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The discussion of mental illness, including how it differs from "physical" illnesses, and whether it is an "illness" or a general condition, is undoubtedly complex, and has significant ramifications for how those afflicted are treated (socially, medically, in terms of insurance, and otherwise). However, our discussion tonight seemed to lack a crucial aspect of its definition: how those with the illness perceive their condition. Mental illnesses are given an additional dimension of complexity by the fact that, unlike most other illnesses, the patient might not always "know" he/she has an illness, or perhaps more importantly, want it to be cured. Depression offers a simpler case, in that I imagine it would be somewhat rare (although certainly not impossible) for a depressed individual not to know that he/she is depressed (in a general sense, not in a "do I fulfill the DSM criteria" sense), and even rarer for that individual not to desire for the mitigation of that condition. However, a patient who is delusional (putting aside what delusions imply for objective/subjective reality) might dismiss claims that he/she is actually delusional, and resent those who want to treat him/her, let alone "want" treatment themselves. Can someone be ill, and not know it? Can someone be perfectly content with their lives, and still have an illness? Or is it a contradiction to suppose that someone could be "afflicted" while feeling ecstatic or euphoric? Do the individuals have any say in the matter for what constitutes an illness? If not, what do we base our definition of an illness upon? We could choose an abstract definition of "normalcy," but we run into the age-old problem of defining a prototypically "normal" brain if every brain differs. We could use a standard of self-harm (is the patient a threat to him/herself), but would a life chained to a bed under heavy sedation be preferable to a psychotic ecstasy? We could choose a standard of harmfulness towards others, but then is depression an illness? The standard that many psychiatrists have seemed to settle upon is a concept of "functionality": can the patient engage in everyday activities and play a functional role in his/her society? But, as before, have we abandoned placing any importance on what the patient actually wants?