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The myth of mental illness: 50 years later

  • Thomas Szasz (a1)
Summary

Fifty years ago I noted that modern psychiatry rests on a basic conceptual error – the systematic misinterpretation of unwanted behaviours as the diagnoses of mental illnesses pointing to underlying neurological diseases susceptible to pharmacological treatments. I proposed instead that we view persons called ‘mental patients' as active players in real life dramas, not passive victims of pathophysiological processes outside their control. In this essay, I briefly review the recent history of this culturally validated medicalisation of (mis)behaviours and its social consequences.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Thomas Szasz (tszasz@aol.com)
Footnotes
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This paper was delivered as a plenary address at the International Congress of the Royal College of Psychiatrists in Edinburgh, 24 June 2010. See also commentary, pp. 183–184, this issue.

Declaration of interest

None.

Footnotes
References
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1 Szasz, T. The myth of mental illness. Am Psychol 1960; 15: 113–8.
2 Szasz, T. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Hoeber-Harper, 1961; rev. ed. HarperCollins 1974, 2000.
3 Szasz, T. Psychiatry and the control of dangerousness: on the apostrophic function of the term ‘mental illness’. J Med Ethics 2003; 29: 227–30.
4 Clinton, WJ. Remarks at the White House Conference on Mental Health, June 7, 1999. Public Papers of the Presidents of the United States: William J. Clinton, 1999, Book 1, January 1 to June 30, 1999: 895. U.S. Government Printing Office, National Archives and Records Administration, Office of the Federal Register, 2000.
5 Satcher, D. Satcher discusses MH issues hurting black community. Psychiatr News 1999; 34: 6.
6 Szasz, T. Psychiatry: The Science of Lies. Syracuse University Press, 2008.
7 Shakespeare, W. Macbeth (ed Harbarge, A): 100–1. Penguin Classics.,
8 Szasz, T. The Meaning of Mind: Language, Morality, and Neuroscience: 12. Syracuse University Press, 2002.
9 Kierkegaard, S. A visit to the doctor: can medicine abolish the anxious conscience? In Parables of Kierkegaard (ed Oden, TC): 57. Princeton University Press, 1978.
10 Hawthorne, N. (1850) The Scarlet Letter: 124–5. Bantam Dell, 2003.
11 Canguilhem, G. On the Normal and the Pathological: 46. D Reidel, 1978.
12 Szasz, T. Diagnoses are not diseases. Lancet 1991; 338: 1574–6.
13 Grenander, ME (ed) Asclepius at Syracuse: Thomas Szasz, Libertarian Humanist. State University of New York, Mimeographed, 1980.
14 Hoeller, K. Thomas Szasz: moral philosopher of psychiatry. Rev Existent Psychol Psychiatry 1997; 23: 1301.
15 Vatz, RE, Weinberg, LS. The rhetorical paradigm in psychiatric history: Thomas Szasz and the myth of mental illness. In Discovering the History of Psychiatry (eds Micale, MS, Porter, R): 311–30. Oxford University Press, 1994.
16 Porter, R. Madness: A Brief History: 13. Oxford University Press,, 2002.
17 Bleuler, E. Dementia Praecox or the Group of Schizophrenias (transl Zinkin, J): 488–9. International Universities Press,, 1911.
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The myth of mental illness: 50 years later

  • Thomas Szasz (a1)
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eLetters

The correct paradigm may be that of evolutionary psychiatry

John S. Price, Retired consultant psychiatrist
19 May 2011

Dr Thomas Szasz (1) repeats his view that psychiatric illness does not exist, and that people should be held responsible for their beliefs and actions. But what if we are presented with a young mother who believes she has committed the unforgivable sin and that she and her baby are infested with the devil and that the only solution is to kill herself and her child? We know that with treatment, or just with the passage of time, she will return to normal and realise that her sinfulness was delusional. As I understand Dr Szasz, he would consider treating her to be “a grave violation of her basic human rights” and he would advise us tolet her “minister to herself”. Does she not have a basic human right to be treated, even if she has no insight into her need for treatment?

It is likely that evolution has prepared mental states for extreme situations and that it is possible to enter one either because one is in an extreme situation, or because one has entered the mental state by mistake, on the “smoke detector “principle that it is better to be frightened to death a hundred times thinking there is a lion in the bush rather than ignore one real clue that a lion is really there (2). It may be impossible to tell whether a mental state is due to a real danger/disaster or to a psychic mistake. A depressed mother with a baby may be a member of one of those societies who try to maintain a constant population, and whose surplus men go into monasteries and only one daughter per family is allowed to breed, and she has offended against society’s rules by getting pregnant outside marriage. In the Book of Job,Job lost all his cattle and his children and became depressed, but the text can be as easily read as a delusional Job who due to psychotic depression had the delusion of loss of property and death of loved ones (3). Why did his so-called comforters not offer their condolences on the death of his children? In psychiatric practice we are often dealing with people who have entered states of depression and anxiety when there is no real cause – are we not to help them?

The paradigm here is evolutionary psychiatry (4) – it is not necessary to view these deluded and anxious people as either sinful or responsible – whether or not we treat them as “sick” depends on factors such as eligibility for Medicare and other practical matters. We have been fashioned by evolution to suffer inappropriate extremes of mental pain and delusional ideas - it is more important to help these people backto normality than to spend time discussing whether they are sick or bad orshould bear responsibility for themselves.

I must acknowledge one debt to Dr Szasz. In my long career in “working age” psychiatry, I was often asked by troubled patients what to say when, applying for a job, they were asked whether they had ever suffered from mental illness. Knowing of the stigma and prejudice which apositive answer would arouse, I was able to say to them with a clear conscience, “Think Szasz and say ‘No!’”

References

1 Szasz T. The myth of mental illness: 50 years later. Psychiatrist 2011. 35, 179-182’

2 Nesse RM. Natural selection and the regulation of defences: a signal detection analysis of the smoke detector principle. Evolution and Human Behavior 2005; 26: 88-105.

3 Price JS, Gardner, R Jr. Does submission to a deity relieve depression? Illustrations from the book of Job and the Bhagavad Gita. Philosophical Papers and Reviews 2009. 1: 017-031. http://www.academicjournals.org/PPR/PDF/Pdf2009/July/Price%20and%20Gardner.pdf

4 Bruene M. Textbook of Evolutionary Psychiatry: The Origins of Psychopathology. Oxford: Oxford University Press, 2008.
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