"Mental illness is like any other medical illness": a critical examination of the statement and its impact on patient care and society.

Abstract

3taking a more physicalist approach, defined different mental conditions as a variety of imbalances be tween different kinds of “humours.” Griesinger 4,5 almost 2 centuries ago was the first to state that “mental illness is brain illness,” an expression that has provided a strong impetus to the more recent medical conception of mental illness. The substantial progress accomplished in genomics and brain imaging in the last few decades made biological psychiatry stronger than ever and contributed to the reification of mental disorders as illnesses of the brain. The almost exclusively biogenetic conceptual framework for understanding mental illness has acquired a hegemony that has influenced mental health practi tioners while also influencing campaigns designed to improve public attitudes toward the mentally ill. As a result, the statement “mental illness is like any other illness” has become almost axiomatic and, therefore, by definition it embodies an ac cepted truth not in need of a proof. This view of mental illness is presented for better acceptance of the mentally ill by the public and of treatment by those experiencing mental illness and is indeed based on accumulated, albeit limited, knowledge in the neurobiology of mental disorders. However, anything that reaches axiomatic proportions needs a serious examination. In this editorial we examine the reasons underlying this perspective, its consequences and the evidence to support or refute its continued justification. We then present a position that we believe best fits the current state of knowledge and is closest to clinical realities and public perceptions of mental illnesses. What does the statement actually imply? The statement that “mental illness is like any other medical illness” implies that mental illness has a biological basis just like other medical illnesses and should be treated in the public’s eye in a similar manner. The purpose of this article is not to present a philosophical or ideological argument in favour of or against a biological basis explaining mental illness, but rather to examine the clinical and public utility of presenting a dominant neurobiological model of mental illness to patients, their families and the public at large. Illness, pathophysiology and the “self’’ To understand the justification of equating mental and medical disorders, a comparison often made between type 2 diabetes and mental disorders, especially schizophrenia, other psychoses and depression, is worth examining in some detail. Diabetes, although very complex, is understood as the result of dysfunctional glucose metabolism related to absolute or relative insuffi ciency of insulin signalling. This dysfunctional metabolism is the consequence of endogenous predispositions, such as hereditary diathesis, and environmental factors, including personal choices, such as poor diet and sedentary life style. Therefore, by improving glucose metabolism, either through medication, insulin replacement or changes in lifestyle, positive health outcomes can be expected. Diabetes is diagnosed by confirming high levels of fasting glucose and other related biochemical markers of glucose metabolism. Further, the cascade of its effects on other systems (e.g., cardiovascular, central nervous system) are, or could be, well explained on the basis of physiologic mechanisms. They can also be prevented/treated by better and early control of diabetes. All through this, however, the patient