The Myth of Thomas Szsaz, by Jeffrey Oliver
A critique of modern psychology/psychiatry:
The Limits of Psychiatry
It is hard to doubt the reality of mental illness, especially when the suffering of affected individuals is so complete and the impairment so extreme, when psyche and identity are crippled almost beyond repair. But it is also remarkable how much of modern psychiatry is still theoretical rather than empirical, and how many of the supposed mental illnesses that appear (and multiply) in the Diagnostic and Statistical Manual of Mental Disorders have no known biological underpinnings or explanations. Although Szasz’s critique often became a caricature, his intuition about the limits and deformations of modern psychiatry cannot be ignored. Many sick people have surely benefited from psychiatric treatment, both “talk therapy” and pharmacotherapy. But psychiatry’s long history of error—from snake pits to ice baths to spinning chairs to electroshock to lobotomy—should give us pause. Skepticism is not backwardness, even if Szasz often took his skepticism to rhetorical extremes.
At his best, Szasz actually clarified the Sisyphean predicament in which psychiatry remains largely stuck. For almost half a century, he has obstinately argued that a mind can only be sick in a metaphorical sense. And all this time, psychiatry has been desperate to prove what it claims to have already proven—to bring mental illnesses “down to the level of all other diseases of the human body, and to show that the mind and the body are moved by the same causes and subject to the same laws.” In response to the image crisis that psychiatry had suffered at Szasz’s hands, past-APA President Robert Felix offered the following cure: “More of us must intensify our efforts to become more identified with the mainstream of American medicine.” In other words, the legitimacy of psychiatry’s refutation of Thomas Szasz rests entirely on the profession’s ability to prove Benjamin Rush right. This was the goal implicit in Felix’s proposed merger with “the mainstream of American medicine.”
Not surprisingly, over the last four decades, psychiatry has systematically placed its greatest hopes in the biology of mental illness. We are led to believe that new disciplines like neuroscience are putting old ambiguities to rest. We hear of “explosions in scientific knowledge of the brain” and “remarkable advances in understanding the human mind.” Evidence of the biological basis of mental illnesses would seem to be so overwhelming that to doubt is akin to doubting evolution. Yet a review of the facts fails to reveal the sort of breathtaking advancement commonly claimed.
In her 2001 book Brave New Brain: Conquering Mental Illness in the Era of the Genome, Nancy Andreasen writes 174 pages before offering this tellingly brief and couched confession: “Because we cannot yet point to a specific lesion or a specific cause ... some critics (most notably Thomas Szasz of the University of Syracuse) have argued that mental illnesses must be myths.” Considering its context, the confession’s delay is disconcerting. In her introduction, Andreasen lauds the “powerful new technologies” that have already illuminated “the causes and mechanisms of mental illnesses on many different levels.” The reader must either assume that the technology is over-hyped or that mental illnesses are veritable black holes, reflecting very little of the blinding light we have apparently thrown on them. (Meanwhile, Szasz’s superfluity somehow continues to supersede the need for historical accuracy. Contrary to Andreasen’s description, he has never worked for the University of Syracuse.)
If mental illnesses truly begin in the brain, no psychiatrist on earth can conclusively say when, where, why, or how. Nearly one hundred years after Eugen Bleuler invented the word “schizophrenia” to describe, among others, the “irritable, odd, moody, withdrawn, or exaggeratedly punctual,” those who “vegetate as day laborers, peddlers, even as servants,” and “the wife ... who is unbearable, constantly scolding, nagging, always making demands but never recognizing duties,” the only way to diagnose this “disease,” or any other mental illness, remains the observation of behavior. Given the complexity of the human psyche, this makes sense: we can hardly expect the many moods and miseries of human life, even the most extreme, to have simple neurological explanations. But given the grand ambitions of modern psychiatry—to explain the human condition, to heal every broken soul—the reliance on behavioral observation has led to the medicalization of an ever-growing range of human behaviors. It treats life’s difficulties and oddities as clinical conditions rather than humanity in its fullness.