The field to which modern psychiatry addresses itself is vast, and I made no effort to encompass it all. My argument was limited to the proposition that mental illness is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations.

I do [*] believe that human happiness or well-being on a hitherto unimaginably large scale, and not just for a select few, is possible.  This goal could be achieved, however, only at the cost of many men, and not just a few being willing and able to tackle their personal, social, and ethical conflicts.  This means having the courage and integrity to forego waging battles on false fronts, finding solutions for substitute problems -- for instance, fighting the battle of stomach acid and chronic fatigue instead of facing up to a marital conflict.

Sustained adherence to the myth of mental illness allows people to avoid facing this problem, believing that mental health, conceived as the absence of mental illness, automatically insures the making of right and safe choices in one's conduct of life. But the facts are all the other way. It is the making of good choices in life that others regard, retrospectively, as good mental health!

Moreover, this seems hardly the proper time in human history for obscuring the issue of man's responsibility for his actions by hiding it behind the skirt of an all-explaining conception of mental illness.

Man's awareness of himself and of the world about him seems to be a steadily expanding one, bringing in its wake an ever large; burden of understanding (an expression borrowed from Susanne Langer, 1953). This burden, then, is to be expected and must not be misinterpreted. Our only rational means for lightening it is more understanding, and appropriate action based on such understanding

It is to suggest that the phenomena now called mental illnesses be looked at afresh and more simple, that they be removed from the category of illness, and that they be regarded as the expressions of man's struggle with the problem of how he should live. The last mentioned problem is obviously a vast one, its enormity reflecting not only man's inability to cope with his environment, but even more his increasing self-reflectiveness.

It is the labels we give them that concerns us and, having labelled them, what we do about them

While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist.  Like the personal and social troubles which people had in the Middle Ages, they are real enough.

Yet, what may be obvious may be also poorly understood. This I think is the case here.  For it seems to me that -- at least in our scientific theories of behavior -- we have failed to accept the simple fact that human relations are inherently fraught with difficulties and that to make them even relatively harmonious requires much patience and hard work. I submit that the idea of mental illness is now being put to work to obscure certain difficulties which at present may be inherent -- not that they need be unmodifiable -- in the social intercourse of persons.  If this is true, the concept functions as a disguise; for instead of calling attention to conflicting human needs, aspirations, and values, the notion of mental illness provides an amoral and impersonal "thing" (an "illness") as an explanation for problems in living

Let me therefore say once more that my aim in presenting this argument was expressly to criticize and counter a prevailing contemporary tendency to deny the moral aspects of psychiatry (and psychotherapy) and to substitute for them allegedly value-free medical considerations.  Psychotherapy, for example, is being widely practiced as though it entailed nothing other than restoring the patient from a state of mental sickness to one of mental health. While it is generally accepted that mental illness has something to do with man's social (or interpersonal) relations, it is paradoxically maintained that problems of values (that is, of ethics) do not [p. 117] arise in this process.[1]  Yet, in one sense, much of psychotherapy may revolve around nothing other than the elucidation and weighing of goals and values -- many of which may be mutually contradictory -- and the means whereby they might best be harmonized, realized, or relinquished.

It shall suffice for us here to emphasize only one important difference between them: namely, that whereas bodily disease refers to public, physicochemical occurrences, the notion of mental illness is used to codify relatively more private, sociopsychological happenings of which the observer (diagnostician) forms a part.

I suspect, however, that what is intended by the proponents of this view is to create the idea in the popular mind that mental illness is some sort of disease entity, like an infection or a malignancy. If this were true, one could catch or get a "mental illness," one might have or harbor it, one might transmit it to others, and finally one could get rid of it.

The foregoing position which holds that con- temporary psychotherapists deal with problems in living, rather than with mental illnesses and their cures, stands in opposition to a currently prevalent claim, according to which mental illness is just as "real" and "objective" as bodily illness. This is a confusing claim since it is never known exactly what is meant by such words as "real" and "objective."

Indeed, if we look at how psychiatry is actually practiced today (especially in the United States), we find that people do seek psychiatric help in accordance with their social status and ethical beliefs

Problems in human relations can be analyzed, interpreted, and given meaning only within given social and ethical contexts. Accordingly, it does make a difference -- arguments to the contrary notwithstanding -- what the psychiatrist's socioethical orientations happen to be; for these will influence his ideas on what is wrong with the patient, what deserves comment or interpretation, in what possible directions change might be desirable, and so forth

Psychiatry, I submit, is very much more intimately tied to problems of ethics than is medicine. I use the word "psychiatry" here to refer to that contemporary discipline which is concerned with problems in living

By making the practice of medicine neutral in regard to some specific issues of value need not, and cannot, mean that it can be kept free from all such values. The practice of medicine is intimately tied to ethics; and the first thing that we must do, it seems to me, is to try to make this clear and explicit.

The discipline of medicine, both as a pure science (for example, research) and as a technology (for example, therapy), contains many ethical considerations and judgments.  Unfortunately, these are often denied, minimized, or merely kept out of focus; for the ideal of the medical profession as well as of the people whom it serves seems to be having a system of medicine (allegedly) free of ethical value. This sentimental notion is expressed by such things as the doctor's willingness to treat and help patients irrespective of their religious or political beliefs, whether they are rich or poor, etc.  While there may be some grounds for this belief -- albeit it is a view that is not impressively true even in these regards -- the fact remains that ethical considerations encompass a vast range of human affairs.

Since medical action is designed to correct only medical deviations, it seems logically absurd to expect that it will help solve problems whose very existence had been defined and established on nonmedical grounds.

The psychiatrist (psychologist or nonmedical psychotherapist), it now develops, may be the agent of the patient, of the relatives, of the school, of the military services, of a business organization, of a court of law, and so forth. In speaking of the psychiatrist as the agent of these persons or organizations, it is not implied that his values concerning norms, or his ideas and aims concerning the proper nature of remedial action, need to coincide exactly with those of his employer.  For example, a patient in individual psychotherapy may believe that his salvation lies in a new marriage; his psychotherapist need not share this hypothesis. As the patient's agent, however, he must abstain from bringing social or legal force to bear on the patient which would prevent him from putting his beliefs into action. If his contract is with the patient, the psychiatrist (psychotherapist) may disagree with him or stop his treatment; but he cannot engage others to obstruct the patient's aspirations. Similarly, if a psychiatrist is engaged by a court to determine the sanity of a criminal, he need not fully share the legal authorities' values and intentions in regard to the criminal and the means available for dealing with him. But the psychiatrist is expressly barred from stating, for example, that it is not the criminal who is "insane" but the men who wrote the law on the basis of which the very actions that are being judged are regarded as "criminal."  Such an opinion could be voiced, of course, but not in a courtroom, and not by a psychiatrist who makes it his practice to assist the court in performing its daily work.

"Who defines the norms and hence the deviation?" Two basic answers may be offered: (a) It may be the person himself (that is, the patient) who decides that he deviates from a norm.  For example, an artist may believe that he suffers from a work inhibition; and he may implement this conclusion by seeking help for himself from a psychotherapist.   (b) It may be someone other than the patient who decides that the latter is deviant (for example, relatives, physicians, legal authorities, society generally, etc.).  In such a case a psychiatrist may be hired by others to do something to the patient in order to correct the deviation.

The definition of the disorder and the terms in which its remedy are sought are therefore at serious odds with one another.  The practical significance of this covert conflict between the alleged nature of the defect and the remedy can hardly be exaggerated.

What is the norm deviation from which is regarded as mental illness?  This question cannot be easily answered.  But whatever this norm might be, we can be certain of only one thing: namely, that it is a norm that must be stated in terms of psycho-social, ethical, and legal concepts.

The concept of illness, whether bodily or mental, implies deviation from some clearly defined norm

Mental illness -- as a deformity of the personality, so to speak -- is then regarded as the cause of the human disharmony. It is implicit in this view that social intercourse between people is regarded as something inherently harmonious, its disturbance being due solely to the presence of "mental illness" in many people. This is obviously fallacious reasoning, for it makes the abstraction "mental illness" into a cause, even though this abstraction was created in the first place to serve only as a shorthand expression for certain types of human behavior. It now becomes necessary to ask: "What hinds of behavior are regarded as indicative of mental illness, and by whom?"

The term "mental illness" is widely used to describe something which is very different than a disease of the brain.  Many people today take it· for granted that living is an arduous process.  Its hardship for modern man, moreover, derives not so much from a struggle for biological survival as from the stresses and strains inherent in the social intercourse of complex human personalities.

To sum up what has been said thus far: I have tried to show that for those who regard mental symptoms as signs of brain disease, the concept of mental illness is unnecessary and misleading.  For what they mean is that people so labeled suffer from diseases of the brain; and, if that is what they mean, it would seem better for the sake of clarity to say that and not something else.

X is a mental symptom" involves rendering a judgment. The judgment entails, moreover, a covert comparison or matching of the patient's ideas, concepts, or beliefs with those of the observer and the society in which they live.  The notion of mental symptom is therefore inextricably tied to the social (including ethical) context in which it is made in much the same way as the notion of bodily symptom is tied to an anatomical and genetic context

In medical practice, when we speak of physical disturbances, we mean either signs (for example, a fever) or symptoms (for example, pain). We speak of mental symptoms, on the other hand, when we refer to a patient's communications about himself, others, and the world about him.  He might state that he is Napoleon or that he is being persecuted by the Communists. These would be considered mental symptoms only if the observer believed that the patient was not Napoleon or that he was not being persecuted[sic] by the Communists

In other words, it is an error pertaining not to any mistakes in observation or reasoning, as such, but rather to the way in which we organize and express our knowledge. In the present case, the error lies in making a symmetrical dualism between mental and physical (or bodily) symptoms, a dualism which is merely a habit of speech and to which no known observations can be found to correspond

On the other hand, a person's belief -- whether this be a belief in Christianity, in Communism, or in the idea that his internal organs are "rotting" and that his body is, in fact, already "dead" -- cannot be explained by a defect or disease of the nervous system.  Explanations of this sort of occurrence -- assuming that one is interested in the belief itself and does not regard it simply as a "symptom" or expression of something else that is more interesting -- must be sought along different lines.

The crux of the matter is that a disease of the brain, analogous to a disease of the skin or bone, is a neurological defect, and not a problem in living.

"Mental illnesses" are thus regarded as basically no different than all other diseases (that is, of the body).  The only difference, in this view, between mental and bodily diseases is that the former, affecting the brain, manifest themselves by means of mental symptoms; whereas the latter, affecting other organ systems (for example, the skin, liver, etc.), manifest themselves by means of symptoms referable to those parts of the body.

All problems in living are attributed to physicochemical processes which in due time will be discovered by medical research.

some neurological defect, perhaps a very subtle one, will ultimately be found for all the disorders of thinking and behavior

Correctly speaking, however, these are diseases of the brain, not of the mind.

I shall argue that this notion has outlived whatever usefulness it might have had and that it now functions merely as a convenient myth.

What is meant when it is asserted that someone is mentally ill?

Is there such a thing as mental illness?" and to argue that there is not. Since the notion of mental illness is extremely widely used nowadays, inquiry into the ways in which this term is employed would seem to be especially indicated.  Mental illness, of course, is not literally a "thing" -- or physical object -- and hence it can "exist" only in the same sort of way in which other theoretical concepts exist. Yet, familiar theories are in the habit of posing, sooner or later -- at least to those who come to believe in them -- as "objective truths" (or "facts").