Solastalgia and hubris syndrome considered through the prism of the contesting definitions of mental illness
Analogies can be drawn between solastalgia and post-traumatic stress disorder. Post traumatic stress disorder is a contested diagnosis within psychiatry. Many argue that it is simply a new name for a condition described by Homer (Shay 1995) and recognised by military physicians and psychiatrists under a variety of names (Shepherd 1994). Others argue that is has been “invented” for political reasons (Summerfield 1999) and reflects the subjugation of psychiatry to socio-political imperatives. Uniquely among conditions described in both DSM-IV and ICD, in its definition the cause is specified.Solastalgia would share this quality. Indeed, online commentators from the environmental movement have criticised Albrecht for the perceived narrowness of the focus and his adoption of a medical model of harm induced by environmental change.
It is of course invidious to try and predict what individual thinkers might “make of” solastalgia and Albrecht’s contention that it is a “new mental illness, ” or of Owen’s identification of hubris syndrome as potentially causing more death and disability than any other illness worldwide. However, it seems reasonable to assume that Thomas Szasz would dismiss the idea of both being “new mental illnesses” because he views mental illness itself as a myth. The problem of adjusting to an environment made strange around one is a “problem of living”, and the problem of leaders growing out of control is a political one. The use of the concept of disease in these two settings is simply an error.
Using Boorse’s framework to analyse these entities also leads to interesting considerations. One of Boorse’s initial arguments in his 1975 paper is that what gives rise to ambiguity and difficulty with mental illness is the “territorial ambitions” it has. Psychiatry is laying claim to more of life’s problems, leading to a “medicalisation of morals.” This,rather than basic definitional issues of what is a mental illness, leads to problems. In a sense Boorse partly agrees with Szasz about “problems of living” being the root of at least some “mental illnesses”—the difference being that Szasz would deem all mental mental illnesses so. This would suggest that Boorse would be sympathetic to the view that the concept of solastalgia and hubris syndrome represents medicalisation of the moral fault of man-made environmental change and of overweening power. Boorse’s 1975 argument came in two parts—by positing disease as dysfunction, it preserved a value-free status for medical and psychiatric practice and decision making, while by describing the social components of illness, it acknowledged the degree to which social practices and behaviours within a social context define illness. In the case of solastalgia, what “dysfunction” may be said to underlie the “disease process?” It is not clear, although perhaps the development of psychological assessments of Environmental Distress may aim at identifying specific thought processes. It is noteworthy that Albrecht and colleagues do not propose a “treatment” for solastalgia, but propose further research. It is not suggested that the interviewees reactions are in any way pathological, or that other reactions and emotions are more appropriate or more “functional.”
Canguilhemian notions of illness as a loss of normativity, a loss of the ability to adapt, are consonant with solastalgia’s emphasis on the distress caused by change. Canguilhem’s other emphasis on an understanding of disease that must move beyond the laboratory and detached “scientific” considerations to the setting where distress is experienced is also echoed in the solastalgia literature. Yet the use of a rating scale, with the inevitable emphasis on scores and purported norms, suggests an approach ultimately very different from that of Canguilhem.
Using Fulford’s “full field” model of mental illness, which incorporates both a “value-laden” pole of failure-of-action/illness and a “value free” or “factual” failure-of-function/disease pole, we again hit the difficulty of which, if any, failure of function is being described.There is a similarity between the approaches of Locker and Albrecht in terms of their use of interviews to discover themes in subjective experience. Using the four features identified by Locker, clearly the experiences described by Albrecht’s interviewees are negatively evaluated. They have an ongoing duration and intensity. The experience is not “done by the person experiencing it.” The “sense of injustice and powerlessness” described by Albrecht et al in their paper as characteristic of solastalgia reinforces this. However, one could observe that that the experience could be said to be due to the actions of another—for instance the mining companies. Using this approach, solastalgia describes distress rather than disease.
As for hubris syndrome, Owen suggests neurochemical imbalances that may underly the phenomenon. These are very much suggestions, however, without any definite suggestions as to what neurological circuitry is involved, for instance. Owen also writes that
Hubris syndrome is not yet a diagnostic category of accepted mental illness but it probably stems from a set of genetically codetermined predisposed personality traits. To the psychiatrist any potential new syndrome is likely to be an interaction between genes and environment or nature and nurture. Early biology and upbringing provide the basis of personality which can then be expressed, or not, depends on constraints or opportunities. (Owen, 2008b, p. 431)
While this statement is accurate, it is also extremely generalised and does not point to which aspects of “early biology and upbringing” might contribute to later hubris syndrome.
Owen locates hubris syndrome as stemming from personality traits. The implications of Canguilhem’s thinking on the normal and the pathological for the diagnosis of personality disorders has been discussed by Buchanan (2007), in particular intolerance of “the inconsistencies of the environment.” Buchanan suggests that “one testable hypothesis arising from Canguilhem’s work is that a failure actively to adapt to one’s surroundings represents the final common pathway by which narcissistic, borderline, schizoid, or other traits prevent someone from achieving his or her potential in a range of social and occupational spheres.” Owen describes a rigidity and unwillingness to reverse decisions as being among the criteria for hubris syndrome.
The distress experienced by Albrecht’s interview subjects is real. Is what they are having a “new mental illness”? While there is clearly some journalistic hyperbole at play here, and in their published papers Albrecht and his co-authors are careful to emphasise the preliminary nature of their work, solastalgia serves as a good example of how the concept of “mental illness” is discussed in the public domain. Albrecht is describing a psychological phenomenon and making a link with environmental change.
From the philosophical point of view, solastalgia is extremely broadly defined and seems synonymous with distress due to environmental changes. Albrecht et al powerfully illustrate the distress of their interviewees, but have not shown this is distress to be a mental illness. The weakness of Robins and Guze’s model of defining mental illness is illustrated by this. Essentially it depends on consensus and the acceptance of a phenomenon as an illness by the body of psychiatrists. Solastalgia, especially since the creation of a relevant and reliable rating scale, may in fact suit this definition more readily that any definition rooted in more philosophical rigour.
Similarly Owen provides a checklist of “symptoms” of hubris syndrome. Unlike what is the case with solastalgia, there is no evidence that the individuals purportedly “suffering from” hubris syndrome are experiencing any distress. The threat is more to society in general. Using Locker’s framework, the experience is not negatively evaluated by the person, or experienced as necessarily inflicted from outside on the person. Furthermore there a sense of powerlessness is not (though possibly one of injustice is) associated with the experience. Overall, then, what Owen is described is not pathological for individual but for wider society.
One could surmise that one of the motivations for developing the concept of solastalgia is to try and quantify the immediate health costs due to environmental change and further influence the arguments about environmental policy (a particular issue in Australia, which has a strong mining lobby) in the context of often rancorous debate, rather than to identify a new mental illness per se. Similarly, Owen’s identification of hubris syndrome can be seen as a plea for rule by cabinet and parliament rather than individuals, for oversight over leaders and for mechanisms to avoid the isolation and insularity that can accompany great power.
The language of psychiatry, as seen with Robins and Guze’s approach to defining schizophrenia as an entity, tends to circularity. Mental illness is treated by psychiatrists, and who are psychiatrists? They treat mental illness. This allows the language of psychiatry to be adopted as a form of rhetoric. What both Albrecht and Owen have identified are serious social problems, ones which in different ways can affect the continuance of human life on this planet. Both raise issues that are worthy of consideration by any thinking person. The rhetoric of mental illness, which of course is related to the rhetoric of illness and disease overall, is a powerful tool to raise awareness and to agitate for change. However we should be cautious of identifying new mental illnesses based purely on the laudable motivations of those who expound them.
Special Lecturer and Senior Registrar in Psychiatry
at the Department of Psychiatry and Mental Health Research,
St Vincent’s University Hospital/University College Dublin,
Elm Park, Dublin 4, Ireland.
Albrecht, G., Sartore, G., Connor, L., Higginbotham, N, Freeman, S, Kelly, B, Stain, H. , Pollard, G (2007) ‘Solastalgia: the distress caused by environmental change’, Australasian Psychiatry, 15:1, S95 – S98
Buchanan, A. (2007) Georges Canguilhem and the Diagnosis of Personality Disorder. Journal of the American Academy of Psychiatryand the Law 35, 2; 148-51
Canguilhem, G. (1989) The normal and the pathological. Trans. Carolyn R Fawcett. New York, Zone Books
Clare, A.W. (1999) Psychiatry’s future: psychological medicine or biological psychiatry? Journal of Mental Health 8, 2, 109-111.
Eysenck, H (1968) Classification and the problems of diagnosis. In Handbook of Abnormal Psychology, London, Pitman Medical.
Fulford, K W M (1993) Praxis makes perfect: illness as a bridge between biological concepts of disease and social conceptions of health. Theoretical Medicine, 14, 323-324
Fulford, KM W (2001) Philosophy into Practice: The Case For Ordinary Language Philosophy. Chapter 2, pps 171-208, in Nordenfelt, L. Health, Science, and Ordinary Language. Amsterdam, Rodopi.
Higginbotham, N. Connor L. Albrecht G. Freeman S. Agho. K. (2007) Validation of an Environmental Distress Scale. EcoHealth 3, 245–254
Horton, R. (1995) “Georges Canguilhem: Philosopher of Disease” Journal of the Royal Society of Medicine 88:316-319
Kendell, R.E. (1975). The concept of disease. British Journal of Psychiatry. 137; 305-15
Kendell, R. E. (2002) The distinction between personality disorder and mental illness British Journal of Psychiatry,; 180: 110 – 115.
Kristjanson, EHobbs J.(2001) Degrading Landscapes: Lessons From Palliative Care Ecosystem Health Vol. 7 No. 4.
Laing, R D (1960), The Divided Self, London, Tavistock.
Leopold, A. (1949) A Sand County Almanac, Oxford University Press USA, New York.
Locker, D (1981) The Construction of illness. Chapter 5 in “Symptoms and Illness”, London, Tavistock Publications.
Magree, V. (2002) Normal and Abnormal: Georges Canguilhem and the Question of Mental Pathology, Philosophy, Psychology, Psychiatry 9, 4, 299-312
Megone, C. (2000) Mental Illness, Human Function, and Values. Philosophy, Psychology, Psychiatry; 7 : 1. 45-56
Oxford English Dictionary (2007), online revision 2007, Oxford University Press, Oxford.
Owen D. (2008a) In sickness and in power: illness in heads of government during the last 100 years. London: Methuen and New York: Praeger
Owen D (2008b) Hubris Syndrome Clinical Medicine ;8:428–32.
Rapport, D J. Whitford, W G. (1999) How Ecosystems respond to stress. BioScience49 (3), 193-203.
Rieff, P. (1965) The Triumph of the Therapeutic. New York
Robins E, Guze SB. (1970) Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. AmericanJournal of Psychiatry. 126:983-987
Schaler, J. A., ed., 2004. Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court Publishers
Scheff, T. (1974) The Labelling Theory of mental illness. American Sociological Review. 39, 444-452
Scadding, J. G. (1967) Diagnosis: the clinician and the computer. Lancet, ii, 877-882.
Shay, J. (1994) Achilles In Vietnam. Combat Trauma and the Undoing of Character. New York: Atheneum.
Shepherd, B. (1994) War of Nerves: Soldiers and Psychiatrists 1914-1994. London, Pimlico.
Szasz, T (1960) The myth of mental illness. American Psychologist, 15: 113-8
Szasz, T S (2000)“Second Commentary on Aristotle’s Function Argument” Philosophy, Psychiatry, & Psychology 7.1, 3-16
Szasz, T. S. (2002) Liberation by Oppression: A Comparative Study of Slavery and Psychiatry.New Brunswick, NJ: Transaction Publishers.
Summerfield, D. (2001) The invention of post traumatic stress disorder and the social usefulness of a psychiatric category. British Medical Journal;322:95-98
Thompson, Clive.(2007) Clive Thompson on How the Next Victim of Climate Change Will Be Our Minds” WIRED magazine. Volume 16 Issue 01 dated 12.20.07