Hence, my anxiety around shifting terminology from the Mental Health Act 1983 to anything else!

erm, I can’t say that I’ve given the matter a lot of thought. Should the above most correctly read:

‘The Mental Health Act 1983, amended in 2007…’ ?

Noooo!

Please, please, please tell me you’re not calling it that in practice, and it was just referenced as a link?

We’re still using the Mental Health Act 1983 (since the 2007 legislation ammended the primary legislation but wasn’t sufficiently comprehensive to replace the original Act), so although it’s the Mental Health Act 1983 I’d accept that a more pedantic (and legally correct) term would be to refer to it as the ammended Act . . . but to refer to a 2007 Act is just confusing, no?

http://www.amazon.co.uk/What-Mental-Disorder-International-Perspectives/dp/0198565925

Bolton’s a professor of philosophy and psychopathology at the Institute of Psychiatry, and the book gets good reviews in the BJP and other places. He spends a lot of time discussing Wakefield’s evolutionary approach to the problem of definition.

Anyway as you know I’m close to the ‘presence of suffering’ position (and I think the stuff about harm to others can be dealt with via considerations of autonomy and decision-making capacity).

With regard to your post, I would ask you “why do we need to define the term ‘mental disorder’ anyway?” Asking such a question presupposes the utility of the concept. Why do we need to know if someone’s suffering qualifies as ‘mental disorder’ before we help them? Surely all that matters is that they are suffering, and that they are asking us for help? We may wish to ask what ‘form’ their suffering takes, but that’s different from asking if their suffering meets mental disorder criteria. People become so bewitched by debates over whether someone has a ‘proper mental illness’ or not, eagerly flicking through their DSM’s or ICD’s for reassurance and moral guidance. In the meantime, the person being discussed continues to experience profound pain and helplessness.

My own view is that the disadvantages of the term outweigh the advantages. More importantly, when all is said and done, we don’t really need the term anyway. Rather than ask “what is mental disorder?” or “does mental disorder exist?”, a much more useful question to ask is “are we justified in helping this person?” In fact, losing the term mental disorder (with all the negative consequences attached to being ‘diagnosed’) makes it easier for professionals to help. Not having a boundary between the ill and the well (and not having one’s passport repeatedly stamped) makes travelling between different emotional states easier for everyone.

On the other hand, I definitely do think we need to classify those recognisable processes and patterns which normally (but not always) lead to subjective psychological distress or impaired decision-making capacity, but I’d like to see less evaluative language used. Terms such as ‘phenomena’, ‘process’, ‘pattern’, ’system’, ‘type’, ‘form’, ‘taxon’, ‘condition’, ’state’ would all be improvements on existing terms such as ‘pathology’, ’symptom’, ’sign’, ‘disorder’, ‘illness’, ‘disease’ or even ‘disability’.