Richard J. McNally


On the roots of mental pathologies

Cover Interview of November 04, 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.