Sunday, 24 May 2009

Thomas Szasz and The Myth of Mental Illness fifty years after publication

Brendan Kelly’s portmanteau paper ‘The Myth of Mental Illness fifty years after publication: What does it mean today?’ has been accepted for publication by the Irish Journal of Psychological Medicine. The contributors are Pat Bracken, Harry Cavendish, Niall Crumlish, Seamus MacSuibhne and Tim Thornton and Thomas Szasz has supplied responses to our comments.

Szasz doesn’t seem as happy with my 800 words as I thought he might have been. His comments on me run as follows (you’ll have to wait for the paper to see what else he says).

Some of Professor Thornton’s views appear to be in agreement with mine, and some seem not to be. After summarizing my reasons for rejecting the concept of mental illness, he writes: “The argument here starts from the assumption [sic] that mental illness and physical illness involve deviation from different norms.” My argument did not start from an “assumption.” Instead, it started from the observation that we use the terms “bodily illness” and “mental illness” differently: for example, psychiatrists regularly deprive patients of liberty, while other physicians do not do so. Problematically, much of Professor Thornton’s writing is abstract and abstruse, such as the following:

[E]ven if mental illness is defined by, or identified via, psycho-social norms, this need not imply that it is identical to or constituted by such deviation. It may be that the illness is the cause of the deviation such that, even though it is picked out by its characteristic effects, it is not identical to them. (Firing the gun may be picked out as the cause of the death of the president; but it is not identical to the death: it slightly predates it.) If so, Szasz’ argument fails. To establish his conclusion he would need to establish the truth of a kind of mental illness behaviourism which goes beyond merely and plausibly highlighting the role of societal norms in picking out illness.

Mental illnesses are not “picked out.” They are constructed and deconstructed, exemplified by the history of homosexuality qua mental disorder. Professor Thornton states that I need “to establish the truth of a kind of mental illness behaviourism.” I do not know how to do such a thing and do not understand what would be the practical consequences, if any, of my accomplishing this feat. Would the courts, the legislators, and the medical-psychiatric system then abolish psychiatric controls and excuses?

“Take the case,” Professor Thornton writes, “of those people who claim that the inner voices that they hear are indicative not of a pathology but of their membership of a different community. Their experiences are a deviation from a societal norm but does the deviation also amount to a pathology?” The answer depends on our/the definition of “pathology.”

Clearly, the demarcation-separation of psychotherapy from somatic medicine (or the rejection of such a demarcation-separation) is of paramount economic, ideological-professional, and political concern to numerous parties. In this connection, let us contrast Karl Jaspers’s and Paul McHugh’s – both famous psychiatrists – reactions to this challenge. Jaspers – today better known as a philosopher – observed: “All therapy, psychotherapy and attitudes to patients depend upon the State, religion, social conditions, the dominant cultural tendencies of the age and finally, but never solely, on accepted scientific views.” Paul McHugh – long-time chairman of the psychiatry department at the Johns Hopkins University Medical School – writes:

As we psychiatrists start to teach our discipline to beginners, we confront a qualm among some students that psychiatrists may not be “real” doctors. “What else,” we respond somewhat defensively, “might we be?” “Well,” comes the answer, “medicine is an applied natural science directed toward sick people. Psychiatric patients seem not sick but troubled, and psychiatric effort more guidance than curing. Perhaps the natural associates of psychiatrists are not physicians and surgeons but counsellors, ministers, social workers, and even, heaven forbid, lawyers.” We flinch at this view and sometimes turn cranky.