Adam Smith's Possible Thoughts on Mental Illnesses and Sympathy

A discussion on the radio yesterday about the reaction of work colleagues and (strangely) within the immediate family during which a person who had recovered from a mental illness (without saying what was involved) asserted that other people react to physical illnesses with far greater sympathy and understanding than they do to mental illnesses or disorders.

This struck me as odd in that I thought that any illness would attract sympathy from relatives and even some degree with others.

But Adam Smith explains that even within physical illnesses there are degrees of sympathy. The impartial spectator has sympathy for what it understands. Perhaps this extract from Moral Sentiments gives a flavour of Smith’s thinking, which I have lightly applied to mental illnesses (read the chapter for a fuller explanation).

“Pain never calls forth any very lively sympathy unless it is accompanied with danger. We sympathize with the fear, though not with the agony of the sufferer. Fear, however, is a passion derived altogether from the imagination, which represents, with an uncertainty and fluctuation that increases our anxiety, not what we really feel, but what we may hereafter possibly suffer. The gout or the tooth-ach, though exquisitely painful, excite very little sympathy; more dangerous diseases, though accompanied with very little pain, excite the highest.

Some people faint and grow sick at the sight of a chirurgical [surgical] operation, and that bodily pain which is occasioned by tearing the flesh, seems, in them, to excite the most excessive sympathy. We conceive in a much more lively and distinct manner the pain which proceeds from an external cause, than we do that which arises from an internal disorder.”
(TMS I.ii.1.9-10: p 30: Chap. I 'Of the Passions which take their origin from the body', p 27)