The concept of mental health – and even more so its converse of mental illness – has become ubiquitous in the modern West, and it deserves serious examination by philosophers. Many, probably most, cultures would not recognize the claim that a mind that sees demons or refuses to speak or commits suicide is in a condition analogous to a body with a fever or a broken limb.
The idea of mental health and illness is the central idea in the psychological approach that we typically refer to as the medical model. The term “medical model”, in its most basic sense, means that one approaches a given field of human endeavour in the manner associated with medicine: that field may then be considered a part of medicine, or simply analogous to it. I believe the term was coined by R.D. Laing, the prominent critic of psychiatry, and so it often takes on a negative cast, for the application of specific aspects of modern medicine in areas where it is inappropriate to do so.
It does not have to, though. Unless we reject modern medicine in its entirety (which would be a stupid idea), we are going to accept some aspects of the medical model for at least the practice of medicine itself. Modern medicine has accomplished a great deal, even in its application to phenomena of the mind: antipsychotics and antidepressants are not cure-alls by any means, but for a great many people, their mental lives are much improved as a result of these medicines.
Moreover, the term “medical model” is used, and I think rightly used, to describe certain philosophical approaches from long before the rise of modern medicine. The medical model as we know it was certainly a shift from earlier Western ways of viewing harmful mental abnormalities, sometimes regarded as sin or as demonic possession. But it is important that medical models of the mind as such are not a modern Western invention.
Consider the Buddhist Four Noble Truths, often stated in the one-word summaries of dukkha, samudaya, nirodha, magga: suffering, origin, cessation, path out. These four could describe the components of medical practice: diagnosis, etiology, prognosis, treatment. In both medicine and the Buddhist dhamma, one identifies the basic problem, its cause, its future course, and what to do about it. And I’m hardly the first to observe this similarity. The observation doesn’t just show up in a lot of Western introductions to Buddhism; it was made by Buddhaghosa, the preeminent Theravāda philosopher, himself. He proclaims that “the truth of suffering is like the disease, the truth of origin is like the disease’s cause, the truth of cessation is like the relief of the disease, and the truth of path is like the medicine.” (Visuddhimagga 512.8-9)
Buddhaghosa, then, explicitly treats a core teaching of the dhamma as analogous to medicine. We have a medical model for our mentally caused suffering and how to get out of it. And Buddhaghosa is hardly alone in this. An article by Albrecht Wezler (Indologica Taurinensia 12 (1984)) goes into marvelous detail on how this fourfold model shows up not only in Buddhist texts but in medical literature (the Caraka Saṃhita) and non-Buddhist philosophical texts like the Yoga Bhāṣya and Nyāya Bhāṣya. Intriguingly, though, Wezler notes that the Four Noble Truths are the earliest attested form of this model: that is, it appears in them before the medical literature. So it could be that rather than Buddhist treatment of the mind being originally modelled on Indian medicine, it was vice versa.
Nor was the idea of a medical model unknown in the West. The Hellenistic philosophers (the Stoics, Epicureans, and Skeptics), referred to their philosophies as therapeia, the Greek word for medical care, and the root of our modern word therapy. Thus Martha Nussbaum entitled her excellent book on these thinkers The Therapy of Desire. In it, she shows how the Hellenistics believed that we are in some significant way sick, and philosophy offered a way of treating it.
The Hellenistics and Indians did not model their philosophical paths on modern experimentally based medicine, but they did see the paths as analogous to medicine nonetheless. There remains one big difference from the modern medical model of mental health, though. And that is that the Four Noble Truths are a diagnosis, etiology, prognosis and treatment of the normal human condition. That is also how the Hellenistics viewed their philosophical therapy: it could benefit everyone. The modern medical model, by contrast, has viewed “mental health” as the normal state of being. And, it seems to me, that is what it gets wrong!
Even when applied to physical health, there is something a little strange about the word “health” being used as a binary: you’re healthy or sick. As one goes through one’s forties and fifties and the daily medications one takes for minor troubles begin to add up, it’s hard to see the divide being so clear-cut. Surely health is more of a continuum. But even if one can accept that a typical twentysomething is physically “healthy”, it’s still not so clear how that term can apply to the mind.
Martin Seligman founded the flourishing field of positive psychology out of frustration with this approach. Psychology had traditionally viewed itself as “curing” the “sick”: taking you from an unusual state in which you had a “disorder” into a normal state of “health”. But when Seligman, a lifelong “grouch”, observed that his five-year-old daughter had done more work on improving her mood than he had as a trained psychologist, he realized something was wrong. One could be perfectly “mentally healthy”, on 20th-century psychology’s model, and still be miserable – or still be a jerk.
It is for this reason that a stigma has long been attached to seeing a therapist: to do so was to indicate that you were “crazy”. It seems that these days the stigma is diminishing – many current pop songs mention seeing a therapist – and I think that is a great thing. The ability to talk out one’s mental problems and find solutions is valuable for most if not all people, not just “crazy” ones. But the “crazy” view of therapy is the logical conclusion of a model that views mental health as normal, and “mental illness” as a deviation from that norm: a model that divides the world into normal people and crazy people. The classical Buddhist model is much wiser when it tells us: we are all crazy. Some of us are just crazier than others.