Mental and physical illness

I agree with much of what Dr Reynolds says and with Baker & Menken's view, to which he refers. I also, like him, look forward to the time when psychiatrists and neurologists speak the same language. Both will need to change a good deal for this to be possible, but increasing understanding of the cerebral substrate of emotions and cognition will eventually provide a powerful stimulus to both specialities. I was not, though, suggesting that we should talk of psychiatric illnesses instead of mental illnesses because I prefer Greek to Latin derivations. The term ‘mental illness’ implies a disorder of the mind. By substituting ‘psychiatric illness’ I wished to imply simply that these are disorders which, if they come to specialist attention, are normally treated by psychiatrists. I should emphasise, too, that my objections to the term ‘physical illness’ are almost as great as to ‘mental illness’. Both encourage doctors and patients alike to make inappropriate and damaging assumptions and to ignore the role of psychological and social influences across the whole spectrum of illness. That is why I do not think it is appropriate simply to combine mental and neurological disorders as ‘brain disorders’.

In reply to Dr Crichton, I did not quote Lady Mary Wortley Montagu with either approval or disapproval, but simply to illustrate the fact that in the mid-18th century it was still the accepted view that madness was no different from other diseases. More importantly, Dr Crichton is confusing the difference between mental and physical events and what are misleadingly called mental and physical illnesses. There are indeed still many mysteries about the relationship between mental and physical (cerebral) events and no unanimity among either philosophers or neuroscientists about the nature of that relationship (although Descartes' original ‘substance dualism’ has passed into history). But this, although important, is irrelevant to my argument that there is no fundamental or qualitative difference between the heterogeneous collections of illnesses we currently distinguish as physical and mental. Both physical and mental phenomena are conspicuous in both — as aetiological factors, as features of the illness itself and as influences on outcome. And pain is indeed a purely subjective phenomenon, even though there are good reasons for assuming that it usually, perhaps always, has physical (cerebral) concomitants.

In reply to Dr Foreman I can only say that he should have read my editorial rather more carefully. I did not argue that psychiatric disorders are physical disorders. Rather, I drew attention to the extensive evidence of somatic abnormalities in almost all common mental disorders and to the lack of any characteristic features of either the symptomatology or the aetiology of so-called mental illnesses that reliably distinguished them from physical illnesses (and vice versa). Nor did I declare “mental to be meaningless”, or argue that there are no important differences between mental and physical illnesses. My argument was that “the differences between mental and physical illnesses, striking though some of them are, are quantitative rather than qualitative, differences of emphasis rather than fundamental differences, and no more profound than the differences between diseases of the circulatory system and those of the digestive system, or between kidney diseases and skin diseases”. And far from wanting mental illnesses to be regarded as physical illnesses, I argued that both terms are misleading. Finally, I did not say that “no alternative has been found” for the term mental illness. On the contrary, I suggested that “we should talk of psychiatric illnesses or disorders” instead. Nor was this merely a suggestion. The most recent edition of theCompanion to Psychiatric Studies, which I co-edited (Kendell & Zealley, 1993), deliberately refers to psychiatric illnesses or disorders rather than to mental disorders throughout its 950 pages, and explains the reasons for doing so.