Physical ailments are much easier to recognize than mental disorders. For example, a person with the flu has a fever, aches and pains, and other recognizable signs; there are laboratory tests that can determine whether a person with a sore throat and a fever has an infection. A doctor can successfully treat the illness based on prior experience treating others with the same symptoms.
But what of mental disorders? It would seem that the same methodology used to classify physical ailments would, in principle, be useful to identify mental illness. However as Karl Jaspers noted in the early 20th century, “In psychology as in psychopathology there are very few, perhaps no, assertions which are not somewhere and at some time under dispute.” (Jaspers, K. transl. Hoenig, J & Hamilton, M.W. General Psychopathology Volume I Baltimore: Johns Hopkins University Press 1997)
Last year, at about the time the new Diagnostic and Statistical Manual of Mental Disorders (DSM 5) was released, I wrote a post about diagnosis and the need for more information about the causes of mental disorders.
According to Foucault, the underlying assumptions in the classification of illnesses in general are: 1) the ‘essentialist’ postulate which defines an illness an entity, or essence, which generates the classifiable signs and symptoms; 2) the ‘naturalist’ postulate in which one can describe illnesses in the same terms as botanical species; there is an underlying set of permanent features that describe an illness, but variations may exist.
The crux of the matter
I’ve been puzzling over the following paragraph for hours. I think it represents the key to how Foucault frames his idea of mental illness:
“If mental illness is defined with the same conceptual methods as organic illness, if psychological symptoms are isolated and assembled like physiological symptoms, it is above all because illness, whether mental or organic, is regarded as a natural essence manifested by specific symptoms. Between these two forms of pathology, therefore, there is no real unity, but only, and by means of these two postulates, an abstract parallelism. And the problem of human unity and of psychosomatic totality remains entirely open.” (Foucault, M. translation, Sheridan, A. Madness, The Invention of an Idea New York, Harper Perennial Edition 2011 p. 11)
I interpret this to mean that his two postulates provide a link between psychological and organic pathologies, only if both types of illness are in fact discrete entities. This view of illness does not address the issue that the make up of a human being consists of interaction between mind and body.
For those who are more familiar with Foucault’s philosophy, I would appreciate knowing if there is another interpretation of the above paragraph.
Back to diagnosis
If the idea of mental illness as a discrete entity is not philosophically sound, how can the current means of diagnosing them be valid?
The next question
With what does Foucault replace the conventional idea of mental illness?