Second Opinion (2009, 4th edition): Online Case Studies by John Germov & Maria Freij
Thomas Szasz and the Myth of Mental Illness
Thomas Szasz, a psychiatrist and academic, is one of the most well-known critics of
the medicalisation of mental illness. In particular, he has been an outspoken critic of
scientism and has targeted the profession of psychiatry as a pseudo-science. In his
influential The Myth of Mental Illness (1960, 1961), originally published as a journal
article and then expanded upon in a book of the same title, he argues that mental
illness is a social construct and that what psychiatrists label ‘mental illness’ is in fact
what society has labelled ‘deviant’. He argues that, in the absence of objectively
observable biological pathology, mental illness (such as schizophrenia) should be
labelled illness. For Szasz, mental illness is a social artefact, and has no scientific
basis. For example, in some cultures the experience of hallucinations is highly
valued, while in Western societies it symbolises a mental disorder (Dammann 1997).
Many behaviours that have previously been regarded as deviant no longer
are—for example, homosexuality, hysteria, and nymphomania (in the past, sexually
active non-married women could be considered ‘nymphomaniacs’ and forced to
undergo sterilisation ‘for their own good’) (Szasz 2003). Szasz highlights psychiatry’s
sordid past as a supporter of lobotomy as a treatment for schizophrenia and draws
parallels between the persecution of minority groups and the treatment of ‘mentally
deviant’ people.
Szasz argues that schizophrenia is not, in fact, a disease, because it cannot
be identified through an autopsy and cannot be pathologically defined or measured.
His point is that psychiatry has invented illness, as there is a lack of evidence of
biological disease. To this day, the vast majority of mental illnesses contained in the
Diagnostic and Statistical Manual of Mental Disorders have no known pathological
disease—as Szasz notes, we’ve been waiting a long time for the underlying diseases
to be discovered. (In fact, the irony is that if biological diseases were found for mental
illnesses, such conditions would cease to be mental illnesses and would instead be
‘brain diseases’ and would become the province of other medical specialities such as
neurology: Dammann 1997.)
Szasz contends that psychiatry is not a real science and not a genuine
branch of medicine. In a secular society, he argues, psychiatrists help humankind
deal with life’s big questions. Essentially, psychiatry, under the guise of being a
science, acts as an agent of social control. Szasz opposes use of the insanity
defence in legal proceedings and the involuntary treatment and hospitalisation of
patients labelled as mentally ill.
Szasz’s controversial arguments have prompted a large volume of criticism
(see Dammann 1997 for a good summary of the major criticisms made of Szasz’s
myth-of-mental-illness thesis). Most notable, Szasz has been criticised for relying on
Cartesian dualism, whereby diseases are either physical or psychological, but not
both. In the context of holistic approaches to health and illness, and growing
acknowledgment of the social determinants of health, his reliance on positivist and
causal relationships appears problematic. Moreover, few people deny that many
people diagnosed with mental illnesses are actually suffering. In response, Szasz
does not dispute the existence of ‘mental suffering’; rather, he denies that it is a
‘disease’ and that psychiatry is best placed to treat it. Szasz responds to arguments
that he is anti-psychiatrist by maintaining that he is not opposed to the practice of
psychiatry if it involves consenting adults, is non-coercive, and has no state
involvement.
Sociological reflection
Where do you stand in the mental-illness-is-a-myth debate?
References
Dammann, E. J. 1997, ‘“The Myth of Mental Illness:” Continuing Controversies and
their Implications for Mental Health Professionals’, Clinical Psychology Review, vol.
17, no. 7, pp. 733–56
Szasz, T. S. 2003, ‘The Myth of Mental Illness’, transcript of lecture held at UCE
Birmingham on 7 December 2003
http://www.hcc.uce.ac.uk/ccmh/thomas_szasz_transcript.pdf
Szasz, T. S. 1971, The Manufacture of Madness, Routledge & Kegan Paul, London.
Szasz, T. S. 1961, The Myth of Mental Illness, Holber-Harper, New York.
Szasz, T. S. 1960, ‘The Myth of Mental Illness’, American Psychologist, vol. 15, pp.
113–18
http://psychclassics.yorku.ca/Szasz/myth.htm
Thomas S. Szasz M.D. Cybercenter for Liberty and Responsibility
http://www.szasz.com/index.html