persons internal mechanisms
to perform their natural function, where what
counts as a natural function is defined according
to (Wakefields version of) evolutionary theory.
Megones (2000) approach shares with Wakefields
the idea of the failure of a natural function, but the
latter is construed in virtue of (Megones version
of) Aristotles theory of the function of human
beings. Finally, Nordenfelt (1995) suggests that a
person has a disorder if she is not able to fulfill her
vital goals, where a persons vital goals are defined
by Nordenfelts theory of vital goals and happiness. (Actually, neither Megone nor Nordenfelt
use the term disorder, but rather illness. I take
it, however, that they use the latter term to express
the concept of disorderwhatever the criteria of
such a concept happen to be.) So all Wakefields,
Megones, and Nordenfelts accounts of the concept of disorder involve theory-laden notions,
such that for one to use the concept in question
one is required to endorse either Wakefields version of evolutionary theory, Megones version of
Aristotles theory or Nordenfelts theory of vital
goals and happiness. None of these accounts offers a valid account of the concept of disorder in
the light of the goal of making possible a dialogue
between mental health professionals of different
theoretical orientations.
So let me now propose an account of the concept of disorder that provides criteria in virtue
of which mental health professionals of different
theoretical orientations can determine, and agree
on, whether or not a person has a disorder. The
proposal is that a person has a (mental) disorder
if, and only if,
(a) such a person lacks (a certain degree of) some
(mental) capacity or capacities that she is expected
to possess given her age and her culture; and
(b) her lacking in such a capacity (or set of capacities)
is causing her some sort of harm.

To spell out the precise meaning of mental


capacity, we have to wait until we tackle question
(2). For the time being, I hope it is pretty uncontroversial that the concepts of capacity (and lack
of capacity), expectation, age, culture, cause, and

harm are all ordinary, theory-free concepts. No


special theoretical stance is required to both make
and understand statements of the form a person
of such and such age and culture is not expected
to lack such and such capacities, such and such is
causing her such and such, and such and such is
harmful to her. Being an English speaker goes far
enough. (By the concept of culture, I obviously
do not mean a theory-laden concept created by a
social scientist, but the very common notion we
employ when, in everyday conversations, we talk
of, for example, peoples cultural differences or
peoples cultural practices.) On the other hand,
to determine that a person is expected to have such
and such capacities given both her age and her
culture certain theories (e.g., certain psychological
and anthropological theories) might certainly be
appealed to. But this in no way means that one
must learn those theories to acquire the concepts
of expectation and age. (I take it that, to say of
a person that she is expected to possess a certain
degree of a certain capacity given her culture, is to
say that most people of that same culture would
expect her to possess such a capacity in such a degree. Sometimes this can be difficult to establish, of
coursewhich is one of the reasons the diagnosis
of a disorder can be difficult to make.)
With regard to criterion (b), I have introduced
it because of this. Because the list of mental capacities people are commonly expected to have is
quite a long one, very few people, if any, can be
said to possess all of those capacities. So, unless
we want to say that everyone has a disorder, a
criterion must be proposed for discriminating between normal lacks of capacity and disorders. My
proposal is that for the lack of a certain capacity
to be a disorder it must result in harmful effects to
the persona criterion that, by the way, is in line
with many mental health professionals intuitions.
Thus, many mental health professionals would not
consider that, for example, a man who lacks the
capacity to control ejaculation has a disorder if
the lack of such a capacity does not cause him any
sort of harm, for example, if the man in question
happens to practice celibacy. Naturally, how to
decide whether a particular consequence is or is
not harmful is a matter of debateand this debate
goes far beyond merely conceptual discussions, for

332 PPP / Vol. 15, No. 4 / December 2008

it has to do with adopting a certain ethical (and


sometimes also political) stance. Such a stance,
whatever it be, will ultimately determine the line
between the normal and the abnormal. Thus,
for instance, whereas in certain cultural contexts
suicide is regarded as harmful, in certain other
cultural contexts it may be regarded as (for example) a (beneficial) act of honor; and, therefore,
a person lacking certain mental capacities that
would have prevented her from committing suicide
has a disorder in some cultural contexts, but not
in some others.
Note that even though a person having a certain
ethical stance might be described as endorsing a
certain ethical theory, her concept of harm does
not rely on such a theory. This can be shown by
pointing to the fact that two people having the
same concept of harm can perfectly have different ethical stances. They may disagree on whether
something is harmful, but this is not to say that
they construe the sentence x is harmful in two different ways; rather, they do not agree on whether x
satisfies the criteria for being harmful. If they have
a genuine disagreement, that is, if they understand
what each other is saying, they do not have a conceptual problem, but a difference of opinion. (No
doubt, to spell out the ordinary concept of harm
would certainly require an important theoretical
effort; but that is not the same as to say that the
concept itself is theory laden. In any case, an account of the ordinary concept of harm is beyond
the scope of this paper.)
What counts as a lack of capacity is also relative to the cultural context. For example, whereas
in some cultures a person who has hallucinations
would be considered to lack the capacity to correctly perceive the world, in other cultures she
would, on the very contrary, be considered to
have the capacity to see things ordinary people
cannot see. Therefore, a person who has hallucinations is diagnosed as having a disorder in some
cultural contexts, but not in some others. I hope
that nowadays this degree of cultural relativism
will not bother most theorists; so herein I assume
it is not necessary for me to present any argument
in favor of the possibility of such relativism either
in science or in general.

The Concept of the Mental


Let us now move on to question (2); more
specifically, to question (2.1). Brlde and Radovic
(2006a) have recently noted how neglected this
question has been in the discussions on the concept
of mental disorder. Nevertheless, the answer they
offer to it is far from being satisfactory. According
to them, there are three characteristics philosophers have regarded as the mark of the mental,
namely subjectivity, phenomenal consciousness,
and intentionality (in the technical sense of intentionality introduced by Brentano [1995], in
which to say of a mental state that it is intentional
is to say that it is referred to a content or directed
toward an object; thus, for instance, in presentation, something is presented, in judgment something is affirmed or denied, in love loved, in hate
hated, in desire desired and so on [p. 88]). Now
subjectivity, at least as Brlde and Radovic (2006a)
understand itnamely as the alleged privacy of
mental states, in the sense that one has some kind
of privileged access to the contents of ones own
mind (p. 102)would by no means be considered
to be a characteristic of the mental (or, a fortiori,
the mark of the mental) by many philosophers
of the mind (see for example, Ayer [1968], Kim
[1998], Ryle [1984] , Wittgenstein [1974], and
Wright [1989]). On the other hand, even though
intentionality and phenomenal consciousness are
present in many mental items, it is pretty clear that
they are absent in others. For instance, the capacity to solve arithmetic problems or the capacity to
make jokes are both mental capacities despite they
are neither intentional states nor episodes taking
place in peoples stream of consciousness.
How, then, can we account for the fact that
among the mental it is possible to find such an
extreme diversity of things as desires, capacities,
dreams, actions, memories, beliefs, pains, imaginations, moods, intentions, beings, perceptions,
fears, reflections, moral virtues, and sensations?
Someone might claim that the reason of this huge
variety among the mental is simply that the term
mental is ambiguous, that is, that it is used to
express different concepts (something like this
seems to be Rortys [1979] view). At least it is clear
that in using such a word people (both people on

Gaete / The Concept of Mental Disorder 333

the street and philosophers) do not always refer


to the same. For example, consider the following
sentences:
(a) Pains are not merely dispositions to cry, wince, and
so on; they have also a mental aspect.
(b) Some mental processes are unconscious.
(c) The capacity to do math is an important mental
capacity.

Sentence (a) might be uttered by (for example)


a philosopher drawing attention to the (alleged)
failure of some versions of behaviorism and
functionalism to account for the phenomenal or
qualitative character of pain, in which case such
a philosopher would be using mental to mean
phenomenally conscious. However, someone
(perhaps the same philosopher) uttering sentence
(b) is definitively not using mental in the same
way; perhaps what she means in this case is intentional. On the other hand, someone (perhaps
again the same philosopher) uttering (c) may be
using mental simply to mean intelligent (without meaning either phenomenally conscious or
intentional).
Now, the fact that people use the word mental
to mean different things does not entail that such a
word has different meanings or expresses different
concepts. For one thing is what a certain expression means, that is, what philosophers of language
calls linguistic meaning or literal meaning, and
quite another is what a speaker means by using a
certain expression (see for example, Bach 1987;
Kripke 1998; Recanati 2004). Thus, for instance,
someone who utters the sentence My grandmother is a saint may be using the word saint to
mean a kind and selfless person, but that does not
entail that the word saint is ambiguous, that is,
that it would have had a different (literal) meaning
if the speaker had been talking of a saint instead
of her grandmother (the example was taken from
Bach [1987]). On the contrary, it is precisely because saint has exactly the same (literal) meaning
in both (for example) Aquinas was a Catholic
saint and My grandmother is a saint that one
is able to understand that in uttering the latter a
speaker may be using such a word to mean a kind
and selfless person.
Furthermore, not all concepts are such that
we can provide an analysis of them in terms of

necessary and sufficient conditions. For instance,


as Wittgenstein (1974) noted, some concepts are
not determined by a set of necessary and sufficient
conditions, but rather by certain resemblances
among the items falling under them, in such a way
that these resemblances, like those between the
members of a family, overlap and crisscross. The
concept of game is the classical example. There
is nothing common to all and only the things
that are called games, but still all of such things
resemble each other in one or another respect;
and it is in virtue of such resemblances that they
all fall under the same concept. This notion was
indeed used by Feigl (1967) to offer an account of
the concept of the mental. According to him, the
latter is to be construed as a family resemblance
concept, in such a way that there would be nothing
common to all and only mental items, but still all
of such items would resemble each other in one
or another respectand it would be in virtue of
such resemblances that they fall under the concept
of the mental.
Construing the concept in question as a family
resemblance concept allows us to explain the huge
variety of things we can find among the mental
(without resorting to the postulation of ambiguity). Thus, for instance, beliefs, perceptions, and
moral virtues resemble each other in that they
are (or, as in the case of the latter, consist of) intentional states; perceptions, sensations, feelings,
and even some moods resemble each other in that
they are (or at least they can be) phenomenally
conscious; moral virtues and higher level capacities
resemble each other in that they are both intelligent dispositions; and so on. Other uses of mental
are more indirect than these, in the sense that they
are derived from the direct uses. For instance, if
a certain being (e.g., a human being) has mental
states or processes it might be characterized as a
mental being (or as having a mind). Likewise, the
capacity to have phenomenally conscious states is
not in itself phenomenally conscious, but can be
classified as mental in a derivative way in virtue
of its involving phenomenally conscious states
(i.e., states that qualify as mental in the direct use
of mental).
So intentionality, phenomenal consciousness,
and intelligence are three different features in vir-

334 PPP / Vol. 15, No. 4 / December 2008

tue of which something can directly or indirectly


fall under the concept of the mental. Perhaps they
are the only features, perhaps they are not. Here I
assume they are, because it seems to me that there
is no mental item the mental character of which
cannot be accounted for in virtue of at least one
of these three features.

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,

(a) such a person lacks (a certain degree of) some


mental capacity or capacities that she is expected
to possess given her age and her culture (where the
expression mental capacity refers to any intelligent
capacity as well as to any capacity involving either
intentional states or phenomenally conscious states
or both); and
(b) her lacking in such a capacity (or set of capacities)
is causing her some sort of harm.

Let us test how this account works when it is


applied to some cases that are normally referred
to with the expression mental disorder. Consider,
for instance, the case of the so-called learning
disorders. They clearly consists in the lack of (a
certain degree of) the capacity or set of capacities
involved in learning certain tasks such as reading,
writing, and calculating. Because the capacities to
perform such tasks are intelligent capacities, they
qualify as mental. So a person who has a learning
disorder is a person who lacks (a certain degree
of) certain mental capacities (a). Now, a person
who cannot read, write, or calculate will be unable to get some important benefits. Therefore, it
is possible to say that a persons lacking (a certain
degree of) the capacities to read, write, or calculate
causes her certain sort of harm (b). Something in
this same line can be said of the so-called mental
disabilities.
Consider now some anxiety disorders such as
phobias or obsessive-compulsive disorders. People
diagnosed with these disorders lack the capacity to
cope with certain intentional states such as fears,
expectations, beliefs, and desires (a). As a result,
they suffer (b). Something similar can be said of
sexual dysfunctions. On the other hand, alcohol
dependence, ludopathy, and other disorders involving failures of the will can be described as a
lack of (a certain degree of) the intelligent capacity
of self-determination (a), which causes (different
sorts of) negative effects (b). Autism and other
communication disorders clearly consist in the
lack of (different degrees of) those mental capacities involved in human communication (a), plus
all of the adverse consequences communication
problems can have to a person (b). Hallucinations
can be considered to be, as observed, manifestations of a lack of the mental capacity to correctly

Gaete / The Concept of Mental Disorder 335

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 Mental Aspect of Mental


Disorder
Brlde and Radovic (2006a) have reported the
existence of four different views on what makes a
disorder mental. On what they call the internal
cause view, a disorder is said to be mental if its
symptoms have mental causes. On what they call
the symptom view, a disorder is said to be mental
if its symptoms themselves are mental. On what
they call the pluralist views, the mental character of mental disorder is accounted for by means
of some combination of the symptom view and
either the internal cause view or some additional
clause (e.g., the idea that the symptoms need to
be understood in psychological terms). Finally, on
what they call the nihilist view, the whole project
of distinguishing mental disorder from somatic
disorders should be dropped (because allegedly
there is no coherent and nonarbitrary way of
distinguishing between them).
The uncontroversial existence of mental disorders without mental symptoms (e.g., psychosomatic disorders) is enough to establish that any
version of the symptom view is irremediably false.
Furthermore, because it is perfectly possible for
a somatic disorder and even for a social disorder
to have mental symptomsnamely, it is perfectly
possible for certain mental states and processes
to be symptomatic of certain somatic and even
social conditionswe can, and must, distinguish
between a mental disorder and a disorder having
mental symptoms.
Brlde and Radovic (2006a) favor a version of
the pluralist view (which if I am right they also
classify as a soft version of the nihilist view) according to which there are no necessary and jointly
sufficient conditions for a disorder to be mental,
so that the conditions we presently classify as
mental disorders are systematically interconnected in ways that make some kind of family
resemblance analysis reasonable (p. 113). Now
appealing to the notion of family resemblance may
be, like positing ambiguity, a lazy, ad hoc way of
approaching certain problems. The reason one is
justified to appeal to such a notion in discussing
the concept of the mental (question [2.1]) is that

336 PPP / Vol. 15, No. 4 / December 2008

there seem to be no other way of spelling out such


a concept (without resorting to the postulation of
ambiguity). Thus, before trying to answer question
(2.2) by positing the thesis that mental disorders
are said to be mental in virtue of a family resemblance between them, one must make it plausible
that there are no necessary and sufficient conditions for a disorder to be mental. For example,
it has to be shown that the internal cause view is
false. However, all of the objections Brlde and
Radovic (2006a) present against such a view seem
to be perfectly answerable (see Wakefield [2006]
and Brlde and Radovic [2006b] for a discussion).
I do not have here the space to elaborate on this,
but in any case the family resemblance analysis (as
well as any other stronger version of the nihilist
view) must be rejected if a good case can be made
for the internal cause viewwhich is what I try
to do next.
When we say that S is a symptom of a disorder
D, we mean that the presence of S is a sign of the
presence of D, such that we are entitled to infer
the presence of D from the presence of S (given
certain circumstances and possibly the presence
of other symptoms). Now, it seems to me that for
an inference from S to D to be possible, S cannot
be constitutive of D. For if S were constitutive of
D, the presence of S would not be something in
virtue of which one could infer to the presence of
D; rather, it would simply consist in the presence
of D (given certain circumstances and possibly the
presence of other symptoms). If I am right about
this, then the lack of a mental capacity should
never be considered to be a symptom of the disorder of which it is a criterionbecause such a
lack is constitutive of such a disorder. Thus, in this
account of mental disorder, the symptoms of such
a given mental disorder must be found among the
harmful effects caused by the lack of the mental
capacities in question. Now because (i) one can
perfectly refer to the lack of a mental capacity as
a mental lack (which would be a derivative use
of mental) and (ii) such a mental lack is the cause
of the symptoms of the disorder of which it is a
criterion, it follows that what is mental in such a
mental disorder is the cause of the symptoms of
the disorder (QED).

Mental Disorder, Illness, and


Mental Health Sciences
Many mental health theorists and professionals use the terms mental disorder and mental
illness interchangeably. Whether or not this usage is correct depends, naturally, on how such
terms are construed. In this section, I argue that
according to not only the account of the concept
of mental I have presented, but also most of the
accounts one can find in the literature, to use the
terms in question interchangeably is misleading.
I also draw some conclusions on the explanation
and the treatment of mental disorders, as well as
on the disciplines which (according to the account
in question) should be in charge of providing that
kind of explanation and treatment.
The fact that there is no general agreement on
how to construe the concepts of illness (see, for
example, Fulford 1991; Nordenfelt 1995) makes
things a bit more complicated than they already
are. Nevertheless, two things seem to me quite
uncontroversial. One is that even if illnesses cannot be reduced to somatic disorders, a person who
has no somatic disorder has no illness either. The
other one is that to lack a certain mental capacity
is not necessarily the same as to have a somatic
disorder. (For instance, a person with no somatic
disorder may still lack the capacities to read and
write, perhaps because she did not have the proper
instruction.) So even though the concept of illness
is not very clear, it is pretty clear that if mental
disorder is understood as the lack of a certain
mental capacity (or set of capacities) a person who
has a mental disorder does not necessarily have
an illness. Moreover, it seems to me that most of
the accounts of the concept of mental disorder
one can find in the literature (e.g., Szasz 1972;
Wakefield 1992a, 1992b; Nordenfelt 1995; Lilienfeld and Marino 1995; Megone 2000; American
Psychiatric Association 2000) leave place for more
or less cases of mental disorder which are not
cases of somatic disorder (for an exception see,
for example, Kendell 2001). I am not saying, of
course, that according to these accounts no mental
disorder may happen to be an illness. Nor am I
suggesting that these accounts deny that a certain
illness can be the cause (or one of the causes) or

Gaete / The Concept of Mental Disorder 337

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

clinical intervention (medication, hospitalization,


etc.). This sort of intervention might be needed,
and if so it is a matter of debate to what extent it
is needed (and who determines whether there is
such a need). But in some cases a medical intervention may be not only unneeded, but also harmful.
To treat every case of mental disorder by medical
means is not only logically wrong but also morally, and medically, wrong. This is of particular
importance in the case of compulsory treatment,
for as Fulford [1991] has noted, in such a case:
what is at issue, generally speaking, is not whether someone who is depressed and suicidal is in a bad condition,
but whether their (admittedly) bad condition is of the
specifically medical kind required to justify specifically
medical means of intervention. (p. 88)

Hence, psychiatry (as far as it is a branch of


medicine) should not be concerned with the treatment of mental disorders in general, but only with
the treatment of medical mental disorders.
Now, if neither the explanation nor the treatment of some mental disorders is the business of
medicine, what science or sciences ought to have
this duty? Here is a suggestion based on the account of mental disorder proposed in this paper.
Given that, according to such an account, to have
a mental disorder is to lack some mental capacity
or capacities, and given that mental capacities are
(part of) the subject matter of psychology, (at least)
nonmedical mental disorders should be explained
by means of psychological explanations. Now
there is nothing novel in this, of course. Psychology, in particular that department of it normally
called clinical psychology, has been producing explanatory theories of mental disorder since its very
origins as an empirical science. But as I see it the
expression clinical psychology wrongly suggests
(among other things) that instead of, or besides,
being a branch of psychology, the discipline thus
referred to is a branch of medicine; that, therefore,
mental disorders are illnesses; and that, therefore,
a person who has a mental disorder necessarily
requires a medical (or clinical) intervention.
On the other hand, if for a person to have a
mental disorder is for her to lack certain mental
capacities, and because many mental capacities can
be taught, it is reasonable to say that many mental
disorders should be treated (if not exclusively, at

338 PPP / Vol. 15, No. 4 / December 2008

least mainly) by training the people who have the


disorders in the particular capacities they happen
to lack. In other words, the treatment would be
a matter of teaching capacitiesand the science
in charge of this is not medicine but education.
Naturally, even in certain cases of nonmedical
mental disorders the administration of a certain
drug may be a very effective treatment, for some
drugs may help people to develop certain capacities. Only that in cases of nonmedical disorders the
drug would not be curing any medical illness and,
therefore, it is not clear why the administration
of such a drug should be classified as a medical
intervention at all. Thus, in many cases it would be
better to describe the psychotherapeutic relationship not as a relationship between a patient and a
physician of the mind, but rather as a relationship
between a person learning certain capacities and
a person facilitating that learning process. It is
not the cure of anything, but the acquisition and
development of certain capacities, what many
times psychotherapy is about. (Sometimes it is also
about directly diminishing the harm produced by
the disorder.)
Thus, besides medicine and psychology, education could be placed among the mental health
sciences as well. And given the cultural relativity
of mental disorders (as acknowledged), it seems
to me that sciences such as anthropology and
sociology should also be members of the family.
Medicine is admittedly a very important mental
health science, but mental health is not the property of medicine.

that condition, but also accounts for the extreme


diversity of things that one can find among mental
disorders. Thus construed, the concept in question
is suitable to provide, to use Wakefields expression
(quoted above), the glue that holds together the
mental health field.
I have also argued that the disciplines concerned
with explaining mental disorder are not necessarily branches of medicine, and that the treatment
of mental disorders is not necessarily a matter of
medical or clinical intervention. My suggestion is
that the treatment of nonmedical mental disorders
is a matter of the training of certain capacities
and, therefore, that such a treatment should be
the business of education. Now the fact that education should be the science in charge of treating
nonmedical mental disorders does not imply, of
course, that teachers, lecturers, and other professionals we normally refer to as professionals of
education have actually developed theories on
how to treat such disorders. Indeed, such theories
have been mostly developed by those professionals
we normally refer to as clinical psychologists
which is another reason why perhaps (to avoid
confusion) we should not refer to them that way.
In so far their job is that of figuring out how to
develop peoples mental capacities, they are far
more professionals of learning than of curing.

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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