|
|
Do We Need A Strong Definition Of Mental Disease In Order To Secure Resources For Psychiatry?
Søren Holm*
* Professor, Centre for Medical Ethics, University of Oslo, NORWAY
The paper describes two interrelated areas of discourse/debate in which doubts about the disease status of mental illness is expressed, and where these doubts are used in arguments concerning resource allocation.
The first of these discourses is concerned with resource allocation to psychiatric in-patient departments. This debate is compared to the similar discussion concerning resource allocation to neurology, and it is suggested that the different outcomes may be (at least partly) explained by the unwavering ascription of disease status to neurological diseases. This conclusion is further supported by looking at some illnesses on the border between neurology and psychiatry (e.g. Gilles de la Tourette syndrome).The second discourse, analysed in this paper, is the discourse about community psychiatry versus hospital psychiatry. It is suggested that the ideological character of this discourse, and some common side-effects of the move towards community psychiatry (i.e. that resources are lost, despite avowed intentions to the contrary), are made possible by the uncertainty of the status of mental illness.
Based on these analyses it is claimed, that the chances of securing adequate funding for psychiatric care and treatment would increase, if doubts about the 'true disease' status of mental illness could be dispelled.
Some initial comments are made about the prospects of reaching a resolution of this problem, and it is, reluctantly, concluded that the prospects look more promising if one accepts a biological model of psychiatric disease. A final question is then raised in the form of a dilemma: 'What should the philosopher do, if a foreseeable side-effect of seeking the 'truth' about mental illness, is a reduction in the help given to those people who are ill and needs help?'Keywords: Psychiatry, Mental Illness, Resource Allocation,
Concept of DiseaseT Klin J Med Ethics 1999, 7:47-52
|
|
|
|
|
