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Paul Roazen famously quotes Freud as claiming that “[t]he optimum conditions for (psychoanalysis) exist where it is not needed—that is, among the healthy” (Roazen 1992, 160).

They argue that that our concept of mental illnesses is often used to disguise the ways in which mental illness categories enforce pre-existing norms and power relations.

Questions remain about the relationship between the role that values play within the concept of mental illness and how those values relate to concepts of illness more generally.

If mental illness undermines rational agency, then there are questions about the degree to which the mentally ill are capable of autonomous decision-making.

This bears on questions regarding the degree of moral and legal responsibility that the mentally ill can be assigned.

All other forms of distress were though to fall outside of the province of the asylum and of medical treatment.

Non-psychotic individuals who were unhappy with their lives, who felt intense anxiety, or who might vacillate between periods of high and low-motivation were not thought to have psychotic problem.

Historically, the central issue centers on how nosologies (or classification-schemas) of mental illness, especially the Diagnostic and Statistical Manual of Mental Disorders (the DSM), relate mental dysfunctions with observable symptoms.

Mental dysfunction, on the DSM system, is identified via the presence or absence of a set of symptoms from a checklist.

The solution for the unhappiness that many individuals suffered was not found within the asylum but instead from the family, god, or other social institutions.

There was, at this time, a clear distinction between medical problems resulting in psychosis and social problems that caused suffering.

Central questions within the philosophy of mental illness include: whether the concept of a mental illness can be given a scientifically adequate, value-free, specification; whether mental illnesses should be understood as a form of distinctly mental dysfunction, and whether mental illnesses are best identified as discrete mental entities with clear inclusion/exclusion criteria or as points along a continuum between the normal and the ill.

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