This month’s issue of Cato Unbound is about mental health and the law, and the strange place of power that our legal system gives to psychiatry. Prof. Jeffrey A. Schaler writes the lead essay, in which he draws on the pioneering work of Dr. Thomas Szasz. Schaler notes that mental illness isn’t like physical illness at all:
“Mental illness” generally refers to how certain people behave. It can also be used to explain why people behave the way they do. It is a fact that there is no literal disease identified by pathologists as mental illness, be it a thought disorder, personality disorder, affective or mood disorder, and/or anxiety-based disorder. In the world of psychiatry and clinical psychology, there are multiple disorders included under each of those rubrics. Mental “disorder” is synonymous with mental “illness.” These are terms used by members of the mental health profession to do and not do certain things to certain people.
The problems here are obvious. Properly speaking, “mental illness” can’t both consist of behavior and also propose to explain that very same behavior. A thing is never adequately explained just by reference to itself. There are diseases of the brain, of course, and Schaler doesn’t deny them. But diseases of the mind are another question altogether. Despite great advances in brain science, it remains the case that the analysis of organic defects of the brain can’t yield a fully satisfying account of irregular or disordered behavior.
Note one other thing Schaler isn’t saying: He’s not claiming that people never behave in strange, inappropriate, disturbing, or violent ways. Obviously they do. He’s claiming only that our explanations for these behaviors, whether in law, medicine, or popular understanding, are conceptually flawed and altogether inadequate.
And yet, on the basis of these same flawed understandings, we excuse some criminals from punishment, and we confine some individuals who have done nothing to harm anyone. This ought to be a cause for concern.