The Reality of Mental Illness

I'm fascinated by the fashions of mental illness. Every few decades, there is an epidemic of a new brain affliction, while an old disease quietly fades away. Mother's Little Helper (aka Valium) is replaced by the polite contentment of SSRI's. (I'm afraid we are still in the era of Prozac and Ritalin. In other words, we are both depressed and hyperactive. I shudder to think what future anthropologists will make of this.) Of course, this doesn't mean that mental illness is a social construction - sorry, Foucault, you're wrong - but it does mean that our descriptions of mental illness often are.

Which brings me to this NY Times article. The headline neatly summarizes the problems with the piece:

Is Hysteria Real? Brain Images Say Yes

First of all, it would be truly amazing if brain imaging didn't detect any physiological differences between the brains of those suffering from hysteria (now known as conversion disorder) and the brains of perfectly healthy people. The most fundamental principle of modern neuroscience is that all changes in the mind - like mental illness - reflect changes in the brain. To simply say that hysteria is real because it alters brain activity is about as meaningful as saying that God is real because the brains of religious believers exhibit increased cortical activity when praying. Everything we think is "real," at least from the perspective of the brain.

But I think these sorts of anatomical questions obscure the much more interesting reality of mental illness. The fact is, Foucault was on to something. Modern science tries to reduce mental illness into a simple set of biological causes. Schizophrenia is just a glitch in the dopaminergic system, depression is just a shortage of serotonin, ADD is just, well, we have no idea what ADD is. But these sorts of anatomical diagnoses will always be incomplete. The fact is, mental illness is an emulsion of brain and mind, neurons and culture. The expression of our mental illnesses - the specific set of symptoms that define them as illnesses - are often shaped by society. Of course, this is no way subtracts from the reality of hysteria, or turns the hundreds of hysteric women that Freud treated at the start of the 20th century into charlatans. (If Freud had an fMRI machine, he absolutely would have detected abnormal brain activity.) What it does suggest, however, is that these ill women would probably exhibit a different set of equally real symptoms today.