Mental Illness is an ill-defined concept because "mental" is an ill-defined adjective. In a dictionary, "mental" can refer to various domains, such as the brain, the mind, the soul, or the intellect. Therefore, "mental" has components that are not so easily defined as the components of "physical" (body). The body is a recognizable physical structure with components that can malfunction. Consequently, the body is a better-defined concept than the mind or brain. This definition is further confounded by the influence of XVII century thinkers (such as Rene Descartes) who strongly emphasized the dualism of the mind and body, which especially heavily influenced westernized societies (Field (2019)). The apparent dualism of our thinking collapses whenever analyzing the defining features, which all are essentially interlinked. Furthermore, dualism prohibits equal treatment to both body and mind, giving rise to the stigma surrounding caring for the mentally ill. This essay will discuss critiques of the aforementioned collapsed frameworks for defining human perceptual variability (e.g., the body, the brain, the mind, the intellect, the mental, and/or the soul) through the work of Roy Richard Grinker Nobody’s Normal, Stephen P. Hinshaw The Mark of Shame, and the use of Oxford Dictionary. In the latter portion, this essay will examine those ill-defined concepts from the perspective of a memoir by Susanna Kaysen Girl, Interrupted and fiction by Laura Restrepo Delirium, which together show how the frameworks above fail in working through the books. Near the end of the essay, this work will examine person-centered care as means for alleviating the burning need for definitions, discussing it through the lens of Karen L. Thornber’s work Global Healing: Literature, Advocacy Care.
Ill-defined definitions
Body Vs. Brain
Some of the ill-defined approaches to the mind and body stem from mind/body dualism. Seeking to understand better the body and the mind, Rene Descartes have provided the framework of mind/body dualism, thereby suggesting that the mind is distinct from the body(Field (2019)). This dichotomy suggests that the mind is not included in the body (but brain is). It is somehow parallel. Rene Descartes claims heavily influenced westernized society. His famous maxim "I think, therefore I am," was a continuation of his claim that mind and body are separate entities (Field (2019)). Mind/body dualism, not only confuses the definitions of mind and brain and body, but also strongly influences treatment of people, placing an "impenetrable wall between the two." Strong evidence of mind/body dualism can be seen via a comparison of how "mentally" ill patients versus "physically" ill patients are treated by the medical community and perceived by society at large (Latoo et al. (2021)). Whereas, in fact, research suggests that no such "wall" should be placed; psychiatric illnesses are in essence the comprised of the mind and brain (Glannon (2020)).Brain vs. Mind
Current working frameworks for understanding the mind and the brain are somehow intertwined, yet they still appear distinct. According to the Oxford dictionary, the mind is "the element of a person that enables them to be aware of the world and their experiences, to think, and to feel; the faculty of consciousness and thought." Interestingly the word "brain," according to the Oxford dictionary, is a synonym for "mind." However, the word "brain" has an exact definition "an organ of soft nervous tissue contained in the skull of vertebrates, functioning as the coordinating centre of sensation and intellectual and nervous activity." Among these definitions, there is a notion that "the mind" is somehow in parallel existence to "the brain," but not entirely spanning the same concepts. Concepts of "the mind" seem much more elusive [as, unlike the brain, which, however ambiguous, can still be reduced to an organ, the mind is far more intangible, though often considered synonymous with or stemming from the brain; still, the more intangible nature of the mind lends itself to spiritual conceptions which are associated with internal (and also somewhat intangible concepts) like personality and soul] (Oxford English dictionary (2000)).Mind vs. Mental
Psychiatric illnesses are referred to as "mental" but the concept mental (similarly to mind) is very blurred. Oxford dictionary defines "mental" as "relating to the mind" or "disorders of the mind." Acknowledging that mind is defined as "the element of a person that enables them to be aware of the world and their experiences, to think, and to feel; the faculty of consciousness and thought," "mental disorder" would imply that "the element of a person" is disordered and therefore ill (Oxford English dictionary (2000)). Careful reading of this statement could potentially suggest that it is "the element," not the entire person that is disordered, however, the “element” is often being collapsed with “person” as opposed to recognized as something for which the person is not necessarily in control of. Mental illness or disorder has became a default for addressing thoughts and behaviours which differ from the society norms, but "mental" is not easily defined.Mental Illness vs. Mental Disorders
Also, when addressing psychiatric ailments there appears to be gap in understanding whether "illness" or "disorder" is a proper word to use. Roy Richard Grinker chose to describe use the word "mental illness" rather than "mental disorder" (favored by psychiatrists). The author explained that disorders, similarly to non-normalcy, are by definition a deviance from "order" and "normal," which are not defined (p. 25, Grinker (2021)). Especially important is his second argument, however, where the author emphasizes the importance of the word "illness" as pertaining to the experience of sickness. Illness, in contrast to disorder, spans a much diverse meaning, than disorder. Author’s emphasizes his point by referring to a psychiatrist and medical anthropologist Arthur Kleinman, who argued that " disease and disorder are clinicians’ terms, the medical frameworks through which to comprehend a patient’s complaint; illness, however, is the personal and social meaning of that disease, the ’experience of symptoms and suffering . . . how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability’" (p. 25, Grinker (2021)). Such diverse approaches to definition appears to have encompassed the idea of sickness in a safer, less discriminating way.Disordered Mind vs. Normal Mind
Encompassing the idea of sickness also spans the idea of normal (as the sickness is considered not normal). In his book Nobody’s Normal Roy Richard Grinker analyzes how the concept of normalcy, stigma, cultural influence and mental illness all play a role in defining "normal." The author skillfully guides the reader to see how each human interaction is filled with instances in whic one could experience stigma. His most powerful idea helps the reader to see how damaging and dangerous it is to define "normalcy." The author argues that "nobody’s normal" and that normalcy is a "damaging illusion" (p. 14, Grinker (2021)). This important concept is closely related to the previous argument where The Oxford Dictionary suggests that "mental illness" is related to the "element of a person." "Normalcy," just as "mental illness" can be a damaging illusion.What is stigma, anyway?
Oxford Dictionary defines stigma as "a mark of disgrace associated with a particular circumstance, quality, or person" (Oxford English dictionary (2000)). However, Grinker takes on a more disapproving approach, claiming that stigma has become a "default concept that condenses a multitude of different kinds of fears, prejudices, and shame into a single and often amorphous word" (p. 16, Grinker (2021)). Grinker’s stance holds true in many instances, where the word "stigma" is used to describe almost anything, without clear pattern. Another author Stephen P. Hinshaw in his book The mark of shame: Stigma of mental illness and an agenda for change, describes stigma as a term "conveying a deep, shameful mark or flaw related to being a member of a group that is devalued by the societal mainstream" (p. 6, Hinshaw (2009)). All definitions of stigma seem to be pointing in the general direction, although have no strictly defined clinical cut-offs. Real-life hurtful applications of ill-defined definitions We have discussed the rigidity of definitions our society established for the ease of communicating and, paradoxically, their grey areas that make communicating difficult. Although only transcending current definitions will encompass the whole spectrum of human experience in many instances, the grey areas in understanding also provoke prejudice and discrimination. In this part, the essay will discuss the severe impact of the ill-defined concepts outlined above.Girl, Interrupted
In her book Girl, Interrupted Susanna Kaysen, beautifully shows the conundrum of definitions. The book follows a life of a girl admitted to McLean Hospital and diagnosed with borderline personality. In the latter portion of the book, the reader follows the protagonist outside the mental hospital walls. In this shallow transition coined by stigma from "insane" to "normal", the reader finds the ultimate irony of definitions. After the protagonist finds the Copy of the Diagnostic and Statistical Manual of Mental Disorders, she reads and finds herself pondering the nature of definitions: "If my diagnosis had been bipolar illness, for instance, the reaction to me and to this story would be slightly different. That’s a chemical problem, you’d say to yourself, manic-depression, Lithium, all that. I would be blameless, somehow. And what about schizophrenia - that would send a chill up your spine. After all, that’s real insanity (...). I am simplyfying, I know. But these words taint everything (...) What does bordeline personality disorder mean, anyhow?" (p. 151, Kaysen (1994)). The protagonist’s confidence that definitions are only somewhat helpful is evident. She uses strong language to emphasize that definitions are not absolute but fluid. They change very frequently. The more society learns about something, the more definition gets refined and updated, but it already hurts those defined by it. This definition already had marked them.Delirium
Another book portraying a somewhat sarcastic approach to definitions is Delirium, by Laura Restrepo. In this book, the reader follows a couple of main characters used by the author interchangeably to show different perspectives on one person - Augustina, who is affected by delirium. The Oxford Dictionary defines delirium as "a disturbed state of mind or consciousness, especially an acute, transient condition associated with fever, intoxication, and certain other physical disorders, characterized by symptoms such as confusion, disorientation, agitation, and hallucinations" (Oxford English dictionary (2000)). It is up to the reader to ultimately formulate their opinion of what type of illness is brought upon Augustina. As more information comes to light, delirium may not be delirium. In other words, it becomes evident that each person consciously or unconsciously took part in Augustina’s illness. In one of the latter parts of the book, Augustina’s husband, Aguilar, confesses: "(...) now I’m convinced that it was really a plea for help, that she needed to go over the events of her life with someone to make sense of them (...), bringing them from inside where they tormented her (p. 192, Restrepo and Wimmer (2007)). As evident in this quote, the protagonist - Augustina, left crumbles of information for her family and friends about what she needed to improve, but no one cared enough to help her. Until it was too late, no one saw the silent screams. It all speaks to the fact that people see and understand in definitions. Until she was "defined" as mentally ill, no one realized how much help she needed. In that sense, the definitions portrayed in this book prolonged Augustina’s suffering.Is there a way forward?
Based on the books, definitions are helpful, but they should serve as a guide rather than an absolute determinant. On the one hand, society strives to define each disease to improve healthcare. On the other hand, more illnesses mean more potential stigma and confusion. From that statement, a way forward is a complex scenario confounded by an ever-growing number of definitions, confusion and stigma. However, apparent in recent literature, the way out of this impasse is grounded in person-focused care and kindness.A Call for Person-centered Care
Karen L. Thornber writes in her 2020 book on Global Healing that person-focused care is an approach that aims to be "concentrating solely on managing health conditions or imposing their own assumptions and beliefs on other people, they engage attentively with their patients as individual people, acknowledging patients’ agency; listening to them carefully; understanding their back- grounds, lived experiences (including overall health), and priorities; and then working with them to best meet their needs, including being as open with them about their prognosis as the patients themselves desire and advocating on their behalf" (p. 203, Thornber (2020)). On top of that, she furthers her argument by adding that "person-focused care – care that is free of stigma and is respectful, compassionate, and empathic – will enable health professionals to more successfully promote patient healing and optimize patient wellbeing" (p. 203, Thornber (2020)).The author favors focusing on the person’s health as a whole rather than treating separate parts will have a more substantial, healthier, and more lasting impact than disease-centered. On top of that, she adds that empathy, cultural humility, and compassion are central to the person-centered approach. In that context, culture, history, and society all shape the approach to healing (p. 213, Thornber (2020)).
Concluding remarks
Healing is a complex process with no single definition. Rigid definitions of our society only exacerbate the lack of understanding and stigma. Although the defining features of certain diseases are undoubtedly helpful for understanding the conceptual framework, the human as a living being is much more than a framework, much more than a construct. Therefore to treat a human being, we must first adopt the concept of healing as the art of caring for a human, not the art of treating a disease. A path of healing is a path of compassion, mutual understanding, cultural competency, and empathy. This path is the only way toward a healthier, more understanding society. Ultimately, we are only as human as the kindness we give, for "a person can only be a person through other persons," where on an infinite continuum, we all are reflections of each other (Kpanake (2018)).References:
Field, T. A. (2019). Bridging the brain–body divide: A commentary and response to wilkinson. The Journal of Humanistic Counseling, 58 (2), 108–118.
Glannon, W. (2020). Mind-brain dualism in psychiatry: ethical implications. Frontiers in psychiatry, 11 , 85.
Grinker, R. (2021). Nobody’s normal: How culture created the stigma of mental illness. W. W. Norton. Retrieved from https://books.google.pl/books?id=uYvxDwAAQBAJ
Hinshaw, S. (2009). The mark of shame: Stigma of mental illness and an agenda for change. Oxford University Press. Retrieved from https://books.google.pl/books?id=1boVDAAAQBAJ
Kaysen, S. (1994). Girl, interrupted. Knopf Doubleday Publishing Group. Retrieved from https://books.google.pl/books?id=NmnhAAAAMAAJ
Kpanake, L. (2018). Cultural concepts of the person and mental health in africa. Transcultural psychiatry, 55 (2), 198–218.
Latoo, J., Mistry, M., Alabdulla, M., Wadoo, O., Jan, F., Munshi, T., . . . Haddad, P. (2021). Mental health stigma: the role of dualism, uncertainty, causation and treatability. General psychiatry, 34 (4).
Oxford english dictionary. (2000). Oxford.
Restrepo, L., & Wimmer, N. (2007). Delirium: A novel. Nan A. Talese/Doubleday. Retrieved from https://books.google.pl/books?id=a21lAAAAMAAJ
Thornber, K. (2020). Global healing: Literature, advocacy, care. Brill Rodopi. Retrieved from https://books.google.pl/books?id=q8epygEACAAJ