Richard J. McNally

On the roots of mental pathologies

Cover Interview of November 03, 2011

The standard view of medicine holds that observant clinicians discover diseases in nature. Accordingly, psychiatrists are no different from other doctors. They, too, discern forms of pathology arising from dysfunctions in our universal human nature. Psychiatric experts, relying on clinical observation and research, develop the diagnostic criteria that best describe the disorders they have identified. Mental disorders are diseases of the brain, on a par with diseases of the immune system, circulatory system, and so forth.

This view implies that mental disorders are timeless maladies, originating in aberrant biology, that occur across cultures and throughout history. Just as success in chemistry entailed discovery of the elements that constitute the periodic table, success in medicine, including psychiatry, will result in the discovery, description, and explanation of the mental illnesses that afflict humanity.

Not everyone buys this line. Social constructionists hold that cultural factors shape the experience and expression of mental disorders in ways impossible for most diseases. Indeed, cognitive and emotional symptoms are constitutive of mental illness, and cultural factors affect how we think and feel. This implies that at least some disorders may not be ahistorical entities whose essence is invariant irrespective of cultural context.

Scrutiny of the connection between culture and mental illness suggests a nuanced version of social constructionism. For some mental disorders, culture barely penetrates the surface, whereas it greatly shapes others and outright creates still others.

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[T]he Holocaust transformed our whole way of thinking about war and heroism. War is no longer a proving ground for heroism in the same way it used to be. Instead, war now is something that we must avoid at all costs—because genocides often take place under the cover of war. We are no longer all potential soldiers (though we are that too), but we are all potential victims of the traumas war creates. This, at least, is one important development in the way Western populations envision war, even if it does not always predominate in the thinking of our political leaders.

Carolyn J. Dean,
Interview of February 01, 2011

The dominant premise in evolution and economics is that a person is being loyal to natural law if he or she attends to self’s interest and welfare before being concerned with the needs and demands of family or community. The public does not realize that this statement is not an established scientific principle but an ethical preference. Nonetheless, this belief has created a moral confusion among North Americans and Europeans because the evolution of our species was accompanied by the disposition to worry about kin and the collectives to which one belongs.

Jerome Kagan,
Interview of September 17, 2009