| To understand mental disease, I develop a coherentist framework, similar to the method of wide reflective equilibrium, initiated by John Rawls, developed by Norman Daniels to address questions of justice and extended by Kai Nielson and others to other ethical questions.; I introduce three critical elements of the framework, including metaphysical, epistemological, and ethical considerations, and when these elements become mutually supportive, fitting together as a unified whole, a better understanding of mental disease arises.; I first examine problems surrounding mental disease from historical, clinical, and philosophical perspectives and then begin to develop the coherentist framework by looking at conceptions of disease and the subject of disease—the person. I look at Christopher Boorse's non-normative conception of disease and H. Tristam Englehardt's normative conception of disease. I show that disease, and especially mental disease, have both non-normative and normative aspects. In practice, this conception of disease is useful for understanding patients as persons, who affect and are affected by disease.; To show how my framework works, I present some illustrations, including homosexuality, neurasthenia, and schizophrenia. I show that homosexuality, if viewed as a mental disease, does not fit among the clinical and philosophical dimensions of the framework, and thus should not be viewed as a disease. Neurasthenia, once known as “the national disease” in America, eventually disappeared because clinicians began to diagnose their patients with more precise disease classifications. Because neurasthenia no longer exists in Western medicine, some would argue it was never a disease but a useful social, political, and moral construction. Regardless of neurasthenia's disappearance, I show that it was a disease (and still is a disease in China). I finally describe schizophrenia, which is viewed as a myth by Thomas Szasz. To debunk Szasz's theory, I use the coherence framework and conclude that schizophrenia is not a myth but a disease. Through these illustrations I show that without a better understanding of mental disease, clinicians are unable to accurately and effectively classify, diagnose, and treat mental disease, and afflicted persons are blamed, pitied, ignored, and/or mistreated by others. |
