Perception Vs Reality: The Challenge of Mental Illness

Introduction

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning, highlighting the intricate interplay between perception vs reality. Some central questions within the philosophy of mental illness include “whether mental illnesses should be understood as a form of distinctly mental dysfunction and whether mental illnesses are best identified as discrete mental entities with clear inclusion/exclusion criteria or as points along a continuum between the “normal” and the ill.” (Internet Encyclopedia of Philosophy, A Peer-Reviewed Academic Resource, Philosophy of Mental Illness).

The Complex Diagnosis of Mental Illness

One of the most important epistemological problems in psychiatry is the relationship between mental illness and its diagnosis or detection of malingering, also known as the exaggeration or feigning of illness usually in order to escape duty or work. This is a consequence of the fact that there is no way to confirm that any psychiatric diagnosis is not influenced by personal feelings or opinions in considering and representing the facts, especially since psychologists and psychiatrists diagnose mental illness through conversation, or rather, an interview, with the patient giving complaints about symptoms which are based on or influenced by personal feelings or opinions. So this is problematic because it necessitates us being able to tell valid from faked. The patient tells them what bothers them, their feelings, their thoughts, etc. Then through the result of a checklist survey completed by the patient to report these subjective symptoms for observation, a disorder can be diagnosed from matching the symptoms to a corresponding category in the Diagnostic and Statistical Manual of Mental Disorders (the DSM).

The ways in which mental illnesses, such as depression, are diagnosed or found out seem to be much less reliable than the way for a physical illness, like a tumor for example. Given this issue, along with how broad it is, some people may ask, can psychology really be called a science? The use of the bio-psycho-social model of the DSM by psychologists is also criticized as the system is severely restricted in its scope for distinguishing a person with a genuine mental illness from a person suffering greatly from a problem in their life. Think grief vs depression.

Psychology as a Science 

However, psychology also uses behavior along with the mapping to the DSM from the checklist survey to separate genuine from faked mental illness and this epistemological problem can be solved using the proven to be successful hypothetico-deductive method, similar to the scientific method with the hypothesis merely being whether a mental illness exists in the patient. Mental illness goes hand in hand with behavior and the scientific rationalism- a belief or theory that opinions and actions should be based on reason and knowledge rather than on religious belief or in this case, emotional response as mental health is defined as a person’s condition with regard to their psychological and emotional well-being. Psychology, though broad, is “a science by virtue of the method it employs to acquire knowledge that can be rationally explained and reliably applied.” (Galuchat from The Philosophy Forum- https://thephilosophyforum.com/discussion/1390/the-epistemology-of-mental-illness-diagnosis) It scientifically studies the human mind and its functions, especially those affecting behavior in a given context, mental characteristics or attitudes of a person or group, and then the mental and emotional factors governing a situation or activity (which would help with distinguishing a genuine mental illness from a prolonged emotional response to a problem in one’s life) To understand someone’s behavior, we have to assume it is largely rational and when it is otherwise and/or someone is going through a state of mental dysfunction, the hypothesis comes in as individuals with mental illness are seen as and stigmatized for being “statistically non-normal” or conforming to the usual, expected state and standard.

Those critical of the DSM also argue that “symptoms are useless without a theoretically adequate conception of what it means for a mental mechanism to function properly” ((Internet Encyclopedia of Philosophy, A Peer-Reviewed Academic Resource, Philosophy of Mental Illness). According to https://www.iep.utm.edu/mental-i/#H2, from the characterization of what behavior is seen as mentally dysfunctional, one can extract four criteria that serve to a genuine mental disorder from other sorts of issues, including problems in living, character flaws, and so forth. In order for a disturbance to be classified as a mental disorder it must:

1. Be a clinically significant disturbance in cognition, emotion regulation, or behavior
2. Reflect a dysfunction in biological, psychological, or developmental processes
3. Usually cause distress or disability
4. Not reflect a culturally approved response to a situation or event
5. Not result purely from a problem between an individual and her society.

In philosophy, rationalism is the theory that reason rather than experience is the foundation of certainty in knowledge. Someone with a mental illness will presumably behave largely irrational as mentioned above and their experiences are based on their perception of reality which is why it is so hard for others to understand and be certain of their claims of knowledge, which is where epistemology comes in- the task of judging and studying someone else’s claim to knowledge, or specifically relating here, their claim to their knowledge of what is real- and epistemic injustice. First, there is epistemic injustice in psychiatry. This is harm done to a person in his/her capacity as an epistemic subject (a knower, a reasoner, a questioner) by undermining her capacity to engage in epistemic practices such as giving knowledge to others (testifying) or making sense of one’s experiences (interpreting). This can happen when an individual does not take the statements of a speaker as seriously as they should be taken and usually happens when the hearer delates the speaker’s level of credibility due to prejudice against them, like negative attitudes towards people with mental illness, and eventually leading to negative stereotypes. Some stereotypes include viewing mentally ill people as cognitively impaired or simply emotionally compromised and as a result, owing to their present condition or psychological reactions. Based on real-life situations, we are aware of people’s unconscious or subconscious desires and beliefs affecting their decisions, for example, some psychiatric patients become reluctant to disclose their psychotic symptoms for fear of being detained in a hospital or unwillingly medicated. Epistemic injustice can be a real problem in psychiatry and have devastating effects on individuals who are actually telling the truth which is why, although difficult sometimes, physicians should accept what patients say unless there is a good reason not to.

Perception vs. Reality Struggle in Mental Health

As mentioned in the last paragraph, epistemology comes in with the task of judging and studying someone else’s claim to knowledge, or specifically relating here, their claim to knowledge of what is real. Perception vs. reality. ‘What is the difference between them?’ one may ask. Perception are your beliefs about, or knowledge of the world. It is your ability to see, hear, or become aware of something through the senses, for example, pain, which explains why there are normal limits to our human perception. It is more importantly the state or process of this awareness. Some other similar words for perception would be realization, consciousness, knowledge, observation, thought, belief, and so on. When it comes to perception vs. reality, the best definition for perception may be a way of regarding, understanding, or interpreting something, or in other words, a mental impression. Now reality is the state of things as they actually exist, as opposed to the perception/idealistic or notional idea of them. Reality is truth. When someone feels so confident in something that they can only see it from their point of view or perception, it becomes their reality, their truth but their truth does not equal actual truth, actual reality. This is where mental illness comes in.

Think of the movie, A Beautiful Mind, the true story of mathematician and Nobel Peace Prize winner, John Nash, who also happened to have one of the main mental illnesses dealing with perception vs reality-schizophrenia. In the beginning of the film, he had travelled to Princeton University and attended there as a graduate student and while he was there, supposedly made several friends, the first being his roommate Charles, who later becomes his best friend over time as after classes, he would hang out with him as friends do. Nash became so confident in this perception or really, hallucination, that it became reality to him. His diagnosis only came later unfortunately. While he was in the hospital, his wife Alice, began an investigation to gather some facts about his undercover work operations, during which she came to the realization that something just wasn’t right. She was then told he had schizophrenia and paranoia as a result. It was discovered that Charles was only a product of his mind, that there had never even been a Charles at Princeton University, nor did Nash ever have a roommate. The undercover work he said he was doing was also just a delusion in his own mind. Remember Descartes? He takes doubt as far as he can as says that our sense perception may be illusion or the product of our own dreams or hallucinations. Another philosopher this can relate to is Berkeley who believed that there can be no entity without a perceiver; everything that is real depends upon a mind or a human consciousness.

The serious brain disorder that Nash had, schizophrenia, is one that clearly distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. A similar disorder, though milder form, is called schizotypal personality disorder and individuals with it may have odd beliefs and tend to distort reality. They are also preoccupied with fantasy and daydreaming, which we all know isn’t real. This condition is informally thought of as “eccentric”, strange, not normal, though normal is just defined by society. Another quick interesting fact about schizophrenia and other “insanity based’’ mental illnesses is that there are two types, one being A or affective type in which the individual is actually aware that they are ill, whereas the other type is so detached from reality that they lack the knowledge of their so called insanity and can’t be convinced that what’s in their mind is not real. They can’t distinguish between hallucination or perception and reality so they really don’t know who or what to believe. This is why faith is so deeply connected to mental health. Faith can improve mental health and overall, individuals who are actively on a spiritual path, whether it be through religion or mindfulness, tend to live healthier lives. Faith gives people a sense of belonging to a community, sense of trust in life, and most importantly for those with a mental illness or their loved ones, hope. (Archdiocese of Toronto Blog, Exploring the connection between faith and mental health)

Conclusion

Anyways, the main idea is that each individual has his or her own perception of reality and the implication of this is that reality itself changes from person to person even if each person’s perception is not truth. It is truth to them. Philosophy comes in again with mental illness, specifically ethics. We have a social and ethical responsibility to advocate for the rights of anyone struggling/diagnosed with a mental illness, especially their right to receive appropriate treatment and to be given equal rights in the workplace. In the Catechism of the Catholic Church, article 5, the fifth commandment (You shall not kill) can also refer to respect for health and the dignity of persons as they are precious gifts entrusted to us by God so we must take care of them, both our own needs and others for common good. “Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance (Catechism of the Catholic Church, Part Three: Life in Christ, Section Two: The Ten Commandments, Chapter Two: You shall love your neighbor as yourself”, Article 5: The Fifth Commandment). We all need to speak up to challenge the stigma and prejudices associated with mental illness, to show people that their suffering is real because what they suffer through is real to them, no matter what anyone else can see or think.

Works Cited

1. Reznek, Lawrie. “On the Epistemology of Mental Illness.” History and Philosophy of the Life Sciences, U.S. National Library of Medicine, 1998, www.ncbi.nlm.nih.gov/pubmed/10326333.
2. Internet Encyclopedia of Philosophy, www.iep.utm.edu/mental-i/#H2.
3. “Perception Versus Reality: The Film A Beautiful Mind.” Bartleby, www.bartleby.com/essay/Perception-Versus-Reality-The-Film-A-Beautiful-P3F2MR39DEHQ.
4. “The Epistemology of Mental Illness Diagnosis.” The Philosophy Forum, thephilosophyforum.com/discussion/1390/the-epistemology-of-mental-illness-diagnosis.
5. “The Perception of Mental Illness: Stigma or Reality.” Psychology Today, Sussex Publishers, www.psychologytoday.com/ca/blog/healing-trauma-s-wounds/201605-the-perception-mental-illness-stigma-or-reality.
6. Goldberg, Joseph. “Schizotypal Personality Disorder: Causes, Symptoms, Diagnosis, Treatment, Complications, Outlook.” WebMD, WebMD, 16 Oct. 2018, www.webmd.com/mental-health/schizotypal-personality-disorder#1.
7. Catechism of the Catholic Church - The Fifth Commandment, www.vatican.va/archive/ccc_css/archive/catechism/p3s2c2a5.htm.
8. “Blog.” Archdiocese of Toronto, www.archtoronto.org/Blog/Lists/Posts/Post.aspx?List=34d5a203-1fa3-4c04-ac64-0bcae6f89efa&ID=165&Web=625770c8-7f72-4fbe-9231-8ce59324a881.
9. Crichton, Paul, et al. “Epistemic Injustice in Psychiatry.” BJPsych Bulletin, Royal College of Psychiatrists, Apr. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5376720/