What Makes Mental Disorder Undesirable Discussion

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Explain, illustrate, and critically evaluate Graham’s response to the question (posed at the beginning of chapter 3) ‘What makes mental disorder undesirable’? Your 5-7 (double-spaced) page essay should aim to be factually correct (faithful to Graham’s text), well-written, reflective, and critical. It will be graded accordingly. It is recommended that you read and re-read the relevant section of the text carefully before you begin writing. It should be clear from your paper that you have understood the nuances of Graham’s response – not merely the gist of it. Please keep in mind that an essay that is “critical” in the relevant sense needn’t be critical of Graham’s position. To be “critical” in the relevant sense is to articulate and justify your own position on what makes mental disorder undesirable in light of Graham’s analysis of that issue.

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WHAT MAKES MENTAL DISORDER UNDESIRABLE? (Introductory section of chapter 3 of Graham, paragraph by paragraph) P1: Terminology: mental disorder, mental illness – what’s the difference? P2: Graham’s project: to describe three facts that help explain why “mental disorder is undesirable” (Does Graham claim that there are only three such facts?) P3: An important distinction: being undesirable for a person/being undesired by a person. (What’s Graham’s example of a condition that is undesirable for a person but not necessarily undesired By a person?) P4: FIRST FACT: a mental disorder is “harmful or dangerous.” What are some of the forms that the harm of a mental disorder may take, according to Graham? P5: Elaborates on the harm of being incomprehensible to oneself – of not understanding why one think, feels, and acts the way they do. P6: Further elaboration of this point; persons who are incomprehensible to themselves cannot take responsibility for themselves; illustrates point by reference to depression P7: A few remarks about the nature of depression – much more than a “mood disorder.” How so? (Hint: look at the last sentence of this paragraph) P8-P12: SECOND FACT (that helps explain the undesirability of mental disorder): mental disorders are non-voluntary; one doesn’t choose to become mentally disordered, nor can the mentally disordered person “just snap out of it” – any more than they can just snap out of scurvy or malaria. But mental disorders are not “all-over involuntary.” How does Graham illustrate this point by reference to depression and addiction? P12-P13: In these paragraphs, Graham makes reference to another fact that contributes to the undesirability of mental disorder – but this is not one of the “three facts” he focusses on. What is this fourth fact?) P14: THIRD FACT (that contributes to the undesirability of mental disorder): Mental disorder cannot be gotten rid of simply by endowing the patient with “other psychological assets.” How does Graham illustrate how such “treatment” might backfire in the cases of depression and paranoid delusional disorder? P 15: Explains this third fact by analogy to somatic injury, as with a broken leg. How does Graham do this? Is it effective? P16: Makes the point that effective treatment of mental disorder involves addressing the disorder itself. P17: Graham acknowledges that mental disorders might, in some cases, have benefits for the patient but claims (plausibly) that such small “gains” do not off-set the harms associated with (and caused by) mental disorders. (We will look at what such “gains” might involve when we read Jamison’s memoir.) P18: Sums up three facts that contribute to the undesirability of mental disorder. Can you describe these three facts in your own words and with your own examples? The Disordered Mind “George Graham is contemporary philosophy’s most gifted and humane writer. The Disordered Mind is a wise, deep, and thorough inquiry into the nature of the human mind and the various ‘creaks, cracks, and crevices’ into which it is prone sometimes to wander.” Owen Flanagan, Duke University, USA “The book is a success, it is consistently insightful and humane, and conveys a clear understanding not only of relevant philosophical topics, but also of a much more difficult issue, the relevance of those topics to understanding mental illness.” Philip Gerrans, University of Adelaide, Australia “The Disordered Mind is a must read for anyone who is a psychiatrist, psychologist, philosopher, neurologist, or mental health worker. Indeed, it is a must read for any thoughtful person who simply desires to understand more deeply and more realistically the workings of their own mind as well as the workings of the human mind in general.” Richard Garrett, Bentley University, USA Mental disorder raises profound questions about the nature of the mind. The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness is the first book to systematically examine and explain, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, and more. It is also an outstanding introduction to philosophy of mind from the perspective of mental disorder. Each chapter explores a central question or problem about mental disorder, including: • • • • • • • What is mental disorder and can it be distinguished from neurological disorder? What roles should reference to psychological, cultural, and social factors play in the medical/scientific understanding of mental disorder? What makes mental disorders undesirable? Are they diseases? Mental disorder and the mind–body problem Is mental disorder a breakdown of rationality? What is a rational mind? Addiction, responsibility, and compulsion Ethical dilemmas posed by mental disorder, including questions of dignity and self-respect. Each topic is clearly explained and placed in both a clinical and philosophical context. Mental disorders discussed include clinical depression, dissociative identity disorder, anxiety, religious delusions, and paranoia. Several non-mental neurological disorders that possess psychological symptoms are also examined, including Alzheimer’s disease, Down’s syndrome, and Tourette’s syndrome. Additional features, such as chapter summaries and annotated further reading, provide helpful tools for those coming to the subject for the first time. Throughout, George Graham draws expertly on issues that cut across philosophy, science and psychiatry. As such, The Disordered Mind is a superb introduction to the philosophy of mental disorder for students of philosophy, psychology, psychiatry, and related mental health professions. George Graham is Professor of Philosophy and Neuroscience at Georgia State University and a past president of the Society for Philosophy and Psychology. He is co-author and co-editor of the Oxford Textbook of Philosophy and Psychiatry (2006). The Disordered Mind An Introduction to Philosophy of Mind and Mental Illness George Graham First published 2010 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Simultaneously published in the USA and Canada by Routledge 270 Madison Avenue, New York, NY 10016 Routledge is an imprint of the Taylor & Francis Group, an informa business This edition published in the Taylor & Francis e-Library, 2010. To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk. © 2010 George Graham All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Graham, George, 1945The disordered mind: an introduction to philosophy of mind and mental illness / George Graham. p.; cm. Includes bibliographical references and index. 1. Mental illness. 2. Philosophy of mind. 3. Psychiatry – Philosophy. 4. Psychophysiology. I. Title. [DNLM: 1. Mental Disorders – psychology. 2. Philosophy, Medical. 3. Psychophysiology. WM 140 G739d 2009] RC437.5.G726 2009 616.89 – dc22 2009033537 ISBN 0-203-85786-0 Master e-book ISBN ISBN 10: 0-415-77471-3 (hbk) ISBN 10: 0-415-77472-1 (pbk) ISBN 10: 0-203-85786-0 (ebk) ISBN 13: 978-0-415-77471-0 (hbk) ISBN 13: 978-0-415-77472-7 (pbk) ISBN 13: 978-0-203-85786-1 (ebk) We are . . . subject to infirmities, miseries, interrupted, tossed and tumbled up and down . . . uncertain [and] brittle, and so is all that we trust unto. And he that knows not this, and is not armed to endure it, is not fit to live in this world. Robert Burton, The Anatomy of Melancholy (1621) And I have asked to be Where no storms come, Where the green swell is in the havens dumb, And out of the swing of the sea. Gerard Manley Hopkins, “Heaven-Haven,” Poems (1918) To try to be happy is to try to build a machine with no other specification than that it shall run noiselessly. J. Robert Oppenheimer, Letters and Recollections (1980) Contents Acknowledgments Preface 1 2 3 Introduction xi xiii 1 Stability and instability One brief history What is this book about? Topics and themes Chapter summary and suggested readings 1 4 7 11 16 Conceiving mental disorder 19 Mental disorder has consequences What should a theory of mental disorder do? The mind of mental disorder Exemplars of mental disorder Roles of the mental in mental disorder Chapter summary and suggested readings 19 20 29 36 40 43 The disorder of mental disorder 45 What makes mental disorder undesirable? Morally therapeutic interlude and lure of the disease model Are mental disorders diseases? A problematic disorder and the place of DSM Chapter summary and suggested readings 45 48 53 63 69 viii  CONTENTS 4 5 6 7 8 9 On being skeptical about mental disorder 71 Mental disorder and the mind/body problem Mental disorder and respect for persons Chapter summary and suggested readings 72 89 97 Seeking norms for mental disorder 99 Despair, depression and disorder Anxiety and DSM Cultural conventionalism Mind maladapted Rationality and Intentionality Logic of its own A brief on incapacities and disabilities Chapter summary and suggested readings 99 102 108 113 117 127 131 134 An original position 137 Social order, mental order and veils of ignorance The importance of conscious experience Basic psychological capacities A concept of mental disorder Chapter summary and suggested readings 139 142 145 156 156 Addiction and responsibility for self 159 Impulse, inhibition and responsibility for self Compulsion and addiction Animal models Neural models One way in which the brain may gum up the works Chapter summary and suggested readings 162 166 172 174 179 184 Reality lost and found 187 Symptom and schizophrenia Grand delusions Delusion and self-comprehension Realism among the ruins? Paranoia, benevolence and imagination Chapter summary and suggested readings 187 193 203 211 214 222 Minding the missing me 225 Me, myself and my selves 225 CONTENTS ix ‘I am dead’ but don’t mean it Self-serving in a supermarket Chapter summary and suggested readings Epilogue: the final affliction – Copenhagen interpretation Bibliography Index 239 244 253 255 267 283 Acknowledgments The conceptual puzzlements that ultimately motivated this book were planted during the Vietnam War, when I served as a psychiatric nurse’s aide in a Harvard teaching hospital in Boston. So there just is no way I can thank all those who contributed to my view of mental disorder. My debts are many. I must acknowledge, however, my special and much more immediate indebtedness to Richard Garrett and G. Lynn Stephens, for their insight and encouragement; to Wake Forest University, which gave me two research leaves during which time, and during two long summers, the greater part of this book, in its present form, was written; and to Tony Bruce and Katy Hamilton at Routledge for their commitment, advice and encouragement at every stage of this project. I would also like to offer thanks to the five readers for the press, whose helpful feedback resulted in significant revisions, to James Thomas for his conscientious editorial work, and to more than fifteen philosophy graduate students at Georgia State University, where an early version of the manuscript was critically discussed in a seminar that I taught in the fall term of 2008. I would like to remember my parents, George and Catherine Graham, for their support of my enthusiasm, as a young person, for the discipline of philosophy, and also my brother, Paul Graham, for his example of compassionate understanding of persons who suffer. Last and most important: love and deepest thanks to Patricia, my wife, and Kathleen, our daughter, for their enthusiasm and support. This book is dedicated to Patricia, without whom it would not contain a single word. Preface This book tells two tales. The first is a tale about mental illness or disorder. (I use ‘mental illness’ and ‘mental disorder’ interchangeably.) It offers a theory of mental disorder. It provides an account of mental disorder’s reality, sources, causes or propensity conditions, contents and consequences, both symptomatic and therapeutic. The second is an introduction to philosophy of mind, to the essential elements of the subject. The book tells each of these two tales simultaneously. Each is tied up in the other. The two tales are one. The second tale of elements of philosophy of mind derives its plot line from the first. It assumes that no sound and sensible philosophy of mind can be constructed without attending to the topic of mental illness and to human vulnerability to mental disorder: to such conditions as addiction, clinical or major depression, dysfunctional anxiety, and disorders of thought and comprehension. The first tale of a theory of mental disorder inherits much of its cast of main characters from the second. It assumes that no conceptually regimented and normatively informed theory of mental disorder can be devised without taking philosophy of mind seriously and knowing something about this subject area of philosophy and of such topics as consciousness, Intentionality, personal identity, the mind/body problem and rationality. The book is intended for multiple audiences. It is designed for undergraduate and graduate courses in various fields of study, philosophy foremost but not exclusively. It is intended as a text for courses on such topics as mind/brain, mental disorders and deficits, and puzzles and perplexities associated with human mental distress and instability. An instructor in philosophy of mind may use it to introduce the subject in an interdisciplinary manner. An instructor in clinical or abnormal psychology may use it to complement exposure to clinical literature and case studies. I hope it may also be read with profit by academic philosophers, mental health professionals, and the interested general reader. xiv PREFACE Partly for the benefit of students I include short chapter summaries and suggestions for further reading at the end of each chapter (but one, the epilogue). The suggestions sometimes cover topics with purposes or commitments that differ, occasionally sharply, from my own. Or sometimes they point readers in directions not explicitly traversed in the book. The suggestions are presented in an annotated and informal style. The book presents my own views. It argues for my own positions. This is not to banish other positions, but to provide purpose to the book’s philosophical theorizing, which is to seek a general philosophical and particular philosophy-of-mind-informed perspective on mental disorder. To help to make reading the book visually as mark free as possible, there are no footnotes or endnotes. When a work is cited in the text this is because it is quoted or immediately relevant to the topic at hand. The combination of in-text citations (with bibliography) and suggested readings makes for a hefty list of readings and sources. I am sure, however, that I have left important work and authors out of my stated sources and influences unintentionally. I expect to find myself at a later date wishing that they had been cited. I apologize in advance for omissions. 1 Introduction Stability and instability Alice trusted Howard, her husband. She had reason for doing so. He was devoted to her. Or so she thought. When Howard died unexpectedly, Alice, in preparing for his memorial service, opened his computer file only to discover that he had recently been leading a secret and complex second life. He had married another woman, fathered a child with her, and periodically lived with both second wife and child, as he described things, while “out of town doing regular business” in Kansas City. Alice’s grief over Howard’s death, which was profound, was mixed with anger and pain, which was deep. A positive interpretation of her husband’s character (“Howard was a good man; he loved me and our children; and, I will miss him terribly”) may have led to a better emotional adjustment to the loss than her bitter negative evaluation (“He lied to me and to the children; I did not really know him”). Alice fell into a protracted despondent mood. Two years later, still despondent, she was diagnosed with clinical depression. Ian believes that he is the victim of a government plot. He is convinced that he is the object of a conspiracy conducted by the Federal Bureau of Investigation. “The FBI believes that I am running a terrorist cell.” Ian refuses to leave his home for fear that he will be arrested. The business he owns, a men’s clothing store, is faltering in his absence. When asked to describe evidence of being persecuted, Ian says that he cannot discuss the matter lest agents overhear the conversation. “The shirts in my closets are bugged with voice detectors.” “The cuffs on my trousers contain electronic devices that signal my physical position to the FBI.” He is diagnosed with paranoid delusional disorder. What to do with the Alices and Ians of this world? How should they be understood? Treated? Sigmund Freud (1856–1939) famously fretted over them. He tried to fathom the 2 INTRODUCTION mind’s emotional and behavioral fault lines: its creaks, cracks and crevices. Freud also recognized that mentally disturbed human beings may and often do reclaim mental health and well-being. People recover from mental illnesses. For Freud, though, there is a prudent precondition for taking wise and measured aim at reclamation or construction of mental health. This is not to set the bar for emotional and psychological well-being too high. The philosopher Owen Flanagan eloquently writes of the “wish to flourish, to be blessed with happiness, to achieve eudaimonia – to be a ‘happy spirit’” (Flanagan 2007: 1). If Flanagan is right, that’s a wish we all share. Truly to be happy, to be blessed. Freud, however, promoted a more modest aspiration. When asked by a despondent patient how he hoped to assist her in regaining mental well-being, he had this to say: “No doubt fate will find it easier than I do to relieve you of your illness.” “But you will be able to convince yourself that much will be gained if we succeed in transforming your hysterical misery into common unhappiness” (Breuer and Freud 2000: 305). Common unhappiness? Was Freud being ironic? In part, yes. Mainly, however, he was trying to be pragmatic or realistic. The conditions or circumstances of human existence, Freud thought, are such that an absolutely healthy, orderly, stable, trouble-free mental life is much too optimistic for a person to expect, whether recovering from a disorder or not. Why so? Why not absolute mental health, behavioral and emotional well-being? Why not flourishing? Because, he said, “our body is doomed to decay and dissolution,” “the external world [rages] against us,” and suffering comes from our relations with other people. “The suffering which comes from this . . . source is perhaps more painful to us than any other” (Freud 1989 [1930]: 26). We are psychologically vulnerable and unstable creatures, whom the vicissitudes and tragedies of life may inevitably wear down or pull apart. As persons we must therefore try to live dignified, productive lives all the while remaining susceptible to periods, perhaps pronounced or protracted periods, of distress, discord and instability. To elicit an intuitive sense of our vulnerability to instability or distress, consider a b ...
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Running Head: THE DISORDER OF MENTAL DISORDER

The Disorder of Mental Disorder
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THE DISORDER OF MENTAL DISORDER

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Introduction
As described by George Graham in his book, “The Disordered Mind,” mental disorder,
sometimes called mental illness or psychiatric disorder, is a behavioral condition or
psychological pattern that results in significant distress or impairment of the healthy functioning
of the human mind. The mental disorder, in other words, is broadly defined by a combination of
the behavior, thinking, acting, perceiving, and feeling of a person (Graham, 2013). Moreover,
Graham argues that people are rational agents meaning that they think, act, or do things for
reasons. In other words, elements of reason and rationality help define normal mental activities
of humans, such thinking, acting, believing, desiring, and hoping, among other things. However,
in the case of mental disorder, the reason-responsiveness of psychological status or faculty of
individuals are impaired or significantly incapacitated thus reducing their ability to reason, think,
act, desire, and do other things that rational mind can do (Graham, 2013). Nonetheless, Graham
notes that mental disorder is not a permanent destruction of the brain but rather incapacitation
that does not entirely prevent one from acting rationally when interventions are made available.
Based on his argument, there is a general agreement that no behavior should be
considered as a direct symptom of mental disorder. Although the general knowledge indicates
that mental disorder has its associated symptoms such as incapacitation of the mind to reason on
a rational ground fully, Graham disagrees with such notions by stating that no behavior should
purely be considered a symptom of a mental disorder unless they are strictly neurological or
brain disorders in which he gives examples such as cortical blindness or Parkinsonism (Graham,
2013). Certain behaviors should only be considered symptoms of mental disorder when they
satisfy some minimal standards of rationality, logic or coherence. It is thus, imperative to
understand that Graham views mental disorder from a broader perspective. He advises that

THE DISORDER OF MENTAL DISORDER

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mental depressive disorder may not wholly be said to be a mental disorder but rather a small
disturbance of the mind due to the state of emotions.
Graham agrees on the fact that in mental disorder, there is the aspect of reason
deficiency. In other words, someone with a mental disorder condition may have challenges in
proper reasoning. This reasoning, in line with Graham’s definition of mental disorder, is a
condition that impairs the ability of the mind to factually reason, act, behavior, decide, and
perceive something in a more rational state (Graham, 2013). In other words, he argues that from
the context of the philosophy of the mind, notions such as consciousness, intentionality,
rationality, and psychological explanation should be integrated when describing the concept of
mental disorder from any perspective. Such thoughts should be deployed whenever and wherever
one is defining the concept of mental disorder. Nonetheless, Graham sees mental disorders as
something undesirable based on three crucial underlying facts, as will be described further in the
analysis.
What makes mental disorder undesirable?
In the course of describing the various reasons that make mental disorder to be
undesirable, Graham provides a classification of the mental disorder based on its undesirability.
In his classification, he urges readers to note that mental condition or mental disorder may be
undesirable or harmful for a person, and this should be differentiated from the fact that a mental
disorder is undesired or thought bad by a person. There is a need for a clear distinction between
mental disorder being considered as undesirable for a person and by a person. A disorder may
thus be undesired or thought bad by a person depending on the situation, although it may not be
undesired by other people who, for example, benefits from the state of a given mental disorder.

THE DISORDER OF MENTAL DISORDER

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In explaining what makes a mental disorder undesirable, Graham highlights three facts.
The three facts that he highlights are based on his philosophical understanding of the state mental
disorder as something undesirable. The first fact he highlights is that mental disorder is harmful
or dangerous (Graham, 2013). Indeed mental disorder is obnoxious because it is harmful and
dangerous. A person’s mind may be subject to improper functioning when subjected to a mental
disorder such as a major depressive epis...

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