A recent New York Times article revealed that Ernest Hemingway spent the last year of his life fearing that the FBI was after him, snooping into details of his life…..and they really were doing that. But, as in many cases, they weren’t doing as much as he suspected they were; he even ended up suspecting close friends of being against him, which of course drove the friends away, leaving him more depressed and alone.
Someone I know, reacting to the story, wondered how much of Hemingway’s fears were due to the FBI being actually after him, and how much due to “mental illness.” I didn’t think that was a helpful way to try to understand what happened, and I wrote the following in response:
I think one reason a lot of people don’t like the term “mental illness” is the way it obscures the way people’s behavior can often be an understandable reaction to difficult life events.
If we look at Hemingway in terms of “mental illness” we would say that the “mental illness” made him be overly suspicious of his friends and of random strangers. If we think of “mental illness” as being the cause, we might think less about the role the FBI played, or less about how some of Hemingway’s personal strengths might have actually led him to be more vulnerable in some ways to the paranoia that engulfed him – for example if he had been less vigilant to start out with, and so have missed seeing that someone seemed to be “after” him, then he might never have nurtured the suspicions that grew into paranoia.
If we look at it in terms of life story, we might say that various life stresses, including the FBI secretly intruding into his life, created some challenges for him, and he made some mistakes in the way he reacted to them, tipping him into a state of being overly suspicious etc. In this case we have an interaction between a talented if imperfect human being and some difficult circumstances, with “mental illness” playing no causal role.
Of course, some would still say that while there perhaps was no “biological mental illness” that caused the problem in the first place, that Hemingway became mentally ill as a result of what happened and then the mental illness was a cause of future events that occurred. Certainly it is true that once a person starts experiencing things and reacting in a problematic way, that style of thinking and reacting then influences the future, but I think the danger of calling this all a “mental illness” is that it makes it easy to forget that the thoughts and reactions emerged out of a history of events, and that the problematic pattern of thinking and reacting could again change given the right sequence of corrective events. “Illness” is just not a great metaphor to describe these patterns and possibilities.
Overall, I am opposed to using the term “illness” for mental and emotional difficulties that cannot be diagnosed by physical tests. I think this typically results in over-simplification of the issues and over-privileges medical approaches.