Abstract

There has been a long tradition of argument claiming that mental "illnesses" are not really illnesses. One such argument is that mental illnesses cannot be analyzed on the same model of disease as physical illnesses. This argument has impacted mental health care policy in significant ways. Insurance reimbursement for mental health care has not been equal to that of physical illness. Moreover, applying the Americans with Disabilities Act of 1991 to mental illnesses was met with outrage by some, claiming that the assumption that mental and physical illnesses are alike is dubious. ;In this dissertation, I argue that mental and physical illnesses can be analyzed on the same model of disease and I develop a model upon which to do so. My method is to first come up with a general account of disease. To this end, I survey various historical and contemporary models of disease. I then develop a model which I call the Scientific-Causal Model of disease, which combines contemporary functionalist, genetic, and evolutionary explanatory approaches to disease. ;To defend an account of disease, however, is to invite much philosophical controversy about the nature of disease. I address the debate between those who claim that disease is a value-laden concept and those who claim that disease is a descriptive concept, as well as related metaphysical issues. I maintain that diseases should be understood naturalistically, informed by scientific investigation rather than by appeal to social convention. ;Next, I apply the S-C model of disease to mental illnesses. I apply the model to various conditions that have been controversial, such as borderline personality disorder, panic disorder, and homosexuality. To be able to clarify psychiatric terrain is an asset of the S-C model, as the model shows the ways in which mental illnesses are illnesses and vindicates psychiatry from the Szaszian charge that it has medicalized "personal, social, and ethical problems in living." ;The S-C model also has several important consequences for public policy. The S-C model shows, with regard to health insurance, that mental illnesses deserve equal status with physical illnesses as diseases. I also address the ADA and concerns over applying it to mental illness using my model. Lastly, I offer the model as a way to determine the conditions appropriate for genetic intervention. Using the S-C model to first specify diseases guards against perpetuating social prejudice in genetic interventions