Szasz in One Lesson

Since there seems to be ample demand for a topic to discuss Szasz, I thought I would create a new one and start with a very clever blog post by Sheldon Richman (another long time friend of Szasz) that condenses Szasz's main points to a few short paragraphs, Szasz in One Lesson:

This is something I came up with some time ago to summarize a good deal of what Thomas Szasz, a great libertarian and hero of mine, has been saying for half a century.

If neuroscientists discovered that mass murderers and people who claim to be Jesus had different brain chemistries from other people, most everyone would accept this as evidence that they suffered from a mental illness/brain disorder (MI/BD) and that this disorder caused their behavior.

If neuroscientists discovered that homosexuals had different brain chemistries from heterosexuals, far fewer people would accept this as evidence that they suffered from a MI/BD and that this disorder caused their behavior.

If neuroscientists discovered that nuns had different brain chemistries from everyone else, very few people would accept this as evidence that they suffered from a MI/BD and that this disorder caused their behavior.

If neuroscientists discovered that married men had different brain chemistries from bachelors, no one would accept this as evidence that they suffered from a MI/BD and that this disorder caused their behavior.

Clearly, a difference in brain chemistry per se is not enough to make people believe that someone has a MI/BD. It takes more. Why, then, would a difference in one case be taken as evidence of MI/BD, while a difference in another case would not be? The obvious answer is that people, including psychiatrists, are willing to attribute behavior to mental illness/brain disorder to the extent that they disapprove of that behavior, and are unwilling to do so to the extent they approve of, or at least are willing to tolerate, that behavior. (Psychiatry once held that homosexuality was a mental illness. That position was changed, but not on the basis of scientific findings. Science had nothing to do with the initial position either.)

In other words, the psychiatric worldview rests, not on science or medicine, as its practitioners would have us believe, but on ethics, politics, and religion. That would be objectionable only intellectually if that were as far as it went. Unfortunately, it goes further, since the practitioners and the legal system they helped shape are empowered:

• First, to involuntarily “hospitalize” and drug people “diagnosed” as mentally ill and thought possibly to be dangerous to themselves or others, and

• Second, to excuse certain people of responsibility for their actions (for example, via the insanity defense).

Postscript: I'm often asked which one of Thomas Szasz's two dozen books I'd recommend to someone unfamiliar with his work. I suggest Insanity: The Idea and Its Consequences. This highly readable book covers most of his views on psychiatry, mental illness, and the Therapeutic State, with responses to his critics along the way. Of course, after that, you'll want to read the rest.

I wasn't aware of Richman's postscript when I first read this blog entry, but I can affirm his choice of Insanity; it strikes an excellent balance between readability and breadth of subject to someone new to his work.  I might also make a case for The Medicalization of Everyday Life.

Great reductio!

A very succinct article however I think there's a problem with Szasz' position.

When I was thinking about whether mental illness or not exists I decided to see whether I could come up with a cogent definition of physical illness/ injury to aid understanding the former. However I found it impossible to do so without invoking a telos of the a good life (however so defined) otherwise there would be no framework in which to identify illness at all.

Consequently there are three positions one could hold: nothing is normative, everything is down to the individual in question (which is my understanding of Szasz's position; everything is normative, to flourish every particular is normative otherwise you will not flourish ; finally there are somethings which are normative for all men and others left to their own particular choice.

If we hold Szasz position then, if we are consistent, we cannot call a guy with no legs as being disabled which is manifestly absurd. The same then applies to the mental realm- I think it perfectly possible to call someone who says walls speak to him and tell him to burn the house down mentally disabled. I think it's clear that there are somethings which are universally normative and others which aren't.

This is not to say they aren't responsible for any actions they do, nor that all mental illness are actually illness nor that anyone should be locked up for them but to say that you cannot say anything about someone's mental state but you can about their physical state is absurd. We can either judge both mental and physical states or none of them.

You're right. Still, it reminds us of the dangers of labeling any deviation from a non-existing perfection as abnormal.

@myhumangetsme

How are you defining mental illness?

Physiocrat:

A very succinct article however I think there's a problem with Szasz' position.

Well, let's be clear on one thing; the problem isn't with Szasz' position but with Richman's incomplete characterization of it, as I will show.

Physiocrat:

...there are three positions one could hold: nothing is normative, everything is down to the individual in question (which is my understanding of Szasz's position; everything is normative, to flourish every particular is normative otherwise you will not flourish ; finally there are somethings which are normative for all men and others left to their own particular choice.

If we hold Szasz position then, if we are consistent, we cannot call a guy with no legs as being disabled which is manifestly absurd.

Ubeknownst to you (and absent from Richman's blog entry), you're actually making Szasz's point for him.  You're using the word 'disabled' in a sense that Szasz would've rejected.  The only definition of 'disabled' that is consistent in the Szaszian (I think I just made up a word) sense is the physical, literal sense.  After all, we don't think of the action 'to disable' in anything but a literal, physical sense (to break your car's axle, to delete a critical system file on your computer, etc.).  We can see what it means for something to be disabled, such as with the man with no legs.  How does one disable someone else's mind, and what does it look like?

If there is an actual physical ailment which results in mental impairment, then the physical ailment is the problem and thus not a mental illness.  Otherwise we come full circle back to the point of Richman's blog entry.

Physiocrat:

I think it perfectly possible to call someone who says walls speak to him and tell him to burn the house down mentally disabled.

You can call them whatever you want, but as demonstrated by Richman's short example, that is you making a moral judgment about that person, not a medical diagnosis.  And that's the point, the current definition of mental illness is used not just to blur the line between medically objective and morally subjective, but to destroy it.

myhumangetsme:

ou can call them whatever you want, but as demonstrated by Richman's short example, that is you making a moral judgment about that person, not a medical diagnosis.  And that's the point, the current definition of mental illness is used not just to blur the line between medically objective and morally subjective, but to destroy it.

But that's my point there isn't a clear distinction between medically objective and subjective. In medicine you could diagnose a guy and say "Look mate, you haven't got any legs" without moral import but to say that it is a problem is to do so. But the only way to do this is to ascribe an end to man and that having two legs helps you to achieve it. Now ends are the framework in which we can make moral judgements. So to say a man who has no legs is disabled you are making a moral judgement.

Now clearly it is more difficult to ascertain what are disabilities of the mind. Given a materialistic framework this would require the positing of an optimum hormone/ chemical levels in the brain which helps man best to flourish. This is difficult but not in principle insumountable.

There is though a further problem. Given materialism man is determined and has no freedom of the will (defined here as the ability to choose between: truth and falshood; good and evil; and beauty and ugliness) since our genetic make-up has pre-ordained what we'll do; you could make a case for quantum randomness but just makes choices pretty much entirely random so they couldn't be considered our choices is any meaningful way.  As such Szasz argument that some mental illnesses are just choices which we are responsible for is undercut. Thus if we wish to retain man's freedom of the will we must reject materialism and accept a form of dualism (defined broadly here that man is more than just physical). Now if this the case we could have literal mental illness which primarily affects the mind rather than the brain; that said I do believe that the mind influences the brain but also the brain the mind.

Again this should not be considered as any endorsement of the present psychiatric profession especially since there are functionally materialists in the main.

myhumangetsme:

If there is an actual physical ailment which results in mental impairment, then the physical ailment is the problem and thus not a mental illness.  Otherwise we come full circle back to the point of Richman's blog entry.

Just out of curiosity, would you say that brain lesions constitute physical ailments?

Otherwise, I think Physiocrat's point is that some definition of "health" must be in play before one can understand what's meant by "ailment" (i.e. "absence/opposite of health"). I'd add, though, that I see the mind as a physical system. Therefore I see mental illness as a kind of physical illness - namely physical illness that involves/affects the mind.