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TOP 100 REVIEWERon August 10, 2010
Thomas Szasz (born 1920) is Professor Emeritus of Psychiatry at the State University of New York Health Science Center. He is a well-known critic of psychiatry, of the social role of medicine in modern society, and is a social libertarian.

In the Preface to the First Edition (1960) of this book, he writes, "Although my thesis is that mental illness is a myth, this book is not an attempt to 'debunk psychiatry'... although I consider the concept of mental illness to be unserviceable, I believe that psychiatry could be a science. I also believe that psychotherapy is an effective method of helping people---not to recover from an 'illness,' but rather to learn about themselves, others, and life."

Here are some representative quotations from the book:

"In this respect---and indeed not only in this respect---psychiatry resembles religion rather than science, politics rather than medicine."
"In ... the traditional psychiatric view, the physician defines what is good or bad, sick or healthy. In the individualistic, autonomous 'psychotherapy' which I prefer, the patient himself defines what is good or bad, sick or healthy."
"By and large, such persons impersonate the roles of helplessness, hopelessness, weakness, and often of bodily illness---when, in fact, their actual roles pertain to frustrations, unhappinesses, and perplexities due to interpersonal, social, and ethical conflicts."
"Mental illness is not something a person has, but is something he does or is."
"There is no medical, moral, or legal justification for involuntary psychiatric interventions. They are crimes against humanity."
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on January 3, 2015
I will start by saying I have Bipolar Disorder, and have struggled with it for many years.

I've had some time off recently, so I wanted to really investigate the science behind my disorder. I started with two books on mental health policy over the past 50 years ( "American Psychosis" for a negative take, and "Better but Not Well" for a more positive, mainstream take), then I read the latest psychiatric information about the disorder- the suspected genetic causes , the brain chemistry approach, the neurological evidence from the official peer-reviewed literature. I altogether found it unsatisfying. Everywhere I turned, it was always "While the specific mechanism is unknown, it is believed..." or "While specific genes cannot be found, it does seem to run in families..." Even the neurological explanation didn't seem able to distinguish cause from effect, or come up with any predictive mechanism. I began to really question the mainstream, so I read "Anatomy of an Epidemic", which was an excellent summary of all the research showing that the brain-chemistry model is ineffective. I even investigated my own medication, and found that Lamictal, the primary drug of choice for bipolar treatment, was found to be ineffective in 7 out of 9 clinical trials ( Of course GSK only published the positive two).

All Thomas Szasz really says here is that we can't view mental illness, that is to say, the major mood disorders and psychoses, as normal diseases. We can't pretend that mental illness is some exogenous force that is totally irrelevant of the victim's life experiences, the victims traumas and tragedies, and the victim's behaviors. In fact, new research into the pscychosocial explanation finds very strong evidence for the importance of these things in predicting the incidence of mental illness. And if its true, as Szasz argues, that there is this very strong psychosocial element, then therapy to understand these issues and perceptions and to allow the patient to change behavior is the best option for treatment. Again, research shows the efficacy of Psychotherapy in general as well as CBT specifically.

Finally, I can say he is 100% correct in his assertion that much of psychiatry is inhumane. Involuntary treatment, and even the attitude that certain ways of life are "right" and other ways "bad," are means of controlling people. They are a way for society to get rid of undesirables and call it compassion, and on the other side, an escape valve for the oppressed. A key piece of evidence for this is that "homosexuality" was a mental illness for a long time, something we would scoff at now; that was a means of social control, not a means of helping the patient. Healing can only occur in an atmosphere of respect and dignity, where the doctor respects the patient's rights and autonomy, and where the patient takes responsibility.

The book is quite plodding at points, but if you skip his abstract explanations and jump straight to the examples he gives, it is very clear. While I'm not convinced that all mental illness is purely a construction, I think Szasz hits the nail on the head for the general direction Psychiatry has moved.
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on May 22, 2011
Szasz is identifying a mechanism which prevents us from looking more seriously at the root of the mental patient's problem, namely the social and personal circumstances in which the patient is trapped. He discusses the advantage to both patient and doctor not to identify the true root of the problem and suggests that the situation is best analyzed in game-theoretic terms. He also isn't judgemental of the person playing the game. He feels that they are generally placed in impossible situations, and display these odd behaviors as the most reasonable way to fill genuine needs which would not otherwise be met. This seems to me an important message and I found a lot that interested me in the book. But it doesn't cover many cases including the one that most interests me.

I turned to Szasz because I was interested in how the surge in diagnoses of autism is influenced by the tangled web of social expectations and law. Szasz might say (and I would agree), that autism does not qualify as `mental illness', because it probably has a physiological basis, albeit one which hasn't been identified. However, in the absence of this identification, autism is `treated' primarily by mental health professionals who have as yet to find a `cure'.

Szasz discusses mental illness as if it involves no physiological change whatever, despite the fact that, for example, hallucinations can be drug-induced. When I enjoy the view out my window, that experience is probably associated with some change in my organism. I don't know how objectively they can now distinguish between physiological changes which are structural and those which reflect mere transitory states.

But I don't think the behavior of a 2-year-old diagnosed with autism can be best understood as a sophisticated conscious or unconscious game to fulfill needs. I think what's going on is more primitive. And I think hysteria in adults that arises from being trapped in an impossible situation can also be far less calculating than he suggests. An abusive marriage can be like low grade ongoing torture, and a torture victim sometimes just screams despite knowing that it won't solve anything.
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on August 4, 2001
Dr. Szasz'definitive work should be revisited by all mental health professionals in this new era of "managed care" and its resultant "new mental health system". Although I don't agree with everything that Dr. Szasz claimed in his groundbreaking book, it seems to me that those who considered him a quack and continued the medical model of mental illness for the last 4+ decades have not proven him wrong. We have miserably failed the "mentally ill", "mentally disordered", people with "problems in living", or whatever term one uses these days. The mental health system and its providers these days use the excuse of managed care to explain its failures, but would be better advised to read or reread Dr. Szasz's forewarning of 40 years ago. It is time to rethink the problem, and a good place to start is with the "Myth of Mental Illness"-before the death of the mental health system is upon us.
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on February 24, 2010
This is the second book written by Thomas Szasz and is undoubtedly his best known work. The book is a reprint of the 1974 revised edition with a new preface and two new essays. The new material shows Szasz in fine form. Nowadays, it is fashionable to write off Szasz as being a relic, yet I believe his observations are more timely than ever. As Szasz points out, everyone today "knows" that mental illnesses are brain diseases despite an absence of evidence. Mental illness is so much a part of our culture that questioning the concept of mental illness is sure to elict the comment that the doubter should have his head examined.

In addition to this work, my favorite Szasz books include Insanity: The Idea and Its Consequences, The Medicalization of Everyday Life, Pharmacracy: Medicine and Politics in America, and A Lexicon of Lunacy: Metaphoric Malady, Moral responsibility, and Psychiatry.

Reading Thomas Szasz is an intellectual delight.
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on January 1, 2012
When I was 17 years old in 1961, I was suffering from depression, probably due to the fact that I was gay and living in a society that considered people like me to be "sick." I went to a shrink who immediately recommended that I be put away in the mental ward of the local charity hospital. I went there with my mother and we were both horrified. It was one of those snake pits that used to exist, and perhaps still do. There was only one entrance/exit door, and it was normally locked, i.e., it was a sort of prison. The screens on the windows were rusted over, and of course there were bars on the windows. The place was so filthy that a cockroach crawled across the bed I was assigned to. The patients were zombies. I was ready to make a run for it when my mother decided that her son wasn't going to face this dreadful fate, and we fled. In 1945 there was a young gay man arrested in Tallahassee for soliciting, and he pled Not guilty by reason of insanity, based on the opinion in those days that homosexuality was a mental illness. He spent the next TWENTY-SEVEN YEARS in the Florida State Hospital For the Criminally Insane. They didn't let him out until 1972. He was 23 when he went in and 50 when he was released. "How shall it be with kingdoms and with kings, when this dumb terror shall reply to God?" (Edwin Markham) Albert Ellis said that Szasz was a hippie. I say that he was a saint and a hero.
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on March 25, 2014
As a retired health care professional, I wish that I had read this book a long, long time ago. It should be standard reading in all health care professional training, and especially in any field related to mental health. Unfortunately, the mainstream powers that be will not allow that. I recommend that you buy this book in paper and give it to any health care professional you deal with. The life and mental health you save may be your own.
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on November 26, 2013
Szasz once said that he is the only doctor in his field who hands were clean, because he never medicated any of his patients. Very illuminating read, this is one of those books that will change your way of looking at the largely pseudo-scientific field of psychiatry. A worldview changer of a read!
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this is the kind of book that touches on everything that leads to Mental illness and the way it is defined and broken down. what can lead to a certain pattern of behavior and how certain responses and motions are called into question. this book explores all the social and inner conflicts and how there are challenges and conflict and the battle within the mind and how certain things play themselves out. this book will make you re examine your own mind set as well others and how certain things are said to make a certain person be stereotyped when in fact they can be Brillant,however other factors get in the way. very compelling book and a must read.
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on July 27, 1999
Though this book might be of paramount importance for those who desire to find an antithetical position to the "Doctors for the pathologizing of human behavior," I think it a terrible mistake to read this book with the assumption that understanding Szasz will be the result. Written early in his career, this book, like Beethoven's early symphonies, deserves not the attention it receives for the titilating title. I believe the influence of Karl Kraus caused the about face demonstrated by "The Myth of Psychotherapy" from the position outlined in "The Ethics of Psychoanalysis," both books he published later. For those that desire to find a summation of Szasz in one volume, I would recommend "Insanity."
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