In his Republic, Plato called 'mental disorder' a "drunken, lustful, passionate" frenzy, in which one gives in to one's "lawless wild-beast nature;" he further suggested that people with such a condition should be punished. Scholars from a wide range of disciplines, including philosophy, psychiatry, psychology, neuroscience, sociology and law, continue to debate the theoretical and practical bearings of this phenomenon. The debate centers on the following issues: whether mental disorder is biological or social; if it is an illness like diabetes that can be treated with methods of scientific medicine; if neuroscientific research about the brain can account for mental disorders; and if persons with a mental disorder should be punished when they commit a crime. Despite the number of works attempting to answer these questions, it is rare to find a book that proposes a well-developed theory of mental disorder which can be implemented in both clinical and political practices.

In Body-subjects and Disordered Minds, Eric Matthews bridges this gap between theory and practice with a close examination of the literature in medicine, psychiatry, philosophy, cognitive science and neuroscience. His non-dogmatic approach accounts for the first-person experience of mental disorder and its place in scientific, political and cultural contexts. Aiming to offer an original response to questions such as "Should we treat mental disorder as an illness like bronchitis, as a problem in living, or something else?" and "Can psychiatry, as a branch of medicine, fix a mental disorder like cardiology fixes heart-related problems?" Matthews concludes that most practical problems in understanding and treating mental disorder in psychiatry are the result of philosophical misconceptions about the nature of the relationship between mind and body.

In the first five chapters, Matthews, traces the source of these misconceptions to Cartesian dualism which conceives the mind as an immaterial substance divorced from the material body and governed by its own special laws. Matthews argues that since Descartes, the traditional medical approach has considered medicine an application of scientific knowledge to the human body, which is seen as a kind of machinery. He compares the medical model of mental disorder which sees the phenomenon as an illness similar to bodily illness, with the approach of the anti-psychiatry movement which is skeptical of the existence of mental disorder. Matthews finds both approaches ineffective in addressing mental disorder. The most serious problem in the medical model of psychiatry, Matthews argues, is its perception of psychiatry as a branch of scientific medicine, which implies that scientific treatments must be physical. For Matthews, the suggestion by defenders of this view that thoughts must be identified with brain states and, thus, must be corrected by means of physical and chemical interventions, is problematic. Matthews then uses Thomas Szasz, Michel Foucault and R.D.Laing's arguments to point out that the anti-psychiatry approach considers mental illness to be a myth enabling social deviants to be controlled by doctors, thereby denying them human dignity. It considers scientific psychiatry an example of how power is exercised in modern culture. According to Matthews, the main problem of the anti-psychiatry approach is that in their rejection of the idea of mental disorder as an illness, its proponents deny the very real suffering of mentally disordered people. He suggests that the solution is neither to examine whether the medical model applies to mental disorder nor to deny the existence of the phenomenon, but to revise our view of what the medical model entails and make it fit mental disorder; this can be done by abandoning the dualist separation of mind and body.

Matthews proposes using Merleau Ponty's conception of human beings as body-subject to explain mental disorder since it does not consider mind as a 'thing' constituting one part of a human being; rather, it takes human beings as wholes who exist in the world and whose bodies are experienced as a means of existing in the world. In his view, to think about human beings as body-subjects is to treat them not as minds loosely attached to biological organisms, or simply as biological organisms, but to affirm that they are human beings. In this sense, mental disorder must be defined as something different from the dysfunction of something called the mind or the brain. He suggests we define mental disorder as thought, or utterance, or emotions, or intentions, or behavior which conflicts with human norms and cuts off the disordered person from ordinary social interaction. 

In the last three chapters, Matthews deals with the practical implications of his theory of mental disorder by considering ethical and political contexts. For example, he investigates whether mentally ill people are responsible for their actions, drawing on Aristotle's notions of excusability and voluntariness and Strawson's notion of objective attitude in approaching people with mental illness. He emphasizes that the complexities of the relationship between psychiatry and bodily medicine should be reflected in psychiatric ethics. In his view, the aim of the psychiatrist is not to direct the patient to any particular conception of what is good, but to enable him or her to form conceptions of the good by means of rational reflection. Mental health is having some degree of control over how one conducts one's life, not whether one conforms to standards of the society.

In this interesting and original book, Matthews displays his strength as a philosopher in his survey of the literature on the mind-body problem and his argument for the inclusion of phenomenology in considering the problems in philosophy of psychiatry. The use of phenomenological traditions when dealing with science is not new. The last decade, for example, has witnessed an attempt to enlist phenomenology as an instrument for the development of cognitive science in a bid to overcome its failure to account for subjective data. Matthews's book, however, is the first successful application of a phenomenological approach to the problems of psychiatry which provides its audience with a wealth of knowledge across several fields. A diligent yet considerate writer, Matthews does not alienate his audience with obscure jargon or lengthy explanations.

The only drawback of the book is the broad content of the individual chapters. Each chapter has a different focus and deals with a specific aspect of Matthews' overall argument; in each, Matthews both gives the historical account of the problem at hand and responds to potential criticism. These wide-ranging analyses make the book seem less focused and may overwhelm readers who are unfamiliar with the literature. However, given the far-reaching implications of the phenomenon of mental disorder in both theoretical and practical contexts, such broad analyses are warranted.

A fascinating look at the subject of mental disorder in the context of phenomenology, Body-subjects and Disordered Minds makes a unique and indispensable contribution to philosophical literature.

© 2008 Serife Tekin

Serife Tekin, PhD Candidate, Department of Philosophy, York University, Toronto

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