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A Theory of Feelings Anger and Forgiveness"My Madness Saved Me"10 Good Questions about Life and Death12 Modern Philosophers50 Reasons People Give for Believing in a GodA Cabinet of Philosophical CuriositiesA Case for IronyA Companion to BioethicsA Companion to Buddhist PhilosophyA Companion to FoucaultA Companion to GenethicsA Companion to GenethicsA Companion to HumeA Companion to KantA Companion to Phenomenology and ExistentialismA Companion to PragmatismA Companion to the Philosophy of ActionA Companion to the Philosophy of BiologyA Companion to the Philosophy of LiteratureA Conceptual History of PsychologyA Critical Overview of Biological FunctionsA Critique of Naturalistic Philosophies of MindA Cursing Brain?A Delicate BalanceA Farewell to AlmsA Frightening LoveA Future for PresentismA Guide to the Good LifeA History of PsychiatryA History of the MindA Life Worth LivingA Manual of Experimental PhilosophyA Map of the MindA Metaphysics of PsychopathologyA Mind So RareA Natural History of Human MoralityA Natural History of Human ThinkingA Natural History of VisionA Parliament of MindsA Philosopher Looks at The Sense of HumorA Philosophical DiseaseA Philosophy of BoredomA Philosophy of Cinematic ArtA Philosophy of CultureA Philosophy of EmptinessA Philosophy of FearA Philosophy of PainA Physicalist ManifestoA Place for ConsciousnessA Question of TrustA Research Agenda for DSM-VA Revolution of the MindA Sentimentalist Theory of the MindA Stroll With William JamesA Tear is an Intellectual ThingA Theory of FreedomA Thousand MachinesA Universe of ConsciousnessA Very Bad WizardA Very Bad Wizard: Morality Behind the CurtainA Virtue EpistemologyA World Full of GodsA World Without ValuesAbout FaceAbout the Beginning of the Hermeneutics of the SelfAction and ResponsibilityAction in ContextAction Theory, Rationality and CompulsionAction, Contemplation, and HappinessAction, Emotion and WillAdam SmithAdaptive DynamicsAddictionAddictionAddiction and ResponsibilityAddiction Is a ChoiceAdvances in Identity Theory and ResearchAftermathAfterwarAgainst AdaptationAgainst AutonomyAgainst BioethicsAgainst HappinessAgainst HealthAgency and ActionAgency and AnswerabilityAgency and EmbodimentAgency and ResponsibilityAgency, Freedom, and Moral ResponsibilityAl-JununAlain BadiouAlain BadiouAlasdair MacIntyreAlien Landscapes?Altered EgosAn Anthology of Psychiatric EthicsAn Ethics for TodayAn Intellectual History of CannibalismAn Interpretation of DesireAn Introduction to EthicsAn Introduction to Kant's Moral Philosophy An Introduction to Philosophy of EducationAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of PsychologyAn Introductory Philosophy of MedicineAn Odd Kind of FameAnalytic FreudAnalytic Philosophy in AmericaAncient AngerAncient Models of MindAncient Philosophy of the SelfAngerAnimal LessonsAnimal MindsAnimals Like UsAnnihilationAnother PlanetAnswers for AristotleAnti-ExternalismAnti-Individualism and KnowledgeAntigone’s ClaimAntipsychiatryAre We Hardwired?Are Women Human?Arguing about DisabilityArguing About Human NatureAristotle and the Philosophy of FriendshipAristotle on Practical WisdomAristotle's ChildrenAristotle's Ethics and Moral ResponsibilityAristotle, Emotions, and EducationArt & MoralityArt After Conceptual ArtArt in Three DimensionsArt, Self and KnowledgeArtificial ConsciousnessArtificial HappinessAspects of PsychologismAsylum to ActionAtonement and ForgivenessAttention is Cognitive UnisonAutobiography as PhilosophyAutonomyAutonomy and Mental DisorderAutonomy and the Challenges to LiberalismBabies by DesignBackslidingBadiouBadiou's DeleuzeBadiou, Balibar, Ranciere: Rethinking EmancipationBare Facts And Naked TruthsBasic Desert, Reactive Attitudes and Free WillBattlestar Galactica and PhilosophyBe Like the FoxBeautyBecoming a SubjectBecoming HumanBehavingBehavioral Genetics in the Postgenomic EraBeing AmoralBeing HumanBeing Mentally Ill: A Sociological Theory Being No OneBeing Realistic about ReasonsBeing ReducedBeing YourselfBelief's Own EthicsBending Over BackwardsBerlin Childhood around 1900Bernard WilliamsBertrand RussellBetter than BothBetter Than WellBetween Two WorldsBeyond HealthBeyond Hegel and NietzscheBeyond KuhnBeyond LossBeyond Moral JudgmentBeyond PostmodernismBeyond ReductionBeyond SchizophreniaBeyond the DSM StoryBioethicsBioethics and the BrainBioethics in the ClinicBiological Complexity and Integrative PluralismBiology Is TechnologyBiosBipolar ExpeditionsBlackwell Companion to the Philosophy of EducationBlindsight & The Nature of ConsciousnessBlues - Philosophy for EveryoneBlushBob Dylan and PhilosophyBody ConsciousnessBody Image And Body SchemaBody ImagesBody LanguageBody MattersBody WorkBody-Subjects and Disordered MindsBoundBoundaries of the MindBoyleBrain Evolution and CognitionBrain FictionBrain, Mind, and Human Behavior in Contemporary Cognitive ScienceBrain-WiseBrainchildrenBrains, Buddhas, and BelievingBrainstormingBrave New WorldsBreakdown of WillBrief Child Therapy Homework PlannerBrief Inquiry into the Meaning of Sin and FaithBrief Therapy Homework PlannerBritain on the CouchBritish Idealism and the Concept of the SelfBrute RationalityBuffy the Vampire Slayer and PhilosophyBut Is It Art?Camus and SartreCartesian LinguisticsCartographies of the MindCarving Nature at Its JointsCase Studies in Biomedical Research EthicsCassandra's DaughterCato's TearsCausation and CounterfactualsCauses, Laws, and Free WillChanging Conceptions of the Child from the Renaissance to Post-ModernityChanging the SubjectChaosophyCharacter and Moral Psychology Character as Moral FictionCharles DarwinCherishmentChildhood and the Philosophy of EducationChildrenChildren, Families, and Health Care Decision MakingChoices and ConflictChoosing Not to ChooseChristmas - Philosophy for EveryoneCinema, Philosophy, BergmanCinematic MythmakingCity and Soul in Plato's RepublicClassifying MadnessClear and Queer ThinkingClinical EthicsClinical Psychiatry in Imperial GermanyCodependent ForevermoreCoffee - Philosophy for EveryoneCognition and the BrainCognition of Value in Aristotle's EthicsCognition Through Understanding: Self-Knowledge, Interlocution, Reasoning, ReflectionCognitive BiologyCognitive FictionsCognitive Neuroscience of EmotionCognitive Systems and the Extended MindCognitive Systems and the Extended Mind Cognitive Theories of Mental IllnessCoherence in Thought and ActionCollected Papers, Volume 1Collected Papers, Volume 2College SexComedy IncarnateCommitmentCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentConcealment And ExposureConceptual Analysis and Philosophical NaturalismConceptual Art and PaintingConceptual Issues in Evolutionary BiologyConfessionsConfucianismConnected, or What It Means to Live in the Network SocietyConquest of AbundanceConscience and ConvenienceConsciousnessConsciousnessConsciousnessConsciousness ConsciousnessConsciousness and Its Place in NatureConsciousness and LanguageConsciousness and Mental LifeConsciousness and MindConsciousness and the NovelConsciousness and the SelfConsciousness EmergingConsciousness EvolvingConsciousness ExplainedConsciousness in ActionConsciousness RecoveredConsciousness RevisitedConsciousness, Color, and ContentConsole and ClassifyConstructing the WorldConstructive AnalysisContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Philosophy of BiologyContemporary Debates in Philosophy of MindContemporary Debates in Political PhilosophyContemporary Debates in Social PhilosophyContemporary Perspectives on Natural LawContested Knowledge: Social Theory TodayContesting PsychiatryContext and the AttitudesContinental Philosophy of ScienceControlControlling Our DestiniesConversations About Psychology and Sexual OrientationCopernicus, Darwin and FreudCrazy for YouCreating a Life of Meaning and CompassionCreating ConsilienceCreating HysteriaCreating Mental IllnessCreating Scientific ConceptsCreating the American JunkieCreation, Rationality and AutonomyCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCrimes of ReasonCritical New Perspectives on Attention Deficit/Hyperactivity DisorderCritical PsychiatryCritical PsychologyCritical ResistanceCritical Thinking About PsychologyCritical VisionsCross and KhoraCruel CompassionCTRL [SPACE]Cultural Psychology of the SelfCultural Theory: An IntroductionCulture and Psychiatric DiagnosisCulture and Subjective Well-BeingCulture of DeathCultures of NeurastheniaCurious EmotionsCurrent Controversies in Experimental PhilosophyCustom and Reason in HumeCustomers and Patrons of the Mad-TradeCutting God in Half - And Putting the Pieces Together AgainCylons in AmericaDamaged IdentitiesDamasio's Error and Descartes' TruthDangerous EmotionsDaniel DennettDaniel DennettDark AgesDarwin and DesignDarwin's Dangerous IdeaDarwin's LegacyDarwin, God and the Meaning of LifeDarwinian PsychiatryDarwinian ReductionismDarwinizing CultureDating: Philosophy for EveryoneDeathDeathDeath and CharacterDeath and CompassionDeath and the AfterlifeDebating DesignDebating HumanismDecision Making, Personhood and DementiaDecomposing the WillDeconstructing PsychotherapyDeconstruction and DemocracyDeeper Than DarwinDeeper than ReasonDefending Science - within ReasonDefining Psychopathology in the 21st CenturyDegrees of BeliefDelusion and Self-DeceptionDelusions and Other Irrational BeliefsDelusions and the Madness of the MassesDementiaDemons, Dreamers, and MadmenDennett and Ricoeur on the Narrative SelfDennett’s PhilosophyDepression Is a ChoiceDepression, Emotion and the SelfDepthDerrida, Deleuze, PsychoanalysisDescartesDescartes and the Passionate MindDescartes' CogitoDescartes's Changing MindDescartes's Concept of MindDescribing Inner Experience?Descriptions and PrescriptionsDesembodied Spirits and Deanimated Bodies Desert Islands and Other Texts (1953-1974)Desire and AffectDesire, Love, and IdentityDesire, Practical Reason, and the GoodDeveloping the VirtuesDiagnosing the Diagnostic and Statistical Manual of Mental DisordersDialectics of the SelfDid My Neurons Make Me Do It?Difference and IdentityDigital SoulDimensional Models of Personality DisordersDisability, Difference, DiscriminationDisjunctivismDisorders of VolitionDisorientation and Moral LifeDispatches from the Freud WarsDisrupted LivesDistractionDisturbed ConsciousnessDivided Minds and Successive SelvesDo Apes Read Minds?Do Fish Feel Pain?Do We Still Need Doctors?Does Consciousness Cause Behavior?Does the Woman Exist?Doing without ConceptsDon't Believe Everything You ThinkDonald DavidsonDonald Davidson on Truth, Meaning, and the MentalDoubting Darwin?Dreaming and Other Involuntary MentationDSM-IV SourcebookDSM-IV SourcebookDSM-IV-TR CasebookDworkin and His CriticsDying to KnowDynamics in ActionDysthymia and the Spectrum of Chronic DepressionsEccentricsEducational MetamorphosesEffective IntentionsElbow Room: The Varieties of Free Will Worth WantingEmbodied Minds in ActionEmbodied RhetoricsEmbodied Selves and Divided MindsEmbryos under the MicroscopeEmergencies in Mental Health PracticeEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotionEmotion and ConsciousnessEmotion and PsycheEmotion ExperienceEmotion RegulationEmotion, Evolution, And RationalityEmotional IntelligenceEmotional ReasonEmotional ReasonEmotional TruthEmotions in Humans and ArtifactsEmotions in the Moral LifeEmotions in the Moral LifeEmotions, Value, and AgencyEmpathyEmpathy and AgencyEmpathy and Moral DevelopmentEmpathy and MoralityEmpathy in the Context of PhilosophyEmpirical Ethics in PsychiatryEnchanted LoomsEngaging BuddhismEngineering the Human GermlineEnjoymentEnvyEpicureanismEpistemic LuckEpistemologyEpistemology and EmotionsEpistemology and the Psychology of Human JudgmentEros and the GoodErotic MoralityEssays in Social NeuroscienceEssays in the Metaphysics of Mind Essays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEssays on Nonconceptual ContentEssays on Philosophical CounselingEssays on Reference, Language, and MindEssays on the Concept of Mind in Early-Modern PhilosophyEssential Sources in the Scientific Study of ConsciousnessEsssential Philosophy of PsychiatryEternal Sunshine of the Spotless MindEthical Conflicts in PsychologyEthical Issues in Forensic Mental Health ResearchEthical Issues in Human CloningEthical TheoryEthicsEthicsEthics and the A PrioriEthics and the Metaphysics of MedicineEthics and Values in PsychotherapyEthics Done RightEthics ExpertiseEthics in Plain EnglishEthics in PracticeEthics in Psychiatric ResearchEthics of PsychiatryEthics without OntologyEuropean Review of Philosophy. Vol. 5Everyday IrrationalityEvil in Modern ThoughtEvolutionEvolution and the Human MindEvolution's RainbowEvolutionary Origins of MoralityEvolutionary PsychologyExamined LifeExamined LivesExistential AmericaExistentialismExistentialism and Romantic LoveExperimental PhilosophyExperimental PhilosophyExperimental PhilosophyExperimental Philosophy, Rationalism, and NaturalismExperiments in EthicsExplaining ConsciousnessExplaining the BrainExplaining the Computational MindExplanatory PluralismExploding the Gene MythExploring HappinessExploring the SelfExpression and the InnerExpressions of JudgmentFaces of IntentionFact and ValueFact and Value in EmotionFacts, Values, and NormsFads and Fallacies in the Social SciencesFaith and Wisdom in ScienceFatherhoodFear of KnowledgeFearless SpeechFeeling Pain and Being in PainFeelings and EmotionsFeelings of BeingFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminism and Philosophy of ScienceFeminist Ethics and Social and Political PhilosophyFeminist Interpretations of Rene DescartesFeminist TheoryField Notes from ElsewhereFinding Consciousness in the BrainFingerprints of GodFlesh in the Age of ReasonFolk Psychological NarrativesFolk Psychology Re-AssessedForces of HabitForgivenessForgiveness and LoveForgiveness and RetributionFoucault 2.0Foucault and PhilosophyFoucault NowFoucault, Psychology and the Analytics of PowerFoundational Issues in Human Brain MappingFoundations of Ethical Practice, Research, and Teaching in PsychologyFour Views on Free WillFrank Ramsey (1903-1930)Free WillFree WillFree WillFree WillFree Will and Action ExplanationFree Will and LuckFree Will And Moral ResponsibilityFree Will as an Open Scientific ProblemFree Will, Agency, and Meaning in LifeFree: Why Science Hasn't Disproved Free WillFreedomFreedom and DeterminismFreedom And NeurobiologyFreedom and ResponsibiltyFreedom and ValueFreedom EvolvesFreedom RegainedFreedom vs. InterventionFreedom, Fame, Lying, and BetrayalFreudFreud and the Question of PseudoscienceFreud As PhilosopherFreud's AnswerFreud, the Reluctant PhilosopherFriedrich NietzscheFrom Chance to ChoiceFrom Clinic to ClassroomFrom Complexity to LifeFrom Enlightenment to ReceptivityFrom Knowledge to Wisdom: A Revolution for Science and the HumanitiesFrom Morality to Mental HealthFrom Passions to EmotionsFrom Philosophy to PsychotherapyFrontiers of ConsciousnessFrontiers of JusticeFurnishing the MindGalileo in PittsburghGenderGender and Mental HealthGender in the MirrorGender TroubleGenesGenes, Women, EqualityGenetic Nature/CultureGenetic ProspectsGenetic ProspectsGenetic SecretsGenocide's AftermathGenomes and What to Make of ThemGerman Idealism and the JewGerman PhilosophyGetting HookedGilles DeleuzeGlobal PhilosophyGluttonyGod and Phenomenal ConsciousnessGoffman's LegacyGoing Amiss in Experimental ResearchGoodness & AdviceGrassroots SpiritualityGrave MattersGrave MattersGreedGreek Models of Mind and SelfGut ReactionsHabilitation, Health, and AgencyHabits of MindHallucinationHandbook of BioethicsHandbook of EmotionsHappinessHappinessHappinessHappinessHappiness and EducationHappiness and the Good LifeHappiness Is OverratedHappiness, Death, and the Remainder of LifeHard LuckHarmful ThoughtsHaving the World in ViewHealing PsychiatryHealing the Soul in the Age of the BrainHealth, Illness and DiseaseHealth, Science, and Ordinary LanguageHegelHeidegger and a Metaphysics of FeelingHeidegger, Metaphysics and the Univocity of BeingHermann von Helmholtz's MechanismHermeneutics As PoliticsHeterophobiaHeterosyncraciesHeuristics and BiasesHeuristics and the LawHidden ResourcesHidden SelvesHiding from HumanityHigh Art LiteHistorical OntologyHistory of Psychiatry and Medical PsychologyHistory, Historicity And ScienceHobbesHomosexualitiesHope and Dread in PsychoanalysisHot ThoughtHow Can I Be Trusted?How Can the Human Mind Occur in the Physical Universe?How Children Learn the Meanings of WordsHow Could Conscious Experiences Affect Brains?How Do We Know Who We Are?How Emotions WorkHow Emotions WorkHow History Made the MindHow Images ThinkHow is Nature Possible?How Propaganda WorksHow Science WorksHow Scientific Practices MatterHow Scientists Explain DiseaseHow The Body Shapes The MindHow the Body Shapes the Way We ThinkHow the Mind Explains BehaviorHow the Mind Uses the BrainHow to Make Opportunity EqualHow to Solve the Mind-Body Problemhow to stop timeHow to Think More About SexHow We HopeHow We ReasonHuman CloningHuman Development, Language and the Future of MankindHuman EnhancementHuman Evolution, Reproduction, and MoralityHuman GoodnessHuman Identity and BioethicsHuman NatureHuman NatureHuman Nature and the Limits of ScienceHuman-Built WorldHumanismHumanism, What's That?HumanityHumans, Animals, MachinesHumeHumeHume on Motivation and VirtueHusserlHystoriesI of the VortexI Was WrongIdeas that MatterIdentifying the MindIdentity and Agency in Cultural WorldsIgnorance and ImaginationIllnessImagination and Its PathologiesImagination and the Meaningful BrainImagining NumbersImmortal RemainsImproving Nature?In Defense of an Evolutionary Concept of HealthIn Defense of SentimentalityIn Love With LifeIn Praise of Athletic BeautyIn Praise of the WhipIn Pursuit of HappinessIn Search of HappinessIn the Name of GodIn the Name of IdentityIn the Space of ReasonsIn Two MindsIncompatibilism's AllureIndividual Differences in Conscious ExperienceInfinity and PerspectiveInformation ArtsInformed Consent in Medical ResearchIngmar Bergman, Cinematic PhilosopherInhuman ThoughtsInner PresenceInsanityIntegrating Psychotherapy and PharmacotherapyIntegrity and the Fragile SelfIntelligent VirtueIntentionIntentionality, Deliberation and AutonomyIntentions and IntentionalityIntentions and IntentionalityInterpreting MindsInterpreting NietzscheIntroducing Greek PhilosophyIntrospection and ConsciousnessIntrospection VindicatedIntuition, Imagination, and Philosophical MethodologyIntuitionismInvestigating the Psychological WorldIrrationalityIrrationalityIs Academic Feminism Dead?Is It Me or My Meds?Is Long-Term Therapy Unethical?Is Oedipus Online?Is Science Neurotic?Is Science Value Free?Is the Visual World a Grand Illusion?Is There a Duty to Die?Issues in Philosophical CounselingJacques LacanJacques RancièreJacques RanciereJean-Paul SartreJohn McDowellJohn SearleJohn Searle's Ideas About Social RealityJohn Stuart MillJohn Stuart Mill and the Writing of CharacterJoint AttentionJokesJonathan EdwardsJudging and UnderstandingJustice for ChildrenJustice in RobesJustice, Luck, and KnowledgeKantKant and MiltonKant and the Fate of AutonomyKant and the Limits of AutonomyKant and the Role of Pleasure in Moral ActionKant on Freedom, Law, and HappinessKant on Moral AutonomyKant's Anatomy of EvilKant's Anatomy of the Intelligent MindKant's Theory of VirtueKarl JaspersKarl PopperKey Concepts in PhilosophyKierkegaardKierkegaard as PhenomenologistKierkegaard's Concept of DespairKierkegaard's MuseKinds of MindsKinds, Things, and StuffKnowing, Knowledge and BeliefsKnowledge MonopoliesKnowledge, Belief, and CharacterKnowledge, Possibility, and ConsciousnessLacanLack of CharacterLack of CharacterLanguageLanguage in ContextLanguage, Consciousness, CultureLanguage, Culture, and MindLanguage, Vision, and MusicLaw and the BrainLaw, Liberty, and PsychiatryLaws, Mind, and Free WillLeaving YouLectures on the History of Political PhilosophyLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberatory PsychiatryLife and ActionLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLife of the MindLife's FormLife, Death, & MeaningLife, Death, and Meaning: Key Philosophical Readings on the Big Questions Life, Liberty, and the Pursuit of UtilityLife, Sex, and IdeasLight in the Dark RoomLike a Splinter in Your MindLiving and Dying WellLiving NarrativeLiving Outside Mental IllnessLiving with DarwinLiving With One’s PastLockeLocke LockeLogic and the Art of Memory Loneliness in Philosophy, Psychology, and LiteratureLooking for SpinozaLooking for The StrangerLost SoulsLOT 2LoveLoveLove's ConfusionsLove's VisionLove, Friendship, and the SelfLove, Sex & TragedyLuckyLudwig WittgensteinLustLyingMachine ConsciousnessMad for FoucaultMad TravelersMade with WordsMadness And Death In PhilosophyMadness and DemocracyMadness at HomeMadness Is CivilizationMaking Natural KnowledgeMaking Sense of EvolutionMaking Sense of Freedom and ResponsibilityMaking the DSM-5Making the Social WorldMaking TruthMale Female EmailMan, Beast, and ZombieMandated Reporting of Suspected Child AbuseManiaManic Depression and CreativityMapping the Edges and the In-betweenMapping the Future of BiologyMarcus AureliusMaster PassionsMatters of the MindMe++Meaning and Moral OrderMeaning and Value in a Secular AgeMeaning in LifeMeaning in Life and Why It MattersMeaning, Basic Self-Knowledge, and MindMeasuring HappinessMeasuring PsychopathologyMedia MadnessMedical Enhancement and PosthumanityMedicine and Philosophy in Classical AntiquityMedicine of the PersonMedicine, Mental Health, Religion, Science and Well-BeingMelancholy And the Care of the SoulMelancholy and the Otherness of GodMementoMemory and NarrativeMental ActionsMental CausationMental Causation and OntologyMental HealthMental Health At The CrossroadsMental Health Policy in BritainMerit, Meaning, and Human BondageMerleau-PontyMerleau-Ponty and the Possibilities of PhilosophyMetacognition and Theory of MindMetacreationMetaethical SubjectivismMetaethicsMetal and FleshMetaphors of MemoryMetapoliticsMethods in MindMichel FoucaultMill's UtilitarianismMindMindMind and ConsciousnessMind and CosmosMind and MechanismMind GamesMind in a Physical WorldMind in Everyday Life and Cognitive ScienceMind in LifeMind TimeMind's LandscapeMind, Brain and the Elusive SoulMind, Brain, and Free WillMind, Reason and ImaginationMinding MindsMindreadersMindreading AnimalsMinds and PersonsMinds, Brains, and LawMinds, Ethics, and ConditionalsMindshapingMindsightMindworldsMirror, MirrorMixed FeelingsMockingbird YearsModels of the SelfModern Social ImaginariesModern Theories of JusticeModernity and SubjectivityModernity and TechnologyMoody Minds DistemperedMoral BrainsMoral DimensionsMoral FailureMoral ImaginationMoral LiteracyMoral MachinesMoral ParticularismMoral PsychologyMoral Psychology and Human AgencyMoral Psychology, Volume 1Moral Psychology, Volume 2Moral Psychology, Volume 3Moral Psychology: Volume IVMoral RepairMoral Responsibility and Alternative PossibilitiesMoral TribesMoral Value and Human DiversityMorality and Self-InterestMorality in a Natural WorldMorality, Moral Luck and ResponsibilityMotherhoodMotive and RightnessMoving Beyond Prozac, DSM, and the New PsychiatryMultiple Analogies in Science and PhilosophyMultiple Identities & False MemoriesMusic, Madness, and the Unworking of LanguageMy Brain Made Me Do ItMy Double UnveiledMy WayNarrativeNarrative and IdentityNarrative MedicineNarrative PsychiatryNarrative Theory and the Cognitive SciencesNatural Ethical FactsNatural Kinds and Conceptual ChangeNatural MindsNatural-Born CybogsNaturalism and the First-Person PerspectiveNaturalism and the Human ConditionNaturalism in the Philosophy of HealthNaturalism in the Philosophy of HealthNaturalized BioethicsNaturalizing the MindNatureNature and NarrativeNear Death ExperienceNeither Bad nor MadNeither Victim nor SurvivorNeuro-Philosophy and the Healthy MindNeuroethicsNeuroethicsNeurological Foundations of Cognitive Neuroscience Neurophilosophy at WorkNeurophilosophy of Free WillNeuropoliticsNeuropsychoanalysis in PracticeNeuroscience and PhilosophyNew Essays on the Explanation of ActionNew Philosophy for a New MediaNew Versions of VictimsNew Waves in Philosophy of ActionNietzscheNietzsche and Buddhist PhilosophyNietzsche on Ethics and PoliticsNietzsche's TherapyNietzsche, Culture and EducationNietzsche: The Man and His PhilosophyNihil UnboundNoir AnxietyNormative EthicsNormativityNorms of NatureNotebooks 1951-1959Notes Toward a Performative Theory of AssemblyNothing So AbsurdOblivionOn AnxietyOn ApologyOn Being AuthenticOn Being AuthenticOn BeliefOn BetrayalOn BullshitOn DelusionOn DesireOn EmotionsOn HashishOn Human RightsOn Loving Our EnemiesOn Nature and LanguageOn PersonalityOn ReflectionOn Romantic LoveOn the EmotionsOn the Freud WatchOn the Government of the LivingOn the Human ConditionOn the InternetOn the Meaning of LifeOn the Philosophy of LawOn the Pragmatics of CommunicationOn the Punitive SocietyOn TruthOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne Hundred DaysOnflowOnly a Promise of HappinessOntology of ConsciousnessOpen MindedOpen Your EyesOrgans without BodiesOther MindsOur Last Great IllusionOur Own MindsOur Posthuman FutureOur StoriesOut of Its MindOut of Our HeadsOxford Guide to the MindOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPanic DisorderPanpsychismPanpsychism in the WestPartialityPassionate EnginesPassionate EnginesPathologies of BeliefPathologies of ReasonPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perceiving the WorldPerception & CognitionPerception and Basic BeliefsPerception, Hallucination, and IllusionPerceptual ExperiencePerfecting VirtuePerplexities of ConsciousnessPersistencePersonal AutonomyPersonal Autonomy in SocietyPersonal IdentityPersonal Identity and EthicsPersonal Identity and Fractured SelvesPersonhood and Health CarePersonsPersons and BodiesPersons, Humanity, and the Definition of DeathPersons, Souls and DeathPerspectives on ImitationPerspectives on PragmatismPessimismPhenomenal Concepts and Phenomenal KnowledgePhenomenal ConsciousnessPhenomenal IntentionalityPhenomenology and ExistentialismPhenomenology and Philosophy of MindPhilosophersPhilosophers on MusicPhilosophers without GodsPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical DevicesPhilosophical Foundations of NeurosciencePhilosophical History and the Problem of ConsciousnessPhilosophical Issues in PsychiatryPhilosophical Issues in PsychiatryPhilosophical Issues in Psychiatry IIPhilosophical MethodologyPhilosophical MidwiferyPhilosophical Myths of the FallPhilosophical Perspectives on DepictionPhilosophical Perspectives on Technology and PsychiatryPhilosophical PracticePhilosophical Reflections on DisabilityPhilosophizing About Sex Philosophizing the EverydayPhilosophy and HappinessPhilosophy and LivingPhilosophy and PsychiatryPhilosophy and PsychotherapyPhilosophy and Science FictionPhilosophy and the EmotionsPhilosophy and the EmotionsPhilosophy and the Interpretation of Pop CulturePhilosophy and the Moving ImagePhilosophy and the NeurosciencesPhilosophy and This Actual WorldPhilosophy As FictionPhilosophy BitesPhilosophy Bites BackPhilosophy for Counselling and PsychotherapyPhilosophy for LifePhilosophy in a New CenturyPhilosophy in an Age of SciencePhilosophy in Children's LiteraturePhilosophy of ActionPhilosophy of ActionPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BodyPhilosophy of Film and Motion PicturesPhilosophy of LovePhilosophy of Love, Sex, and MarriagePhilosophy of MindPhilosophy of Mind and CognitionPhilosophy of Personal Identity and Multiple PersonalityPhilosophy of PsychologyPhilosophy of Public HealthPhilosophy of SciencePhilosophy of SciencePhilosophy of Technology: The Technological ConditionPhilosophy of the Social SciencesPhilosophy on TapPhilosophy PracticePhilosophy the Day after TomorrowPhilosophy's Role in Counseling and PsychotherapyPhilosophy, Neuroscience and ConsciousnessPhilosophy, Politics, DemocracyPhotography and PhilosophyPhysical RealizationPhysicalism and Its DiscontentsPhysicalism and Mental CausationPhysicalism, or Something Near EnoughPhysician-Assisted DyingPillar of SaltPin-up GrrrlsPlatoPlatoPlato, Not Prozac!Platonic Ethics, Old and NewPluralistic CasuistryPolarities of ExperiencesPolitical EmotionsPopper, Objectivity and the Growth of KnowledgePornPorn StudiesPornography, Sex, and FeminismPortrait of the Psychiatrist as a Young ManPostcolonial DisordersPostpsychiatryPosttraumatic Stress DisorderPower and the SelfPower SplitPractical Autonomy and BioethicsPractical ConflictsPractical Identity and Narrative AgencyPractical PhilosophyPractical RulesPractical Tortoise RaisingPractically ProfoundPracticing Feminist Ethics in PsychologyPragmatic BioethicsPragmatismPragmatism, Old And NewPraise and BlamePredicative MindsPreferences and Well-BeingPrescriptions for the MindPresocraticsPrimary and Secondary QualitiesPrimates and PhilosophersPrivacyPrivileged AccessProblems in MindProblems of RationalityProzac As a Way of LifeProzac BacklashProzac on the CouchPsyche and SomaPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric EthicsPsychiatric HegemonyPsychiatric PowerPsychiatric SlaveryPsychiatry and Philosophy of SciencePsychiatry and ReligionPsychiatry as a Human SciencePsychiatry as Cognitive NeurosciencePsychiatry in SocietyPsychiatry in the New MilleniumPsychiatry in the Scientific ImagePsychiatry, Psychoanalysis, And The New Biology Of MindPsycho-Physical Dualism TodayPsychoanalysis and Narrative MedicinePsychoanalysis and the Philosophy of SciencePsychological Concepts and Biological PsychiatryPsychology and PhilosophyPsychology and the Question of AgencyPsychology's Interpretive TurnPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychotherapy and ConfidentialityPsychotherapy As PraxisPublic PhilosophyPunishmentPure ImmanencePurple HazePursuing MeaningQuality of Life and Human DifferenceQueer PhilosophyQuestions for FreudQuestions for FreudQuine and Davidson on Language, Thought and RealityRaceRace in Contemporary MedicineRadiant CoolRadical AlterityRadical ExternalismRadical HopeRational and Social AgencyRational CausationRational Choice in an Uncertain WorldRationality + Consciousness = Free WillRationality and FreedomRationality and the Reflective MindRationality in ActionRawls, Dewey, and ConstructivismRe-creating MedicineRe-EmergenceRe-Engineering Philosophy for Limited BeingsReading AutobiographyReading Bernard WilliamsReading SartreReadings in the Philosophy of TechnologyReal MaterialismReal Natures and Familiar ObjectsReal ScienceRealism in ActionReason & EmancipationReason in ActionReason in PhilosophyReason's GriefReasonably ViciousReasoning About Rational AgentsReasoning in Biological DiscoveriesReasons from WithinReasons without RationalismReclaiming CognitionReclaiming the SoulReconceiving SchizophreniaReconstructing Reason and RepresentationReconstructing the Cognitive WorldRecreative MindsRediscovering EmotionRediscovering EmpathyReference and ExistenceReference and the Rational MindReflections On How We LiveReframing Disease ContextuallyRefusing CareRegulating SexReinventing the SoulRelativism and Human RightsRelativism and the Foundations of PhilosophyRelativism and the Foundations of PhilosophyReliable ReasoningReligion without GodRelying on OthersRemembering HomeResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsRestraining RageRethinking ExpertiseRethinking IntrospectionRethinking Mental Health and DisorderRethinking RapeRethinking the DSMRethinking the Sociology of Mental HealthRethinking the Western Understanding of the SelfReturn to ReasonRevolt, She SaidRichard RortyRichard RortyRichard RortyRichard RortyRichard RortyRichard Rorty's New PragmatismRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRise And Fall of Soul And SelfRitalin NationRobert NozickRousseauRousseau and the Dilemmas of Modernity Routledge Philosophy Guidebook to Derrida on DeconstructionRules, Reason, and Self-KnowledgeSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSartreSartreSartreSartre in Search of an EthicsSatisficing and MaximizingSaving GodScandalous KnowledgeSchizophreniaSchizophrenia and the Fate of the SelfSchizophrenia: A Scientific Delusion?SchopenhauerSchopenhauer's TelescopeScienceScience and EthicsScience and Pseudoscience in Clinical PsychologyScience and SpiritualityScience and the Pursuit of WisdomScience Fiction and PhilosophyScience Fiction and PhilosophyScience in Civil SocietyScience in DemocracyScience RulesScience WarsScience, Consciousness and Ultimate RealityScience, Policy, and the Value-Free IdealSciences from BelowScientific EvidenceScientific IrrationalismScientific PerspectivismScientific PluralismScientific Realism and the Rationality of ScienceScratching the Surface of BioethicsSecond NatureSecond OpinionsSecond PhilosophySecrets of the MindSecular Philosophy and the Religious TemperamentSecurity, Territory, PopulationSeeing and VisualizingSeeing DoubleSeeing Fictions in FilmSeeing RedSeeing Wittgenstein AnewSeeing, Doing, And KnowingSelfSelf and OtherSelf and SubjectivitySelf, No Self?Self-ConsciousnessSelf-ConstitutionSelf-ExpressionSelf-FulfillmentSelf-Knowledge and ResentmentSelf-Knowledge and Self-DeceptionSelf-Made MadnessSelf-Reference and Self-AwarenessSelf-Representational Approaches to ConsciousnessSelvesSentimental RulesSexing the BodySexualized BrainsShades of LonelinessShame and GuiltShame and NecessityShame and PhilosophyShop Class as SoulcraftShynessSigns, Mind, And RealitySimone de BeauvoirSimple MindednessSimulating MindsSimulation and SimilaritySinging in the FireSisyphus's BoulderSituating SemanticsSix Questions of SocratesSkeptical FeminismSkepticismSketch for a Theory of the EmotionsSleeping With Extra-TerrestrialsSlothSocial EpistemologySocial PhenomenologySocializing MetaphysicsSociological Perspectives on the New GeneticsSocratesSocrates CafeSocrates in LoveSocratic Moral PsychologySoft SubversionsSoren 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The Medicalization of Everyday LifeReview - The Medicalization of Everyday Life
Selected Essays
by Thomas Szasz
Syracuse University Press, 2007
Review by Jeffrey Poland, Ph.D.
Aug 26th 2008 (Volume 12, Issue 35)

The Medicalization of Everyday Life is a collection of sixteen essays written by Thomas Szasz between 1972 and 2006. Although each of the essays has been published elsewhere, there is substantial value attained by viewing them together in a single volume. The collection is unified by the idea there have been, and continue to be, powerful trends toward the "medicalization" of many aspects of life -- indeed, too many aspects of life. Its aim is to clarify what medicalization is, how it is manifested in different medical institutions and practices, what is wrong with it, why it occurs, and what should be done about it. The focus of the discussion is, of course, psychiatric practices and institutions, although other medical practices also receive close scrutiny. The collection is divided into two parts. The first, Demarcating Disease from Nondisease, consists of seven essays addressing questions of the definition of 'disease' and 'mental disease' and clarifying the history and significance of such definitions. The second, Disturbing Behavior and Medicine's Responses to It, consists of nine essays surveying numerous putative examples of medicalization and providing detailed discussion of each (e.g., coercive psychiatric practices, hysteria, routine neonatal circumcision, suicide, pedophilia, criminal responsibility, euthanasia, medical ethics, relations between medicine and the state.)

Those familiar with Szasz's writings over the past fifty years, will recognize many of the themes found in this collection: the importance of history for understanding current medical and psychiatric practices, the importance of language in structuring medical practices and institutions, the coercive potential of language, the "myth" of mental illness, the importance of individual autonomy, the threat to individual autonomy and responsibility posed by psychiatric diagnosis, the tensions between individual autonomy and the state, and the recruitment of medicine and psychiatry as extensions of the police powers of the state. Those who are new to Szasz's writings will quickly be brought up to speed on Szasz's critical stance toward contemporary psychiatry and the deeper trends in medicine and society that underlie psychiatric practices and institutions.

The basic conceptual framework underwriting Szasz's analysis is as follows. Assuming that the distinction between medical and non-medical practice is of critical importance because it influences medical care, law and social policy, and hence the lives people live, it is of paramount importance to delineate legitimate medical practice. Simply put, 'medicalization' refers to an illegitimate practice of introducing medical terms, concepts, and practices into an area of social or personal life when it is inappropriate to do so (e.g., viewing racism or homosexuality as diseases.) As Szasz understands it, medicalization is a semantic and attributional strategy that shapes forms of social and professional practice and forms of individual consciousness and behavior. The thrust of this strategy is that, when someone is viewed as sick (ill, diseased) or their behavior is viewed as the product of sickness (illness, disease), then the behavior is viewed as not under the person's rational control (i.e., not reason-based, not motivated), the individual is viewed as not fully a moral agent, and his/her moral and social status is diminished. As a consequence, medicalized individuals are viewed as less responsible for their behavior and as more fitting candidates for being the object of coercive treatment by others. Furthermore, such individuals are classified in a way that enlists various social institutions and practices erected for the purpose of dealing with them (e.g., sick individuals fall within the domain of medical practice.)

There are two general forms of medicalization. First, there is "medicalization from below" (i.e., from powerlessness) which takes the form of malingering or self-medicalization, wherein the individual (falsely) assumes the role of patient to be treated in certain ways and excused from certain responsibilities. In this sort of case, the individual adopts the medicalizing strategy to pursue certain interests (e.g., avoid punishment, avoid having to confront difficult situations, receive benefits), at the expense of others. Second, there is "medicalization from above" (i.e., from power) which takes the form of "medicalization of the other to control or punish", wherein individuals who are disruptive, deviant, dangerous, troublesome, etc are placed in the patient role which then legitimates various forms of "treatment" or other (coercive) measures with or without the person's consent. In this sort of case, an individual (or group) viewed as detrimental in some way to other people, society or the state, is identified as diseased and controlled in ways that harm them (via dehumanization and deprivations of liberty). In both sorts of case, the interests of some are served while those of others are harmed as a consequence of a powerful linguistic-social strategy.

At the root of this analysis is a conception of what is a genuine medical disease and, hence, what is an appropriate use of the terms 'disease', 'diagnosis', 'treatment', "physician", and "patient". Without such an analysis, the distinction between "medicalization" and legitimate medical practice cannot be made. According to Szasz, a genuine disease involves an objectively identifiable physical lesion of the body, where a lesion is a disturbance in the structure or function of cells, tissues, and organs. (22) In legitimate medical practice, such diseases are discovered and classified by research pathologists, and they are diagnosed and treated by physicians, always with the consent of the individual patient. In medicalization, there are departures from this standard in which "diseases" are constructed and projected onto "patients" for the purposes of justifying "treatment" by "physicians", with or without consent. The deep significance of this latter practice is at least twofold. First, medicalization leads to increased dehumanization (viewing someone as less than a moral agent) and loss of freedom (depriving someone of their rights) for individuals in a wide range of contexts. Second, it is a driving force in the emergence of the "therapeutic state": as individuals, the public, the government, and various special interest groups promote medicalization of more and more areas of personal or social life, the prestige and power of science and medicine are recruited into legitimizing medical practices in the service of the economic, political, ideological, and social interests of the state, thereby increasing its sphere of influence. The various papers in the volume aim, in one way or another, to clarify and justify these two points of significance. A few examples will have to suffice.

As explained by most of the essays in the volume, the paradigmatic example of  medicalization, according to Szasz, is the use in psychiatry and related "mental health" professions of such terms as 'disease', 'diagnosis', 'treatment', 'patient', and other terms designating medical conditions, practices, and roles. Though literally applicable in genuine medicine contexts, such terms are used at best "metaphorically" when applied to disturbing behavior and life problems that become the objects of psychiatric practice. One argument for this claim proceeds as follows: a genuine disease involves a physical lesion of the body, and, hence, only bodily parts or processes can be diseased; the mind and all things mental are either thoughts or behaviors or dispositions to think or behave, none of which are substances or parts of bodies and, hence, none of them can be diseased. To attribute 'disease' to the mind is to commit a "category mistake" or to engage in a metaphor (as in a "sick" joke), perhaps for rhetorical and strategic purposes. Buttressing this argument are two further points: 1) rejection of naïve materialist reductionism and determinism (i.e., the mind is not reducible to or otherwise determined by the brain); and 2) assertion that the standards by which bodies and minds are judged are different (e.g., while bodies can be diseased, minds can only be irrational or vicious.) To bring home the point, Szasz uses the following analogy: physical disease is to "mental disease" as a broken television is to a bad television show.

Szasz famously concludes that mental illness is a harmful myth, psychiatry is not a bona fide medical specialty, and psychiatrists are not medical experts. The deep harms that result from these practices include: dehumanization of individuals by not viewing them as the authors of their behavior and as responsible for it (e.g., the Church's initial internal response to child-abusing priests), loss of freedom by coercive intervention (e.g., involuntary commitment, involuntary treatment, suicide prevention), undermining of legal and social justice by influence on legal proceedings and social policy (e.g., the insanity defense, the Americans with Disabilities Act), and creation of a broad culture of pathologizing and control in contexts where other approaches are called for. Of medical classification in general, but especially psychiatric classification, he charges that its purpose is not to objectively identify conditions that are diseases but to prescribe what conditions should be viewed as diseases for the purposes of prescribing social policy regarding what is appropriate treatment for what conditions and paid for by whom; he links such classification to monetary gain and the politicization of medicine.

Past or present categories of mental disorder that come under critical scrutiny in this volume include homosexuality, masturbation, hysteria, depression, schizophrenia, pedophilia, sexual perversions, and drug addiction: in all cases medical, disease-oriented interpretations of the behavior associated with these categories are disputed; if there were a brain disease associated with any of them (which Szasz deems most improbable), then they would be brain diseases, not mental diseases.

Szasz's alternative view of individuals who are classified as "mentally ill" is as follows: the individual is a moral agent who is the author of his or her actions and hence is responsible for them. Since life is fundamentally tragic, involving free will, responsibility, and human weakness, some people are unhappy, failures, in conflict with others, liars, manipulative, violent, or criminals or have bad habits; but none of these things are appropriately called "illness." For example:

·         -Of individuals expressing "delusional ideas" he contends that, on a par with actors and criminals, such individuals should be viewed as acting on "the desire to gain existential rather than economic advantage" and "we ought to view such behavior as a type of "existential identity theft..." (39)

·         -With respect to "hysteria" he insists that "hysterical symptoms" are a form of communication used in the context of "game-playing" and that "hysterics act disabled and sick; their illness is not real but an imitation of a bodily illness. By means of body language, hysterics communicate with themselves and others, especially those willing, perhaps even eager, to assume the role of protecting and controlling them." (76)

·         -And, finally, commenting on a defendant pursuing a verdict of not guilty by reason of insanity, Szasz writes that the defendant was "suffering from the consequences of having lived a life very badly, very stupidly. Very evilly; that from the time of her teens, for reasons which I don't know, she had, whatever she had done, she has done very badly. She was a bad student. There is no evidence that she was a particularly good daughter, sister. She was a bad wife. She was a bad mother. She was a bad employee insofar as she was employable. Then she started to engage [in taking] illegal drugs, then she escalated to illegal assault, and finally she committed this murder...Life is a task. You either cope with it or it gets you...If you do not know how to build, you can always destroy. These are the people that destroy us in society, our society, and other people." (110-111)

In addition to psychiatry, Szasz discusses several other examples of medicalizing trends and practices. In "The Fatal Temptation: Drug Control and Suicide", Szasz attempts to draw out latent contradictions in orthodox talk about suicide, drugs, autonomy, and rights involving life and death. Associating the "right to die" with "our skittishness about suicide and our longing for good doctors to kill us at just the right time and in just the right way but, more fundamentally, ... [with] our repudiation of bodily self ownership and the responsibilities that go with it", Szasz argues that suicide is a basic human right and that it implies a right to free access to drugs. He suggests that it is the dual fears of dying a protracted, pointless, and painful death and of living with a free market in drugs that undermine "pharmacological autonomy" and that inappropriately vest power in medical agents, institutions, and practices.

In "Routine Neonatal Circumcision: A Medical Ritual", Szasz argues that routine neonatal circumcision (RNC) is a practice that demonstrates how contemporary culture has bought into medicalizing practices. According to Szasz, RNC is not justifiable on health grounds (e.g., prevention of cancer or infection), is ethically and medically on a par with female genital mutilation, and, hence, is an essentially religious ritual that is legitimized as a medical practice to serve ideological, political, and religious interests.

"Killing as Therapy: The Case of Terri Schiavo" is presented as a study of hypocrisies concerning euthanasia, physician-assisted suicide, the medicalization of death and dying, and access to drugs. Szasz observes that "The Schiavo drama was a classic battle of words: he who controlled the vocabulary controlled the debate and was assured of victory," (118) and he details how the language of ethics (e.g., 'rights', 'persons', 'autonomy') and medicine (e.g., 'coma', 'permanent vegetative state', 'irreversible brain damage', 'patient', 'physician', 'treatment', 'physician assisted suicide') shaped the unfolding of the case which, on his view, was badly handled by all parties involved: the husband, the parents, the media, medical ethicists, religious groups, physicians, the courts, and the state. He concludes that "Terri Schiavo was killed ... [b]ecause no one --not her husband, not her parents, not any philanthropist, not the American taxpayer- was willing to pay to keep her alive ... If we believe that executing innocent people is wrong, then the Schiavo case presents no ethical problem. It presents economic, political, and social problems." (129-130) And the deeper moral is supposed to be that practices concerning death, dying, and dependency, matters that previously have been problems for the family and the church, are now becoming problems for the state and are increasingly being framed in medical terms (e.g., 'physician-assisted suicide").  But, again, such medicalization comes with a cost: "In short, the legal definition of PAS as a procedure that only a physician can perform expands the medicalization of everyday life, extends medical control over personal conduct, especially at the end of life, and diminishes patient autonomy." (129)

"Peter Singer's Ethics of Medicalization", is a study of the views of Peter Singer, a medical ethicist. Szasz writes as follows: "Why do I consider his views --which I think are mistaken and wicked- in this volume? I do so because he is a prominent figure in contemporary bioethics and because his "preference utilitarian perspective" is a striking example of the contemporary debauchment of morality and politics by means of the medicalization of ethics." (134) Szasz sees in Singer a prime example of how processes of medicalization and the therapeutic state, with their objectionable consequences for personal responsibility and freedom, are buttressed by medical ethicists.

"Pharmacracy: The New Despotism" (2001), focuses on issues related to practices informed by medicalizing ideology and the use of force "by physicians acting --explicitly or implicitly, wittingly or unwittingly- as agents of the state." (151) In particular, Szasz argues that, although certain coercive public health measures can be legitimate instruments of state control (e.g., quarantine during an epidemic), this sort of justification does not legitimately extend the role of the state to matters of private health.  Just as it is important to maintain a separation between the church and the state, so, Szasz contends, it is important to maintain a separation between medicine and the coercive apparatus of the state: such a separation "is necessary for the protection of our traditional rights to life, liberty, and property." (154) Thus, "the answer to the question of whether a person has a "right to be ill" --physically or mentally- comes down to whether he is viewed as a private person or as public property: the former has no obligation to the community to be or stay healthy; the latter does have such an obligation. In proportion as medical care is provided by the state, doctors and patients alike cease to be private persons and forfeit their "rights" against the opposing interests of the state." (161)

Szasz's diagnosis for why America is drifting toward pharmacracy and the therapeutic state is that "Americans want a therapist-in-chief who is both physician and priest, an authority that will protect them from having to assume responsibility not only for their own health but also for their behaviors that make them ill, literally or figuratively. Pandering to this passion, politicians assure people that they have a "right to health" and that their maladies are "no-fault diseases"; promise them a "patient's bill of rights" and an America "free of cancer" and "free of drugs"; and stupefy them with an inexhaustible torrent of mind-altering prescription drugs and mind-numbing anti-disease and anti-drug propaganda --as if anyone could be for illness or drug abuse." (167-8) But, Szasz warns, as people rush to embrace the therapeutic state, "by the time they discover that the therapeutic state is about tyranny, not therapy, it will be too late." (168)

Strengths and Weaknesses

In addition to being quite readable and often entertaining, this collection of papers has several strengths. First, Szasz provides a critical perspective that demonstrates the sorts of analysis (e.g., unmasking influential ideologies and vested interests; identifying flawed inferences) that ought to be pursued if contemporary medical and psychiatric practices and institutions are to be understood, improved, or (if necessary) replaced. His is a perspective that all interested parties should understand and know how to respond to. Second, Szasz pursues attempts to clarify the historical roots and, hence, the contingency of contemporary practices: i.e., the world is not the way it is necessarily and understanding how it came to be the way it is is essential for progress. Third, more specifically, he provides a valuable clarification of the nature of medicalization practices and how they operate to shape consciousness, practices, and institutions. Fourth, he identifies important dimensions of medical and psychiatric practice that are often obscured from view: e.g., the psychosocial structure of mental health contexts and the risks to individuals inherent in such contexts (e.g., dehumanization, stigma, discrimination, and coercion.) Finally, he clarifies the importance of understanding the grades and types of criticism that might be pursued: some critical stances, while addressing recognizable problems, may (in so doing) reinforce problematic underlying assumptions that sustain the very practices being criticized (e.g., criticizing a specific category of mental disorder while implicitly affirming the concept of mental disorder).

Weaknesses of the volume are of three sorts. Szasz often depends on questionable assumptions and flawed argumentation, he is frequently silent on critical matters, and he makes limited recommendations for constructive change. First, Szasz relies upon a 19th century conception of disease that has been variously criticized as being unclear (what precisely is a "lesion"), as harboring normative assumptions, as failing to provide necessary and sufficient conditions, and as being too narrow if it precludes mental processes and functions from the domain of possible disease. Further, along with the definition of 'disease', Szasz relies on a quite dated philosophy of mind and an overly simplistic conception of "reduction" in the sciences to buttress his arguments for the mythical or metaphorical nature of "mental illness". As a consequence the arguments are not very compelling. Similar flaws undercut arguments for other claims made in the book (e.g., arguments about the right to suicide entailing an unrestricted right to drugs); although interesting and suggestive, the arguments are often not persuasive.

Second, there are several matters, the clarification of which would both strengthen his arguments and promote a more effective agenda of change. For example, in recent years the so-called "harmful dysfunction" analysis of mental disorder has led many to (incorrectly) believe that the central organizing concept of psychiatry has been sufficiently clarified to render Szasz's critique otiose. Szasz's case would be strengthened by showing why such an analysis falls short; simplistic claims about category mistakes and minds not being substances do not suffice for this. And again, his case would be strengthened by explaining in technical detail why contemporary genetic and neuroscience research programs are not producing findings that support a disease model of "depression", "schizophrenia", and other psychiatric categories. For this, a more sophisticated philosophy of science than the crude anti-reductionism Szasz embraces, one which clarifies the nature of scientific evidence, inference, and explanation, is required. Further, although alert to the problem of dehumanization and stigma, Szasz does not adequately emphasize and explain why contemporary "anti-stigma" programs, currently pursued by defenders of psychiatric practice, are so wrong-headed. Performing these tasks would help arm the public for coping with the rhetoric of defenders of psychiatric practice who "educate" us about the disease status of these categories. The key limitation is that of not providing more effective tools for those who are confronted with the pressures of medicalization and the therapeutic state.

Finally, Szasz's constructive proposals for change are limited. In the first essay, he makes three such proposals as follows. First, since "mental health problems" are "not medical but human (that is, moral, social, political) problems, we cannot solve them by therapeutic means; hence we must stop continuing and even intensifying our efforts to solve them by such means." (8) Second, "since the vocabulary of psychiatry serves to systematically redefine moral and political problems as diseases, we must repudiate and stop this abuse of our language." (9) Third, "as psychiatric "treatments" are chiefly overtly or covertly involuntary, such interventions must be disavowed; we must reject the use of psychiatrists as policemen, judges and jailers; and we must seriously dedicate ourselves to the proposition that "mental health" workers should help only those who want to be helped, that they should do so only in ways acceptable to their clients, and they should stop doing everything else." (9) And, in the Introduction he makes yet a fourth proposal in the context of discussing "education" about mental illness: "It is also obvious that the self-styled psychiatric "educators" never mention two major risks inherent in every professional contact between an individual and a psychiatrist, namely, stigmatization by diagnosis and loss of liberty by forced psychiatric "hospitalization."" (xxvi) The proposal, of course, is that such risks should be regularly disclosed. Finally, Szasz's alternative conceptualizations of the behavior of those identified as "mentally ill" (e.g., the hysteric, the delusional person, the defendant pleading insanity) repudiates a disease interpretation in favor of using non-disease descriptions heavily freighted with  moral terms of evaluation.

Unfortunately, for the most part, the above recommendations are negative, far too abstract to be of much use, and not terribly responsive to the demands of the context in which change might be pursued. In the case of alternatives to a disease conceptualization of behavior, Szasz seems to promote the false dichotomy, "brain disease or moral failing" that is relied upon by many defenders of psychiatry. In general, more detailed and constructive proposals are called for: e.g., proposals which clarify not only what viable alternative forms of discourse, institutions, and practices might be like, but also how change might be realistically implemented with alternatives that do not reinforce problematic dichotomies and assumptions that inform current practices.

Despite the critical points just rehearsed, this is a valuable collection of papers. In a culture of rampant medicalization with many apparent crises brewing (e.g., widespread psychiatric diagnosis and drug treatment of increasingly younger children; deep confusion in the development of the DSM system of classification), most of us are quite ill-equipped for recognizing and resisting the powerful social and linguistic influences that promote such practices and breed such crises. Szasz's writing stimulates thought, motivates a desire for change, and demonstrates forms of criticism in which everyone (especially those in the mental health professions) should be well versed.

© 2008 Jeffrey Poland

Jeffrey Poland, Rhode Island School of Design & Brown University


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