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Richard J. McNally

What Is Mental Illness? Hardcover – January 15, 2011

by Richard J. McNally (Author)

4.4 32 ratings

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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.

Print length

288 pages
Language

English
Publisher

Belknap Press
Publication date

January 15, 2011
Dimensions

6 x 1 x 8.75 inches
ISBN-10

0674046498
ISBN-13

978-0674046498
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Editorial Reviews

From Publishers Weekly

"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.
(c) Copyright PWxyz, LLC. All rights reserved.

Review

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)

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)

Compassionate and insightful. (Kirkus Reviews 2010-10-01)

McNally, 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 [labeled] 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. 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 Library Journal (starred review) 2010-11-15)

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 2011-05-18)

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 2011-05-12)

Product details

Publisher ‏ : ‎ Belknap Press; 1st edition (January 15, 2011)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 288 pages
ISBN-10 ‏ : ‎ 0674046498
ISBN-13 ‏ : ‎ 978-0674046498
Item Weight ‏ : ‎ 1.1 pounds
Dimensions ‏ : ‎ 6 x 1 x 8.75 inches

Best Sellers Rank: #2,165,660 in Books (See Top 100 in Books)
- #3,032 in Medical Psychology Pathologies
- #3,755 in Popular Psychology Pathologies
- #11,039 in Medical General Psychology

Customer Reviews:
4.4 32 ratings

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Richard J. McNally

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Richard J. McNally received his B.S. in psychology from Wayne State University in 1976, and his Ph.D. in clinical psychology from the University of Illinois at Chicago in 1982. He completed his clinical internship and postdoctoral fellowship at the Behavior Therapy Unit, Department of Psychiatry, Temple University School of Medicine. In 1984 he was appointed Assistant Professor in the Department of Psychology at the University of Health Sciences/The Chicago Medical School where he established the Anxiety Disorders Clinic and directed the university counseling center. He moved to the Department of Psychology at Harvard University in 1991 where he is now Professor and Director of Clinical Training. He has more than 330 publications, most concerning anxiety disorders (e.g., posttraumatic stress disorder, panic disorder, phobias, obsessive-compulsive disorder), including the books Panic Disorder: A Critical Analysis (Guilford Press, 1994), Remembering Trauma (Belknap Press/Harvard University Press, 2003), and What is Mental Illness? (Belknap Press/Harvard University Press, 2011). He has conducted laboratory studies concerning cognitive functioning in adults reporting histories of childhood sexual abuse, including those reporting recovered memories of abuse. His research has been supported by the National Institute of Mental Health. He served on the American Psychiatric Association’s DSM-IV PTSD and specific phobia committees, and he is an advisor to the DSM-V Anxiety Disorders Sub-Workgroup. He is a Licensed Clinical Psychologist, a Fellow of the Association for Psychological Science, winner of the 2005 Distinguished Scientist Award from the Society for the Science of Clinical Psychology, winner of the 2010 Outstanding Mentor Award from the Association for Behavioral and Cognitive Therapies, and he is on the Institute for Scientific Information’s “Highly Cited” list for psychology and psychiatry [top 0.5% of published authors worldwide in terms of citation impact].

Customer reviews

4.4 out of 5

32 global ratings

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1 star		6%

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Matthew Sullivan

A Sympathetic but Honest Look at the State of Mental Health

Reviewed in the United States 🇺🇸 on February 23, 2012

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This is a very informed and sympathetic assessment of psychiatry (and other mental health professions) and the many problems that come with understanding mental illness. To what extent are mental disorders genetic? Socially caused? Socially constructed, even? Is the current state of psychiatry scientific? Is the DSM purely political and subject to the whims of culture?

McNally, who has served in various roles as an adviser to the DSM review committees, addresses all of these concerns, and more, and does so without pointing fingers and laying blame. He highlights the difficulties psychiatrists face on the ground not only with trying to help patients who are suffering, but also when dealing with insurance companies. In fact, he emphasizes the role that insurance coding and the need for patient benefits has played in the significant growth of the DSM and its myriad disorders over the past decades.

Regarding the DSM more generally, McNally provides a bit of history of the motivations behind the symptoms-only focus of DSM III, discussing how this was (deemed) necessary and how this both helped and hindered psychiatry ever since. He also discusses a number of ongoing debates within the field (along with psychology) about how DSM 5 ought to be restructured, focusing more on psychopathology and perhaps adjusting diagnoses to reflect degrees of mental illness rather than distinct kinds.

Perhaps one of the weak points of the book is the time he sets aside to discuss differing ideas about the role mental disorders might have played in -- and the problems they may present for -- human evolution. The fault is not so much his as that of the proponents of many of the ideas that, frankly, aren't worthy of much consideration. He returns to the idea more fruitfully in his discussion of genetics and the problem of accounting for disorders like schizophrenia.

Overall, McNally is quite sympathetic to the many problems facing psychiatrists and psychologists today, and realistic about the current state of neurology and psychopathology, and any real chance to fully understand the complex etiology of many disorders. Nonetheless, he addresses those problems honestly and fairly, lightly weighing in certain issues without framing the discussions in his favor.

6 people found this helpful

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Douglas

A Wonderfully Thorough Analysis of what is/and isn't mental illness...

Reviewed in the United States 🇺🇸 on November 13, 2012

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Just a warning to those with a low attention span: there are no car chases or titillating stories here, just good hard, thorough science that is going to require you to stay awake and pay attention. But if you can manage to do that, you will really learn something about the myriad theories about what is and isn't mental illness and how it should be judged when invoking a diagnosis of such. McNally gives us all the theories and then points to the most sensible viewpoint, and his analysis and evaluation of these theories is well thought-out scientifically and given to good old fashioned common sense.

5 people found this helpful

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Clear, Insightful

Reviewed in the United States 🇺🇸 on November 30, 2013

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McNally writes clearly about complex and nuanced issues ranging from the inner politics of the APA to the theoretical approaches that inform treatments and research. His account of the "recovered memory syndrome" fad alone is worth the price of the book! His candid discussion of issues and assumptions, and their implications for policy and treatment are a refreshing look at the fuzzy lines and gray areas which we often fail to acknowledge in the advocacy or advertising propaganda which dominates most discourse about this topic.

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Amazon Customer

So, you know what mental illness is. Take another look there might be more to it!

Reviewed in the United States 🇺🇸 on March 29, 2016

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Richard McNally leaves no stone unturned while looking for a definition of mental illness. This book is definatly a scholarly work and not intemded for casual reading. If you work with or live with a mentally ill person, you probably feel that you know what that means, well try to describe it. Dr. Mcnally shows how difficult it can be.

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ReadsGreatBooks

Answer: Whatever We Decide At The Time

Reviewed in the United States 🇺🇸 on June 16, 2014

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I thought I understood what mental illness was. Then Dr McNally showed me up. In a series of elegant and well-cited chapters, McNally points out exactly where the strengths and limits of the current diagnostic system are. Eminently readable and enlightening.

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Jackalynne

Seller awesome, book was boring

Reviewed in the United States 🇺🇸 on July 20, 2013

Verified Purchase

This book arrived in great condition and was exactly what I expected. I would recommend this seller to others and revisit for future purchases. The book was based on the authors opinion regarding the topics throughout the book.

Reviewed in the United States 🇺🇸 on September 19, 2017

Verified Purchase

Thoughtful, informative, invites one to think more deeply about out beliefs about mental illness.

Reviewed in the United States 🇺🇸 on July 25, 2017

Verified Purchase

Simply awesome! Read read read!! =)

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@Acrographia

精神医学の哲学の絶好の入門書！

Reviewed in Japan 🇯🇵 on December 31, 2013

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DSM第三版以降、操作的診断に依拠し米国が中心となって牽引してきた精神医学を批判的に振り返る動きが近年活発になってきた。2013年にDSM-5が2013年に出版されたが、この前後では「精神疾患をカテゴリーで捉えるべきか、ディメンジョナルに捉えるべきか」といった、精神疾患概念についての根本的な問いが提起され、Nassir Ghaemi, Allen Frances, Ethan Wattersなどが本を著し議論をにぎわせている。本書はそのような流れにおいて出版された書籍の中でも、特に秀逸な一冊である。

Richard J. McNallyはハーヴァード大学の心理学教授であり、いわば精神医療の「内部」の人間である。精神疾患診断の拡大は人間心理の過度な「病理化」であるとか、背後には製薬会社の陰謀があるといって精神医療・精神医学の批判を行うのは容易である。しかしMcNallyはそのような批判を豊富な事例を通して、感情を交えずに淡々と加えるだけでなく、診断の拡大が必要になった理由や、精神医学批判に対するありうる再反論を付け加えることを怠らない。

本書では主張と反論が交互し、最後になっても単純な結論には到達しない。分かりやすい意見を求めて本書を手にした者は、きっと失望するだろう。しかし「精神疾患とは何か」という問題に忍耐強く真摯に取り組んでいきたい者にとっては、遺伝学、進化心理学から社会的構成説に至る広範な話題を扱い、議論の経緯や提起されてきた論点を比較的中立的な視点から学ぶことができる本書は、絶好の入門書である。

McNallyは哲学の正式な教育を受けていないが、哲学に対する深い造詣があることが全体を通して伝わってくる。一方で全ゲノム相関解析やコピー数変異についての最新の遺伝学の研究動向を論じながら、他方で機能についての歴史的定義と非歴史的定義、カテゴリカル診断に伴う疾患の数的同一性のパズル、果ては自然種についての非本質主義に至るまで、これほど高い質を維持しながら論じられる著者は稀有な存在であろう。

One person found this helpful

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hits

わからないことがわかる　著者の幅広い見識が視野を広げてくれる

Reviewed in Japan 🇯🇵 on August 26, 2013

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精神障害とは何か？ネットを見ると、ある症状がいくつあったら～障害です、などわかったように書いてあるが、実は、精神障害とは何か、誰もわかっていないのだ、ということを説明してくれる。
診断基準の話にとどまらず、進化論から、社会環境、などなど、幅広い視点から論じられる。
参考文献も豊富で本書を根元にして様々に好奇心を展開できるし、逆に幅広い分野の人の興味に答えることができる内容である。
精神障害に関わる人には必読と思う。

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