Fifty Years After The Myth of Mental Illness

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This is
the preface for the new edition of The
Myth of Mental Illness
.

Good intentions
will always be pleaded for every assumption of authority. It is
hardly too strong to say that the Constitution was made to guard
the people against the dangers of good intentions.

~ Daniel Webster

1

"My aim
in this essay is to raise the question ‘Is there such a thing as
mental illness?’ and to argue that there is not.” That was the opening
line of my essay, “The Myth of Mental Illness,” published in the
February 1960 issue of The American Psychologist. The book
of the same title appeared the following year. [1]

In the 1950s,
when I wrote The
Myth of Mental Illness
, the notion that it is the responsibility
of the federal government to provide “health care” to the American
people had not yet entered national consciousness. Most persons
called mental patients were then considered “chronic” and incurable
and were confined in state mental hospitals. The physicians who
cared for them were employees of the state governments. Physicians
in the private sector treated voluntary patients and were paid by
their clients or the clients’ families.

Since that
time, the formerly sharp distinctions between medical hospitals
and mental hospitals, voluntary and involuntary mental patients,
and private and public psychiatry have blurred into nonexistence.
Virtually all medical and mental health care is now the responsibility
of and is regulated by the federal government, and its cost paid,
in full or in part, by the federal government. Few, if any, psychiatrists
make a living from fees collected directly from patients, and none
is free to contract directly with his patients about the terms of
the “therapeutic contract” governing their relationship. Everyone
defined as a “mental health professional” is now legally responsible
for preventing his patient from being “dangerous to himself or others.”
In short, psychiatry is medicalized, through and through. The opinion
of official American psychiatry, embodied in the American Psychiatric
Association, contains the imprimatur of the federal and state governments.
There is no legally valid non-medical approach to “mental illness,”
just as there is no non-medical approach to measles or melanoma.

This is why,
fifty years ago, it made sense to assert that mental illnesses are
not diseases, but it makes no sense to say so today. Debate
about what counts as mental illness has been replaced by legislation
about the medicalization and demedicalization of behavior. Old diseases
such as homosexuality and hysteria disappear. New diseases such
as gambling and smoking appear.

Fifty years
ago, the question “What is mental illness?” was of interest to the
general public as well as to philosophers, sociologists, and medical
professionals. This is no longer the case. The question has been
answered — “dismissed” would be more accurate — by the holders of
political power: representing the State, they decree that “mental
illness is a disease like any other.” Political power and professional
self-interest unite in turning a false belief into a “lying fact.”
[2]

In 1999, President
William J. Clinton declared: "Mental illness can be accurately
diagnosed, successfully treated, just as physical illness.”
[3]
Tipper Gore, President Clinton’s Mental Health Advisor,
stated: "One of the most widely believed and most damaging
myths is that mental illness is not a physical disease. Nothing
could be further from the truth.”
[4]
Surgeon General David Satcher agreed: "Just
as things go wrong with the heart and kidneys and liver, so things
go wrong with the brain."
[5]
A White House Fact Sheet on Myths and Facts about
Mental Illness asserted: “Research in the last decade proves
that mental illnesses are diagnosable disorders of the brain.”
[6]
In 2007, Joseph Biden — then Senator, now Vice President
— declared: “Addiction is a neurobiological disease — not a lifestyle
choice — and it’s about time we start treating it as such. … We
must lead by example and change the names of our federal research
institutes to accurately reflect this reality. By changing the way
we talk about addiction, we change the way people think about addiction,
both of which are critical steps in getting past the social stigma
too often associated with the disease.”
[7]
At the same time, Biden introduced a bill in the
Senate titled “The Recognizing Addiction as a Disease Act.” The
legislation called for renaming the National Institute on Drug Abuse
as the "National Institute on Diseases of Addiction,"
and the National Institute on Alcohol Abuse and Alcoholism as the
"National Institute on Alcohol Disorders and Health."
In 2008, Congress required insurance companies to provide people
with mental illnesses “the same access to affordable coverage as
those with physical illnesses." [8]

The claim that
“mental illnesses are diagnosable disorders of the brain” is not
based on scientific research; it is a lie, an error, or a naive
revival of the somatic premise of the long-discredited humoral theory
of disease. My claim that mental illnesses are fictitious illnesses
is also not based on scientific research; it rests on the materialist-scientific
definition of illness as a pathological alteration of cells, tissues,
and organs. If we accept this scientific definition of disease,
then it follows that mental illness is a metaphor, and that asserting
that view is stating an analytic truth, not subject to empirical
falsification.

My great, unforgivable
sin in The Myth of Mental Illness was calling public attention
to the linguistic pretensions of psychiatry and its preemptive rhetoric.
Who can be against “helping suffering patients” or “treating treatable
diseases”? Who can be for “ignoring sick people” or, worse, “refusing
patients life-saving treatment”? Rejecting that jargon, I insisted
that mental hospitals are like prisons not hospitals, that involuntary
mental hospitalization is a type of imprisonment not medical care,
and that coercive psychiatrists function as judges and jailers not
physicians and healers, and suggested that we view and understand
“mental illnesses” and psychiatric responses to them as matters
of law and rhetoric, not matters of medicine or science.

This sort of
rhetorical preemption is, of course, not limited to “mental health.”
On the contrary, it is a popular political stratagem. For example,
my late friend, the development economist P. T. Bauer saw the same
sort of deceptive rhetoric controlling the debate about foreign
aid: “To call official wealth transfers ‘aid’ promotes an unquestioning
attitude. It disarms criticism, obscures realities, and prejudges
results. Who can be against aid to the less fortunate?”
[9]

Although it
is intuitively obvious that there is no such thing as a disease
of the mind, the idea that mental illness is not a medical
problem runs counter to public opinion and psychiatric dogma, defining
psychiatry as a branch of medicine and mental disease as brain disease.
Thus, when a person hears me say that there is no such thing as
mental illness, he is likely to reply: “But I know so-and-so who
was diagnosed as mentally ill and turned out to have a brain tumor.
In due time, with refinements in medical technology, psychiatrists
will be able to show that all mental illnesses are bodily diseases.”
This contingency does not falsify my contention that mental illness
is a metaphor. It verifies it: The physician who discovers that
a particular person diagnosed as mentally ill suffers from a brain
disease discovers that the patient was misdiagnosed: the patient
did not have a mental illness, he had an undiagnosed bodily illness.
The physician’s erroneous diagnosis is not proof that the term “mental
illness” refers to a class of brain diseases.

In part, such
a process of biological discovery has characterized the history
of medicine, one form of “madness” after another being identified
as the manifestation of one or another somatic disease, such as
beri-beri or neurosyphilis. The result of such a discovery is that
the illness ceases to be a form of psychopathology and is classified
and treated as neuropathology. If all the “conditions” now called
“mental illnesses” proved to be brain diseases, there would be no
need for the notion of mental illness and the term would become
devoid of meaning. However, because the term refers to the judgments
of some persons about the (bad) behaviors of other persons,
the opposite is what actually happens: The history of psychiatry
is the history of an ever-expanding list of “mental disorders.”

2

The thesis
I had put forward in The Myth of Mental Illness was not a
fresh insight, much less a new discovery. It only seemed that way,
and seems that way even more so today, because we have replaced
the old religious-humanistic perspective on the tragic nature of
life with a modern dehumanized pseudomedical perspective on it.

The secularization
of everyday life — and, with it, the medicalization of the soul
and of suffering of all kinds — begins in late sixteenth century
England. Shakespeare’s Macbeth (1611) is a harbinger. Overcome
by guilt for her murderous deeds, Lady Macbeth “goes mad”: She feels
agitated, is anxious, unable to eat, rest, or sleep. Her behavior
disturbs Macbeth, who sends for a doctor to cure his wife. The doctor
arrives and quickly recognizes the source of Lady Macbeth’s problem:
“Doctor [to Gentlewoman]. Go to, go to! You have known what you
should not. / Gentlewoman. She has spoke what she should not, I
am sure of that.”
[10]

The doctor
tries to reject Macbeth’s effort to medicalize his wife’s disturbance:

"This
disease is beyond my practice. … / Unnatural deeds / Do breed
unnatural troubles. Infected minds / To their deaf pillows will
discharge their secrets. /More needs she the divine than the physician.
… / I think, but dare not speak.” Macbeth rejects this “diagnosis”
and demands that the doctor cure his wife. Shakespeare then has
the doctor say these immortal words, exactly the opposite of what
psychiatrists and the public are now taught to say and think:

“Macbeth. How
does your patient, doctor? / Doctor. Not so sick, my lord, / As
she is troubled with thick-coming fancies / That keep her from her
rest. / Macbeth. Cure her of that! / Canst thou not minister to
a mind diseased, / Pluck from the memory a rooted sorrow, / Raze
out the written troubles of the brain, / And with some sweet oblivious
antidote / Cleanse the stuffed bosom of that perilous stuff / Which
weighs upon her heart. / Doctor. Therein the patient / Must minister
to himself.” [11]

Shakespeare’s
insight that the mad person “must minister to himself” is at once
profound and obvious. Profound because witnessing suffering calls
forth in us the impulse to help, “to do something” for or to the
sufferer. Yet also obvious because understanding Lady Macbeth’s
suffering as a consequence of internal rhetoric (the "voice”
of conscience, imagination, “hallucination”), the remedy must be
internal rhetoric (self-conversation, “internal ministry”).

By the end
of the nineteenth century, the medical conquest of the soul is secure.

Only writers
are left to discern and denounce the tragic error. Sren Kierkegaard
(1813–1855) warned: “In our time it is the physician who exercises
the cure of souls. … And he knows what to do. / [Doctor]: ‘You
must travel to a watering-place, and then must keep riding a horse
… and then diversion, diversion, plenty of diversion…’/ [Patient]:
‘To relieve an anxious conscience?’[Doctor]: ‘Bosh! Get out with
that stuff! An anxious conscience! No such thing exists any more.’" [12]

Today, the
role of the physician as curer of the soul is uncontested.
[13]
There are no more bad people in the world, there
are only mentally ill people. The “insanity defense” annuls misbehavior,
the sin of yielding to temptation, and tragedy. Lady Macbeth is
human not because she is, like all of us, a “fallen being”; she
is human because she is a mentally ill patient who, like humans,
is inherently “healthy” / good unless mental illness makes her “sick”
/ ill-behaved: “The current trend of critical opinion is toward
an upward reevaluation of Lady Macbeth, who is said to be rehumanized
by her insanity and her suicide.”
[14]

3

Everything
I read, observed, and learned supported my adolescent impression
that the behaviors we call “mental illnesses” and to which we attach
the hundreds of derogatory labels in our lexicon of lunacy are not
medical diseases. [15] They are the products of the medicalization of
disturbing or disturbed behaviors — that is, the observer’s
construction and definition of the behavior of the persons he observes
as medically disabled individuals needing medical treatment.
This cultural transformation is driven mainly by the modern therapeutic
ideology that has replaced the old theological world view, and the
political and professional interests it sets in motion.

Yet, perhaps
there was one childhood experience that set me thinking along the
lines that led to the writing of The Myth of Mental Illness
and to the timing of its publication. Growing up in Budapest
in the 1920s, I learned about the famous nineteenth-century Hungarian
obstetrician, Ignaz Semmelweis (1818–1865) and his tragic fate.
His statue stood, and still stands, in a small park in front of
the city’s old general hospital, not far from the Gymnasium I attended
for eight years.

Semmelweis
discovered the cause of puerperal (childbed) fever before the discovery
of bacteria as causative agents of diseases. As he accurately but
impolitely put it, the cause was the doctors’ dirty hands. Semmelweis
also developed a method for preventing the terrifying epidemics
of puerperal fever, endemic to mid-nineteenth-century hospital maternity
wards: hand-washing with chlorinated water.

I was deeply
moved by the story of Semmelweis’s life, the rejection of his discovery
and remedy by the medical profession inconvenienced by it, and his
incarceration and death in an insane asylum. It taught me, at an
early age, that being wrong can be dangerous, but being right, when
society regards the majority’s falsehood as truth, could be fatal. [16] This principle is especially relevant
to the false truths that are a basic part of an entire society’s
belief system and support economically and existentially important
common practices. In the past, fundamental false truths were religious
in nature. Today, they are mainly medical in nature. The lesson
of Semmelweis’s fate served me well.

Once I grasped
the scientific concept of disease, it seemed to me self-evident
that many persons categorized as mentally ill are not sick and depriving
them of liberty and responsibility on the grounds of a non-existing
disease is a grave violation of basic human rights. In medical school,
I began to understand clearly that my interpretation was correct,
that mental illness is a myth, and that it is therefore foolish
to look for the causes and cures of the imaginary ailments we call
“mental diseases.” Diseases of the body have causes, such
as infectious agents or nutritional deficiencies, and often can
be prevented or cured by dealing with these causes. Persons
said to have mental diseases, on the other hand, have reasons for
their actions that must be understood; they cannot be treated or
cured by drugs or other medical interventions, but may be helped
by persons who understand their predicament to help themselves overcome
the obstacles they face.

The societal
need to deny embarrassing truths, sometimes called the “Semmelweis
reflex,” is described as “the reflex-like rejection of new knowledge
because it contradicts entrenched norms, beliefs or paradigms. …
the automatic rejection of the obvious, without thought, inspection,
or experiment."
[17]
A deep sense of the invincible social power of false
truths enabled me to conceal my ideas from representatives of received
psychiatric wisdom until such time as I was no longer under their
educational or economic control and to conduct myself in such a
way that would minimize the chances of being cast in the role of
“an enemy of the people.”
[18]

Unaware of
the evidence and reasoning summarized above, interviewers unfailingly
ask, “How can a psychiatrist say there is no mental illness? What
experiences did you have that led you to adopt such an unusual a
point of view? When and why did you change your mind about mental
illness?” I try to explain — usually without much success — that
I did not have any unusual experiences, did not do any “research,”
did not discover anything, and did not replace belief in mental
illness with disbelief in it. Instead, I exposed a popular falsehood
and its far-reaching economic, political, and social consequences
and showed that psychiatry rests on two profoundly immoral forensic
practices, civil commitment and the insanity defense. Consistent
with those conclusions, I rejected the mendacious rhetoric of diagnoses-diseases-treatments,
eschewed the massive coercive-excusing apparatus of the institution
called “psychiatry,” and limited my work to psychiatric relations
with consenting adults, that is, confidential conversations conventionally
called “psychotherapy.”

4

The birth of
modern scientific medicine is usually dated to the publication,
in 1858, of Cellular
Pathology as Based upon Physiological and Pathological Histology
,
by the German pathologist Rudolf Virchow (1821–1902). Emanuel Rubin
and John L. Farber, authors of the textbook, Pathology, state:
"Rudolf Virchow, often referred to as the father of modern
pathology … propos(ed) that the basis of all disease is injury
to the smallest living unit of the body, namely, the cell. More
than a century later, both clinical and experimental pathology remain
rooted in Virchow’s Cellular Pathology."
[19]

The standard
American pathology text, Robbins Basic Pathology, defines
disease in terms of what pathologists do: “Pathologists use a variety
of molecular, microbiologic, and immunologic techniques to understand
the biochemical, structural, and functional changes that occur in
cells, tissues, and organs. To render diagnoses and guide therapy,
pathologists identify changes in the gross and microscopic appearance
(morphology) of cells and tissues, and biochemical alterations in
body fluids (such as blood and urine).”
[20]

The pathologist
uses the term “disease” as a predicate of physical objects — cells,
tissues, organs, and bodies. Textbooks of pathology describe disorders
of the body, living or dead, not disorders of the person, mind,
or behavior. Ren Leriche (1874–1955), the founder of modern vascular
surgery, aptly observed: "If one wants to define disease it
must be dehumanized. … In disease, when all is said and done,
the least important thing is man."
[21]
For the practice of pathology and for disease as
a scientific concept, the person as potential sufferer is unimportant.
For the practice of medicine as a human service, in contrast, the
person as patient is supremely important. Why? Because the practice
of Western medicine is informed by the ethical injunction, Primum
non nocere! and rests on the premise that the patient is free
to seek, accept, or reject medical diagnosis and treatment. Psychiatric
practice, in contrast, is informed by the premise that the mental
patient may be “dangerous to himself or others” and that it is the
moral and professional duty of the psychiatrist to protect the patient
from himself and society from the patient. [22]

According to
pathological-scientific criteria, disease is a material phenomenon,
the product of the body, in the same sense that urine is a product
of the body. In contrast, diagnosis is not a material phenomenon
or bodily product: it is a product of a person, typically a physician,
in the same sense that a work of art is the product of a person
called an “artist.” Having a disease is not the same as occupying
the patient role: not all sick persons are patients, and not all
patients are sick. Nevertheless, physicians, politicians, the press,
and the public conflate and confuse the two categories. [23]

Given the demonstrated
usefulness and conceptual stability of the pathological definition
of disease, how do psychiatrists support their claim that the human
conflicts and unwanted behaviors they call “mental illnesses” are
diseases in the same material sense as bodily illnesses?
They do so by means of the self-contradictory claim that mental
diseases are brain diseases and by declaring the Virchowian model
of disease pass, a patent error. The work of the late Robert Kendell
(1935–2002) — professor of psychiatry at the University of Edinburgh
and one of the most respected experts on psychiatric diagnoses in
the world — is illustrative. He wrote:

1981:
“By the 1960s the ‘lesion’ concept of disease … had been discredited
beyond redemption…”
[24]
He did not say how this was done.

1991: “Szasz’s famous jibe that ‘schizophrenia does not exist’
would have been equally meaningless had it been made in regard to
tuberculosis or malaria. The organisms Mycobacterium tuberculosis
and Plasmodium falciparum may reasonably be said to exist,
but the diseases attributed to their propagation in the human body
are concepts just like schizophrenia.”
[25]
Diagnoses of malaria and tuberculosis rest on the
demonstration of pathogenic microbes in the patient’s body fluids
or tissues; diagnoses of depression and schizophrenia rest on no
similar objective evidence.

2001:
“Not only is the distinction between mental and physical illness
ill-founded and incompatible with contemporary understanding of
disease, it is also damaging to the long-term interests of patients
themselves. … by implying that illnesses so described are fundamentally
different from all other types of ill-health it helps to perpetuate
the stigma associated with ‘mental’ illness.”
[26]
The stigma of mental illness rests largely on mental
health laws aimed at controlling persons said to be mentally ill
and dangerous to themselves or others.

Politicians,
pandering to the public’s ever-present fears of dangers, find the
psychiatrists’ willingness to define deviance as disease and social
control as treatment useful in their quest to enlarge the scope
and power of the therapeutic state.
[27]
Moreover, the belief that so-called mental health
problems stand in the same relation to brain diseases as, say, urinary
problems stand in relation to kidney diseases is superficially attractive,
even plausible. The argument goes like this. The human body is a
biological machine, composed of parts, called organs, such as the
kidneys, the lungs, and the liver. Each organ has a "natural
function" and when one of these fails, we have a disease. If
we define human problems as the symptoms of brain diseases, and
if we have the power to impose our definition on an entire society,
then they are brain diseases, even in the absence of any medically
ascertainable evidence of brain disease. We can then treat mental
diseases as if they were brain diseases.

However, a
living human being — a person — is not merely a collection of organs,
tissues, and cells. The pancreas may be said to have a natural function.
But what is the natural function of the person? That is like asking
what is the meaning of life, which is a religious-philosophical,
not medical-scientific, question. Individuals professing different
religious faiths have kidneys so similar that one may be transplanted
into the body of another without altering his personal identity;
but their beliefs and habits differ so profoundly that they often
find it difficult or impossible to live with one another.

5

In the Preface
to The Myth of Mental Illness I explicitly state that the
book is not a contribution to psychiatry: “This is not a
book on psychiatry … It is a book about psychiatry
— inquiring, as it does, into what people, but particularly psychiatrists
and patients, have done with and to one another.”
[28]
Nevertheless, many critics misread, and continue
to misread, the book, overlooking that it is a radical effort to
recast “mental illness” from a medical problem into a linguistic-rhetorical
phenomenon. Not surprisingly, the most sympathetic appraisals of
my work have come from non-psychiatrists who felt unthreatened by
my re-visioning of psychiatry and allied occupations.
[29]
One of the most perceptive such evaluation is the
essay, “The Rhetorical Paradigm in Psychiatric History: Thomas Szasz
and the Myth of Mental Illness,” by professor of communication Richard
E. Vatz and law professor Lee S. Weinberg. They wrote:

In his rhetorical
attack on the medical paradigm of psychiatry, Szasz was not only
arguing for an alternative paradigm, but was explicitly saying
that psychiatry was a "pseudoscience," comparable to
astrology. … [A]ccommodation to the rhetorical paradigm [on
the part of psychiatry] is quite unlikely inasmuch as the rhetorical
paradigm represents so drastic a change — indeed a repudiation
of psychiatry-as-scientific-enterprise — that the vocabularies
of the two paradigms are completely different and incompatible.
… This focus on persuasive language in Szasz’s rhetorical paradigm
has significant ethical implications for both psychiatrists and
mental patients. … Just as Szasz insists that psychiatric patients
are moral agents, he similarly sees psychiatrists as moral agents.
… In the rhetorical paradigm the psychiatrist who deprives people
of their autonomy would be seen as a consciously imprisoning agent,
not merely a doctor providing "therapy," language which
insulates psychiatrists from the moral responsibility for their
acts. … The rhetorical paradigm represents a significant threat
to institutional psychiatry, for … without the medical model
for protection, psychiatry becomes little more than a vehicle
for social control — and a primary violator of individual freedom
and autonomy — made acceptable by the medical cloak. … The
Myth of Mental Illness is written without the polemics of
some of Szasz’s later work, yet this first major book, according
to Harvard psychiatrist Alan Stone, "earned him the lasting
enmity of his profession."
[30]

Noted English
medical historian the late Roy Porter began his posthumously published,
book, Madness:
A Brief History
, as follows: “In a brace of books,
The Myth of Mental Illness (1961) and The
Manufacture of Madness
(1970), Thomas Szasz denied there
was any such thing as “mental illness”: it was not a fact of nature
but a man-made “myth.” Porter explained further:

“Psychiatry
is conventionally defined as a medical specialty concerned with
the diagnosis and treatment of mental diseases. I submit that
this definition, which is still widely accepted, places psychiatry
in the company of alchemy and astrology and commits it to the
category of pseudoscience.” Why so? The reason was plain: “there
is no such thing as “mental illness.” For Szasz, who has continued
to uphold these opinions for the last forty years, mental illness
is not a disease, whose nature is being elucidated by science;
it is rather a myth, fabricated by psychiatrists for reasons of
professional advancement and endorsed by society because it sanctions
easy solutions for problem people. Over the centuries, he alleges,
medical men and their supporters have been involved in a self-serving
“manufacture of madness,” by affixing psychiatric labels to people
who are social pests, odd, or challenging. …. All expectations
of finding the aetiology of mental illness in body or mind — not
to mention some Freudian underworld — is, in Szasz’s view, a category
mistake or sheer bad faith: “mental illness” and the “unconscious”
are but metaphors, and misleading ones at that. In reifying such
loose talk, psychiatrists have either naively pictorialized the
psyche or been complicit in shady professional imperialism, pretending
to expertise they do not possess. In view of all this, standard
psychiatric approaches to insanity and its history are vitiated
by hosts of illicit assumptions and questions mal poss.
[31]

6

One of the
most illicit assumptions inherent in the standard psychiatric approach
to insanity is treating persons called mentally ill as sick patients
needing psychiatric treatment, regardless of whether they seek or
reject such help. This accounts for an obvious but often overlooked
difficulty peculiar to psychiatry, namely that the term refers to
two radically different kinds of practices: curing-healing "souls"
by conversation, and coercing-controlling persons by force, authorized
and mandated by the state. Critics of psychiatry, journalists, and
the public alike regularly fail to distinguish between counseling
voluntary clients and coercing-and-excusing captives of the psychiatric
system. [32]

In 1967, my
efforts to undermine the moral legitimacy of the alliance of psychiatry
and the state suffered a serious blow: the creation of the antipsychiatry
movement by David Cooper (1931–1986) and Ronald D. Laing (1927–1989).
Instead of advocating the abolition of Institutional Psychiatry,
they sought to replace it with their own brand of psychiatry, which
they called “Anti-Psychiatry.” By means of this dramatic misnomer,
they attracted attention to themselves and deflected attention from
what they did, which included coercions and excuses based on psychiatric
authority and power. Antipsychiatry is a type of psychiatry: The
psychiatrist qua health-care professional is a fraud, and so too
is the antipsychiatrist.
[33]

Voltaire’s
famous aphorism, “God protect me from my friends, I’ll take care
of my enemies,” proved to apply perfectly to what happened next:
although my critique of the alliance of psychiatry and the state
antedates by two decades the reinvention and popularization of the
term “antipsychiatry,” I was smeared as an antipsychiatrist and
my critics wasted no time identifying and dismissing me as a “leading
antipsychiatrist.”

For more than
fifty years I have maintained that mental illnesses are counterfeit
diseases (“nondiseases”), that coerced psychiatric relations are
like coerced labor relations ("slavery") or coerced sexual
relations (rape), and spent the better part of my professional life
criticizing the concept of mental illness, objecting to the practices
of involuntary-institutional psychiatry, and advocating the abolition
of “psychiatric slavery” and “psychiatric rape.”

Not surprisingly,
the more aggressively I reminded psychiatrists that individuals
incarcerated in mental hospitals are deprived of liberty, the more
zealously they insisted that “mental illnesses are like other illnesses”
and that psychiatric institutions are bona fide medical hospitals.
The psychiatric establishment’s defense of coercions and excuses
thus reinforced my argument about the metaphorical nature of mental
illness and importance of the distinction between coerced and consensual
psychiatry

Anyone who
seeks to help others — whether by means of religion or by means
of medicine — must eschew the use of force. I am not aware of any
antipsychiatrist who has agreed with this principle or abided by
this limitation. Subsuming my work under the rubric of antipsychiatry
betrays and negates it just as effectively and surely as subsuming
it under the rubric of psychiatry. My writings form no part of
either psychiatry or antipsychiatry and belong to neither. They
belong to conceptual analysis, social-political criticism, civil
liberties, and common sense. This is why I rejected, and continue
to reject, psychiatry and antipsychiatry with equal vigor.

The psychiatric
establishment’s rejection of my critique of the concept of mental
illness and its defense of coercion as cure and of excuse-making
as humanist mercy posed no danger to my work. On the contrary. Contemporary
“biological” psychiatrists tacitly recognized that mental illnesses
are not, and cannot be, brain diseases: once a putative disease
becomes a proven disease it ceases to be classified as a mental
disorder and is reclassified as a bodily disease; or, in the persistent
absence of such evidence, a mental disorder becomes a nondisease.
That is how one type of mental illness, neurosyphilis, became a
brain disease, while another type, homosexuality, became reclassified
as a nondisease.

Formerly, when
Church and State were allied, people accepted theological justifications
for state-sanctioned coercion. Today, when Medicine and the State
are allied, people accept therapeutic justifications for state-sanctioned
coercion. This is how, some two hundred years ago, psychiatry became
an arm of the coercive apparatus of the state. And this is why today
all of medicine threatens to become transformed from personal therapy
into political tyranny.

References


[1]
. Szasz, T., “The myth of mental illness,” American
Psychologist, 15: 113–118 (February), 1960, The
Myth of Mental Illness: Foundations of a Theory of Personal Conduct

[New York: Hoeber-Harper, 1961], revised edition (New York: HarperCollins,
1974).


[2]
. Szasz, T., Psychiatry:
The Science of Lies
(Syracuse: Syracuse University Press,
2008).

[3] . Clinton, W. J., in "Remarks
by the President, the First Lady, the Vice President, and Mrs.
Gore at White House Conference on Mental Health," June 7,
1999.


[4]
. Gore, T., in ibid.


[5]
. Satcher, D., quoted in "Satcher discusses MH issues
hurting black community," Psychiatric News, 34: 6
(October 15), 1999.


[6]
. White House Press Office, White House Fact Sheet
on Myths and Facts About Mental Illness, June 5, 1999.
"Myths and Facts about Mental Illness," New York
Times, June 7, 1999, Internet edition.


[7]
. ABC News, “Biden
bill labels addiction as a disease, sparks debate
,” August
7, 2007.

[8] . Bender, B., “Mental-health
parity law a big win for Kennedys
,” Boston Globe, October
4, 2008.


[9]
. Bauer, P. T., From
Subsistence to Exchange and Other Essays
(Princeton: Princeton
University Press, 2000), p. 42.

[10] . Macbeth,
Act V, Scene I.

[11] . Ibid., Scenes I and viii.


[12]
. Kierkegaard, S., “A visit to the doctor: Can medicine
abolish the anxious conscience?,” in Parables
of Kierkegaard
, edited by Thomas C. Oden (Princeton: Princeton
University Press, 1978), p. 57.


[13]
. See Hawthorne, N., The
Scarlet Letter
(1850) (New York: Bantam Dell, 2003), pp.
124–125.


[14]
. “Macbeth Summary,”
Study Guide.


[15]
. Szasz, T., A
Lexicon of Lunacy: Metaphoric Malady, Moral Responsibility, and
Psychiatry
(New Brunswick, NJ: Transaction Publishers,
1993).


[16]
. Szasz, T., “An Autobiographical Sketch,” in Jeffrey
A. Schaler, editor, Szasz
Under Fire: The Psychiatric Abolitionist Faces His Critics

(Chicago: Open Court, 2004), pp. 1–28.

[17] . Wikipedia, “Semmelweis
reflex
.”


[18]
. Ibsen, H., An
Enemy of the People
(1883), translated by James Walter
McFarlane (New York: Oxford University Press, 1999).


[19]
. Rubin, E. and Farber, J. L., Pathology
(Philadelphia: Lippincott, 1994), p. 2.


[20]
. Kumar, V., Abbas, A. K., Fausto, N., and Mitchell,
R. N., editors, Robbins
Basic Pathology
, 8th edition (Philadelphia:
Saunders / Elsevier, 2007), p. 1.


[21]
. Quoted in Canguilhem, G., On
the Normal and the Pathological
(Boston: D. Reidel, 1978),
p. 46.


[22]
. Szasz, T., “Psychiatry and the control of dangerousness:
On the apostrophic function of the term ‘mental illness,’"
Journal of Medical Ethics, 29: 227–230 (August), 2003.


[23]
. Szasz, T., “Diagnoses are not diseases,” The Lancet,
338: 1574–1576 (December 21/28), 1991.


[24]
. Kendell, R. E., “The concept of disease and its implications
for psychiatry,” in Caplan, A. I., Engelhardt, H. T., Jr., and
McCartney, J. J., eds., Concepts
of Health and Disease: Interdisciplinary Perspectives
(Reading,
MA: Addison-Wesley, 1981), pp. 443–458; p. 449.


[25]
. Kendell, R. E., “Schizophrenia: A Medical View of a
Medical Concept,” in Flack, W. F., Jr., Miller, D. R., and Wiener,
M., eds., What
is Schizophrenia?
(New York: Springer, 1991), pp.
9–72; p. 60.


[26]
. Kendell, R. E., “The
distinction between mental and physical illness
” (Editorial),
British Journal of Psychiatry, 178: 490–493, 2001.


[27]
. Szasz, T., Pharmacracy:
Medicine and Politics in America
[2001] (Syracuse: Syracuse
University Press, 2003).


[28]
. Szasz, T., The Myth of Mental Illness (1961),
p. xi.


[29]
. See for example Grenander, M. E., editor, Asclepius
at Syracuse: Thomas Szasz, Libertarian Humanist (Albany, NY:
State University of New York, Mimeographed, 1980), 2 volumes;
and Hoeller, K., editor, “Thomas Szasz: Moral Philosopher of Psychiatry,”
Review of Existential Psychology & Psychiatry, Special
Issue, vol. 23, Nos. 1, 2 & 3, 1997.


[30]
. Vatz, R. E. and Weinberg, L. S., “The Rhetorical Paradigm
in Psychiatric History: Thomas Szasz and the Myth of Mental Illness,”
in Micale, M. S. and Porter, R., editors, Discovering
the History of Psychiatry
(New York: Oxford University
Press, 1994), pp. 311–330. See also Vatz, R. E., "The Myth
of the Rhetorical Situation," Philosophy and Rhetoric,
6: 154–161 (Summer) 1973.


[31]
. Porter, R., Madness:
A Brief History
(Oxford: Oxford University Press, 2002),
pp. 1–3.


[32]
. See especially Szasz, T., Law,
Liberty, and Psychiatry: An Inquiry into the Social Uses of Psychiatry

[1963] (Syracuse: Syracuse University Press, 1989), Insanity:
The Idea and Its Consequences
[1987] (Syracuse: Syracuse
University Press, 1997), and Liberation
By Oppression: A Comparative Study of Slavery and Psychiatry

(New Brunswick, NJ: Transaction Publishers, 2002).


[33]
. See Szasz, T., Antipsychiatry:
Quackery Squared
(Syracuse: Syracuse University Press, 2009).

February
22, 2010

Thomas Szasz
is professor of Psychiatry Emeritus at the State University of New
York Health Science Center in Syracuse, New York. Visit
his website.

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