What is "mental illness" as a concept?
The concept of mental illness is an interesting one, as interesting as the fact that “violence” today now often means, in middle class and professional settings, the merely imaginary violence that settles on something symbolic presumed portentous, like someone talking a bit louder and so “raising their voice.” Usually this means that a subordinate has disagreed with someone in relative power, and they wish to bring the person in line by using such tactics. It also is a cue to themselves and their colleagues that they can use actual violence, which is usually all too real, or threats of bodily harm presented by security guards and the like, using the imaginary violence as their excuse for doing so.
“Mental illness” is not a mental illness. It is a concept that names a set of elements, like each of the 297 “disorders” in the DSM-V, the diagnostic and statistical manual that is the bible of the psychiatric profession. “Mental illness” is not a mental illness, in the same way the set of natural numbers is not itself a natural number. It is the set that they are all members of and is named as such. Why is this significant? Because the concept is only invoked when people want to separate the normal and the abnormal on the basis of norms that come from a psychology of both personality types and treatable conditions.
It is a floating concept, in the sense that on the one hand, its use is legitimated by its meaning very little of serious consequence, such that no one should fear it being said of them. And yet at the same, its utterance in certain circumstances means that a person can be excluded from normal society on its basis.
It is a concept of totality as including all normal instances of a kind of thing and excluding from itself those deemed exceptions. It is a concept of norm or law as defining totalities of this kind, that only exist because they both bound an inside and point to at least the possibility of an excluded outside. Such notions should worry people as we are not so far distant from the last century’s murderous totalitarianisms.
Our society regards psychology as a normative discourse that sets the most basic social norms that constitute social propriety but may fall short of laws of government enforceable by official punishments that expert authorities rule on. Psychological discourse has largely replaced the older discourse of morality. Though a gap is retained between the medical and the legal, which updates the older religious one of sin vs. crime. One definition of a totalitarian regime is that all private sins are public crimes; there is no tolerance for moral failure. Sins have classically entailed individual and essentially private, extra-legal, procedures for their amelioration through sacrifice or other measures reparative of the soul and its ideal but damageable moral purity. Such systems are based on a notion of totality, and ultimately excluded are those who will be said to have excluded themselves. One does this who says that he is not subject to the authority of the authorities. Then he will be accused of the arrogance of placing his own will above the sovereign one of the state, institution, or system; this is always the ultimate crime. Traditionally, the term for this is treason (in the middle ages, it was heresy, and a form of hubristic arrogance). The traitor has not so much broken a particular law of the state as he has betrayed the state by denying its legitimacy, or as a consequence of doing so. This is why you cannot be permitted to tell a psychiatrist that you are not mentally ill. For the same, you cannot be permitted to re-describe the same facts with a different descriptive term indicative of an alternative (scientific or folk) theory. If you do this, you will be corrected, and it will made clear that you are required to validate their discourse by using it yourself, if only to describe your behavior to their satisfaction.
In fact, in every systematic “discourse” (a way of talking about things of some kind in relation to the practices of some social institution and assigning certain terms to certain objects), conceptual names are used with both sense and reference. The reference is what the name indicates and represents, and the question of the correctness of the use of the term is here just a matter of whether an object referred to be the concept exists. The sense is what the descriptively naming expression means in relationship to a proximate field of other signifying terms. In this sense, a term like “mental illness” means something that exists if there are objects that appear to fit the descriptions. But it names badly and in a sense falsely if, for example, what it names are not illnesses but should be called, perhaps, conditions, or if the illnesses mentioned are really of body and not mind.
There is also a shift from act to character. In this sense, actions of a certain type are performed by individuals of a certain type (rather than, say, constituting them). Is a sinner one who is sinning or has sinned (or even who might sin), or is a sin an act, perhaps any act, performed by someone who is in some sense already a sinner?
Psychology and psychiatry shift what people do, think, feel, say, etc., to what they are. And with this the notion of responsibility changes. Now there must be criminal types, not just people who are criminals because they have a committed a crime (and as a fact that is known or established through the appropriate legal proceeding). A person who “raises his voice” could be a violent person, just because experts infer or decide that he could or is likely to do something in particular that would be rightly called violent, based on his personality, a behavioral (pre-)disposition that could be identified in advance in a crime prevention procedure. It would make people in effect responsible for what they are rather than what they do. This would shift responsibility away from the agentive, so that there is nothing that they, acting in their own will, can do about it. They would be subjects subjected to the authority of managing personnel.
In Ingmar Bergman’s film “Wild Strawberries,” Professor Borg is declared in a dreamt school examination “guilty of guilt.” This condition applies when a set containing an element is identified with that element. This produces self-referential identities that repeat one term with its encapsulating reflection. This helps in seeing the difference between being, say, hysterical (traditionally, a neurosis), in answer to the question, not, “Do you have any mental illness?” but “Which mental illness (or psychiatric category of personality types and behavioral dispositions) do you have?” Often in reality an unnoticed shift is performed from the latter to the former: “You are an hysterical neurotic, and this is a mental illness.” The difference here is between type of condition and a social status as normal or abnormal, acceptable or excluded.
We have society with administrative government and the mass media formation of ideologies, in which psychology as both science and folk discipline is almost supreme. To this corresponds our therapeutic culture. The “spiritualities” of the “New Age” are all about that. Everyone is now supposed to busy themselves in much ado about getting right with a new idea of “God” who wants us all to be "healthy,” to maximize our happiness, and to live in as much trouble-free contentment as we can. If something goes wrong or anyone has a problem, it’s someone’s, usually someone else’s, illness acting up.
One thing such a society will not be is democratic, which is to say, political.