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The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (Revised Edition) Paperback – October 10, 1984
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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.
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."
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.