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Book Review: The Myth of Mental Illness: Foundations of a Theory of Personal Conduct Thomas S. Szasz, MD

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Just in time for April Fool’s Day, we have the re-release of a book that sets mental health back fifty years. Too bad the author isn’t kidding. In an updated version of his 1961 book, The Myth of Mental Illness, Thomas Szasz again is out to convince the world that there is no such thing as mental illness. Is he nuts or what?

Szasz’s argument would seem wholly based on semantics, if not for the fact that he dismisses some mental disorders, such as “so-called schizophrenia” (which, of course, is suffered by “so-called schizophrenics.”) Don’t worry he’s not out to alienate the mentally ill (who don’t actually exist); he manages to insult everyone working in the mental health field, families of the mentally ill, women, Christians, and Jews, as well as those suffering from mental illness.

Szasz is hung up on the terms “mental illness” and “mental disease.” He uses, as his guideline, a very narrow definition of illness, on which he then bases his attacks. He does not address genetic links to mental disorders, brain chemistry, or much of anything from the past 50 years. What he does discuss is hysteria. Szasz uses hysteria as an example of why there is no such thing as mental illness. He also uses lots of words. Over and over again. There is so much repetition, that we feel we’re being brainwashed. However, at times when an example would clarify a point he makes, it’s not offered.

We also feel that if we were to disagree with Szasz, he would say that’s because we already are brainwashed by the psychiatry establishment. Full of kind words for psychiatrists, he compares them to alchemists and astrologers; he likens the practice of psychiatry to rape and slave-holding. Szasz, obviously suffering from some childhood trauma, repeatedly goes after Freud, attacking his work and intellect. You won’t hear me defending Freud, but c’mon, enough’s enough!

There’s got to be a reason why none of my college psych courses included The Myth of Mental Illness on their reading lists. Szasz admits that his view was/is controversial, and that he was demonized by many people working in the mental health field (which can’t possibly exist — if there’s no such thing as mental illness, how can there be mental health?); he also stands by his original work. He peddles a conspiracy theory that charges government, the courts, doctors, lawyers, hospitals, and assorted health workers with exploiting the healthy.

Szasz seems to regard everyone working with mental disorders as scammers perpetrating a fraud against healthy people. I am not quite sure why a book that takes on hysteria as its major mental disorder is even relevant, unless it’s because Freud worked with hysteria, and this work definitely says, “Down with Freud.” For those who haven’t gotten past Freud-bashing, Szasz is THE MAN.

According to Szasz, hysteria is not an illness of the mind, it is a language. It is the means by which some people express their feelings. Is psychotic behavior a language? Do people who suffer from major mental disorders like schizophrenia and bipolar disorder (which isn’t even listed in the index) get something out of their demons?

I can’t remember ever reading a book that made me as angry as The Myth of Mental Illness. Think of people who live normal lives because they use medications that keep their brains on track. They weren’t ill? When dismissing these disorders, he overlooks advances such as technology that allows doctors to see what is happening inside a living person’s brain, that shows abnormal brain activity in persons exhibiting symptoms of mental disorders.

In describing the diagnosis of mental illness, Szasz states, “The alleged sufferer (especially the ‘psychotic’) considers himself neither sick nor disabled; but others insist that he is both. The role of mental patient is thus often imposed on persons against their will.” Here he totally dismisses people who recognize that they have an illness and proceed to get help. Szasz writes a lot about people who are “declared” insane and who are involuntarily treated. He claims that they are prisoners and are misused. Is that the majority of mentally ill people?

Since psychiatrists treat their patients with “talk therapy,” Szasz seems to think that proves mental disorders are actually communication problems. He also has a lot to say about malingerers, people who fake illnesses (and he complains that people who fake illnesses are believed to be suffering from an illness).

The Myth of Mental Illness is such a disservice to society, I am amazed it has supporters. That Szasz, despite the research, discoveries, and advances in this field in the past fifty years, adamantly defends and clings to every word in his original work is disturbing. The new preface and two bonus essays included in this printing make the same old arguments, and they are tiresome. His concern for civil liberties is admirable, but misplaced. No doubt Szasz is better educated and more experienced than I, but I wouldn’t let him treat a family member for a splinter, no less bipolar disorder or major depression.

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About Miss Bob Etier

  • Day thgiN

    Wow I am completely offended by this author, unbelievable and to me it’s proof that there is much truth in this. As for it doing no benefit for society? Fuck society and fuck this journalist. Another minion for the corporate control agenda to disenpower individuals and make them think they are messed up, when the reality is that society is messed up.

  • Costello

    The article author seems to protest too much

  • I’m staggered as to how this rant was published as a book review when it is clearly more of an opinion piece.

    I think the book makes many relevant points and would endorse the views of Erminio Costa above.

  • Erminio Costa

    It beggars belief that intelligent people can’t see through the agenda of the wealthy pharmaceutical industry and its cronies in the psychiatry “profession”. Its about offering a placebo to people who are experiencing self inflicted distress and making them addicted to the placebo. Psychiatrists, convinced that the chemical imbalabance in the “mind” is the cause of aberrant human behaviour are satisfied. Pharmaceutical companies rake in enormous profits. Everyone wins. Except the patient. The properties of the drugs have long term side effects. Not only that but the cause of their behaviour derived from an emotional state has not been addressed. Personal responsibility for behaviour is removed – “addiction” exonerates people from accepting the consequences of their actions. The public is only to happy to wallow in self pity while the pharmas rake in billions upon billions. Voices of reason, even if clearly agnostic, are silenced. True happiness and “freedom” is to lead a rational life, conscious that not all events in life will have satisfying outcomes – relationships fail, we experience sickness, economies rise and fall etc. Our interpetation of these events is what drives behaviour not chemical imbalances which are out of our control.

    • Day thgiN

      Sooooo beautifully put, thank you brother!!!

  • the real bob

    Actually, I don’t need to go away and do some research.

  • darren

    Miss Bob Etier. What advances in medical psychiatry are you referring to? The development of atypical anti-psychotics? The development of Selective Serotine Re-uptake inhibitors? Ah perhaps your referring to the use of anti-psychotics on the elderly with dementia? I think you need to go away and do some research. SSRI’s historically do little better than placebo (fact). We do not know and cannot measure what serontin is (fact). We still do not understand how the chemistry of the brain is affected by anti-psychotics. Ah you must be referring to ECT. Have we gained any insight into how ECT works? Nothing at all. These treatments have a few things in common. Firstly, we don’t know precisely how they work it is all hypothesis. Secondly, we usually find out through research that they are harmful (e.g. anti-pscyhotic usage with dementia patients) As we did with comma induced therapy, cold water immersion and every other crack pot treatment tried. Like treatments, diagnosis morphs and one diagnosis is replaced with another in a self-perpetuating cycle of self-breeding so that every single ailment of the human condition is folded into “mental disorder” (I use the Mental Health Act 1983 amended 2007 definition).

    What has changed is the respect agenda, human rights and the right to autonomy; not medical advancement psychiatry remains aetiologically non-specific. However the social construction and evolution of and oppressive nature of psychiatry continues. Most general doctors pour scorn on psychiatrists usually because they can’t handle general medicine. They are glorified overpaid pharmiscists (in my experience pharmicists know more about the medications than the psychs)patients receive 10mins of medication management thats their input, when they’re not attending pharmaceutical lunches or jollies abroad.

  • Ignore the last line above.

  • thePod,

    Szasz’s present affiliation with Scientology should be no kind of reflection on his original work. So your inference is invalid, because it is based on post factum.

    You could argue, of course, that Szasz may have joined the Scientology group precisely because they stand in opposition to the psychiatric profession and community, but that’s a horse of another color. [Whereas you’re putting a cart before the horse.]

    Besides, The Church of Scientology wasn’t even around at the time; and even

  • Here’s the link: Psychiatrists Respond.

  • Herb

    Thomas Szasz is the darling of Scientologists, so – brace for incoming?

    In the meantime, enjoy this: Thomas Szasz: Psychiatrists Respond

  • thePod

    Mr Etier: Spot on (“hung up on the terms”)
    (“very narrow definition”)(“so much repetition”)

    This should explain (and support) it all”
    “The trick is — WORDS ARE REDEFINED TO MEAN SOMETHING ELSE TO THE ADVANTAGE OF THE PROPAGANDIST. Many instances of planned and campaigned in order to obtain a public opinion advantage for the group doing the propaganda. Given enough repetition of the redefinition public opinion can be altered by altering the meaning of a word. The technique is good or bad depending on the ultimate objective of the propagandist.

    “‘Psychiatry’ and ‘psychiatrist’ are easily redefined to mean ‘an anti-social enemy of the people’. This takes the kill crazy psychiatrist off the preferred list of Professions… The redefinition of words is done by associating different emotions and symbols with the word than were intended…Scientologists are redefining ‘doctor’, ‘Psychiatry’ and ‘psychology’ to mean ‘undesirable antisocial elements’…The way to redefine a word is to get the new definition repeated as often as possible. Thus it is necessary to redefine medicine, psychiatry and psychology downward and define Dianetics and Scientology upwards. This, so far as words are concerned, is the public opinion battle for belief in your definitions, and not those of the opposition. A consistent, repeated effort is the key to any success with this technique of propaganda.” – L. Ron Hubbard, Hubbard Communications Office Policy Letter, 5 October 1971, PR Series 12, “Propaganda by Redefinition of Words”

  • Oh, I guess I’ve been spelling the poor guy’s name wrong all this time! Anyhow, I think that connection is vital to any social enterprise. And I imagine that’s the main struggle that mankind will always be faced with.

    I’m not a pessimist nor pie-eyed optimist about the future. My best guess is that human beings will forever be trying to keep a balance. Well, maybe not a perfect balance, per se, because I’d hope the scales would be tipped in favor of mercy, forgiveness, second chances, etc.

  • Well, to spirituality and, indirectly, to morality and human values.

    One of Szasz’s strong points was his insistence on the necessary connection between therapy (any psychiatric practice, in fact) and moral values.

  • Hmm.. not sure if you checked or not but the title of my thesis was “Synchronicity and Postructuralism: C. G. Jung’s Secularization of the Supramundane” (1997).

    This might seem like a bit of a jump but the psychiatrist Jung said that synch. and numinosity can occur together.

    Not many people realize that Jung was a full-fledged medical psychiatrist. But he was, which brings us back to Szaz.

    I think contemporary psychiatry might benefit from a more nuanced approach to spirituality. I’m not sure about the latest DSM-5 (to be released in May 2013?) but past manuals seem to recognize spirituality as long as it conforms to some kind of standardized group belief (as with a Church, for instance).

    Not much room there for individual innovation–i.e. mavericks, pioneers of the spirit, and so on.

  • Precisely. The semantic relationship is all there staring you in the face. It’s only a question of secularizing the religious content, but given Greek classical, anthropomorphic culture, I would argue for a relationship in reverse – namely, one of deifying the secular.

  • That’s funny because another Wiki entry that I looked at said the two terms, Kant’s and Otto’s, are not etymologically related–i.e. it was far more definitive than the entry you mention.

    “He coined this new term based on the Latin numen (deity). This expression is etymologically unrelated to Immanuel Kant’s noumenon, a Greek term referring to an unknowable reality underlying all things.” >> Rudolf Otto

    But even if the words are not etymologically related, they can still point to a semantic relation, however imperfectly.

  • The Greek characters don’t post.

  • My first reaction was, it’s the old Kantian usage, and I was right. As per the following:

    “?????????” is the nominative, neuter, singular, middle/passive participle of the ancient Greek word, “????? (noein)”, which in turn originates from “nous” (roughly, “mind”). Noumenon does not refer to “numinous”, a term coined by Rudolf Otto who, though well versed in Kant, drew the term from the Latin word numen which means deity, divine will or divine presence; it is unknown however if the ancient Latinate etymology of numen itself is not of Greek origin.


  • Roger,

    It’s funny because one of the first things I said to one of the profs at the U. (in a preliminary interview before signing up for my Ph.D) was that “we needed more discourse” about what I then called, “persons of numinosity.”

    I’m not sure if you are familiar with the term, numinous. It was coined by a Lutheran, Rudolf Otto, as an attempt to get at some of the varieties of religious experience.

    I mention this because IMHO the numinous can come into play for individuals undergoing a personal quest–i.e. transformation.

    So yes, I agree. The more we talk about this stuff, the more that can ripple out into the social nexus and effect positive change.

  • To follow up, my (theoretical) interest is how to enlarge on personal “self-transformation” – a relatively easy thing to do, for some – so as to bring others “into the fold” and affect a sort of “societal transformation.”

    Which is why we’re exploring right now the concept of community as on possible end result/accretion of a “personal quest” when applied to, and hopefully realizable in, “the social.”

  • MC,

    That’s why I put “creative resistance” in scare quotes. Foucault himself spoke of necessity for a kind of “self-transformation,” not of resistance in terms of liberation movements or attaining greater autonomy, because resistance (to power) is self-defining and only perpetuates the existing social order.

    So we are on the same page, more or less.

  • Roger,

    My main interest these days is to combine theory and practice by doing a kind of postmodern theology. By that I mean deconstructing just about everything while engaging in a serious attempt to “do the right thing.”

    Having said that, I do believe in God and an individual, transhistorical self. I should state this bias right at the outset.

    When I speak of the creative aspects of power, apropos of Foucault’s later works, I’m not only referring to the idea of personal or subcultural empowerment. I’m referring more to the idea that successful discourses have a tendency to create social knowledge (and thus inform ways of thinking). And this is not just an abstract, cerebral process; the tangible effects of these relative truths are often quite real.

    For instance, within the mental health debate, we only have to think of the potential short and long term side effects of many medications. While medications can no doubt be of benefit to certain individuals, I think some may suffer needlessly due to incompetent practitioners.

    I’m not sure if this issue of competence vs. incompetence within psychiatry has cropped up yet. But in any case, I think it’s a worthwhile point to consider.

    As for my own agenda, because I’m not a revolutionary personality type like Karl Marx, for example, I’m really talking about tweaking existing structures for the common good. I guess I believe in social evolution (another potentially complicated issue!). So instead of “creative resistance” I’d probably prefer to say “creative redirection.” It’s a soft approach. But as Jim Morrison once put it… “The soft parade has now begun!” 🙂

  • Thanks for responding, MC.

    You’re quite right, we’re not antagonistic in the wrong sense (although disagreements ensue), but I believe we all share the value of an open-ended discussion.

    My agenda is to explore the ramifications of the current “social theory” to the fullest, to the cutting edge as it were, and I’m certain Cindy’s aims are no different. Besides, we have another resident philosopher on the thread Mark Eden (see his comment early up the thread) who serves as sort of stop-gap – keeping both of us honest and from “running ahead of ourselves.” So we do have a rather special, congenial group – but I feel there’s definitely a need for “new blood,” especially since the subject matter is one of your specialties.

    In particular, I would be interested – actually, am interested – in exploring the positive aspects of “power” somewhat latent in Foucault’s latter works, for therein, I believe, lie answers to the proper kind of stance we as individuals or groups of individuals can take by way of “creative resistance.” As you shall see, we’re already exploring this aspect of Foucault’s studies.

    So in any case, please feel free to join in as your time will allow. I’m certain all three of us would very much welcome your contributions and input.


  • Roger,

    Thanks very much for the invite. I am interested in much of what you and Cindy are talking about. And it seems I could learn from both of you. If I can find time I’ll certainly drop by.

    I usually don’t get into long threads because in the past they’ve been antagonistic, and too time and energy consuming. But you both seem committed to positive dialogue, which is nice.

    I bit at this one because my doctorate was about Jung’s concept of synchronicity and Foucault’s poststructuralism. I was interested in how Jung was “selling” the concept–i.e. making it acceptable for a Western audience. The closest thing I’ve come to the concept of synchronicity might be Lacan’s synchrony. Although a Lacan expert disagreed when I tried to include it in my thesis. Hence, it’s all been removed from the final version.


    When I was younger I was probably more inclined to view psychiatry as a monolithic power-truth-defining scheme, if you will. But these days I tend to see social realities as more complex. And I think Foucault would agree with this kind of approach. His notion of discourse includes the idea of counter-discourse. So whenever a truth claim is generated, something arises to oppose or modify it.

    As you probably know, Foucault saw history in terms of struggle.

    Regarding other thinkers, I tend to extract and modify some of their ideas for my own agenda. I doubt I would entirely agree with anyone. But I do find value in other people’s ideas and tend to apply them… my way.

    Btw, sorry for assuming lack of familiarity with Foucault and PM ideas. I can see that both you and Roger are very up on these things.

  • Thanks. I’ll have a look tomorrow if I get a chance. Back to the grindstone tomorrow. Better go to sleep now. Night night.

  • And addendum to Szasz’s link from Lacan on schizophrenia.

    Haven’t read it yet but will. I haven’t got into S’s political views (will look up your link/s), but it would appear to me he sort of indirectly expresses them at the end of the cited digest.

    Well, not “political” views per se, but views concerning the need for persons to take responsibility. So one can extrapolate from there.

    And since, I’m at it, here’s another book on Lacan, a collection of essays, which I intend to get: it indeed looks interesting. Plus, I think I might import parts of this thread to our discussion circle.


  • Good link, Roger. A little summary.

    Here is something worth noting: Szasz’s Political Views. He was apparently a right-wing libertarian.

    Szasz’s political views, inasmuch as they are about regulating relations among citizens, can be characterized as “libertarian,” at least, when this word is understood in the meaning that the word “liberal” had for the founders of the United States of America. Szasz often quotes these Founding Fathers approvingly, and he not infrequently refers to the United States Constitution in his arguments. In Law, Liberty, and Psychiatry he even dedicated a chapter to it, in which he notes which basic legal rights are unjustly denied psychiatric patients.

    Laing was a leftist. Laing was brilliant. Laing said things like this:

    “The specifically human feature of human groupings can be exploited to turn them into the semblance of non-human systems. ….All those people who seek to control the behaviour of large numbers of other people work on the experiences of those other people. Once people can be induced to experience a situation in a similar way, they can be expected to behave in similar ways. Induce people all to want the same thing, hate the same things, feel the same threat, then their behaviour is already captive – you have acquired your consumers or your cannon-fodder. Induce a common perception of Negroes as subhuman, or the Whites as vicious and effete, and behaviour can be concerted accordingly…..

    The inertia of human groups, however, which appear as the very negation of praxis, is in fact the product of praxis and nothing else. This group inertia can only be an instrument of mystification if it is taken to be part of the ‘natural order of things’. The ideological abuse of such an idea is obvious. It so clearly serves the interests of those whose interest it is to have people believe that the status quo is of the ‘natural order’, ordained Divinely or by ‘natural’ laws. …The group becomes a machine – and it is forgotten that it is a man-made machine in which the machine is the very men who make it. It is quite unlike a machine made by men, which can have an existence of its own. The group is men themselves arranging themselves in patterns, strata, assuming and assigning different powers, functions, roles, rights, obligations and so on.”

    Ronnie Laing – pp80-1 / Ch.4 – The Politics of Experience. [1967]

  • Alan: from (#1) “I suppose you also fault Tolstoy’s War and Peace for ignoring Predator drones and Apache helicopters armed with laser-guided missiles. A classic book must be considered as a product of its times.”
    You missed the point of my analogy. I had no intention of comparing the work of Spock to Szasz, nor their different fields. I was addressing the point that you brought up regarding old men changing their minds. Spock constantly updated his work to include new findings and new information. Szasz did not.

  • Here’s a digest.

  • Laing just thought it was caused socially.

  • Yes, I am certain. (Still, I haven’t read the book since I was a teen.)

    This is my rough idea of what Szasz believed: He believed that ‘illness’ is the result of a physical ‘abnormality’ or ‘disease’ (my words). Because there is no discoverable physical ailment component to a mental state, then how can there be ‘mental illness’? Ipso facto mental illness is a myth. It is a fiction.

    Now the part about psychiatry being an oppressive and coercive system is the part I agree with him on and I agree with Foucault and with Laing.

    But, Szasz was critical of Laing for the very reason that Laing did ‘believe’ in ‘mental illness’ in a sense more than Szasz did. This quote is a good way of putting it: Thomas Szasz attacked Laing for his lack of rigour (Mullan 1995) and although Laing agreed that the term mental illness is a metaphor, he argued that it mapped onto reality.

  • His life is of no concern to me, his thought is. And yes, people can be blinded by their own ideas, especially if they’re powerful ideas. (So I’m not going to judge him as a person.)

    Besides, I’m not exactly certain that he denied the possibility of genuine mental disorder in his original work. Are you certain now he made no kind of allowance?

  • Exactly. That’s why to focus on exceptions is to be taking a detour from the topic.

  • I’m drawing a distinction between social and individual pathology.

    I consider psychopathology to be based in the social realm rather than the biological realm. Are you in agreement? Or are you saying something else?

    I’m not aware of his contemporaneous sins. Only referred to his original work.

    Okay, well, his contemporary sins (as I said in my comments above) are: 1) that he never ever modified his position, and 2) he cofounded an organization with one of the most destructive and powerful cults in the history of the world. He was so blinded by his own ideas that he either didn’t seem to notice (was he stupid?) that he was in league with the devil OR he intentionally joined with this cult despite knowing this in order to promote his ideas, because he was either obsessed or egotistical, or somehow or other personally deficient.

    One cannot team up with the cult of scientology and in my book be both rational and good. One is either nuts to do so, or evil.

  • I’m not aware of his contemporaneous sins. Only referred to his original work.

  • I’m drawing a distinction between social and individual pathology.

  • I am only holding his current trespasses against him.

  • Roger,

    I don’t really understand your first sentence. Can you reiterate?

    Sentence 2 & 3: Ah, okay, now that makes sense to me! And I agree 102%! However, until the society changes people are bleeding. But, I want to cure an individual depressed person–whose depression, I would agree is caused by the state of society. Making them wait until society changes is selfish. In fact, they may be in a better position to change society after experiencing its deleterious effects upon them, from a well mental state which may require medication rather than by actually making them wait until society changes…

    So, I don’t see medication as an end goal. I do see social change as the real need. But if society causes me a headache, then I still want an aspirin. I argue that we can offer splints and bandaids and sutures during the war without forgetting that we need to end the war.

    As to your last two paragraphs, I agreed wholeheartedly throughout my comments. I hope you saw that. See my first comment to Alan about Szasz. I prefer sane people, like Foucault and Laing to nuts like Szasz though. And I say he is nuts mostly because of what he has done contemporarily rather than 50 years ago.

  • Well, you know Cindy that I’ll be first to admit existence of exceptions (e.g, mental disorder of organic variety, a “criminal mind,” as it were, a psychopath, etcetera and etcetera). But exceptions don’t prove the rule.

    And the whole stress of much of the postmodern thought has to do with social, not individual/personal pathology, with “social” identified as the root cause.

    It is for that reason why stress on medication runs counter to the spirit of the postmodernist critique – for it makes us take our eyes off the ball.

    I hope you understand where I was coming from. And regardless your antipathy to Szasz (we’ve been over this before, see, I don’t really forget anything), his kind of work, along with Erwin Goffman (and Foucault of course) was pioneering work – to alert all of us to the extent to which the mechanism of “social deviance” was but a means of social control, again, not necessarily by way of conspiracy but in a Foucauldian, insidious kind of way – the way of power.

    It is for that reason that Szasz and the others are important – despite the radical position taken. And taking a radical position was precisely in order in order to alert us to “alternative social reality.” It was strategically sound, even if not altogether accurate or true to facts.

  • He who controls the ‘truth’ also gets to decide which version of reality dominates.

  • 41 – MC,

    Is it that you were just being careful about the ‘conspiracy’ thing because most people seem to think along those lines: that in order for the whole Foucaldian power thing to work, a conspiracy is required?

    I don’t think a conspiracy is required either. Mark (who posted on the first page) put it well once when he said it is more a collaboration.

    The very fact that psychiatry updates the DSM every now and then can be taken as evidence that it’s a self-correcting science and not an oppressive ‘regime of truth’ as some extremists would have it.

    I think this can be taken as evidence maybe that there is no conspiracy of evil masterminds trying to control truth in an orchestrated completely conscious way. But, I do think Foucault was right about power; I just think it is insidious. He who controls the ‘truth’ makes the rules.

    I am a little confused–not sure whether you are agreeing with Foucault or disagreeing.

    BTW, I am familiar with Foucault because we have been studying him in that thread Roger pointed you to for the last 6 months, it seems. But I really appreciate your clear and careful explanation. I would have understood it even if I was not familiar with him and that is a difficult thing to explain.

  • You should join our discussion group on Foucault and postmodernist thought, MC.

    Here is the link: discussion.

    I didn’t mean to beat Cindy to the punch, but I’m certain she would concur.

  • Roger – Right you are. I was actually referring to Szaz there, along with the extreme anti-psychiatry advocates. The fault is in my writing. It could have been more clear.

    Cindy – Toward the end of his career Foucault came to believe that power is not just oppressive but also creative. This means that power has the ability to create social “truths” or, if you prefer, instances of “social knowledge.” But these truth claims are relative to a given culture or subculture and not trans-historical or absolute.

    From this, many postmodern thinkers have picked up on Foucault’s ideas to “deconstruct” truth claims that are taken for granted within a given social group or subgroup. To deconstruct simply means to look at something and ask… hey, is this really right? Could we explain this another way?

    Foucault himself was gay, and he deconstructed the notion that homosexuality is “unnatural,” citing instances in ancient Greece where homosexuality was, to some degree, acceptable.

    Interestingly enough, the DSM used to classify homosexuality as a disorder. But the APA changed that around 1970 (I can’t remember the exact date offhand). Some see this as evidence that psychiatry isn’t a science but simply bends to popular opinion. Others see it as evidence that psychiatry is scientific and self-correcting. Meanwhile, some traditional religious people see it as evidence that psychiatry can be swayed by Satan.

    It’s a complicated area to be sure. The mind involves so many things… nature, nurture and, I would add, spirituality.

    I hope this makes it a bit more clear!

  • Well, I just read you as being contrary, so I decided to lay off. But angry?

    You didn’t attack me or anything, not that I recall.

  • I assumed you might be angry because you said that you might say something you regret. Isn’t that when people generally do such things, when they are angry?

    Now, I see what happened. You might say something you would regret because you thought I was in a mood. Okay, that would be reasonable. But I didn’t think of that because I was not in a mood at all. I was entirely straight, serious, and relaxed.

  • Why should your reply make me angry? If I didn’t respond, it’s because I read you as being in a mood. But moods pass.

  • The main point I got was that you were calling into question my support of medication as opposed to talk therapy. You stated (approximately) that supporting medication would go against everything I stand for. I say that is a pretty controversial thing to say. Funny enough, at one time I would have agreed with that.

    As for saying things you would regret. I guess that it’s you who might be lucky not to say things you regret rather than me. I will take you for what you are. If you want to say things you regret, if my reply made you angry for some reason I can’t figure out, I’ll deal with it.

  • I’ve just re-read your #25, and I can only reiterate:

    “Except for organically-based mental disorders, other forms of therapy are just as effective.”

    This is a categorical, i.e., definitional, not a factual statement. I have no way of telling which disorders are strictly organically-based and which are not. And I’m certain this matter is a subject to disagreement even among practitioners.

    And when I spoke of “psychiatry,” I had in mind a more encompassing term than what may be in current use and delimited to dispensing of drugs – which is to say, inclusive of anything connected with mental health. (Psyche in Greek stands for “soul.”)

    And given that sense, therapy is also part of the psychiatric practice, as well as administration of drugs.

    Consequently, I don’t see why my rather balanced statement was controversial.

  • You should be glad.

    I did not want to say what I might regret.

  • Ok, that’s cool, then.

  • I preferred to skip it, Cindy.

  • Ouch Roger, I didn’t see that post. I hope MC will answer anyway with what s/he(?) thinks.

    Roger, I posted to you on the previous page. Not sure if you saw it or not. Or you preferred to skip a reply. I was curious about your thinking.

  • MC –

    28 is very intriguing. I’ll have to think about my response awhile. Meantime, do you think Foucault saw a grand conspiracy? Further, whether ‘yes’ or ‘no’, how does this relate to your analysis of what you are calling ‘socially’ created ‘truth’? That is how do you tie in your idea of what Foucault is saying with what you are saying?

  • At least you’re trying to fair and balanced, MC.

    BTW, when Foucault spoke of “mechanisms of power,” and the various strategies that “power” deployed, he wasn’t talking in any naive sense of there being any conspiracy.

  • FCEtier (#27), you’re actually comparing The Common Sense Book of Baby and Child Care with The Myth of Mental Illness? Spousal loyalty (even unacknowledged, as you ought to have done) is gallant, but that’s a stretch. Pediatricians are to psychiatrists as Nobel laureates are to witch doctors.

  • Thanks Cindy.

    Emm, thank you too for the refresher! It’s been a long time since I sat in psyc. courses at undergraduate university (mid-1980s). My memory told me there was a basic distinction between casual and correlational experiments.

    After snooping around on the web last night I realized the distinction is, more properly, between the experimental and correlational design. Some sites seem to suggest, as some profs might have in my undergrad. courses, that experimental designs could infer causality if confounding variables were carefully controlled. But in the next paragraph these sites would also admit this is very difficult to achieve, for various reasons.

    Okay, so now that I’ve brushed up on my clinical psychology, I’ll switch to the sociology of science, just as I switched my major from psychology to sociology before graduating…

    And I guess the point to be made here is that once the idea of, say, chemical imbalance, filters down to the social services and advertising level, it’s often treated as if a causal relationship exits between that idea and mood disturbances. I remember seeing an ad to this effect on TV, replete with a simplified cartoon, telling viewers that “depression is caused by a chemical imbalance… and buy this medication to fix it.”

    Now, many people haven’t taken the time to research nor carefully think these things through. So the idea of chemical imbalances becomes a kind of social “truth” in the Foucauldian postmodern sense (someone mentioned Michel Foucault here earlier).

    I don’t see this as a grand conspiracy, however. I believe that many scientific researchers and practicing psychiatrists are decent, well-meaning people who sincerely wish to help people. And they can’t control how psychiatric ideas are disseminated in the media and through other social apparatuses.

    So Szaz has it partly right in that a socially generated idea gains more legitimacy and power than it really deserves. But I think this just happens, mostly due to lack of education and the prevalent desire for quick answers and equally quick remedies.

    Again, I don’t see any grand conspiracy. I think that is off base and unfair. The very fact that psychiatry updates the DSM every now and then can be taken as evidence that it’s a self-correcting science and not an oppressive ‘regime of truth’ as some extremists would have it.

    Having said that, there have been a few stories on the web about abuses in some countries where political opponents have been institutionalized on the basis of their being “mentally ill.” And that kind of professional abuse is frightening. But it would be flat wrong to generalize those extreme instances to every psychiatrist in every nation.

  • 1) “The Common Sense Book of Baby and Child Care” by Benjamin Spock, M.D. was originally published in 1946. According to Jay Parini in his analysis, “Spock’s own ideas would certainly develop, even shift, in subsequent decades, and he revised his book again and again, always taking into account new research in medicine and fresh ideas.” Obviously Szasz was not of a like mind.
    2) Szasz wrote the preface himself to this most recent edition. I wonder why none of his legions of supporters didn’t step forward and honor his work with a testimony in another voice? Isn’t that type of loyalty common with significant new publications of classic works?

  • 17 – MC

    I think that is an excellent point.

  • Roger,

    I merely said that psychiatry, as a field, is concerned with medication and that I’ve never heard of any psychiatrists who actually practice psychoanalysis; psychoanalysis, of course, being associated with psychiatry specifically, not with psychology or psychologists, in general. People generally go to a psychologist for psychotherapy unless they need medication. Then they are referred to a psychiatrist and may continue to see both a psychologist for psychotherapy and a psychiatrist for medication. So, I didn’t actually say what I think, one way or another.

    But, now that you mention it, why should the idea of medication, in general, go against everything I stand for, as you say? Why should I have something against medication that works to alleviate mental pain or suffering when I have nothing against medicine to alleviate physical pain or suffering? These are not the days of thorazine as a standard, after all. people don’t have to be zombies. Also, I presume by biological you are talking about bipolar and schizophrenia and not, say, unipolar depression? I think it would be a mistake to be forced to suffer with depression endlessly and needlessly for years while being subjected to pointless talk therapy when an antidepressant could be brilliantly effective in a few months and return a person to a productive state of well-being. I find that medication is in some cases the only reasonable and effective solution.

    Except for organically-based mental disorders, other forms of therapy are just as effective.

    Are you sure about that? Because that is not my experience. I have found that most forms of talk therapy may not be not very effective solutions–say, for unipolar depression, for example. Is unipolar depression biological? Who knows? Maybe it is, maybe it is only sometimes…??? It is difficult to know exactly what is organically based. But regardless of organic basis, we are still biologically effected by mental states. Also, I recall that when I was in school (early 80s), evidence suggested that people mostly got better at the same rate whether they underwent psychotherapy (talk therapy) or not. What is called psychotherapy is, in my view, nothing much different from what happens among friends quite naturally. Psychologists are generally, in my experience, not only not magical, but also not particularly skilled at anything much special but being good listeners.

    I do find therapy can be effective for support and also (on occasion for those lucky enough to find a good practitioner) for relationship problems, addictions, and things of a behavioral nature.

    So, why do you feel that the idea of taking medication should go against everything I stand for?

  • Except for organically-based mental disorders, other forms of therapy are just as effective.

    I really don’t see your enthusiasm for supporting the idea of medication. This contradicts everything you stand for.

    Unless of course you’re trying to endear yourself to the author of this article – again, against your grain, or so I would have believed.

  • Psychiatry then gets reduced to medication on this account.

    I could be wrong. But, that, in my experience is the way most practicing psychiatrists see themselves. In real life, they are merely medical doctors who prescribe and monitor the patient and her responses to psychotropic medication. They are primarily biologically oriented. Psychoanalysis? Is that even actually taught or practiced anywhere?

    (Forgive me for being dumb, I guess I should actually know this. I’ve never seen that actually offered anywhere except in movies.)

  • Emm

    Aaah, okay then. I’m an Erikson girl myself (a later psychoanalyst) although I definitely see the benefits of cognitive behaviour therapy. I believe that most therapies have their place and are useful in different areas.

  • Psychiatry then gets reduced to medication on this account.

  • It’s psychoanalysis I have a problem with, Emm, not the field of psychiatry as a whole. I guess I didn’t express that clearly. Sorry. Psychiatry–good; psychoanalysis–not so much.

  • Emm

    MC – Everything in science has to do with correlations. Some are stronger than others, that is all. That is the basis of the Scientific Method. Anyone who claims to prove anything using the Scientific Method is either referring to an extremely strong correlation with a tiny degree of possible error or they are probably a quack.

  • Emm

    This is an excelent review and even more excellent discussion! We studied Szasz during my Psychology degree in the early 90s. We did study him in terms of the historical context of his writings though, as Alan said.

    One small question Miss Bob. (Actually, turns out, wasn’t small). Pshchoanalysis is one of a multitude of forms of psychotherapy which is just one branch of psychiatry along with techniques such as electroshock therapy. Also Freud was just one psychoanalyist amongst many and the whole practice of psychoanalysis has not been discredited. Surely you can’t write off the whole of pschiatry because of that!?

  • Just a word on the idea of chemical imbalances. According to a respected neuropsychology textbook, there have been competing theories as to what’s going on in the brain and how this may or may not be linked to certain mood disturbances. Not too many people are made aware of that.

    And even if we were to accept a dominant theory about chemical imbalance in relation to a given mood disturbance, I think it would still be correlational at best.

  • Cindy,
    Yes, there are still behaviorists–but maybe only “at heart.” I do believe that be-mod is a workable alternative to a variety of treatments. I am also not the biggest fan in the world of psychiatry, but that’s really because of psychoanalysis rather than the practice as a whole.

  • Well, Mark did, but not the author of the article.

  • Since Fraud is (somewhat) discredited…

    (Snoopy laugh)

    I think Mark’s comment approximately implied the alternative means of treating the patient would be a change in society. With which I would agree.

    Miss Bob,

    At heart, I’m a behaviorist, but I’m open to considering anything non-invasive (and non-torturing)that will help a patient.

    Are there really still behaviorists? I am shocked (pun intended). I’ll try not to wince noticeably. 😉

  • At any rate, the author didn’t seem to address alternative means of treatment, as per Mark’s comment, for example.

    BTW, my #12 was posted prior to #11 having appeared on screen.

  • Cindy,

    Since Fraud is (somewhat) discredited, and the same goes for social-constructivism view, the total reliance on the scientific view (in this case, in the field of psychiatry) implies total or near-total reliance on psychiatric drugs.

  • Thanks, Cindy. I don’t think there is ONE solution to anything. Drugs are appropriate for some, but not all (definitely not all!). I do believe that there are chemical imbalances and that the brain’s “wiring” may be faulty and that these things can be corrected by drugs (better living through chemistry). At heart, I’m a behaviorist, but I’m open to considering anything non-invasive (and non-torturing)that will help a patient. –Bob E.

  • I meant to include the following two links in my comment. Voodoo Correlations in Social Neuroscience (Now called by the, more accurate but less fun, title: Puzzlingly high correlations in fMRI studies of emotion, personality, and social cognition)

    And at number “6”, the question: If non-independent analyses are so untrustworthy, why are they producing replicable results? Which is not answered here.

  • but so are the author’s views in relying on psychiatric drugs as being the all-around cure for all cases. Indeed, she does err on the side of “scientism.”

    She may err on the side of scientism, but not because she has expressed any views that drugs are all-around cures. My sense of that is that it is more implied because she calls upon the authority of her education as well as testing like fMRIs which have left a lot of questionable research analysis in their wake. As well as an intriguing puzzle about why such questionable analysis have been replicated despite the apparently flawed method of arriving at them. (This being one of the interesting things that I looked at in my own move away from scientism. The interesting implication evidenced being that reality is to some degree what we make it, despite all the conventional wisdom about replicability being a measure of reliability.)

    Anyway, you may wish to reiterate that. I read it again and did not see any claim about drugs–merely an implied scientistic view.

  • I think the Wikipedia entry on “Mental disorder” is quite good, and hopefully will help to balance out any extreme, intransigent positions.

  • Granted, Szasz’s position is extreme if taken to deny the possibility of organically-based mental dis-eases, but so are the author’s views in relying on psychiatric drugs as being the all-around cure for all cases. Indeed, she does err on the side of “scientism.”

    She would do well to reread Goffman’s work cited by Alan, and some Foucault perhaps, for good measure, to understand to what extent the notion of deviance has been used throughout the ages, to include the present times, as means of social control (to say nothing of its use by the professions for the purpose of self-legitimization.)

  • Mark

    While I never found Szaz’s observations useful in attempts to reduce the agitation and discomfort experienced by folks with brain dis-orders and mental dis-eases, I can’t disagree with the implication of his work that the way to ‘cure’ these diseases is through some kind of a thorough social transformation.

  • I am probably as inflexible on the subject of Szasz as he is on the subject of mental illness, and shouldn’t break my policy of silence after publication. However, Alan Kurtz so charmingly referred not once, but twice, to my extreme youth, and I couldn’t help but be drawn back into the conversation. (Mr. Kurtz, you DO know how to flatter grandmothers, don’t you?) Actually, there’s only one point I’d like to clarify.

    Mr. Kurtz wrote:
    In one breath you allege The Myth of Mental Illness “sets mental health back fifty years,” and in the next breath allude to its having been published half a century ago. Duh! Obviously a 50-year-old book is going to take us back fifty years.

    This 2010 edition includes two additional essays and a new preface. Since there is new material, it would have been relevant if “new” diagnostics and treatments were acknowledged. Szasz’s essays reinforce his original premise, and ignore most of what occurred between 1961 and 1997, and between 1961 and 2006 (however, he does thoroughly attack DSM). The 2010 preface does include modern history (more legal/political than psychiatric) but again, reinforces what Szasz wrote 50 years ago.

    The man may be 90-ish, but had he changed any of his thinking in the past 50 years, he would not have been the first to admit it. We don’t stop growing and learning once we publish a controversial opinion, and some elderly people are known to have regrets. (Who knows? In my dotage, I may thoroughly agree with Szasz. Currently, I am sure I will regret posting this comment.)

    Alan, despite our differences, I enjoyed your thought-provoking comments and thank you for posting. Thank you, especially, for mistaking me for a “youngster.”

    –Bob E.

  • Great comment, Alan.

    Szasz was required reading in graduate schools in the seventies. His work, along similar such works in Sociology of Deviance broke new grounds.

  • Szaz’s bias is extreme (just check out his website Thomas Szasz) but I don’t think everything he says should be summarily dismissed.

    Over the years I’ve encountered several intelligent thinkers, artists and religious persons who believe that psychiatry could be a bit more reflective. Apparently psychiatrists exhibit a high degree of consistency in diagnosing patients. But does this necessarily mean that psychiatry enjoys a high degree of legitimacy?

    Because this rather basic question is often ignored or glossed over, Szaz’s polemic might be of some value if we take it as an invitation to think responsibly.

    Perhaps this isn’t Szaz’s intention. But intelligent readers should be able to sift through the good and not so good to find something of value in his critique.

    In my view social realities are rarely ‘this or that.’ They’re usually somewhere in the middle. And to go to either extreme seems unwarranted.

  • I think this piece is excellent! Yet, I also think that Alan’s criticism has a great deal of merit (to a point).

    I want to make a small disagreement with Alan on the matter of whether or not Szasz is nuts. He is indubitably nuts. Regardless that I agree with you that his work was important in its time. So was the work of others, less kooky–some of whom you’ve mentioned. Some, like Laing, whom you’ve left off. It was, after all, in the zeitgeist. If not Szasz, the nut, then…

    Unfortunately, Szasz never ever corrected his viewpoint with relevant or appropriate information–presumably he arrived at 90 by living in the world not in a half a century old bubble. What he did, in case you were not aware, was team up with the Cult of Scientology, who happen to hold psychiatrists in low esteem (notwithstanding the typical reasons one would associate with snake pits, Foucault, lobotomies, electroshock therapy, and imprisonment). So Szasz went way overboard, have a look at the organization he co-founded with the cult. In a word, he was nuts.

    To explain my position, I have no love for the mental health system, nor for psychiatrists. They, like other authorities can be abusive and are very intricately a part of an authoritarian, abusive system that does control and imprison. However, being the partner of a bipolar man, I find Szasz’s alternative view is almost as bad (and sometimes worse) than the oppressive system he is opposing.

    What deserved some background, or at least a nod, in the article was the history of abuse and imprisonment of the, both, mentally ill and the ‘proclaimed’ mentally ill at the hands of authority–psychiatrists heading up this team effort–that Szasz’s book was a part of opposing.

  • In condemning this book as “a disservice to society,” you do readers a disservice by neglecting its historical context. In one breath you allege The Myth of Mental Illness “sets mental health back fifty years,” and in the next breath allude to its having been published half a century ago. Duh! Obviously a 50-year-old book is going to take us back fifty years. Yet you review this 50th Anniversary Edition of what its publisher calls “the most influential critique of psychiatry” as if it’d been written yesterday. In contrast to the 1984 imprint, this doesn’t claim to be a revised edition, but as you indicate is merely updated with a new preface and two bonus essays. Nevertheless, you write, “He does not address genetic links to mental disorders, brain chemistry, or much of anything from the past 50 years.” I suppose you also fault Tolstoy’s War and Peace for ignoring Predator drones and Apache helicopters armed with laser-guided missiles. A classic book must be considered as a product of its times.

    In that regard, The Myth of Mental Illness is indispensable. You’re of course too young to remember, but throughout the 1950s patients committed against their will to state-run psychiatric hospitals were routinely subjected to such enlightened involuntary “treatments” as full-body submersive hydrotherapy (what might nowadays be considered water-boarding), electroconvulsive shock (another form of torture), and prefrontal lobotomy (the procedure that turned Jack Nicholson into a zombie in One Flew Over the Cuckoo’s Nest). First-generation neuroleptic drugs to manage psychotic behavior were only then being introduced.

    It’s no accident that Szasz’s book appeared in 1961, the same year as Michel Foucault’s Madness and Civilization and Erving Goffman’s Asylums, each of which likewise challenged the scientific/medical legitimacy of psychiatry. Nor is it coincidental that Congress soon thereafter passed the Community Mental Health Act of 1963, a pet project of President Kennedy, whose younger sister Rosemary had been lobotomized at age 23, reducing her to an infantile state of speechless, helpless vegetation for the remaining 64 years of her life. In conjunction with ongoing psycho-pharmaceutical advances, the CMHA led to widespread deinstitutionalization, putting tens of thousands of discharged patients into halfway homes and, tragically for many, eventually onto the street to fend for themselves. Dr. Szasz’s role in all this cannot be easily dismissed by painting him as an isolated, ineffectual kook.

    “There’s got to be a reason,” you assert, “why none of my college psych courses included The Myth of Mental Illness on their reading lists.” You insinuate that this is because Szasz is such a charlatan that he’s not taken seriously by academia. Yet there’s a perfectly plausible alternative explanation. The compilers of those lists are dues-paying members of the very profession that Dr. Szasz has lambasted tirelessly for half a century. Do you honestly think they can objectively evaluate his magnum opus?

    You find it especially galling that Szasz “stands by his original work.” Miss Bob, the man is three weeks shy of his 90th birthday. Can you name any other notable author in the field of psychiatry who, at age 90, publicly renounced his life’s mission? Let’s face it, most intellectuals who live to be nonagenarians do so in large part because of a steadfast sense of their own rightness. Is Dr. Szasz misguided? Perhaps. Is he, to adopt your clinical diagnosis, nuts? No, that’s just the same invidious name-calling that Szasz debunked long before you were born. While The Myth of Mental Illness may not be au courant, this important book deserves a better historical overview than you provide.