The Myth of Mental Illness: Thomas Szasz on Freedom and Psychotherapy

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Thomas Szasz on Freedom and Psychotherapy

by Randall C. Wyatt

The foremost psychiatric critic of our times, Thomas Szasz, engages in an in-depth dialogue of his life’s work including freedom and liberty, the myth of mental illness, drug laws, the fragile state of psychotherapy, and his passion for humanistic values and social justice.
Randall C. Wyatt: I am going to ask you a wide variety of questions, given the diversity of your interests, and I want to make sure to also focus on your work as a psychotherapist. A little background first. You’ve been well-known for the phrase, “the myth of mental illness.” In less than 1000 words, what does it mean?
Thomas Szasz: The phrase “the myth of mental illness” means that mental illness qua illness does not exist. The scientific concept of illness refers to a bodily lesion, that is, to a material — structural or functional — abnormality of the body, as a machine. This is the classic, Virchowian, pathological definition of disease and it is still the definition of disease used by pathologists and physicians as scientific healers.

The brain is an organ — like the bones, liver, kidney, and so on — and of course can be diseased. That’s the domain of neurology. Since a mind is not a bodily organ, it cannot be diseased, except in a metaphorical sense — in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc.

In other words, talking about “sick minds” is analogous to talking about “sick jokes” or “sick economies.”

In other words, talking about “sick minds” is analogous to talking about “sick jokes” or “sick economies.” In the case of mental illness, we are dealing with a metaphorical way of expressing the view that the speaker thinks there is something wrong about the behavior of the person to whom he attributes the “illness.”

In short, just as there were no witches, only women disapproved and called “witches,” so there are no mental diseases, only behaviors of which psychiatrists disapprove and call them “mental illnesses.” Let’s say a person has a fear of going out into the open. Psychiatrists call that “agoraphobia” and claim it is an illness. Or if a person has odd ideas or perceptions, psychiatrists say he has “delusions” or “hallucinations.” Or he uses illegal drugs or commits mass murder. These are all instances of behaviors, not diseases. Nearly everything I say about psychiatry follows from that.

RW: Let’s say that modern science, with all the advances in genetics and biochemistry, finds out that there are some behavioral correlates of biological deficits or imbalances, or genetic defects. Let’s say people who have hallucinations or are delusional have some biological deficits. What does that make of your ideas?
TS: Such a development would validate my views, not invalidate them, as my critics think. Obviously, I don’t deny the existence of brain diseases; on the contrary, my point is that if mental illnesses are brain diseases, we ought to call them brain diseases and treat them as brain diseases — and not call them mental illnesses and treat them as such. In the 19th century, madhouses were full of people who were “crazy”; more than half of them, as it turned out, had brain diseases — mainly neurosyphilis, or brain injuries, intoxications, or infections. Once that was understood, neurosyphilis ceased to be a mental illness and became a brain disease. The same thing happened with epilepsy.
RW: It’s interesting, because a lot of students of mine, and colleagues, who have read your work or heard of your ideas, think that when condition previously thought to be mental is to be a brain disease, as noted, your ideas become moot.
TS: That’s because they are not familiar with the history of psychiatry, don’t really understand what a metaphor is, and don’t want to see how and why psychiatric diagnoses are attached to people. Ted Kaczynski, the so-called Unabomber, was diagnosed as schizophrenic by government psychiatrists. If people want to believe that a “genetic defect” causes a person to commit such a series of brilliantly conceived crimes — but that when a person composes a great symphony, that’s due to his talent and free will — so be it.

Objective, medical diagnostic tests measure chemical and physical changes in tissues; they do not evaluate or judge ideas or behaviors. Before there were sophisticated diagnostic tests, physicians had a hard time distinguishing between real epilepsy — that is to say, neurological seizures — and what we call “hysterical seizures,” which is simply faking epilepsy, pretending to have a seizure. When epilepsy became understood as due to an increased excitability of some area of the brain, then it ceased to be psychopathology or mental illness, and became neuropathology or brain disease. It then becomes a part of neurology. Epilepsy still exists. Neurosyphilis, though very rare, still exists, and is not treated by psychiatrists; it is treated by specialists in infectious diseases, because it’s an infection of the brain.

The discovery that all mental diseases are brain diseases would mean the disappearance of psychiatry into neurology. But that would mean that a condition would be a “mental disease” only if it could be demonstrated, by objective tests, that a person has got it, or has not got it. You can prove — objectively, not by making a “clinical diagnosis” — that X has neurosyphilis or does not have it; but you cannot prove, objectively, that X has or does not have schizophrenia or “clinical depression” or post traumatic stress disorder. Like most nouns and verbs, the word “disease” will always be used both literally and metaphorically. As long as psychiatrists are unwilling to fix the literal meaning of mental illness to an objective standard, there will remain no way of distinguishing between literal and metaphorical “mental diseases.”

RW: Psychiatrists, of course, don’t want to be pushed out of the picture. They want to hold on to schizophrenia as long as they can, and now depression and gambling, and drug abuse, and so on, are proposed as biological or genetically determined. Everything is thought to have a genetic marker, perhaps even normality. What do you make of this?
TS: I hardly know what to say about this silliness. Unless a person understands the history of psychiatry and something about semantics, it’s very difficult to deal with this. Diagnoses are NOT diseases. Period.

Psychiatrists have had some very famous diseases for which they have never apologized, the two most obvious ones being masturbation and homosexuality.

Psychiatrists have had some very famous diseases for which they have never apologized, the two most obvious ones being masturbation and homosexuality. People with these so-called “diseases” were tortured by psychiatrists — for hundreds of years. Children were tortured by antimasturbation treatments. Homosexuals were incarcerated and tortured by psychiatrists. Now all that is conveniently forgotten, while psychiatrists — prostitutes of the dominant ethic — invent new diseases, like the ones you mentioned. The war on drugs is the current psychiatric-judicial pogrom. And so is the war on children called “hyperactive,” poisoned in schools with the illegal street drug called “speed,” which, when called “Ritalin,” is a miracle cure for them.

Let me mention another, closely related characteristic of psychiatry, as distinct from the rest of medicine. Only in psychiatry are there “patients” who don’t want to be patients. This is crucial because my critique of psychiatry is two-pronged. One of my criticisms is conceptual: that is, that mental illness is not a real illness. The other one is political: that is, that mental illness is a piece of justificatory rhetoric, legitimizing civil commitment and the insanity defense.

Dermatologists, ophthalmologists, gynecologists, don’t have any patients who don’t want to be their patients. But the psychiatrists’ patients are paradigmatically involuntarily.

Dermatologists, ophthalmologists, gynecologists, don’t have any patients who don’t want to be their patients. But the psychiatrists’ patients are paradigmatically involuntarily.

Originally, all mental patients were involuntary, state hospital patients. That concept, that phenomenon, still forms the nucleus of psychiatry. And that is what is basically wrong with psychiatry. In my view, involuntary hospitalization and the insanity defense ought to be abolished, exactly as slavery was abolished, or the disfranchisement of women was abolished, or the persecution of homosexuals was abolished. Only then could we begin to examine so-called “mental illnesses” as forms of behavior, like other behaviors.

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6 thoughts on “The Myth of Mental Illness: Thomas Szasz on Freedom and Psychotherapy

    Amanda Krzywonski said:
    March 27, 2016 at 10:08

    Wonderful article. I clicked because I swore it said “Szabo” who is my Neurologist/Epileptologist!!! Similar names lol 🙂

    Garth Amundson, Psy.D. said:
    March 27, 2016 at 11:37

    Fabulous. Thanks!

    Dave DuBay said:
    March 27, 2016 at 15:36

    This is really interesting. At first I wondered about the mind/brain distinction – what is the mind except brain activity? But he puts this in focus with the point that, “The discovery that all mental diseases are brain diseases would mean the disappearance of psychiatry into neurology.”

    So, if we can show that a so-called mental illness has no neurological basis then we must question why it’s considered an illness at all. Like being lesbian or gay, it looks like cultural bias rather than personal pathology.

    On the other hand, if a person with a female body identifies as male, and there’s an identifiable neurological reason for this then is it proper to describe being transgender as a brain disorder? If the most effective treatment is for the person to take hormones (and perhaps even have surgery) so that others perceive him physically as male, then the treatment is to embrace the brain state. As such, “disorder” would be the wrong word to use.

    The question then becomes: When is a neurological state that falls outside of the average a disorder, and when is it not a disorder? After all, geniuses and other highly creative people also have neurological states that fall outside the average, but clearly these are not disorders. But someone with schizophrenia has a neurological state that can seriously impair the person’s ability for self-care without immense help from others or even medication to alter the neurological condition.

    There’s a lot to think about here.

      mirrorgirl responded:
      March 28, 2016 at 13:25

      Yes, I must confess that it was hard to listen to his thoughts when I read his book ‘the medicalization of everyday life’, because it turns everything I’ve learnt upside-down. But thinking about it, I realize that I must be open to his opinions. He has some good points that are worth exploring further. Thank you for the comment !!

    drdonrussell said:
    July 20, 2016 at 04:38

    Reblogged this on Dr Don Russell Presents and commented:
    Thomas Szasz is one of those few renegade thinkers who is profound, not just creating dissent for the shear pleasure of it. Also, his ideas are easy to dismiss if you don’t like thinking deeply. Be advised.

      mirrorgirl responded:
      July 21, 2016 at 09:37

      Thank you for the reblog

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