Anthropological and Evolutionary Concepts of Mental Disorders
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Patients suffering from mental disorders are often not treated on an equal basis with patients suffering from organic diseases. In Germany, for example, alcohol-dependent patients will be detoxified on a clinical ward to ensure that they survive acute alcohol withdrawal; however, medical insurances often do not cover treatment costs for a therapy for the addictive behavior that underlies the acute alcohol problem. While patients suffering from diabetes mellitus can also display personally harmful choices and, for example, consume sugar although they know that this is detrimental for their health, medical insurances pay for the acute hyperglycemic shock treatment as well as for dietary and medical treatment of the underlying disorder, diabetes mellitus. Not so in alcoholism, where emergency treatment for delirium tremens (a form of severe alcohol withdrawal) will be covered but not psychosocial and medical treatment for the addiction itself. Problems of stigmatization and discrimination obviously play a role in this context. However, nicotine addiction is an example that clearly shows that the disease status of mental disorders itself is controversial—Is nicotine [End Page 292] consumption always a lifestyle issue, or can smokers become as severely dependent on nicotine as heroin consumers become addicted to opiates? If the latter is the case, then why is a certain behavior a disease and not just an unconventional choice? That is, which criteria do not just characterize a certain disease (e.g., addiction) but instead define whether a condition or set of symptoms (syndrome) characterizes a disease?
Most authors try to answer this question by pointing to criteria that characterize organic disease, pointing to some kind of anthropological norm from which a condition differs fundamentally and which is negative for the patient, who feels sick and wants to return to a healthy condition. However, in psychiatric disorders, patients often do not feel sick but, rather, persecuted or enlightened, and—as we discuss below—the question of adequate norms is much more complicated than when we discuss, for example, liver function and dysfunction. Psychiatry and psychology have, for about a century, tried to answer the question about health and disease by pointing to an evolutionary understanding of human development. Health is then defined as a functional level at the top of the evolutionary pyramid, while disease is a breakdown of such higher functions.
However, this whole construction is based on a unilinear concept of human development and history and tends to mistake cultural differences for evolutionary stages. In this essay, we will first reflect on these traditional concepts and then discuss the possibility to define minimal anthropological functions, which are supposed to characterize mental health in different cultures and which in case of impairment can be used as symptoms of a psychiatric disease. We will do so by keeping in mind that modern morality does not endorse the limiting of individual choices about how one lives one’s life (at least as long as these choices do not harm others). Thus, we are looking for functions that are necessary for being able to choose what to do in one’s life; we are not looking for indicators that classify certain goals or choices of life as symptoms of a pathological process (Tugendhat 1984).
Degeneration, Dissolution, and Regression—Evolutionary Concepts of Mental Health
A traditional view held that God created man in a perfect state but that degeneration, understood as a “fall from God’s grace” (Topsell 1607), has deteriorated human capacities. In the eighteenth century, Blumenbach (1795) and [End Page 293] other anthropologists reasoned about racial hierarchies, with Blumenbach being rather critical of the usual tendency to assume that “Ethiopians” or “Negroes” are more degenerate than “Mongolians,” with Europeans for some reason always ending up at the top of the rank order (Figure 1). In the nineteenth century, Morel (1857) applied the concept of degeneration to mental disorders and suggested that a multitude of environmental and constitutional factors (smog, alcoholism, uncontrolled desires) can induce degeneration, which manifests itself as minor disorders (libertinage, nervousness, anxieties) in the first generation, with the second generation showing more serious problems (alcoholism, neurosis), the next generation suffering from severe mental disorders, and finally the...
