Sunday, April 05, 2009

All in the Mind - Thomas Szasz speaks (Part 1 of 2)

Thomas Szasz has been a renegade in the field of psychology for several decades now. He has repeated and pointedly criticized the use of drugs in psychiatry. While I often disagree with him on many topics, his arguments are thought-provoking.

This is from the Wikipedia article linked to above:

Szasz is a critic of the influence of modern medicine on society, which he considers to be the secularisation of religion's hold on humankind. Criticizing scientism, he targets in particular psychiatry, underscoring its campaigns against masturbation at the end of the 19th century or the use of lobotomy to treat schizophrenia. To sum up his conception of medicine, he declared:

Since theocracy is the rule of God or its priests, and democracy the rule of the people or of the majority, pharmacracy is therefore the rule of medicine or of doctors.[1]

He considers that:

"The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed."[2]

His main arguments can be summarised as follows:

  • The myth of mental illness: It is a medical metaphor to describe a behavioral disorder, such as schizophrenia, as an "illness" or "disease". Szasz wrote: "If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic."[2] While people behave and think in ways that are very disturbing, this does not mean they have a disease. To Szasz, people with mental illness have a "fake disease," and these "scientific categories" are in fact used for power controls. Schizophrenia is "the sacred symbol of psychiatry" and, according to Szasz, is not really an illness. To be a true disease, the entity must somehow be capable of being approached, measured, or tested in scientific fashion. According to Szasz, disease must be found on the autopsy table and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. Mental illnesses are "like a" disease, argues Szasz, putting mental illness in a semantic metaphorical language arts category. Psychiatry is a pseudo-science that parodies medicine by using medical sounding words invented over the last 100 years. To be clear, heart break and heart attack belong to two completely different categories. Psychiatrists are but "soul doctors", the successors of priests, who deal with the spiritual "problems in living" that have troubled people forever. Psychiatry, through various Mental Health Acts has become the secular state religion according to Thomas Szasz. It is a social control system, which disguises itself under the claims of scientificity. The notion that biological psychiatry is a real science or a genuine branch of medicine has been challenged by other critics as well, such as Michel Foucault in Madness and Civilization (1961).
  • Separation of psychiatry and the state: State government by enforcing the use of shock therapy has abused Psychiatry with impunity.[3] If we accept that "mental illness" is a euphemism for behaviors that are disapproved of, then the state has no right to force psychiatric "treatment" on these individuals. Similarly, the state should not be able to interfere in mental health practices between consenting adults (for example, by legally controlling the supply of psychotropic drugs or psychiatric medication). The medicalization of government produces a "therapeutic state," designating someone as "insane" or as a "drug addict". In Ceremonial Chemistry (1973), he argued that the same persecution which has targeted witches, Jews, Gypsies or homosexuals now targets "drug addicts" and "insane" people. Szasz argued that all these categories of people were taken as scapegoats of the community in ritual ceremonies. To underscore this continuation of religion through medicine, he even takes as example obesity: instead of concentrating on junk food (ill-nutrition), physicians denounced hypernutrition. According to Szasz, despite their scientific appearance, the diets imposed were a moral substitute to the former fasts, and the social injunction not to be overweight is to be considered as a moral order, not as a scientific advice as it claims to be. As with those thought bad (insane people), those who took the wrong drugs (drug-addicts), medicine created a category for those who had the wrong weight (obeses). Szasz argued that psychiatrics were created in the 17th century to study and control those who erred from the medical norms of social behavior; a new specialization, drogophobia, was created in the 20th century to study and control those who erred from the medical norms of drug consumption; and then, in the 1960s, another specialization, bariatrics, was created to deal with those who erred from the medical norms concerning the weight which the body should have. Thus, he underscores that in 1970, the American Society of Bariatic Physicians (from the Greek baros, weight) had 30 members, and already 450 two years later.
  • Presumption of competence: Just as legal systems work on the presumption that a person is innocent until proven guilty, individuals accused of crimes should not be presumed incompetent simply because a doctor or psychiatrist labels them as such. Mental incompetence should be assessed like any other form of incompetence, i.e., by purely legal and judicial means with the right of representation and appeal by the accused.
  • Death control: In an analogy to birth control, Szasz argues that individuals should be able to choose when to die without interference from medicine or the state, just as they are able to choose when to conceive without outside interference. He considers suicide to be among the most fundamental rights, but he opposes state-sanctioned euthanasia. In his 2006 book about Virginia Woolf he stated that she put an end to her life by a conscious and deliberate act, her suicide being an expression of her freedom of choice.[4][5]
  • Abolition of the insanity defense: Szasz believes that testimony about the mental competence of a defendant should not be admissible in trials. Psychiatrist testifying about the mental state of an accused person's mind have about as much business as a priest testifying about the religious state of a person's soul in our courts. Insanity was a legal tactic invented to circumvent the punishments of the Church, which, at the time included confiscation of the property of those who committed suicide, which often left widows and orphans destitute. Only an insane person would do such a thing to his widow and children, it was successfully argued. Legal mercy masquerading as medicine, said Szasz.
  • Abolition of involuntary hospitalization: No one should be deprived of liberty unless he is found guilty of a criminal offense. Depriving a person of liberty for what is said to be his own good is immoral. Just as a person suffering from terminal cancer may refuse treatment, so should a person be able to refuse psychiatric treatment.
  • Our right to drugs: Drug addiction is not a "disease" to be cured through legal drugs (Methadone instead of heroin; which forgets that heroin was created in the first place to be a substitute to opium), but a social habit. Szasz also argues in favor of a drugs free-market. He criticized the war on drugs, arguing that using drugs was in fact a victimless crime. Prohibition itself constituted the crime. He shows how the war on drugs lead states to do things that would have never been considered half a century before, such as prohibiting a person from ingesting certain substances or interfering in other countries to impede the production of certain plants (e.g. coca eradication plans, or the campaigns against opium; both are traditional plants opposed by the Western world). Although Szasz is skeptical about the merits of psychotropic medications, he favors the repeal of drug prohibition. "Because we have a free market in food, we can buy all the bacon, eggs, and ice cream we want and can afford. If we had a free market in drugs, we could similarly buy all the barbiturates, chloral hydrate, and morphine we want and could afford." Szasz argued that the prohibition and other legal restrictions on drugs are enforced not because of their lethality, but in a ritualistic aim (he quotes Mary Douglas's studies of rituals). He also recalls that pharmakos, the Greek root of pharmacology, originally meant "scapegoat". Szasz dubbed pharmacology "pharmacomythology" because of its inclusion of social practices in its studies, in particular through the inclusion of the category of "addictiveness" in its programs. "Addictiveness" is a social category, argued Szasz, and the use of drugs should be apprehended as a social ritual rather than exclusively as the act of ingesting a chemical substance. There are many ways of ingesting a chemical substance, or drug (which comes from pharmakos), just as there are many different cultural ways of eating or drinking. Thus, some cultures prohibit certain types of substances, which they call "taboo", while they make use of others in various types of ceremonies.

Szasz has been associated with the anti-psychiatry movement of the 1960s and 1970s, although he has resisted being identified as an anti-psychiatrist. He is not opposed to the practice of psychiatry if it is non-coercive. He maintains that psychiatry should be a contractual service between consenting adults with no state involvement. In a 2006 documentary film called Psychiatry: An Industry of Death released on DVD Szasz stated that involuntary mental hospitalization is a crime against humanity. Szasz also believes that, if unopposed, involuntary hospitalization will expand into "pharmacratic" dictatorship.

This week's (and next) All in the Mind podcast is a discussion with Szasz.

Thomas Szasz speaks (Part 1 of 2)

In 1961 maverick psychiatrist and libertarian Professor Thomas Szasz published his controversial and influential epic, The Myth of Mental Illness. In it he argued that mental illness is a fiction and a medical metaphor. Half a century later he maintains we live in a therapeutic state—a 'pharmacracy' where psychiatry is synonymous with coercion. On the eve of his 89th birthday he joins Natasha Mitchell in conversation over two weeks about his contentious legacy.

Show Transcript | Hide Transcript

Transcripts published Wednesdays. Audio published by Saturday afternoons.

Guests

Professor Thomas Szasz
Professor of Psychiatry Emeritus
State University of New York Health Science Center
Syracuse, New York
http://www.szasz.com/

Further Information

We welcom your comments on Professor Szasz's interview - join Natasha Mitchell in the All in the Mind blog

Mind and Mood on the ABC's Health and Wellbeing's Online gateway

All in the Mind on twitter

Email the program
Have a go at posting your comments to the blog too, to share your thoughts with others. It's easy to do.

Publications

Title: Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics
Author: Edited by Jeffrey A Schaler
Publisher: 2004
Contributors include Thomas Szasz, R.R Kendell, K.W.M Fulford, Ray Scott Percival, Ralph Slovenko, Stanton Peele, Rita J. Simon, E. James Lieberman, Margaret A. Hagen, Margaret P. Battin and Ryan Spellecy, Richard Bentall, Ronald Pies, H. Tristam Engelhardt, Jr.

Title: The Medicalization of Everyday Life - Selected Essays
Author: Thomas Szasz
Publisher: Syracuse University Press, 2007
ISBN-13 978-0-8156-0867-7

Title: The Myth of Mental Illness: Foundations of a Theory of Personal Conduct
Author: Thomas Szasz
Publisher: 1984 Harper Perennial (Revised edition), first published 1961.

Title: The Myth of Mental Illness (original journal paper)
Author: Thomas S. Szasz
Publisher: American Psychologist, 15, 113-118. 1960
URL: http://psychclassics.yorku.ca/Szasz/myth.htm
This became the basis of Thomas Szasz's book of the same title, published the year later.

Title: The Myth of Psychotherapy
Author: Thomas Szasz
Publisher: Syracuse University Press, 1988.
ISBN-10: 0815602235

Title: Psychiatry: The Science of Lies
Author: Thomas Szasz
Publisher: Syracuse University Press, 2008

Title: Coercion As Cure: A Critical History of Psychiatry
Author: Thomas S. Szasz
Publisher: Transaction Publishers, 2007

Presenter

Natasha Mitchell

Producer

Natasha Mitchell/Anita Barraud


1 comment:

Amanda said...

Wow. I admire his thoroughness. His arguments are both extreme and compelling. There's a lot to consider here.