Philosophy of Mental Disorder: An Ability-Based Approach

This post is by Sanja Dembić. Sanja is a research associate at Humboldt-Universität zu Berlin and a member of the “Human Abilities” Centre for Advanced Studies in the Humanities. Here, she discusses her recent book 'Philosophy of Mental Disorder: An Ability-Based Approach'. 

What is it to have a mental disorder? There are many different answers to this question in the literature, the most prominent being those that refer to the concept of biological dysfunction. These views are usually developed with reference to clear cases of bodily disorders (or: diseases). The idea behind them is that if we have an adequate analysis of the concept of bodily disorder, we will also have an adequate analysis of the concept of mental disorder. In contrast, my aim was to develop a concept of mental disorder that is developed with reference to clear cases of mental disorder.

In this book, I offer an ability-based view of mental disorders. I argue that an individual has a mental disorder if and only if they are—in the relevant sense—unable to respond adequately to their available reasons in some of their thinking, feeling or acting and they are harmed by the condition underlying or resulting from this inability. I call this the “Rehability View”. I develop a detailed analysis of the concept of inability that is relevant in the psychiatric and psychotherapeutic context by drawing on the most recent literature on the concepts of ability, reasons and harm. The Rehability View does not imply that an individual with a mental disorder cannot learn to respond adequately to their available reasons. It suggests that therapy aimed at “cure” should, at its core, empower the affected individual.

Sanja Dembić

The Rehability View is developed by the method of explication. The goal of an explication is to formulate a concept that is fruitful to us for certain purposes. I argue that we need the concept of mental disorder for (a) the theoretical purpose of scientific classification and (b) to help us settle certain practical or normative questions concerning treatment and responsibility. In light of these purposes, I propose the following set of adequacy conditions for an explication of the concept of mental disorder: to capture the distinction between (1) mental health and disorder, (2) mental and bodily disorder, (3) mental disorder and deviances from social, legal or moral norms, as well as to clarify (4) what about having a mental disorder it is that may justify certain normative consequences (such as eligibility for treatment or excuse from moral responsibility).

The Rehability View has various normative aspects. Normative considerations are relevant to determine (1) what class of abilities is relevant to mental disorders; (2) at what threshold an inability can be attributed; (3) what constitutes psychiatrically relevant harms; and (4) whether an individual’s actions or mental states are adequate responses to their available reasons. I see this as an advantage of this approach because I believe that it is better to make clear (and discuss) the normative aspects of the attribution of mental disorders than to deny them.

In sum, my aim was not to offer just another conception of mental disorder, but to develop a systematic approach that incorporates insights from philosophy of psychiatry and adjacent philosophical disciplines.