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Disorders: Mental or Medical?

A widespread controversy involves the medical model of mental illness as a ‘‘disease.’’ Interestingly, definitions of disease or illness have the same conceptual difficulties in disentangling a scientific or neutral definition from value statements as definitions of abnormal behavior. All disorders are usually undesirable and harmful according to social values, but disorders are more than just values. They are failures of internal mechanisms that maintain coping behavior as well as psychological and physiological adjustment.

The general concept of disorder applies to both mental and physical conditions, whereas the notion of internal mechanism refers to both physical structures and functioning as well as mental structures and functioning such as memory, perception, and other psychological systems that we shall discuss later. In the former case, the disorder is labeled a physical disorder, and in the latter case a mental disorder. The former involves the physiological response systems, and the latter the psychological response systems. The overlap of the two types of disorders causes confusion among lay people as well as professionals. For example, cancer can cause severe depression, but it should be a ‘‘mental disorder’’ only if the physical illness has caused a dysfunction of the internal psychological mechanisms that control emotional behavior. If that is the case, then the individual has both a physical and mental disorder.

The reverse can also occur. A mental disorder, such as alcohol abuse, can cause a physical disorder (i.e., liver damage). Physical and mental disorders can occur together or separately, but it is important to understand that they are different conditions. The relationship of the two conditions has instigated the growth and development of behavioral medicine and health psychology.

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