This is one of the latest books released by Oxford in the continuing series titled International Perspectives in Philosophy and Psychiatry. With the twenty-two volumes published to date Oxford has created a strong foothold for itself in a rapidly growing field of interest that has seen very little material published by other presses.  I have read many of them and reviewed some of the titles in this series.  I find them to be generally very well written and quite informative.

Any discussion in the area of mental illness is going to be contentious, and this book is no exception.  It covers a number of important issues:  the relationship between psychiatry and the standard or historical conception of mental wellness and illness; the various treatment modalities going back to ancient times; numerous attempts at defining consciousness, reason, insanity, abnormality, and so on; and the morality of a life lived within the realm of mental illness. There is a helpful brief summary of each chapter in the Introduction.  And many of the chapters conclude with a summary of philosophical questions raised, but left unresolved because of the inherent difficulty in discussing issues concerning mental illness.  There are also eight Appendices which offer explanations of some of the concepts used in the book such as metaphysics and epistemology of the mind, causality, consciousness, intentionality, alienation, free will and moral responsibility, structuralism, post-structuralism, and personal identity. It might be a good idea for readers of this text to actually read these Appendices first, before starting on chapter one.

This particular volume is a fairly dense work that requires careful reading and re-reading to make sense of the some of the passages. There are many long, complex, compound sentences that make the material difficult to grasp with just a casual reading. This is a scholarly work that will definitely require your full attention.

 While there are many thought-provoking passages, Gillett makes some very controversial assertions that need to be argued for and not simply stated as categorical truths.  For example, he states, “The biological basis of certain conditions (such as acute schizophrenia, and Manic-Depressive Psychosis, and possibly, obsessive-compulsive disorder, depression, and certain agitated mood disorders) is so evident that to deny the connection is foolish”  (77).  But many psychotherapists would disagree, and would therefore be labeled as foolish.  The evidence is not at all convincing that the basis of any of these conditions are biological. In fact it seems very foolish to claim biological causation for any strictly mental disorder.

For example, in the chapter titled  “Mental Illness and its Limits” in the book The Philosophy of Psychiatry Professor of philosophy and bioethics, Carl Elliot writes, “Not only are the pathological mechanisms behind most mental disorders unknown, but also most disorders are not characterized by any objective findings on physical examination, medical imaging devices, or laboratory tests.” (Jennifer Radden ed.  Oxford:  Oxford UP, 2004. 428). And in the preface of the book Psychiatric Diagnosis and Classification the editors write that in more than thirty years of biological research “have not been able to identify a specific marker for any of the current diagnostic categories” (Mario Maj et al editors.  WestSussex: John Wiley & Sons, 2002). Thomas Szasz and many other psychotherapists have argued, if the word ‘mental’ refers to the contents of the mind–such as beliefs, values, and assumptions–then to claim a biological cause for a mental disorder is blatantly contradictory. Furthermore, if the cause of so-called mental disorder is found to be biological then it automatically stops being a mental disorder and becomes instead a medical illness requiring medical treatment.

Biological brain disorders, such as Alzheimer’s and Turret Syndrome were at one time believed to be mental problems because these conditions muddle beliefs, values and assumptions.  But they have been discovered to be diseases of the biological brain (the container) which cause a physical deterioration of brain structure and functioning. This has eliminated them from the category of purely mental disorders (problems with the content).  This author seems to conflate these sort of physical deteriorations of brain matter with non-material thought disorders. This is not particularly surprising, given that the first edition of this book was published in 1999 when most of the material published in the field of psychotherapy still considered brain disease and disorganized thinking to be synonymous. It seems to me that this edition, although updated, is still out of date with the current developments in thinking in the field of clinical psychology and psychotherapy:  biological brain diseases are clearly not the same things as muddled thinking.

Throughout this book there is an awkward equivocation as to what the mind actually is; an ambiguity in the discussion quite familiar to those who have studied the literature.  The title of the book is “The Mind and its Discontents” but the author often discusses biological issues, problems, and/or treatments, which are clearly biological brain-oriented, as though they are the same thing as problems with mental content.  On page 138 Gillett says “A mental life is a narrative construct…”  This would lead to the conclusion that so-called mental illness should be defined as problems within, or a disruption of, that narrative. But on page 148 he goes so far as to say that a particular mental illness is “a serious life-threatening disease.” I find this an odd and ambiguous use of the word “disease.” What on earth would a life-threatening diseased of a “narrative construct” be? He often brings in neuropathology and biological disorders as though they are the same thing as problematic beliefs, values, and assumptions which constitute that “narrative construct” which is mental life.

In short, while this book offers much food for thought it seems to be outdated in its ambiguously bifurcated conception of mental health problems and distress.  I would recommend this book only to those who have a solid education in philosophy, and a reasonable competence in philosophical psychology. Gillett assumes a high level of intellectual ability in his readers, which is of course fair enough.

© 2009 Peter B. Raabe

Peter B. Raabe teaches philosophy and has a private practice in philosophical counseling in North Vancouver, Canada. He is the author of the books Philosophical Counseling: Theory and Practice (Praeger, 2001), Issues in Philosophical Counseling (Praeger, 2002), and Philosophical Counselling and the Unconscious (Trivium, 2006).

Keywords: philosophy of psychiatry