Disease/Illness and Mind/Brain Distinctions

In addition to constructing mental illness as the categorical opposition of “normal,” (see The Discourse of Mental Illness) psychiatry and medicine also constructs mental illness as a biochemical problem which is best treated with medication. More simply, bipolar disorder is something that happens when something goes wrong with your brain, much as cardiovascular disease is something that happens when something is wrong with your heart. With bipolar disorder, the problem is one of pathological brain structure and function. Something is wrong with the brain as an organ, and in order to fix the behavioral ramifications of this problem – that is, mania and depression – the brain needs to be fixed.

Inevitably this explanation does not leave much room for the actual experience of being bipolar; a person’s emotions, actions, motivations, and so on, all become symptoms of a disease. Further, the disease is what is treated, instead of the person his or herself.

In medical anthropology, this is called the disease/illness distinction, where the disease is the actual pathological entity, and the illness is the far-reaching social and psychological consequences of said disease. All chronic pathologies are both disease and illness; cancer, for instance, is a disease treated by doctors, and an illness which affects the many areas of an individual’s life, including their well-being, activity level, social relationships, and so on.

While it would seem that mental illnesses could somehow transcend such a distinction (you would imagine, for instance, that a psychiatrist would be interested in treating the social ramifications of bipolar disorder), psychiatry emphasizes the symptomatic and episodic nature of bipolar disorder, firmly constructing it as a disease. This can be seen in the language of the DSM-IV (again, see here), as well as in the idea that bipolar disorder is caused by problematic structure and synapses gone haywire.

The idea that bipolar behavior is caused by brain structure is an example of neuroreductionism. Neuroreductionism is a stance in which all actions are removed from any context but a neurological one; any social, cultural, or moral motivation is dismissed as being a product of the brain to begin with. In philosophy there is a problem which is called the mind-brain problem; the mind is not only all of the thoughts and feelings we have, but our own knowledge of who we are, and the brain is the physical organ which sits in our head and fires off chemicals to keep us going. The problem is about the relationship between the two: are they the same thing? Are they two different things? Is one superior to the other? Neuroreductionism answers this last question with a yes: the brain is superior to the mind. What happens in the mind first happens in the brain; the mind is something which is embedded in the brain, rather than something which transcends it.

I, personally, do not like neuroreductionsim, because I think it takes something away from us. While a doctor may be able to treat bipolar as a disease, I deal with the effects of bipolar as an illness every day. As I said before, I think it is insulting to reduce my life to a disease. Emily Martin uses a metaphor I like in Bipolar Expeditions. She says that when we see a finger pointing, we can see what it’s doing structurally; we can identify the fingers used, the angles, and so on. But there is no real meaning to the gesture without a common social understanding of what it means to point. The brain can be understood as being made up of various structures serving a variety of purposes, but it can give no meaning without the mind to interpret our experiences.

Further Reading

Fleischman, S. (2007). Language and Medicine. In D. Schiffrin, D. Tannen, & H. E. Hamilton (Eds.), The Handbook of Discourse Analysis (pp. 470-502).Blackwell Hanbooks of Linguistics. Malden: Blackwell Publishers.

Kuipers, J. C. (1989, June). "Medical Discourse" in Anthropoligical Context: Views of Language and Power. Medical Anthropology Quarterly, 3(2), 99-123. Retrieved from JSTOR database: http://www.jstor.org/stable/648888

Martin, Emily. “Mind-Body Problems.” American Ethnologist. 2000: 27(3). 569-590.

The Discourse of Abnormal Behavior