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The Meaning of Mind: Language, Morality, and Neuroscience

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A BOOK REVIEW

by John Friedberg, M.D.

Hippocrates located the mind in the brain; Descartes, the soul in the pineal gland; and in 1994, Nobel Laureate Francis Crick reported "Free Will...in or near the anterior cingulate sulcus." Diseases of the mind, "mental illnesses," are even better localized: obsessive compulsive disorder is spotted in the frontal lobes, homosexuality in the hypothalamus and Schizophrenia is assigned now to Dopamine, now to Serotonin and now to the neurotransmitter molecule "du jour." "What's going on here?" asks the author, rhetorically: "They can't all be right." Thomas Szasz, M.D., Professor Emeritus of Psychiatry at State University of New York in Syracuse, thinks they may all be wrong. In this, his 23rd book, he quotes Hughlings Jackson, the great 19th century British neurologist: "There is no such entity as consciousness; we are from moment to moment differently conscious...(consciousness is) the directional mechanism of attention." And paying attention (minding), thinking, and even memory are not bits of neuroanatomy like hippocampal formations. Not all words denote things. This is an entertaining book, an erudite discourse into history and philosophy, linguistics and logic. Neurologists, whose authority resides in the reality of the nervous system, may find it especially pertinent. We must be as clear as possible in our thinking about the mind and the brain. If they were identical, Dr. Szasz points out, we wouldn't have two very different words. This book is a must for those of us who need to deal rationally with the tempting tales of "neuromythology" issuing daily from the media, the drug companies, and our psychiatric colleagues. The author argues that most of the popular mind/brain theorists, in their materialist-reductionist simplifications, "...are writing science fiction or justifying the medical (psychiatric) control of deviance or both." He reminds us that people deceive themselves and others by twisting words, medicalizing straightforward sins such as bearing false witness into modern non-entities such as recovered memory syndrome, false memory syndrome, even alien abduction. Such literal or "concrete thinking" is supposed to be a symptom of schizophrenia which according to Dr. Szasz, is the "paradigmatic metaphoric illness of modernity." Quoting Immanuel Kant that "to think is to talk to oneself," the author asserts that thinking is "self-conversation," the subject acknowledging his inner voices as his own; and that "hearing voices" (auditory hallucinations, one cardinal "symptom" of Schizophrenia) are self-conversations that the subject disowns, attributing his inner voices to other "speakers" such as God, the FBI, etc. Tenacious in this central criticism of schizophrenia since his Myth of Mental Illness was published in 1961, Dr. Szasz speculates that "...never before in history have so many educated people wasted so much time and money as have diverse professionals squandered on studying this nonexistent illness." The Meaning of Mind is an easy but scholarly read, alive with quotes. Dr. Szasz leads us through six chapters: Thought: Self-Conversation Responsibility: Self-blame and Self-Praise Memory: Fabricating the Past and the Future Brain: The Abuse of Neuroscience Mind: The History of an Idea Modernity's Master Metaphors: Mental Illness and Mental Treatment Here's a work of philosophy, true love of logic, with relevance for daily life. It will open your mind - metaphorically, of course.

This is an important book for anyone interested in such big issues as free will, neuroscience, morality, and the meaning of personhood. If you've wondered how Thomas Szasz can possibly believe that mental illness is a myth, here is the most basic answer. The idea of mental illness depends on a particular notion of "mind," and if that notion is mistaken, then the concepts dependent on it are likely mistaken also. Read it and see. Wonderfully written, informative, and thought-provoking.

The Meaning Of Mind: Language, Morality, And Neuroscience by Thomas Szasz (Professor Emeritus of Psychiatry, State University of New York Health Science Center, Syracuse) is an articulate, highly accessible, and persuasive treatise that calls into question the trend of analyzing the mind as if it were nothing more than a collection of brain functions. Taking the viewpoint that people should be understood and judged as moral individuals with free will, and not as mindless slaves to the workings of brain chemistry, The Meaning Of Mind is a persuasive, challenging, succinctly written account that can be confidently recommended to students of Human Psychology.

_The Meaning of Mind: Language, Morality, and Neuroscience_ (1996) by anti-psychiatrist Thomas Szasz provides for a fascinating reading in terms of the philosophy of mind. The book contains much wisdom from psychology including the nature of mind, self, and responsibility. Szasz shows how the traditional pre-modern and medieval concept of the soul and the person came to be replaced by a mind/body dualism in Descartes. In modern times, scientific materialism (what Szasz calls "scientism") has effectively become the prevailing viewpoint and maintains that mind is synonymous with brain. The book argues that the notion of language is fundamentally linked up with the idea of mind.

Szasz who is perhaps most famous for his remark that "If you talk to God you are praying, but if God talks to you then you are schizophrenic", spends much of this book attacking the psychiatric establishment for de-humanizing people (much of this is probably deserved). Szasz shows how neuroscience also effectively de-humanizes. One example of this is the case of H.M., who through a procedure performed on him lost his memory. Not only did this procedure permanently ruin a human life, but to add insult to injury he was used as a case study by the neuroscientific establishment, further de-humanizing him. An interesting experiment was performed, in which individuals feigned mental illness and were placed in an institution even after admitting that they were part of an experiment. Such studies are highly disturbing and show that there is far more to understand of the human mind than we currently know.

Szasz also delves into the subject of religion. He shows how the notion of the devil and temptation arose. Szasz provides an analysis of the notion of the scapegoat, showing how those with "deviant thoughts" came to be scapegoated by society. In fact, in the Soviet Union dissenters against the state were frequently placed into mental institutions. A similar thing might be occurring in the capitalist West. Szasz shows how outbreaks of irrationality are ubiquitous to the human condition. In fact, contrary to what is commonly believed Szasz maintains that one can effectively be blamed for anything. Szasz also argues that the only solution to society's moral problems is a "final solution" and thus that such problems must be dealt with by the individual rather than a totalistic state. He also considers instances of "false memory". He shows that it is far too easy to see exactly what we want to see. But, then he too readily blames the victims of such delusions. Ultimately, human reason can only take us so far, and it is far too easy to fall prey to irrationality.

Szasz does show how the psychiatric establishment and its "siamese twin" the criminal justice establishment have effectively reduced modern man to an "infantilistic" state. Szasz considers hallucinations and delusions. He argues that the schizophrenic effectively "hears his own thoughts" and passes off responsibility to them to a "voice". But, epileptics often "hear voices" too. Would Szasz argue that the epileptic does not have a legitimate brain disorder? Probably (nearly) all people have experience of altered states of consciousness during dreams. And we know from personal experience or from observation of others that alcohol and dugs can produce similar effects. Why then does Szasz have so much trouble believing that they do not also exist for the schizophrenic? The schizophrenic fundamentally suffers from an inability to communicate, but so do many individuals who have suffered from stroke. Why does Szasz maintain that one is merely "talking crazy" but the other is a legitimate brain problem.

This book provides a good argument to show that scientism de-humanizes. But, Szasz is far too quick to blame the entire psychiatric establishment and effectively throws the baby out with the bath-water. In the end, he denounces too many people, and then ends up falling for a dumb ideology himself - Scientology of L. Ron Hubbard. Just further proof that it is often those who most boldly proclaim their "rationality" who fall for the dumbest ideologies - Marxism, Scientology, etc. etc.

Tom Szasz has been my mentor for a long time.

He, and only he, showed me the big picture as to what involuntary psychiatry, and so-called free societies, really are.

His analysis of the psychiatric Newspeak; his concept of the Therapeutic State; his stance against both psychiatric bio-reductionism and psychoanalysis, and especially his moral caliber and love for liberty have had tremendous impact on my thought and worldview. Anyone who wants to know a truly dissident of our system should read Szasz's classics. THE MANUFACTURE OF MADNESS is a good starting point.

Alas, my dear mentor went astray in some passages of THE MEANING OF MIND. He just simply doesn't understand what is going on inside the heads of people who have been through psychotic crises. Szasz makes the very same error that psychiatrists make when interpreting a disturbed mind: "Don't listen to them!"

There is only one way to understand people in psycho crisis: to read what they have written about their experiences. John Modrow's HOW TO BECOME A SCHIZOPHRENIC: THE CASE AGAINST BIOLOGICAL PSYCHIATRY, for instance, is a window into the mind of the author and into the parental abuse dynamics that made him (temporarily) mad. Since Modrow sent the manuscript of his book to Szasz, and since he read it, there is no excuse for those passages in THE MEANING OF MIND in which Szasz blames the victims for their hallucinations, delusions of grandeur, hearing voices and obsessions. Szasz does not even mention Modrow's seminal work, which was published since 1992; and he blames poor Virginia Woolf for the voices she heard.

Szasz is not concerned about what it feels, from the insider's subjective self, to have a panic attack and to lose one's mind. He tries to approach the subject of the process of going mad "objectively", as if it were a normal, everyday experience that can be understood with plain common sense. But Szasz has never had a psychotic breakdown. Modrow has. Modrow has the key to understand the mad world. Szasz doesn't.

Anyone who really wants to know something about the subject is advised to read not only Modrow's study, but Alice Miller's books as well. The "model of trauma" of mental disorders is the only rational alternative to the psychiatrist's medical model. I find it unbelievable that almost no one has heard of it.

Parental abuse, conscious or not, is the cause of about 99 per cent of mental disorders in humans, even in the grown up neurotic adult (see Susan Forward's bestseller TOXIC PARENTS). Szasz makes the incredible statement that "child abuse, sex abuse, ignorance, poverty, racism" is no causative factor (p. 37). Even worse, Szasz states that "autism is a poorly understood, perhaps genetically caused, condition" (p. 56). This is an incredible statement from the one who has been biological psychiatry's main debunker for the last forty years. Actually, autism is a purely psychogenic condition caused by a psychologically invasive and extremely intrusive mother with the baby (again, see Alice Miller's books).

Here there is another Szasz statement that I find unbelievable: "If, on balance, the voices would perturb him [the so-called schizophrenic] more than they please him, he would stop producing them" (pp. 130f).

This is a rather silly remark. Though I have never had a schizo crisis, I personally know what an obsessive thought is; and I know that I never had the slightest chance to kick the damn thought out of my head. Szasz continues:

"However, hallucinating persons refuse to take antipsychotic drugs voluntarily, preferring the company of their voices".

Ups! Has this statement been written by the great Thomas Szasz, or is it a slogan of Orwellian NAMI?

"As I already suggested, the schizophrenic patient who hallucinates or has delusions is profoundly dishonest with himself" (p. 130).

It is unnecessary to continue with these silly blame-the-victim pronunciations. It is enough to say that Szasz is absolutely ignorant of what mental hell is. I insist that since the process of going mad is a thoroughly subjective experience, both Szasz and his enemy, the orthodox psychiatrist, have no right to "interpret" what if going on inside the minds of the people who endure it.

Let the true insiders talk, for God's sake! Let us give them a chance to speak out of their horrible tragedies that made them mad for a while!

I would like to finish this review with words that come not from Szasz's book, but from a quotation in Modrow's, whose abusive parents were internalized in the poor boy he was:

"After each assault by these internal persecutors, the individual's ego retreats more and more behind a fortress that becomes increasingly empty, until at last, in words of Peter Rosenbaum, the moat is empty; the bridge is down; the sentinels fail to stand guard. The unconscious storms into consciousness, and the walking dreamer of Jung is to be seen".

The general impression of this book is that it is superficial, poorly argued, conspirative, unnecessarily accusatory and abusive, sometimes outright cynical, and fails to address fundamental questions about the relationship between brain and mind (or "mind", if you will).

Szasz asserts that mind as an entity doesn't exist, rather people *mind* (as a verb). Minding and thinking are self-conversations, we are told, inner dialogues that people have with themselves. And since the mind doesn't exist, mental illnesses don't exist, either. What does exist are people having self-conversations that society, in particular psychiatrists, don't understand and consider deviant (Szasz calls it "wrong-minding"). Therefore, these people are put away in psychiatric institutions and are forced to receive mental "treatment", which of course is no treatment at all but a poorly disguised means to keep "society's unwanted" at a safe distance.

Szasz focuses on "hearing voices" as a key symptom in schizophrenia and obsessive-compulsive disorder (OCD), arguing, first, that "hearing voices" is an inadequate description of the phenomenology of this symptom. A better description is the "becoming audible of one's own thoughts". This may well be true. But, second and more importantly, Szasz claims that what is wrong with patients who "hear voices" is simply that they refuse to take responsibility for their own thoughts, that they willfully disavow their own inner voices. Szasz goes as far as claiming that "viewing the schizophrenic as a liar would advance our understanding of schizophrenia" (p. 130). "[T]he schizophrenic patient who "hallucinates" or has "delusions" is profoundly dishonest with himself. He denies that the voices he hears are his own thoughts and that his delusions are metaphors he interprets literally." (p. 130). "If, on balance, the voices would perturb him more than they please him, he would stop producing them" (p. 130/131).

Now, in the absence of *very convincing* evidence, I can't see such as view as anything else but utterly cynical and contemptuous. And there is nothing in the way of convincing evidence to be found in the book. Equally absurd is Szasz' claim that psychiatry, neuroscience and society at large have conspired to bereave unwanted citizens of their personal responsibility. Yet, we are told that exactly this is the hidden agenda of psychiatry and neuroscience. I don't know about American psychiatry, but at least here in Europe I know many psychiatrists or psychotherapists who are primarily motivated by the desire to help - simple as that. Szasz' claim is even more outlandish with regard to neuroscientists. I agree with him that in the US there is indeed an increasing erosion of personal responsibility, and an "infantilization" and "paternalization" of the citizen, evident mainly in legal practice. But this is a different issue, concerning normal, truly self-responsible people, not mental patients.

Regarding the ontological status of the mind, Szasz' book is as unsatisfactory as the rest. Although he repeatedly asserts that thinking or "minding" is internal self-conversation ("autologue"), this idea is left almost entirely unelaborated. For example, we're left to wonder if all mental phenomena are self-conversations, and if so, how this is supposed to work (e.g. feelings, pains, bodily sensations and sensory perceptions as self-conversations?). In fact, Szasz remains almost entirely silent on the relationship between brain and mind. He does, however, severely criticize the fashionable view that the mind is the brain, and pours derision over all those misguided neuroscientists and philosophers who believe so or who believe that something like a mind even exists. But his accusations are superficial and characterized more by abusive language than by argument. In this part of the book he comes across as someone who believes himself to be in certain possession of the truth and thinks that all others are idiots. This arrogant stance hardly conceals that Szasz simply evades the crucial question of how the brain is connected to what we call the mind. All he offers us are vacuous statements like "Mind and brain belong to different discourses." And simply asserting that mind as an entity doesn't exist likewise evades the important issues. Clearly, there are mental phenomena: various forms of consciousness, cognition, language, memory, imagination, to name just a few. Even insisting that all mental phenomena come down to self-conversations (a view I'm not sure Szasz holds), we would still be left with these inner conversations as mental phenomena. Whether or not you subsume these phenomena under the term "mind" doesn't seem to be such an important issue, provided using the term "mind" in this way doesn't lead our thinking astray. Of course, Szasz insists that the reification of the mind has already done enough damage, but if he thinks that the use of the word "mind" as a noun by neuroscientists or psychiatrists means that they hold dualist views of the mind as an immaterial substance or some such, he is clearly wrong. Most neuroscientists and philosophers of mind are not dualists.

In any case, we are left with the overwhelming evidence that mental phenomena are dependent on the brain. And it is the task of neuroscience and related disciplines to examine and explain the nature of this dependence. Like any organ of the body, the brain can be damaged or parts of it can become dysfunctional, and this can and often does manifest on the mental level. So there is no a priori reason to rule out that schizophrenia and other mental disorders are caused by brain alterations. Szasz has not much to say against this possibility except that patients with aphasia due to stroke (i.e. "real" brain damage) don't exhibit the same speech impairment as schizophrenics, and therefore the schizophrenic's disordered speech is unlikely to be based on brain damage. This, of course, is a non sequitur.

In the end, Szasz evades the relevant questions about the relationship between the brain and mental phenomena by drawing an all-too-convenient distinction between persons and brains. Persons have responsibility, brains don't. So don't blame a lack of personal responsibility on deficits of the brain. But the real challenge, I submit, is exactly to understand how something like personal responsibility and free will (etc.) can be rooted in a physical organ, our brain. It is just a cheap excuse to claim that mind and brain, or person and brain, belong to "different discourses". In the face of the overwhelming evidence for a tight link between the two, this explains absolutely nothing.

Yes, I too am worried about the increasing erosion of personal responsibility, including the dangers and abuse potential of insanity defenses in court (for an absurd example, google "twinkie defense"). I believe there is an important sense in which human beings are responsible for their actions (even if the latter turn out to be completely determined by brain processes), but taking seriously the evidence that, like all mental phenomena, responsibility depends on brain processes and doesn't just float free of any material substrate (*that* belief would be a true reification of the mental!), we have to acknowledge the possibility that it can be impaired or absent when certain processes in the brain run off track. That is, there is no easy answer to the question under what circumstances somebody is fully or partly responsible for their actions. Each case must be judged separately. And sometimes, brain damage and/or mental illness *are* relevant factors. To claim otherwise is to ignore the fruits of 20/21th century science - and psychiatry.

I still believe in everything I said about those remarks in THE MEANING OF MIND in my last review. But I would like to add that Thomas Szasz's view of psychiatry is the most profound critical appraisal available in the literature.