i want briefly to consider henry's view that bipolar disorder is a brain disease, treatable with drugs. i do not reject it out of hand, and also i am not really acquainted with the research, so this will be at a pretty high or useless level of generality. now first of all of course the illness is not defined in terms of brain states, but in terms of symptoms: you're down, then you're manic. do that intensely enough, and you're bipolar, whatever your brain states. furthermore, i will stipulate that any particular (token) emotion, thought, etc is identical to some sequence of physical events, (some of them) in the brain. but it's not like we have a bacteria or virus which we can identify as the cause of the symptoms, which is what gives heft to the physiological concept of disease. now what we want to do is see whether, in people that report such symptoms, there are underlying similarities of neural structures or events, pharmaceutically alterable. i am betting that there are such similarities among many, though not all, cases, if we withdraw to a suitable level of generality. but once you give any very precise characterization of these similarities, i'm also betting that there are people with bipolar symptoms who don't display them, and people who don't have bipolar disorder who do. also i'm betting that to encompass as many cases as possible, the characterization of brain states has to become more and more amorphous and impressionistic, taking in as many varied individual states as possible: the characterization of the brain states is from the get-go an attempt to account for as many symptomatically-similar mental states as possible: the reasoning is from symptom to state rather than vice versa. in such a strategy, you will always be able to generate a rough set of symptom-correlated brain states. furthermore, though there are good reasons to think that people who display the symptoms of bubonic plague are all caused to do so by a certain germ, in the bipolar case the relation, to whatever extent it does intend to identify an organic cause, is far, far more elusive, ranging over constructed families of similar brain events. and of course, the matter is correlation rather than causation: the bacteria causes plague, more or less demonstrably. but the brain states, described at a certain level of generality, sort of correlate with the emotional states; either might be the cause of the other or, plausibly, the causal relations are extremely complex.
to just say it's a brain disease is, hence, simplistic. to the extent that this helps us diagnose and treat - to the extent that it makes people less miserable (for one thing by eliminating the disturbing idea that one is responsible in some way for one's emotional disaster) it is useful, though for all that...metaphorical. the "disease model of addiction" is surely exactly like this, and it's embroiled in a whole ethics of responsibility and a whole strategy for treatment. the question of whether it's true or not, no matter how many recovering addicts believe it with total commitment, is a hard question. yes and no. it depends on what you mean, etc.
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