It is reasonably clear that there can be chronic mental malfunction, when people’s capacities to respond to the world, to absorb and remember information, respond with appropriate emotions, and form coherent plans are impaired. What is not so clear is that the mind can be the self-contained locus of an illness, or whether mental malfunction should always be thought of as the by-product of physical or bodily illness or impairment or whether sometimes the arrow of causation goes the other way. The interpretation may determine whether a subject is approached with reason and argument, or simply as a physical or pharmacological problem.