It's Illness, But Is It Mental Disorder?

Is there anything about mental disorders that makes their evaluation unique, or can the same kind of analysis given in Brülde's paper be applied just as usefully to other areas of health care including physical conditions? If there is little difference in the way values are ascribed to mental and physical disorders, or if there is considerable commonality, then perhaps the paper is analyzing values in disorder generally rather than just mental disorder, or even values in health care practice generally.

Brülde quite rightly starts from the observation that it is widely acknowledged that value judgments play a significant role in determining which conditions count as medical disorders. The questions he identifies—how the evaluative content should be characterized, and what kind of internal underlying cause is involved in mental disorder—are legitimate and relevant. He chooses to focus exclusively on the first of these, the evaluative content, rather than the "right kind of internal cause," even though at times he is forced to recognize that there is a relationship between the internal cause and value judgments.

Physical Disorder and Values

Before looking specifically at physical illness (assuming that illness, both mental and physical, entails some kind of disorder) I want to look broadly at the way value judgments are applied in other related areas. Brülde's paper begins with the observation that it is widely acknowledged that values and facts are required to determine which conditions should count as mental disorders. This echoes the debate in health care practice about the roles of science and art where science relates to facts and art to values (of some kind). It is usually acknowledged that good clinical practice entails both art and science, the dispute is over how they enter the picture and their relative significance; this is true both of physical and mental care. The art of practice, it is assumed, depends in some way on values. My question is this: Are there significant differences between the way value judgments are used to distinguish mental disorders from other conditions, and how they (or a similar set of values) are used to distinguish good clinical practice from other activities? I accept that the values themselves will be different, the issue and the subject of Brülde's paper is how those values are attributed. I begin with an examination of art itself. How does the attribution of values make an artefact or a performance into a work of art?

Values in Art

The English writer and poet, Rudyard Kipling, wrote a poem called "The Conundrum of the Workshops," the first, fifth, and final stanzas of which are:

When the flush of a new-born sun fell first on Eden's green and gold,Our father Adam sat under the Tree and scratched with a stick in the mould;And the first rude sketch that the world had seen was joy to his mighty heart,Till the Devil whispered behind the leaves, "It's pretty, but is it Art?"The tale is as old as the Eden Tree—and new as the new-cut tooth—For each man knows ere his lip-thatch grows he is master of Art and Truth;And each man hears as the twilight nears, to the beat of his dying heart,The Devil drum on the darkened pane: "You did it, but was it Art?"Now, if we could win to the Eden Tree where the Four Great Rivers flow,And the Wreath of Eve is red on the turf as she left it long ago,And if we could come when the sentry slept and softly scurry through,By the favour of God we might know as much—as our father Adam knew!

(from "The Conundrum of the Workshops" by Rudyard Kipling)

As with mental health, it is widely accepted that in the art world objects and performances entail both factual (or objective) and aesthetic (or evaluative) elements. This applies right across the arts from performances of music, drama, and dance to objects such as statues...