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The institutions of psychiatry and more generally psychiatric practice, are a prominent part of our modern world view; specifically belonging to the medical world, and all the connotations of illness, diagnosis, and cure that follow. Being part of the medical world entails that psychiatry is also bound up with our worlds of economy and legislature to quite an astonishing degree. We only need think of the massive economy built around the education of psychiatry, the jobs reliant on its existence, the prescribing and selling of drugs, the insanity defense used in court of law, involuntary hospital confinement, and so on. These inter-institutional practices are so entrenched in our public consciousness that we'd be forgiven for thinking all is well and good. Thomas Szasz, however, disagrees, and has built his career (Spanning over 40 years and numerous publications) on trying to prove the bogus notion of mental illness, and the ethically questionable ramifications this has both for potential patients and the institutions built around and relating to psychiatric practice.
Szasz' central thesis is that the notion of mental illness can be understood at best as a metaphor, at worst an oxymoron. He outlines the currently accepted definition of illness as based on the normal or abnormal functioning of the body -- specifically lesions at the cellular level. Given the nature of mental phenomena, we cannot properly ascribe to them lesions at the cellular level. As soon as we start pointing to lesions in the brain, we are dealing with brain diseases, not mental diseases. He concludes it makes no sense to talk of the mental, or our behavior, as a disease. Szasz accepts that behavior may be a symptom of a disease -- this much is obvious -- but the disease itself is always going to be of the body. If behavior is to be a symptom of disease, we need to locate the pathological cause before we can talk of it as such. However, Szasz contends that many of the so called mental illnesses, such as those listed in the APA (American Psychiatric Association), have no scientifically proven pathological cause locatable in the body. By way of example he offers the fact that homosexuality used to be included on this very list, and that it was no scientific study which urged its removal, but rather that homosexuality became socially acceptable. Szasz contends that most mental illnesses are simply social stigmatization. Given the aforementioned strong links between the institutions of psychiatry and our economic and legal institutions, the existence or non-existence of mental illness could have serious ethical ramifications.
The majority of this book focuses on an unraveling of the history of psychiatry through an analysis of some of the key figures in its development, as well as some lesser known commentators. His aim here seems to be to show the foundations of psychiatry as built on and sustained by mutually beneficial lying. For example, Szasz considers Freud a “quack” who was seeking a prestigious career. Patients and psychiatrists engage in a mutual lie; one to sustain their career, the other to avoid responsibilities and garner the attention due to normally ill people. It is in this historical exegesis, however, that Szasz loses some of his rigor, and the role of this book as charged polemic becomes abundantly clear. At one point Szasz quotes a letter written by Freud to his wife, in which he describes his admiration for Charcot in admittedly overly-colorful prose, Freud sounding more in love with Charcot then his own wife. Szasz uses this in an attempt to discredit Freud's migration to France in order to study under Charcot, as comparable to a Muslim pilgrim travelling to Mecca “to reaffirm and strengthen his faith”. In fact, lines are continually drawn between the role of religion and psychiatry, with Szasz arguing the psychiatrist fills the role of priest in terms of socio-economic role, absolving patients of their responsibilities. While much of this is an interesting historical interpretation, full of potential insight, thoroughly researched by an expert in his field, and always supported with relevant quotes, it is also questionable as a valid line of argument. For example, discrediting Freud in the manner mentioned is a classic Ad Hominem fallacy -- attacking the person, not their arguments. What this historical interpretation does offer, is some background to help understand how -- if we accept the potential of psychiatry as unscientific -- the notion of mental illness, and the institutions of psychiatry may have come to be so deeply entrenched and accepted.
In many ways Szasz can be considered the Richard Dawkins of anti-psychiatry, with all the benefits and criticisms this entails. Indeed, many of his arguments - especially when religion is brought into the picture - share a certain ideological alignment with Dawkins; a call for honest science in defeating supposedly dangerous institutions. What this means is that Psychiatry: The Science of Lies is a charged and entertaining polemic, not without good arguments, but also not without some heavy handed attempts at discrediting its target. It seems clear that this work is aimed at a fairly general audience, written clearly, and often fairly humorously. Indeed, it doesn't seem above Szasz to occasionally mock the institutions he so strongly disagrees with, employing a certain wry wit. This can be seen when he retitles Karin Stephens book 'The Wish to Fall Ill' as 'The Wish to Be Excused and Pampered as If One Were Sick' or when he describes the fraudulent journey of postal worker Gert Postel infiltrating the psychiatric job market with forged papers and faked psychiatric talents. Indeed, it may be a desire on Szasz' part to reach a wider audience that this work takes on the role of charged polemic at the cost of losing some argumentative force. For this purpose, the work succeeds as a well written and entertaining piece of writing. It is also informative, and raises what seems to me to be important ethical issues. I only wish Szasz offered some more direct and rigorous rebuttals of the arguments in favor of mental illness, though for this purpose there are always his earlier works, including the classic and controversial The Myth of Mental Illness.
© 2009 Matthew Whittingham
Matthew Whittingham writes about himself:
I am just finishing my MA in philosophy at the University of Kent, and am about to start my PhD at the same institution. My Ma thesis uses the therapeutic methods of Wittgenstein's philosophy of language to criticise traditional approaches to the philosophy of mind and cognitive science. My PhD thesis will be on the relation between our notion of self and the socio-political sphere we are a part of. I will be investigating the nature and role of freedom, in determining to what extent we rely on our socio-political climate for our identity, and to what extent we can define ourselves independently of that socio-political climate, or determine its direction through involvement within its institutions.