Afterword: Against “global mental health”

TLDR

The ontological status of mental disorder remains unresolved, with definitions such as the UK Mental Health Act’s “any disorder or disability of mind” offering only a tautological framing, and DSM/ICD categories being constructed from symptom clusters rather than natural entities. The authors argue that psychiatry offers no substantive definition of mental disorder, treating it as a socially constructed label that gains reality once declared, thereby functioning more as alchemy than science.

Abstract

A surely foundational question for psychiatric science is the ontological status of ‘‘mental disorder’’. One attempt at a definition would be the one used in the UK Mental Health Act – this might be expected to be rigorous since it legitimates involuntary detention: a mental disorder is ‘‘any disorder or disability of mind’’. This is no definition at all, merely a circularity or tautology. In fact psychiatry has no answer to the question ‘‘what is a mental disorder?’’, and instead exalts a way of working it has devised: if there are sufficient phenomena at sufficient threshold, a mental disorder is declared to exist! This is as much alchemy as science. Once something is declared real, it becomes real in its consequences. In practice, mental categories emerge as DSM or ICD committee decisions based on symptom clusters clustered by us, not by nature. This has not retarded their use as if they were facts of nature identifiable ‘‘out there’’ as is, say, a tree or a broken leg. The authors of DSM and ICD do state that ‘‘there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no disorder’’ but this does not deter the American Psychiatric Association (APA), who aver that mental disorders will all eventually boil down to brain disorders (Kendell & Jablensky, 2003).