Mental illness is an organic illness of the mind. Something about this sentence sounds inherently contradictory and it deserves to be carefully unpacked.
First, what is organic illness?
An organic illness is a physical disease with a physical, scientific cause (what doctors call pathology) that affects a physical part of the body, or an organ. A blocked artery to one’s heart causes a well-known organic disease known as a myocardial infarction, or a heart attack. A rapidly growing collection of cells in the inner lining of one’s colon may cause an organic disease known as colon cancer. You are starting to get the point. Organic illness is physical. Essentially, we can point to the problem on our body. We can study it scientifically. We know what it is. We know where it is. We know that we have it.
So now, what is the mind?
The mind, at least the way we speak about it, is non-physical. It is the collection of one’s thoughts, values, memories, judgments, general state of consciousness and perception of the world. The mind has been the object of much dispute throughout the history of philosophy. Generations of thinkers have tried to decipher precisely where the brain ends and the mind begins. This problem, known as the mind-body problem, has two general approaches. One, known as Dualism, is to assume that the separation between mind and body is clear and rigid, two distinct entities. In fact, Renee Descartes (a 16th century philosopher) actually theorized a particular location within the brain where the mind sat as a separate entity altogether. The second approach, physicalism or functionalism, represents the alternative view, stating that every mind, or all of the mind’s experiences, can be reduced to the physical functions of the brain within our skulls.
Patients with mental illness have diseases of the mind. The perplexing nature of the mind – the same problem that plagued the history of philosophy – is a fundamental part of what complicates their illness experience. The very dilemma that has played out in philosophy over centuries plays out in the minds of these patients: “They tell me I have a disease… but I don’t feel diseased, I just feel unlike myself, or different from who I am supposed to be.” Some patients word it differently: “I am told that I just need to snap out of this, that I am being too weak. This is who I am. It is my fault.” This sentiment is heard quite frequently. Some patients cannot distinguish their disease from their self and, all too often, neither can their friends or family.
The conflict of terms:
Psychiatrists have come to know mental illness as an organic disease, one that has a basis in chemistry, cellular/neuronal biology and neuroanatomy (in a sense, no different from a heart attack or cancer). But to patients, it hardly feels organic at all. With mental illness, we are not talking about a patient’s heart that has changed, or a liver, or a kidney that just isn’t what it used to be. With mental illness, a patient’s self is compromised and that very self is at great risk of being damaged. When a disease affects one’s self (one’s mind) it becomes increasingly difficult to conceptualize it as a disease, or to differentiate it from the patient experiencing it. This may contribute significantly to a patient’s sense of guilt, worthlessness and isolation that comes with the illness experience. For family members, this phenomenon can make it unimaginably challenging to empathize with those who suffer. It may be difficult, for example, to see the suffering of a family member with bipolar mania if the patient herself cannot recognize her suffering. Or it can be challenging to sympathize with a victim of depression when the patient himself has no words with which to convey the experience. Even more so, if a patient physically or emotionally hurts those they love in the context of illness, it can be exceedingly difficult for family members to separate the man or woman from the evils of the disease.
So what can we do about it?
It is important to call attention to these challenges, to be explicit about the vast and important ways in which mental illness is different from other medical diseases. It is crucial to acknowledge that the experience of mental illness is fundamentally different from the kind of suffering endured by a patient with cancer, neurodegenerative diseases, heart attacks etc. Mental illness, for all the reasons discussed above, is isolating, confusing, and deeply perplexing to patients, families and community leaders alike.
For this reason, conversations need to take place. Those who suffer with mental disease need to speak out about their experiences as they grapple with the issues mentioned. Those who don’t fall victim to these illnesses need to remain open-minded. They must be willing enough to ask their friends what the experience is like and to genuinely care about understanding its challenges. Lastly, and somewhat ironically, it may help to speak about the ways in which mental illness is just like any other illness: a disease that plagues a vital organ and significantly changes how it functions. Learning about the organic underpinnings of psychiatric diseases may, in some small way, help to normalize them. It may help to distinguish the illness from the patient. And just maybe, patients and their families will begin to see the profound individual self behind a devastating organic disease.
Latest posts by Aryeh Goldberg MD MA (see all)
- The Who, What, Why of Borderline Personality Disorder - May 17, 2017
- An Organic Illness of the Mind - December 12, 2016