As a psychiatrist, it drives me nuts to see immoral and unethical behavior labeled "mental illness". It's a discredit to patients with legitimate mental disorders---and it lets those who make unethical and self-serving decisions to the detriment of society off the hook, by implying that they are in the thrall of some sort of pathological entity, rather than making a moral choice of their own accord.
The largely positive reception that Granny Doc's diary has received from many here upsets me, because it reaffirms for me the prevalence of one of the most disturbing trends in contemporary society--our tendency to view moral lapses as some sort of psychological disorder, rather than than, well, moral lapses. My years of practice in psychiatry has confirmed that in fact there is crazy, and there is evil--and they are not at all the same thing.
Just this morning I saw a woman in treatment for depression, about 45 years old, that was complaining of feeling tired and sad. We discussed her personal situation, and it turns out she is working 48 hours a week, AND caring for two grandchildren (ages 2 and 6) that were dumped on her by her 23-year-old daughter about 8 weeks ago. She told me that her daughter was in New York "partying" and staying with various friends, having left Maine because she was suffering from "depression and anxiety". I asked her if her daughter was depressed or anxious now, and she replied no, probably not, that probably she was drinking, using drugs, and prostituting herself on occasion as she is prone to do. She expected to see her daughter return in the next few days, since she would be coming back to get presents for her birthday in 3 days (!!), and picking up the welfare check for the kids (!!!) so she would have money to go back to New York.
I confronted the patient with her inappropriate characterization of "depression and anxiety", since it was pretty clear the daughter's chief complaint was the expectation that she should provide care for the children. Further review of the history revealed that the children both had severe dermatological conditions that are improving now that the patient is taking them in for medical care, and that the two-year-old is exhibiting developmental delays consistent with chronic neglect. Fortunately the patient is working with DHS to obtain custody of the children, although there is substantial bureaucratic foot-dragging.
The point of all this is that there may be a "mental illness" component to the daughter's behavior--I would venture to say that this is not the behavior of a happy, healthy person--but that does NOT explain the malicious indeifference she has for the welfare of her own children. The vast majority of "depressed and anxious" people I treat are conscientious, thoughtful, and maintain reasonably high moral standards of behavior REGARDLESS of their psychiatric complaints. There is a moral axis that determines behavior as well, one that measures our ability to make choices that are considerate of others around us, and of society at large, that resists emotional and cognitive impairment in most cases. And that axis spans the continuum of good and evil.
As a society we have lost sight of evil, having mostly relegated the term to define Adolf Hitler-types and fantasy villains. In its original incarnation evil did not allude to this Boschian stereotype, but to a malevolent drive that was ubiquitous, mundane, and even banal. Using this broader definition, we can see it as a continuum of behavior that includes all manner of petty crimes and self-serving manipulations--a force that each of us struggles with from day to day, each time we know we're supposed to do the right thing, but want to do something else instead. As I see it, this sort of evil never went away, but rather has been subsumed by a misguided social consensus to regard all misbehavior as a psychological disorder of some sort.
I know full well that when I refer to evil in this more general sense that it bugs the hell out of many of my peers, who identify the word with fundamentalist Christian ideology. For what it's worth, I consider myself a Buddhist, although I'm fully aware that my conception of evil wouldn't necessarily be endorsed by Buddha. My definition of evil doesn't arise from any ideological perspective, but rather from what I believe to be a rational one--that is, full recognition of the dark side of human nature, the side that drives wars, financial exploitation, racism, cruelty, and lust for power, but also the porn industry, the consumption of slasher movies, parents who refuse to fully embrace their responsibility to their children, and every other mundane symptom of selfishness and insensitivity in this world. These are afflictions we bring upon ourselves and each other--not imposed upon us like the whims of a disease.
The more familiar one is with the mentally ill, the more one is offended by the false accusation that is manifest in Granny Doc's title and diary. If you want to see the world as it really is, you have to recognize evil in some way or another, not as some sort of sickness that exists in others, but the unsavory impulses with which we all struggle. The vast majority of mentally ill, when tortured by the worst of these impulses, will choose suicide over homicide. I've worked with many patients who are on the far end of crazy, and have seen that their lack of judgment has led them not to inflict harm, but rather to be victimized--often abused, or financially and/or sexually exploited by the "sane" world. In choosing this idiosyncratic and thoughtless definition of "mental illness", Granny Doc's diary implicitly disparages many victims of this world, and absolves the perpetrators of both their culpability and their stupidity.