Table Of ContentMENTAL HEALTH: PHILOSOPHICAL PERSPECTIVES
PHILOSOPHY AND MEDICINE
Editors:
H. TRISTRAM ENGELHARDT, JR.
Georgetown University, Kennedy Institute, Washington, D.C., U.S.A.
STUART F. SPIeKER
University o[Connecticut Health Center, Farmington, Conn., U.S.A.
VOLUME4
MENTAL HEALTH:
PHILOSOPHICAL
PERSPECTIVES
PROCEEDINGS OF THE FOURTH TRANS-DISCIPLINARY
SYMPOSIUM ON PHILOSOPHY AND MEDICINE
HELD AT GALVESTON, TEXAS, MAY 16-18,1976
Edited by
H. TRISTRAM ENGELHARDT, JR.
Georgetown University, Kennedy Institute, Washington, D.C, U.S.A.
and
STUART F. SPIeKER
University of Connecticut Health Center, Farmington, Conn., US.A.
SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
Libraty of Congress Cataloging in Publication Data
Trans-<iiscipIinary Symposium on Philosophy and Medicine,
4th, Galveston, 1976.
Mental health, philosophical perspectives.
(Philosophy and medicine; v. 4)
Includes bibliographies.
1. Mental health - COf'!t\Tesses. 2. Psychology
Pathological - Congresses. I. Engelhardt, Hugo Tristram,
1941- II. Spicker, Stuart F., 1937- III.
Title. [DNLM: 1. Mental health - Congresses. 2. Mental
disorders - Congresses. 3. Philosophy, Medical - Congresses.
W/PHb09 v. 4/WMlOO T772m 1976]
T772m 1976]
RA 790. Al T72 1976 616.8'9'001 77 -24974
ISBN 978-94-015-6911-8 ISBN 978-94-015-6909-5 (eBook)
DOI 10.1007/978-94-015-6909-5
All Righ ts Reserved
Copyright © 1978 by Springer Science+Business Media Dordrecht
Originally published by D. Reidel Publishing Company, Dordrecht, Holland in 1978
Softcover reprint of the hardcover 1st edition 1978
and copyright holders as specified on appropriate pages.
No part of the material protected by: this copyright notice may be reproduced or
utilized in any form or by any means, electronic or mechanical,
including photocopying, recording or by any informational storage and
retrieval system, without written permission from the copyright owner.
TABLE OF CONTENTS
INTRODUCTION VII
SECTION 1/ AMERICAN LEGAL PERSPECTIVES ON
INSANITY: SOME ROOTS IN THE NINETEENTH CENTURY
CHESTER R. BURNS / American Medico-Legal Traditions and Concepts
of Mental Health: The Nineteenth Century 3
CORINNA DELKESKAMP / Philosophical Reflections in the Nineteenth
Century Medicolegal Discussion 15
SECTION II/MENTAL ILLNESS AND MENTAL COMPLAINTS:
SOME CONCEPTUAL PRESUPPOSITIONS
ALAN DONAGAN / How Much Neurosis Should We Bear? 41
STEPHEN TOULMIN / Psychic Health, Mental Clarity, Self-Knowledge
and Other Virtues 55
D. L. CRESON / Models and Mental Illness 71
HORACIO FABREGA, JR. / Disease Viewed as a Symbolic Category 79
RUTH MACKLIN / Health and Disease: The Holistic Approach 107
SECTION III/PHENOMENOLOGICAL AND SPECULATIVE
VIEWS OF MENTAL ILLNESS
J. H. VAN DEN BERG / A Metabletic-Philosophical Evaluation of Mental
Health 121
RICHARD M. ZANER / Synchronism and Therapy 137
STUART F. SPICKER / Commemorative Remarks in Honor of Erwin
W. Straus 143
Bibliography of the Works of Erwin W. Straus 157
ROBERT NEVILLE / Environments of the Mind 169
LEONARD C. FELDSTEIN I Luminosity: The Unconscious in the
Integrated Person 177
VI TABLE OF CONTENTS
CORINNA DELKESKAMP / Body, Mind, and Conditions of Novelty:
Some Remarks on Leonard C. Feldstein's Luminosity 191
SECTION IV/ACTING FREELY AND ACTING IN GOOD HEALTH
IRVING THALBERG / Motivational Disturbances and Free Will 201
CAROLINE WHITBECK / Towards an Understanding of Motivational
Disturbance and Freedom of Action: Comments on 'Motivational
Disturbances and Free Will' 221
SECTION V/THE MYTH OF MENTAL ILLNESS:
A FURTHER EXAMINATION
THOMAS S. SZASZ / The Concept of Mental Illness: Explanation or
Justification? 235
BARUCH BRODY / Szasz on Mental Illness 251
SECTION VI/ REAPPRAISING THE CONCEPTS OF MENTAL
HEALTH AND DISEASE
ROUND-TABLE DISCUSSION
H. Tristram Engelhardt, Jr./ Chairman's Remarks 261
Horacio Fabrega 262
James A. Knight 269
Karen Lebacqz 275
Thomas Szasz 280
Bernard Towers 280
Edmund L. Erde 285
H. TRISTRAM ENGELHARDT, JR. and STUART F. SPICKER / Closing
Reflections 295
NOTES ON CONTRIBUTORS 297
INDEX 299
INTRODUCTION
The concept 'health' is ambiguous [18,9, 11]. The concept 'mental health' is
even more so. 'Health' compasses senses of well-being, wholeness, and sound
ness that mean more than the simple freedom from illness - a fact appreci
ated in the World Health Organization's definition of health as more than the
absence of disease or infirmity [7]. The wide range of viewpoints of the con
tributors to this volume attests to the scope of issues placed under the rubric
'mental health.' These papers, presented at the Fourth Symposium on Philos
ophy and Medicine, were written and discussed within a broad context of
interests concerning mental health. Moreover, in their diversity these papers
point to the many descriptive, evaluative, and, in fact, performative functions
of statements concerning mental health. Before introducing the substance of
these papers in any detail, I want to indicate the profound commerce
between philosophical and psychological ideas in theories of mental health
and disease. This will be done in part by a consideration of some conceptual
developments in the history of psychiatry, as well as through an analysis of
some of the functions of the notions of mental illness and health.
'Mental health' lays a special stress on the wholeness of human intuition,
emotion, thought, and action. This positive sense of mental health as sound
ness of perception and conduct, not just freedom from mental disease (the
negative or privative sense of mental health), endows 'mental health' with its
particular rhetorical flourish and force. Being mentally ill bears on the
integrity of the person afflicted in a way in which being physically ill does
not. One can be a diabetic or have heart disease and maintain a distance from
the pathological processes of one's body in a way one cannot if one is schizo
phrenic or has an obsession. This is not to say that physical illnesses do not
intrude into one's psyche or fashion one's view of the world. The diabetic
who is hypoglycemic or acidotic may experience alterations in clarity of con
sciousness; the individual with angina finds his or her life structured by limi
tations on activity imposed by a pain that is insistent and intrusive. But the
schizophrenic experiences a disintegration of his or her very self, a coming
apart and loss of control, a feeling of the world as alien. The person with an
obsessive compulsive neurosis is impelled to perform activities or finds his or
her mind intruded upon by unwanted ideas.
H. T. Engelhardt, Jr. and S. F. Spieker (eds.), Mental Health:
Philosophical Perspectives, VI/-XXII. All Rights Reserved.
Copyright © 1977 by D. Reidel Publishing Company, Dordrecht-Holland.
VIII INTRODUCTION
As a result, mental disease or illness strikes to the core of persons in a more
direct fashion than most physical illnesses. This is especially true of
psychoses, and, in particular, thought disorders. Schizophrenia can be seen as
a failure to integrate reality, to construct a coherent framework of experi
ence. The conceptual importance of the integration of reality is salient in the
history of the development of contemporary psychiatry and psychology.
Eugen Bleuler in his classic work on schizophrenia, Dementia Praecox, while
sketching the hallmarks of the disease - ambivalence, inappropriate affect,
associative disorder, and autims - indicated, especially through the last
criterion, an inability to gear into the common reality of everyday life.
'Healthy people have a tendency, in logical operations, to draw upon all
appropriate material without consideration of its affective value. On the other
hand, the schizophrenic loosening of logical processes leads to the exclusion
of all associations conflicting with mentally charged complexes' ([2], p. 373).
Instead of attempting to integrate all the data of experience, the schizo
phrenic attends to some and ignores others in order to meet idiosyncratic
emotional needs. The result is a picture of reality not shared, or not fully
shared, in common with other persons.
In developing his view of mental health and illness, Bleuler signalled the
extent to which mental health indicates a successfully intersubjective con
struction of reality. In his Textbook on Psychiatry, Bleuler argued that it is
impossible to prove the existence of an external world: ' ... for the existence
of the external world there are no proofs. That the table which we see has
existence is only an assumption, even if of practical necessity' ([3], p. 8).
Mental health includes apparent acceptance of participation in an assumed
objective reality. Mental health becomes synonymous with the ability to gear
into a commonly constructed world of everyday life and experience. '[I] f I
once take for granted the existence of the table, and that of other people,
and the external world, then this table can be shown to these other people'
([3], p. 8).
For Bleuler, the failure to participate in this intersubjective reality shows
itself in the autistic mentation of schizophrenics, a failure to gear into every
day life and an emersion in a world not structured by those logical constraints
which make an intersubjective world possible. As Bleuler put it:
In the same way as autistic feeling is detached from reality, autistic thinking obeys its
own special laws. To be sure, autistic thinking makes use of the customary logical con
nections insofar as they are suitable, but it is in no way bound to such logical laws.
Autistic thinking is directed by affective needs; the patient thinks in symbols, in anal
ogies, in fragmentary concepts, in accidental connections. Should the same patient turn
back to reality, he may be able to think sharply and logically ([ 2], p. 67).
INTRODUCTION IX
Mental health thus includes the ability and the commitment to participate in
an intersubjective reality bound by the general constraints of rationality.
Such views of schizophrenia, and pari passu of mental health, have been
stressed by others. For example, Silvano Arieti summarized von Domarus'
principle [23], in this fashion: 'Whereas the normal person accepts identity
only upon the basis of identical subjects, the paleo logician (e.g., the schizo
phrenic) accepts identity based upon identical predicates' ([1], p. 194). Thus,
'suppose that the following information is given to a schizophrenic: "The
President of the United States is a person who was born in the United States.
John Doe is a person who was born in the United States." In certain circum
stances, the schizophrenic may conclude: "John Doe is the President of the
United States'" ([1], p. 194). Or, '''The Virgin Mary was a virgin~ I am a
virgin; therefore, I am the Virgin Mary" , ([1], p. 195). Though this account
of the thought disorder of the schizophrenic does not apply to the difficulty
of neurotics, nor apply in the same way to other psychoses, or even all schizo
phrenics, it indicates the extent to which being in mental health, unlike being
in physical health, turns immediately and explicitly on questions concerning
the nature of reality and of proper attitudes towards that reality. As a conse
quence, mental health can be seen in theoretical terms as it is in common dis
course - namely, indicating an adequate grasp upon reality.
But how 'adequate' does one's grasp upon reality need to be for mental
health? And where does one draw the lines distinguishing mental health,
'normal' idiosyncrasies, and mental disease? These questions are addressed in
a classic article by D. Hack Tuke, 'Imperative Ideas', where the author dis
cussed the obsessions and compulsions of many individuals who were well
integrated into their societies, including Dr. Samuel Johnson. Tuke concluded
that individuals afflicted by 'imperative ideas,' by obsessions and compulsions,
can hardly be termed persons 'of perfectly sound minds.' But such afflictions
do not preclude legal competence. For example: 'no "last will and testa
ment" would be set aside in this case (that of a law student obsessed concern
ing the correct placement of negatives in sentences), or on the ground that a
testator had an invincible desire to touch certain objects (e.g., Dr. Samuel
Johnson) ... ' ([22], p. 191). Further, in the case of such difficulties, which
do not incapacitate an individual's ability to deal with reality, how does one
distinguish mental disease from personal peculiarities compatible with mental
health? Consider Dr. Tuke's suggestion that an inclination to speculate
inquiry into cosmogony is a form of insanity, or at least a form of the symp
tom 'insanity of doubt' or 'maladie du doute.'
Closely allied is the insanity of the metaphysicians - Schopfungsfrage. According to the
