Mental Health and The Views of Thomas Szasz

(All adults are yesterday’s children)

Professor of Psychiatry at New York University

Recent Szasz publications

• Words to the Wise: A medical-philosophical dictionary 2004

• Liberation by Oppression 2003

• A Lexicon of Lunacy 2003

• The meaning of mind: Language, morality and neuroscience 1996

• Sex by Prescription 1990

Szasz Aims

His aim is to argue that mental illness should primarily be conceptualized as a moral and political problem related to the interaction of an individual with his/her environment.

He sees mental health practitioners as part of the problem if they avoid pursuit of general social understanding and autonomous self control.

The brain and the mind

• If mental illnesses are diseases of the central nervous system, then they are diseases of the brain, not the mind. If mental illnesses are the names of (mis)behaviours, then they are behaviours, not diseases.

On the physiological model of mental illness

• We say that chemicals is the brain cause depression and suicide; but we don’t say that chemicals in the ovaries or testes cause lust and marriage.

• Our environment and our related choices determine who we are.

Thomas Szasz on drugs

Drugs may function as chemical straightjackets…

A diagnosis and drug relieves the providers of the necessity to convince themselves that they may not be acting altogether on behalf of their patient

Herein lies the danger to the patient

On drugs and doctors

• Giving oneself a controlled substance is a crime.• Accepting it from a physician is a treatment• The truth is that coercive psychiatry serves the

interests of the coercers and contractual psychiatry serves the interests of the contracting parties. Acknowledging this is taboo intellectually, professionally and politically.

From priest to health practitioner

• The reciprocally opposing voices of angels and the devil reflect the ancients’ view that the struggle for self control was a moral problem with a religious solution

• Today it is conceived of as a psychiatric problem with a pharmacological solution

On child psychiatry

• Poverty, untreatability, chance and the desire to escape punishment, rather than need for medical attention are often the tickets of entry to child psychiatric services. Child psychiatry has persistently avoided debating this issue.

‘Mental illness’

• One of the most important political-philosophical features of the concept of mental illness is that it removes motivation from action, adds it to illness, and thus destroys the very possibility of distinguishing disease from non-disease.

Psychiatrists and their allies

• Psychiatrists and their powerful allies (drug companies, lawyers, doctors, insurance companies) have succeeded in persuading the scientific community, the courts, the media and the general public that the conditions they call ‘mental disorders’ are diseases rather than unwanted behaviours fashioned in response to an environment.

Vested interests in mental illness

• Scientific- to identify organs or tissues related to illness

• Professional – to enlarge the scope, power and prestige of the state-protected medical monopoly and the income of practitioners

• Legal – to justify state-sanctioned coercive interventions outside the criminal justice system

Vested interests in mental illness

• Social-economic: to authenticate persons as legitimate occupants of the sick role; for example to secure drugs, compensation payments, disability support, etc.

• Personal: To enlist the support of public opinion for bestowing special privileges and imposing special penalties on those diagnosed mentally ill.

In short…..

• No psychiatric diagnosis is, or can be, pathology-driven; instead, all such diagnoses are driven by nonmedical (economic, personal, legal, political and social) factors or incentives.

George Herbert Mead

• The mind refers to the relationship between modern society and the independent, responsible individual. Mind is mediated through language. The distinguishing trait of selfhood is in the capacity of the minded animal to be an object to itself. Language enables us to distinguish between I and me, in order to self-converse.

On the concept of mind

All thought is conversation with the self.

How and what we ‘mind’ is who we are. The greatest injury a person can inflict on himself (herself) is to treat his mind as if its business were not worth minding.

On Language

• Language is a form of self-expression. There are many readily discernable reasons why there have always been, and always will be, persons who choose to express themselves in unconventional ways.

On Language

• Ignoring the strategic use of medical terms enables jurists, physicians, mental health professionals, scientists and journalists to debate ad nauseam whether alcoholism, smoking and this or that unwanted behaviour is or is not a disease.

• Homosexuality was agreed to be a disease until recently. This has changed.

On Education

• Only after he acquires speech does the child become provokable by words and hence temptable – which we call ‘teachable’ if we approve his yielding, and call ‘corruptible’ if we do not.

• There are several good protections against temptation, but the surest is cowardice (Mark Twain)

Remember the Greeks?

• In the Greek philosophy of life the principles of right living are self-control and moderation

• The concept of ‘healthy lifestyle’ equates virtue with health and thereby trivialises moral and political debate about life and how it should be understood.

From Isaiah Berlin

• To seek to avoid the moral categories of right and wrong is to adopt another moral outlook, not none at all…..Does it spring from a desire to resign our responsibility to cease from judging, providing we be be not judged ourselves, or be compelled to judge ourselves.

The nature of the group

• The group – especially if it is or believes itself to be under attack – values erroneous consensus more highly than contested truth. The quest for truth tends to be divisive.

• Laing wrote: ‘Our sanity is not ‘true’ sanity. Their madness is not ‘true’ madness.True sanity entails the dissolution of the normal ego, that false self completely adjusted to our alienated social reality.

Fear of self and fear of others

• Americans consistently vote for politicians who let them buy guns but prohibit them from buying drugs. I interpret this to mean that we are more afraid of injecting ourselves with a drug than being shot by an assailant; more afraid of ourselves metaphorically than of someone literally shooting us; in short, more afraid of ourselves than of criminals.

On delusion

• Psychiatrists say that the man who claims to be Jesus suffers from a delusion. They do not say the man who claims the Eucharist is the body and blood of Jesus suffers from a delusion.

• Does the person who takes the Eucharist believe it literally, use it as a metaphor, or do they lie?

Function of health practitioners

• It is the social mandate of the mental health practitioner to define the (crazy) Other’s speech as gibberish, the unintelligible discharge of his diseased brain.

• (What you look for is what you see?)

On lack of response

• Our deep seated dread of silence as loneliness explains why religion and madness – faith and prayer, or hearing and talking to voices – are two of the most enduring elements in human life. They constitute ‘cures’ for the elemental human fear of death as existential-semantic abandonment.

Schizophrenia

• The schizophrenic discourse appears to be incomprehensible because it is vocalised self-conversation, that is, a speech act intended to be understood by the speaker, not the listener.

On government services

• How should people go about gaining help for their mental problems?

• The same way they go about getting help for their religious problems.

• People should be free to inquire into, learn about and practice or reject religion. They should be equally free to get mental help from a wide range of sources they choose themselves.

Lord Acton

• The centre and supreme object of liberty is the reign of conscience….Liberty is the condition which makes it easy for conscience to govern.

• Let there be true asylums where a person can seek shelter and sustenance, and will not be expelled against his/her will

Science and emotion

• Love and hate, loyalty and betrayal, intemperance and self discipline, productivity and parasitism – These and other personal dispositions and qualities have little or nothing to do with science. So much the worse for science. However, the fact that something in the world is not subject to scientific analysis or control does not mean that we cannot look at it carefully and describe it truthfully.

Science and emotion

• Honesty is not a scientific concept, yet it is the slender reed on which science itself rests.

Three baseball umpires use language politically

• The first umpire says ‘I calls ‘em as they are’.

• The second umpire says ‘I calls ‘em as I sees em’.

• The third umpire says, ‘Until I calls ‘em, they ain’t’.

• (Which umpire would you want and why?)