"It Was the Brain Tumor That Done It!": Szasz and Wittgenstein on the Importance of Distinguishing Disease from Behavior and Implications for the Nature of Mental Disorder

The current article looks at the distinction between bodily conditions, such as diseases, which may affect behavior, and situations that comprise self-directed behavior. This distinction was emphasized by the late Thomas Szasz, who recognized that regarding a situation as a disease or illness has important consequences that flow from the association of these concepts with the body. Wittgenstein's critique of the concept of mind helps to clarify and support Szasz's intuitions. Both Szasz and Wittgenstein suggest that we misunderstand the nature of 'mind,' and that mental states and events are not independent entities that can be discovered and described by natural science, but activities of living human beings that are manifested in, and recognized through, forms of public behavior. Mental disorders, which are also manifested in behavior, cannot, therefore, be aligned with biological conditions, unless there is evidence of an underlying disease. Attempts to expand the concepts of illness and disease by separating them from their bodily context, to accommodate mental disorders within a medical framework, only denude the terms of any distinctive meaning. Wittgenstein, like Szasz, suggests that what we characterize as mental illness, therefore, refers not to an illness or disease, but to patterns of unusual but still essentially self-directed behavior. These patterns can be understood as aspects of character, although they have a complex relationship to agency. The implications of this analysis for the justification of psychiatric coercion and the treatment of common psychological complaints are explored.