Abolishing the Concept of Mental Illness by Richard Hallam

Author:Richard Hallam
Language: eng
Format: epub
ISBN: 9781351664769
Publisher: Taylor & Francis (CAM)

Reconciling natural causation and personal responsibility for a ‘mental health problem’

When a person acknowledges the existence of a problem, there is a rather subtle relationship between the self that wills to change and that part of the self that is externalised as ‘the problem’. This has been well described by Rego (2004), drawing upon the writings of the philosopher Harry Frankfurt (1988). A person who is so enmeshed with their problem that they cannot perceive what it is must first externalise it in some way in order to be able to address it. Typically, this leads to discord between their frustration or unhappiness and their uncertain ability to do anything about it. By dissociating that part of themselves which constitutes the problem from the self that chooses to overcome it, a person is able to reflect and employ their agency from a new standpoint. The essential idea drawn from Frankfurt is that there are first order, second order, and third order thoughts or desires. For example, a person might want to smoke, want not to smoke, and also think that it is idle to contemplate whether or not to give up smoking (third order), given the strength of their addiction. A person at some point decides which attitude to adopt and withdraws allegiance from the other options. This effectively ends the appeal to higher order thoughts or desires even though they may remain available for reflection. According to Frankfurt, a person’s decision to adopt an attitude to a problem contributes to the way they define their identity. As Rego summarises his position: ‘The patient can now treat him- or herself in a manner of speaking. She or he can relate to the problem at hand in a quasi-third person style by appreciating its characteristics and interacting with them in a prescribed manner’ (2004: 316).

The medical model of woes is also a form of objective distancing. A bodily symptom can be viewed from a second order perspective, assuming that the illness is not an advanced dementia that precludes reflection and memory. The chief problem with the view that mental illness defines what a person is (e.g. unstable, neurotic, depressed, deluded, etc.) is that it discourages the employment of higher order perspectives. The biomedical model assumes that what a person has to deal with has already been decided. In this way, it reduces the options open to them.

It is well documented that people go through various stages when they entertain making a change and then act upon it. Prochaska, DiClemente, and Norcross (1992) describe the stages as pre-contemplation, contemplation, action, and maintenance. This sounds like a well-thought out reflective process, but the experiences that prompt reflection have a complex relationship with a sense of agency and self. A person’s unwanted experience may already be ‘external’ if it lacks a normal sense of ownership, and consequently it may be perceived as an intrusion that is attributed to alien forces. The problem is still one’s own (‘this is happening to me’) but a sense of agency is lost, i.

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