Mental Disorders as Lacks of Mental Capacities

Richard Gipps (2008) has pointed out that the account of the concept of mental disorder I have proposed is revisionary rather than descriptive. He is right. My aim has not been to describe the way in which ‘clinical’ psychologists, psychiatrists, and other mental health professionals construe the term ‘mental disorder’; in fact, so far they have not agreed on how such a term is to be construed. What I have tried to do is to suggest a way in which they could construe the term—a way that does not prevent them from both assessing and (when appropriate) combining different theoretical approaches for explaining and treating mental disorders. In other words, I have suggested a demarcation of the phenomenon (or at least one of the phenomena) these professionals are concerned with, which demarcation respects the theoretical diversity one can find in their field.

I certainly agree with Gipps (2008) that, in ‘clinical’ contexts, some mental disorders (e.g., schizophrenia) are not considered to be disabilities. However, to argue that because of this my account is or might be incorrect is to beg the question; if my account were to be accepted, it would simply be wrong not to classify a mental disorder as a case of disability. Of course, if my account were descriptive, rather than revisionary, of the ways in which the expression ‘mental disorder’ is used in some ‘clinical’ contexts, it should respect such uses. But this is not the case. Furthermore, as far as I can see, the phenomenon mental health professionals are concerned with consists of both mental disruptions and mental deficits (as one can verify it, for example, by looking into their diagnostic manuals)—regardless of whether or not I am right in considering the former as a species of the latter.

Now, it would be nonsense to suggest a way of construing the expression in question that did not respect at least some (perhaps most) of the intuitions of those who normally use it. This is why I tried to show, on a case-by-case basis, that most of the conditions normally classified as mental disorders do consist in the lack of certain capacities. But Gipps (2008) has raised some objections to my case by case analysis, so I will try to provide satisfactory answers to them.

I have suggested that some disorders can be understood as lacks of capacities not to do certain things—for example, not to commit suicide. On Gipps’ (2008) view, however, it is problematic to construe the concept of (in)capacity in such a way that it is possible to talk of the (in)capacity not to do something. But our ordinary concept of capacity (which is the relevant one for my account) does allow us to talk that way. Someone can perfectly be (either truly or falsely) described as lacking the capacity to refrain from gambling, drinking, telling lies, and so on. When psychologists say of some people that they do not have the capacity to control their impulses, or to postpone satisfaction, nobody feels that they are abusing the everyday concept of capacity—even though to control one’s impulses, or to postpone one’s satisfaction, is (at least very commonly) a matter of not performing certain actions. Indeed, not infrequently people’s suicidal attempts are understood (at least by psychologists) as resulting from their lacking the capacity to control their impulses.

Gipps (2008) has also noted that, for instance, a suicidal attempt of a person who has a mental disorder would be better described as resulting from the presence of urges to self-kill rather than from the lack of the capacity to refrain from such urges. In this same vein, he rightly points out that a person who has hallucinations is not normally said to suffer from the absence of the capacity to correctly perceive the world, but rather from the presence of additional quasi-perceptions. Likewise, he observes that what is striking about anxiety disorders “is not primarily the absence of a capacity to cope with normal anxiety, but the positive presence of abnormally...