Pain is an interesting case. Pain (in medicine) is described as a SUBJECTIVE state rather than an OBJECTIVE STATE. Basically the notion is: If someone says they are in pain then (so long as they aren't lying in order to avoid work or obtain narcotics) they are in pain.

E.g.,

> Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors.

Now sometimes people report that they have the experience of pain even in the absense of nerve stimulation. SOmetimes people report that they have the experience of pain even in the absense of brain activation in the areas that have been associated with painful nerve stimulation. So the subjective experience of pain can come apart from the objective notion of pain and the medical definition tracks the subjective experience. In the case of mental illness, however, subjective distress can come apart from objective dysfunction and mental illness is meant to track the objective dysfunction (in the sense that we classify and treat people against their will if necessary).

Pain is a 'thick concept' (which is to say that it has an evaluative component). Pain is disvalued (bad) by definition. (Massochism creates a problem and there is a bit of a literature on how pleasurable experiences can come to be associated with painful experiences). Mental disorder is similarly a 'thick concept' (which is to say that it has an evaluative component). Mental illness is disvalued (bad) by definition. The idea is that people would be (objectively) BETTER OFF if they weren't in pain and they would be (objectively) BETTER OFF if they werne't mentally ill.

The internal / external problem

Would it be adaptive to not have a negative emotional response to rape? Would the DSM consider rape to be a negative ENVIRONMENTAL event such that my negative emotional response would be excusable (so not a mark of mental non optimality)? How about childhood sexual abuse? Childhood neglect? Those have been found to have a significant impact on later mental illness. But is it really the case that people aren't mentally ill when their symptoms are due to what are fairly obviously environmental events?

One idea is that the response to the environmental event must be 'unexpected'. The idea here is that some people aren't negatively affected by rape or by childhood neglect to the point of displaying symptoms of mental illness. Other people are, however. Since there is variation maybe the people who do respond with symptoms count as being mentally ill because it must be that something is wrong with them that it affects them so. What if 99% of people respond to rape or childhood neglect with symptoms of mental illness and 1% don't... Does that make the symtpoms of mental illness due to EXTERNAL or ENVIRONMENTAL factors rather than malfunction of the person? How do we decide?

> Everything looks like it is worded to "help" the person being evaluated to me?

Sure. What is controversial, however, is how much we should lament the fact that more people don't ask for help (take drugs seek therapy) when we have decided that they have a mental illness. What is controversial, however, is how much we should go on in to india and diagnose and attempt to treat people where indian society (for example) regards the person as being merely different, or in some cases positively revered. We might think we are 'helping' but outcomes of therapy and medication intervention are problematic... It is controversial whether the benefits from medication outweigh the harms from side-effects in quite a number of cases. It is controversial whether the benefits from being categorised as 'mentally ill' outweigh harms of being categorised as 'mentally ill'.

Emotional pain isn't sufficient for mental disorder. It isn't the case that whenever there is emotional pain there is mental disorder. Who has not experienced emotional pain at some point in their life? People in the grip of a manic episode often report feeling WONDERFUL and people in the grip of a psychotic episode often similarly deny that they are experiencing emotional pain. And yet... We slap a treatment order on them and medicate them against their will if necessary.

What justifies that kind of 'helping'?????

There must be an OBJECTIVE (and not merely SUBJECTIVE) definition of 'health' or 'functioning' that justifies psychiatrists (and others) regarding people to be mentally disordered even when subjectively the person denies that they are distressed or dysfunctional.

Part of the colonialism involves trying to persuade people that they have a MEDICAL problem rather than a SPIRITUAL or ENVIRONMENTAL problem. If we can persuade them that this is the case then they are less likely to resist (or refrain from seeking) medical intervention (which begins with a diagnosis of mental illness). In our society people are quick to regard themselves to be mentally disordered and people are quick to run off to medical doctors in the face of emotional pain. In other soceities people are more likely to seek social supports in the form of family or friends or priests or religious leaders. The problem is that we look at people in india and we say 'they are delusional! they are psychotic! they are mentally ill! they need medical treatment!' and we don't have very many qualms with going on in and medicating people to a state that we think is better (e.g., so they don't report hearing voices anymore). Are they better off for our having done so? WE think they are but THEY often don't think they are.

Trouble is that we think that OBJECTIVELY they are malfunctioning / mentally ill. We think we are OBJECTIVELY right and they are OBJECTIVELY wrong. We pity people for not seeing that they have a MEDICAL CONDITION