(Original post by Calumcalum)
I wrote this as part of a recent essay on psychosis, which is sort of related. Let me know what you think, or if you take issue with any:
"Is psychosis an illness/dysfunction?
The pathological status of mental conditions has been much debated, perhaps because of the dominance of a dualistic theme in Western philosophy of mind since Plato. This has often been expressed through libertarian free will theories, which have emphasised persons as essentially and uniquely self-determined, that is, that much human behaviour, though mediated through the body, is not determined by external factors but rather by an immaterial ‘self’ which can freely make a decision and impose that decision onto a body for physical mediation. In contrast, medicine has traditionally been concerned with deterministic, mechanical, ‘bodily’ dysfunction, and so not necessarily involved with manipulation of the mind (despite the effects of physical substances e.g. alcohol on the mind being well known).
The emphasis on intuitive belief in free will has thus shaped moral, political and legal philosophy for many centuries in that, while people have been judged to be less responsible for actions that they were seen to have no control over (e.g. infection), the dualist, libertarian solution to the mind-body problem allowed for the construction of a moral, political and social framework which linked accountability with self-determination.
The more recent undermining of metaphysical libertarianism by neuropsychological studies (cf. work by Libet, Desmurget, Haggard, etc) has thus brought to the fore a significant tension between medicine and politics, in that one now seems to view behaviour as essentially pre-determined, while the other assumes a self-determined responsibility for behaviour. Any discussion of psychiatry, that is, the medical specialty involved in diagnosis, management and treatment of mental (including behavioural) disorders, necessarily takes place in the context of an extremely incoherent socio-political framework, and so diagnoses of behavioural disorders have enormous political implications. It is my contention that, in order to properly assess the nature of psychosis as dysfunctional requires that this context be addressed. Further, I submit that there is a tension between the medical understanding of illness/dysfunction and the political understanding of illness/dysfunction, and so there is an inevitable ambiguity. While dysfunction may be judged by evolutionary paradigms in biology and by the social zeitgeist in politics, medicine is led to an inevitable paradox in that, though its understanding of how the body works is based on evolutionary function, it is employed by politics and so is, in reality, told what proper ‘function’ is by the reigning political zeitgeist. Since these two functions are so often different when discussing the nervous system, it is impossible to answer this question wholly adequately. However, this ambiguity does not necessarily undermine the integrity of a firm diagnosis in many cases: it does not seem that someone who is deluded to the extent that they believe they are immortal and who is hence likely to risk suicide can be regarded as functional under any common understanding of function."