That psychoactive medication alters behaviour and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That changes brought about by prescription are desirable is debatable and involves tautological thinking. If a certain pattern of behaviour is described as (socially) "dysfunctional" or (psychologically) "sick" clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".
The same applies to alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behaviour patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about interaction of nature and nurture, genotype and phenotype, plasticity of brain and psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.
Nor is distinction between psychotropic substances and talk therapy that clear-cut. Words and interaction with therapist also affect brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) treat symptoms, not underlying processes that yield them.
IV. The Variance of Mental Disease
If mental illnesses are bodily and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed, case. Psychological diseases are not context dependent but pathologizing of certain behaviours is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are considered sick by some cultures and utterly normative or advantageous in others.
This was to be expected. The human mind and its dysfunctions are alike around world. But values differ from time to time and from one place to another. Hence, disagreements about propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.
As long as pseudo-medical definitions of mental health disorders continue to rely exclusively on signs and symptoms i.e., mostly on observed or reported behaviours they remain vulnerable to such discord and devoid of much-sought universality and rigor.
V. Mental Disorders and Social Order
The mentally sick receive same treatment as carriers of AIDS or SARS or Ebola virus or smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done in name of greater good, largely as a preventive policy.
Conspiracy theories notwithstanding, it is impossible to ignore enormous interests vested in psychiatry and psychopharmacology. The multibillion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies rely, for their continued and exponential growth, on propagation of concept of "mental illness" and its corollaries: treatment and research.
VI. Mental Ailment as a Useful Metaphor
Abstract concepts form core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visited unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power.
"Mental health disorders" are no different. They are shorthand for capturing unsettling quiddity of "the Other". Useful as taxonomies, they are also tools of social coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating both dangerous and idiosyncratic to collective fringes is a vital technique of social engineering.
The aim is progress through social cohesion and regulation of innovation and creative destruction. Psychiatry, therefore, is reifies society's preference of evolution to revolution, or, worse still, to mayhem. As is often case with human endeavour, it is a noble cause, unscrupulously and dogmatically pursued.
VII. The Insanity Defense
"It is an ill thing to knock against a deaf-mute, an imbecile, or a minor. He that wounds them is culpable, but if they wound him they are not culpable." (Mishna, Babylonian Talmud)
If mental illness is culture-dependent and mostly serves as an organizing social principle - what should we make of insanity defense (NGRI- Not Guilty by Reason of Insanity)?
A person is held not responsible for his criminal actions if s/he cannot tell right from wrong ("lacks substantial capacity either to appreciate criminality (wrongfulness) of his conduct" - diminished capacity), did not intend to act way he did (absent "mens rea") and/or could not control his behavior ("irresistible impulse"). These handicaps are often associated with "mental disease or defect" or "mental retardation".