“A Mental Problem?”

I've been puzzling over an old question. What is mental? What is physical? The most recent DSM (Diagnostic Statistical Manual for Mental Disorders IV) describes the separation of mental and physical as "a reductionistic anachronism of mind/body dualism." That dualism—we are made of two things: spirit and matter—is very old, but it is a philosophical conundrum of the most befuddling kind, and the authors of the DSM want to make it clear that they haven't fallen into that trap. They do not define the two, however. They are hedging their bets by saying that psyche and soma can't really be separated. Every mental state is also physical. My question is why do we have "mental disorders" at all, if the current wisdom is that they are really physical? Schizophrenia, bipolar disorder, OCD, depression, and other "mental" afflictions are now often referred to as "organic brain diseases." The popular press is especially fond of this terminology. What has happened?

For years, psychiatry distinguished between an organic illness and a functional one. If a psychotic patient was found to have a brain tumor—a cause that could be seen and identified—he would have an organic problem, but if there were no sign of a cause for his symptoms, he would be labeled functional. The DSM IV threw out these categories. The pressing reason for the change came from research that confirmed brain abnormalities in people suffering from a functional illness. Enlarged brain ventricles and reduced gray matter are characteristic of schizophrenia, for example, but no one knows what causes these organic differences. Schizophrenia remains a medical mystery, but twin studies suggest that both genetics and environment play a role.
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