'Mental Illness' as language

Ivan Illich, in his Deschooling Society, speaks of how in our western culture values and process has become institutionalised. We are taught to look toward institutions for the satisfaction of our needs - health, education, and so on - and this in turn contributes to the actual defining of those needs. Taking schooling as a paradigm, Illich shows how various myths that are bound up with schooling (such as learning being contingent on teaching) enables the school to monopolise the desire for knowledge in the creation of a certificated society: intelligence, ergo, becomes measured via an arbitrary scale that serves the order of hierarchy.

School, it could be said, hijacks man's need to know - in much the same way that religion hijacks his metaphysical longings and his moral code - to create not so much the educated agent but the schooled subject. School, as the institutionalisation of knowledge and of the pursuit of knowledge, should not be defined by its geographical locus but the mindset that it produces. In other words, school should not be thought of as ending at the gates. We become inured to the process, desiring schooling throughout our lives: we seek instruction, find succor in authority, we confuse symbols for substance, and we defer playtime until after our work.

One prominent example of the school subject and the institutionalisation of value is, I think, the myth of mental illness. The very notion suggests the medicalisation of personal problems and, concomitantly, the willing embracing of this process by those with problems in living. Mental illness is a myth, whose origins archaeologists of western thought have long documented, that has rose to theoretical ascension, unquestioned, unchallenged, to dominate the public mind in much the same way that the notion of devil possession once did. Here I want to set up a dialogue between Illich and Szasz: that is, I want to understand the dynamics of mythical illness in the context of institutionalisation.

Labeling personal problems as illnesses is often regarded as humane, as it suggests a recognition of severity. But, states Szasz, the term is derisive because it is a refusal to respect the existential nature of problems and it circumvents their moral import. Society seeks to institutionalise personal problems - to translate suffering into illness - so that its minions, in psychiatric hospitals and elsewhere, can construct themselves as authorities when, in fact, they have no special insight into the problems of life. If we understand problems as the creation of solutions, then we can state that the power of solutions depends on what can be withheld or withdrawn. The psychiatrist becomes the messiah in the age in which the elixir is psychotropic medication. If we, conversely, see a different solution - we stop following dominant discourse and cease translating life problems into medical ones - the psychiatrist is silent.

Depression is a metaphorical, not a literal illness. The depressed are sick in the same sense that the economy is. The institutionalisation of personal problems is convenient for all concerned: family, embarrassed by the behaviour of a member, can tell themselves that he is 'ill'; the unhappy man can look forward to the warm arms of psychiatry knowing that he will not be held responsible for his own life; and society itself has a simple explanation for why its denizens seem so browbeaten: it is not at fault, they are. This is why the medicalisation of personal problems holds such allure.

Classifying an illness (A) necessarily depends on non-illness (B) and counterfeit illness (C). Depression is a fake illness that would have been seen as such until Freud and Charcot rewrote the rules. Depression became an illness not because its medical origins were discovered - if that were really so, it would be a neurological disorder - but because the criteria of what constitutes a disease were reordered: unhappiness, suffering and so forth, rather than an actual physical ailment, now is said to indicate a veritable illness. Any behaviour that is dysfunctional has become, for institutionalised psychiatry, symptomatic of an illness - shyness, anger, misery - and, in being such, psychiatry naturally tends toward expansionism. Even the imitation of 'mental illness' becomes a sign of mental illness as psychiatry, taken to the extremes, extends only to unravel its own absurdity.

As Szasz points out, psychiatry is dehumanising if it focuses on biochemical changes. As it invariably does. There are, no doubt, changes in the brain that are of certain significance if someone learns French: but is the most relevant factor? Those who subscribe to the organic model of 'mental illness' are, perhaps without realising it, committed to a system of thought that purports that this is so. They are subscribed to a science of man based on reductionism of this kind. And reductionism lends itself to institutionalisation in the form of diagnoses, prognosis, treatment, and so forth.

An alternative way to understand human behaviour, the semiotical, could be said to undermine the process of institutionalising personal problems. Such an approach compels us to think of what we now know, in the dominant discourse, as 'mental illness' as a type of communication. Semiotics describes three types of sign: the indexical, the iconic, and the arbitrary. In our context, these signs can be used to communicate information and/or emotion and belong, depending on the relation to objects, to either a protolanguage or a metalanguage of illness. A protolanguage is the expression of oneself prior to words, or in the absence of the symbols that are words, or the absence of a logical construct of words. Weeping, self-harm, and other communicative utterances occur when words are deficient or insufficient but are taken, if we switch back to the organic model, as symptomatic of an illness. The utterances of 'mental illness' are emotive, nor informative per se, and are heard in the frame of unequal power relations: one chooses to make oneself heard through recourse to protolanguage but this, presently, is understood only within the framework of an institution.

Take depression. Depression is a special form of sign communication. It is the language of illness in a society that is receptive to its signs. Depression is idiom, not illness. It cannot be said to have a medical aetiology - anymore than French could - but it is possible to speak of how depression is learned and what it means to the individual. It cannot be treated, or cured - anymore than the English man could be if he began communicating in French. Depression should be defined as a protolanguage that depends on indexical signs and indirect communication because, those who purport to 'have' depression, are not explicit about their real problems.

The rise of the acceptability of helplessness, within a wider social and historical context, legitimises the institutionalisation of personal problems. We do not shape our destinies: we are not I's, but victims of circumstances. There are not actions, but happenings. Freud stated that such regression is biologically given, that humans are prone to infantilism, and often convince themselves that their problems are caused by external source that they may exculpate themselves of personal responsibility. We live in a society receptive to the language of illness. A semiotical language, such as 'mental illness', is only fluent if a society is, as it were, listening: the helplessness of 'mental illness' is an effective form of communication because our society responds favourably to its tenets. This means that:

Within the institutional context, only those who are willing to think of themselves as mentally ill - are willing to accept that socially constructed label - will warrant humane treatment. Problems, however severe, can not be thought of as such unless a translation into medical discourse occurs. Any problem not medicalised is not conceivable as a 'real' problem in the age of pharmocracy. And it is as absurd today to think of the idea of 'mental illness' as discrimination, and of those labelled such as living unacceptable lifestyles, as it would have been to think of 'heresy' as such in the middle Ages. As Szasz points out: it is easy to be skeptical of the beliefs held by our forebears, but difficult to extricate oneself from contemporary beliefs to see their mythical nature.