It can be argued that referring to a psychological disorder as an "illness" is, to some extent, metaphorical. It's been such an apt and useful metaphor that we forget that. Some critics of "the medical model" object to what they call "the medicalization of problems of living." I believe they have a point. A big problem with "the medical model" - IMO - is that it has influenced many to see psychological disorders as forms of brain disease. That involves failure to distinguish the mind from the brain. They are not the same thing. I can agree that the mind is a function of the brain. Destroy the brain, and the mind will be gone. However the mind is not a function only of the brain. It is also a function of experience. You can have a perfectly healthy brain and a very damaged mind. Experience matters. The ideas one believes matter. The habits one has gotten into matter.

The disease model did seem a big improvement over prior paradigms, such as the "possessed by demons" model. One risks censuring, if one rejects the disease model, because others fear that doing so means regressing to a less scientific way of analyzing mind and a return to superstition. However, a lot of what has gone on in psychology and psychiatry is not all that scientific. Ideological bias infects and drives much of it. That tends to boil down to practitioners wondering how they can manipulate the physiology of the brain to produce changed behavior. I liken that to me going to an orthopedic specialist in search of treatment that will make me a better dancer. "Gee, Doctor, all my friends dance better than me. Please find out what's wrong with my legs that is causing me to be a clutz on the dance floor." Dancing is a function of the legs, but it's also a function of other things - like the quality of training that one receives, the amount of practicing that one does, and the availability of a good dance partner to practice with. I can have a perfectly decent pair of legs and yet be a crummy dancer. Likewise, you can experience horrendous psychological distress, despite having a healthy brain. It's a complicated world. Living in it successfully requires a very great deal of good training. Not everyone gets adequately trained.

Asking "What mental disease do I have . . . and is it terminal?" are the wrong questions. (I also don't believe that MSW-counselors should be in the business of diagnosing.) It would be more useful to explore "What difficulty am I having living successfully and getting my needs met?" and "What living skills do I lack?" and "How can I acquire a better approach to living successfully?" Another line of inquiry might be "What's wrong with my attitude?" and "What incorrect ideas do I have about how life works?"

Unfortunately, the disease model has turned emotionally troubled persons into "patients" who need "medical treatment" to correct the physiological pathology causing their brains to not work right. They are so relieved to be told that they have a "sickness" because they believe that means "It's not my fault." I think we'ld be better off figuring that "If I'm chronically despondent, then I must have an approach to life that is not working for me." That is self-empowering.