I’ve always been curious about catatonia because it brings something into focus I’ve never understood, which I will try to explain. Mental illnesses as far as I can tell are physical illnesses. Calling them mental always confused me. I guess I see them as mental to the extent that a person make choices in their behavior and thinking. But the part of the illness that makes a person have different thinking or behavior is at least partially physical, even if the etiology is unknown (I understand there is also a social component). For this reason I’ve always thought of mental illnesses as syndromes: distinct patterns of behavior with unknown causes. Is there a reason not to view them this way and to refer to them as mental, e.g., mental health and mental illness? I think the confusion for me and maybe other people is that with some disorders like anxiety or depression, there is an extent to which a person can affect their condition in ways that are somewhat indistinguishable from moral fortitude. There is an idea that a person can to an extent have will over their state. In those ways, the illnesses seem mental, but in the ways that they are out of a person’s control they seem physical (which I generally take to mean biological). That’s why catatonia interests me. As I understand it, catatonia is an intractable state. A person who is catatonic cannot will themselves out of the state they are in. It’s not like having the alarm ring and refusing to wake up, even if it’s difficult. So, I guess in some ways, to me that seems very clearly biological when a person doesn’t have will over it. Yet it can be caused by depression—something people can have will over to an extent. So my question is: Is catatonia, before it develops, invariable for the person it will affect? That is to say, if you could run a counterfactual on a person who has catatonia before they develop it and have that person do cognitive behavioral therapy, could it eliminate or reduce the chance a person would lapse into catatonia?