What Is Mental Illness?

by Richard J. McNally

Overview

According to a major health survey, nearly half of all Americans have been mentally ill at some point in their lives—more than a quarter in the last year. Can this be true? What exactly does it mean, anyway? What’s a disorder, and what’s just a struggle with real life?

This lucid and incisive book cuts through both professional jargon and polemical hot air, to describe the intense political and intellectual struggles over what counts as a “real” disorder, and what goes into the “DSM,” the psychiatric bible. Is schizophrenia a disorder? Absolutely. Is homosexuality? It was—till gay rights activists drove it out of the DSM a generation ago. What about new and controversial diagnoses? Is “social anxiety disorder” a way of saying that it’s sick to be shy, or “female sexual arousal disorder” that it’s sick to be tired?

An advisor to the DSM, but also a fierce critic of exaggerated overuse, McNally defends the careful approach of describing disorders by patterns of symptoms that can be seen, and illustrates how often the system medicalizes everyday emotional life.

Neuroscience, genetics, and evolutionary psychology may illuminate the biological bases of mental illness, but at this point, McNally argues, no science can draw a bright line between disorder and distress. In a pragmatic and humane conclusion, he offers questions for patients and professionals alike to help understand, and cope with, the sorrows and psychopathologies of everyday life.

Product Details

ISBN-13:	9780674066205
Publisher:	Harvard University Press
Publication date:	11/12/2012
Edition description:	Reprint
Pages:	288
Product dimensions:	5.10(w) x 7.90(h) x 0.60(d)

About the Author

Richard J. McNally is Professor of Psychology and Director of Clinical Training at Harvard University.

Table of Contents

An Epidemic of Madness? 1

Are We Pathologizing Everyday Life? 32

Can Evolutionary Psychology Make Sense of Mental Disorder? 69

Psychopathology as Adaptation? 97

Does Society Create (Some) Mental Disorders? 128

Is It in Our Genes? 159

Do Mental Disorders Differ by Kind or Degree? 184

So What Is Mental Illness Anyway? 212

Notes 219

Acknowledgments 265

Index 267

What People are Saying About This

David H. Barlow

The meaning of madness has confounded us for centuries. Now, we learn that half the population meets criteria for mental disorders. In this lucid and erudite book, Richard McNally tackles the difficult questions of science, philosophy, and politics that bear on this issue. His answers will have a great impact on the study of psychopathology.
— David H. Barlow, Boston University

Paul R. McHugh

Richard McNally's book is the definitive description of the cultural impact of DSM-style empiricism in psychiatry, and the mostly rational but ultimately unsatisfactory approaches that have led to the state of confusion over the nature of mental maladies and mental health we have today. Although our present chaos will probably last at least a decade past the publication of the DSM-V in 2012, all who long for the replacement of this strange and primitive answer to the question 'What is Mental Illness?' will find some hope in McNally's analysis of new ways of thinking about caring for patients and understanding the mind.
— Paul R. McHugh, M.D., Johns Hopkins School of Medicine

Editorial Reviews

McNally's wide-ranging and extremely readable book is quite sane, and vastly illuminating...Perhaps the most profound insight in What Is Mental Illness? has to do with the role of culture. McNally presents a clinically nuanced, historically rich, and anthropologically informed discussion of how mental illnesses are expressed...The next DSM edition, the fifth, is now in the works. To judge by the heated controversy within academic and advocacy circles generated by interim progress reports, its unveiling in 2013 will doubtless shine an uncomfortable spotlight on the psychiatric profession and spark plenty of debate. McNally's masterful synthesis will help us understand the discussion, and thereby help us to understand ourselves.

New Republic - Sally Satel

McNally's book is essentially an extended critique of the DSM, for which he serves as an advisor...[He] begins by asking if we are pathologizing everyday life...One thing that I particularly appreciated about this book is that McNally doesn't take any sides when describing...hypotheses about the origins of mental illness, allowing the reader to draw his or her own conclusions. Those conclusions will probably be mixed and inconsistent, and that's okay. You get the real sense that he is truly committed to the alleviation of mental suffering...It's a clear, thorough, and lively accounting of the problems facing mental health and its practitioners today, and will prove a fascinating read to scientist and layperson alike.

Wired blog - Jason Goldman

Richard McNally's book is the definitive description of the cultural impact of DSM-style empiricism in psychiatry, and the mostly rational but ultimately unsatisfactory approaches that have led to the state of confusion over the nature of mental maladies and mental health we have today. Although our present chaos will probably last at least a decade past the publication of the DSM-V in 2012, all who long for the replacement of this strange and primitive answer to the question 'What is Mental Illness?' will find some hope in McNally's analysis of new ways of thinking about caring for patients and understanding the mind.

Paul R. McHugh

The meaning of madness has confounded us for centuries. Now, we learn that half the population meets criteria for mental disorders. In this lucid and erudite book, Richard McNally tackles the difficult questions of science, philosophy, and politics that bear on this issue. His answers will have a great impact on the study of psychopathology.

David H. Barlow

The meaning of madness has confounded us for centuries. Now, we learn that half the population meets criteria for mental disorders. In this lucid and erudite book, Richard McNally tackles the difficult questions of science, philosophy, and politics that bear on this issue. His answers will have a great impact on the study of psychopathology.

David H. Barlow

McNally's wide-ranging and extremely readable book is quite sane, and vastly illuminating...Perhaps the most profound insight in What Is Mental Illness? has to do with the role of culture. McNally presents a clinically nuanced, historically rich, and anthropologically informed discussion of how mental illnesses are expressed...The next DSM edition, the fifth, is now in the works. To judge by the heated controversy within academic and advocacy circles generated by interim progress reports, its unveiling in 2013 will doubtless shine an uncomfortable spotlight on the psychiatric profession and spark plenty of debate. McNally's masterful synthesis will help us understand the discussion, and thereby help us to understand ourselves.
— Sally Satel

New Republic

McNally's book is essentially an extended critique of the DSM, for which he serves as an advisor...[He] begins by asking if we are pathologizing everyday life...One thing that I particularly appreciated about this book is that McNally doesn't take any sides when describing...hypotheses about the origins of mental illness, allowing the reader to draw his or her own conclusions. Those conclusions will probably be mixed and inconsistent, and that's okay. You get the real sense that he is truly committed to the alleviation of mental suffering...It's a clear, thorough, and lively accounting of the problems facing mental health and its practitioners today, and will prove a fascinating read to scientist and layperson alike.
— Jason Goldman

Wired blog

"The boundary between mental distress and mental illness will never be neat and clean," says Harvard professor McNally (Remembering Trauma) in this dense and well-researched scholarly work. He explores changes in society and science that influence how we distinguish disorder from distress. Though McNally serves as an advisor to the DSM (psychiatry's diagnostic bible), he warns against its over application and asks if we should look at mental illness as a spectrum, as we do physical illness; mild expressions would count (and, perhaps, their treatment would be reimbursed for by insurance companies) as much as severe cases. Alternately, the expansion of a disorder's definition, which would include more and more people, does a disservice to patients as well. McNally explores the genetic components of mental illness and looks to evolutionary psychology to explain its persistence. A standout chapter examines the social construction of mental disorders, comparing, for example, the ways that depression sufferers in China and the United States describe their symptoms. This is no pop psychology handbook and will not appeal to the casual reader, but those involved or interested in the field will find it useful.
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Publishers Weekly

McNally (psychology, Harvard Univ.; Remembering Trauma), an adviser on the Diagnostic and Statistical Manual of Mental Disorders, calls himself a "friendly critic" of psychiatry. In eight compact, well-written chapters, he points out the high prevalence of mental disorder in the United States, the tendency to create diagnoses to fit with new pharmaceuticals, and the blurred line between distress and disorder that allows grief to be labeled depression and high spirits, or mania. McNally explains how homosexuality was removed from the list of disorders, how posttraumatic stress disorder was added, how the "recovered memory" phenomenon rose and fell, and much more. Together, biology, culture, politics, economics, and religion determine what is and isn't normal. VERDICT Essential for mental-health professionals, this remarkable book will give diligent lay readers a grasp of genetics, evolutionary psychology, and diagnostic controversies.—E. James Lieberman, George Washington Univ. Sch. of Medicine, Washington, DC

Library Journal

McNally (Psychology/Harvard Univ.;Remembering Trauma, 2003, etc.) takes a hard look at statistics that seem to indicate that "[m]adness...is rampant in America."

At issue are the diagnostic guidelines used to determine what constitutes a "mental disorder." These are delineated by the American Psychiatric Association and codified in the Diagnostic and Statistical Manual of Mental Disorders. (The DSM-V is scheduled to appear in 2013.) As someone who has been directly involved in updating the manual, the author struggles with a thorny question: "Does our system of diagnosing mental disorders fail to distinguish normal human suffering from genuine mental illness? Or are we really getting sicker?"Since the 1980 publication of DSM-III, critics have accused the profession of being self-interested, "expanding the boundaries of mental disorders" to "relatively trivial problems" such as "caffeine-induced sleep disorder" or blurring the difference between shyness and "social phobia." Yet people do seek psychological help in alleviating suffering, and eligibility for health-insurance coverage is dependent on the diagnosis they receive. While pharmaceutical companies may be charged with encouraging broad definitions of mental illness, the opposite is true of insurers. McNally reviews advances in the field since the publication of DSM-III, examining research in evolutionary psychology, the role of social norms in defining maladaptive behavior and the interplay of genetics and environment. He also points to how nonpsychiatric medicine has shifted the "boundary between health and sickness" by treating people with preventative medication for high blood sugar, blood pressure and cholesterol. Whether or not—and how—to treat psychological difficulties will remain a problem that individuals, medical professionals and society at large will grapple with, but McNally is optimistic.

Compassionate and insightful.

Kirkus Reviews