The Myth of Thomas Szasz

Controversial psychiatrist Thomas Szasz is the subject of an in-depth article in The New Atlantis magazine that re-examines his legacy and impact on psychiatry.

Szasz has made some of the most important and cutting criticisms of modern psychiatry but is now largely ignored by both academia and patients’ rights groups.

This is partly because the classical liberal philosophy that motivates many of his arguments has become less popular and partly because he’s been associated with Scientology – known for its wild-eyed anti-psychiatry.

It is also true to say that while making some pertinent and uncomfortable observations, he’s also made some rather less impressive and sometimes, downright insulting, accusations.

One of his most well-known arguments is that mental illness is a ‘myth’. This is widely misunderstood to mean that Szasz is arguing that there is no such thing as mental suffering or bizarre behaviour, or that it shouldn’t be treated, which is not the case.

Szasz would argue that these things are labelled as mental illnesses because of society’s willingness to medicalise, and often control, people who behave abnormally.

He argues that while these things occur, they are not diseases in the same sense that, say, AIDS, is an disease, because there is no clear biological marker for mental distress.

In a sense, modern psychiatry is cursed only to deal with disorders that do not have a discrete biological cause.

As soon as a clear biological cause is found, the disorder is often taken out of the hands of mainstream psychiatry and becomes the domain of neurology or neuropsychiatry, as has happened with neurosyphilis, epilepsy, Huntingdon’s disease and many others.

In a way then, Szasz is right, because psychiatry necessarily applies medical concepts only to fuzzy human phenomena.

As science advances, the concepts become less fuzzy, and so Szasz’s arguments might apply to a smaller and smaller number of disorders.

This would be the case, perhaps, if it weren’t for the fact that other unpleasant experiences and behaviours are increasingly included in psychiatry’s remit. Extreme shyness can now be diagnosed as social phobia, for example.

The New Atlantis article examines some of the motivations behind Szasz’s 40 year crusade, the hubris of 60s psychiatry, and why he is now less relevant in modern psychiatric practice when he was once centre stage.

Link to article ‘The Myth of Thomas Szasz’.

4 thoughts on “The Myth of Thomas Szasz”

  1. Szasz would have done better to focus on the artificiality of the terminology rather than the absence of biological correlates (of which there are quite a few.)
    In other words, there is an association between, say, depression and serotonin, so Szasz’s argument collapses. However, this association is by no means causal nor necessary. There are plenty of ways to treat depression without serotonin involvement.
    An updated “Szasz” argument would be that many of the constructs in psychiatry are recursive (e.g. Prozac helps depression therefore serotonin is relevant therefore we should use serotonergic drugs) or are postulates which are used to support erroneous propositions (“bipolar illness” consists of two poles, so treating one pole should bring you closer to the other pole, therefore “antidepressant induced mania” and “anticonvulsant breakthrough mania”).
    The economist Milton Friedman had a view that things were scientific if they could be used to predict outcomes–not if they were built on solid assumptions. Popper had a similar argument (falsifiability.)
    So Szasz was wrong because he focused on biology vs. freedom; and Szasz was right because psychiatry has a tough time predicting anything, even when there is biology there.

  2. One thing Szasz did have right is the “mission creep” in psychiatry. The moment we pretend aggression is even partially outside of volitional control (for example, “bipolar made me do it”) then it becomes psychiatry’s responsibility to handle _all_ of it.
    Consider the simple example of a “bipolar” person who says he wants to kill his GF for cheating on him. My responsibility is to protect and warn her, because, well, he’s bipolar– even though the bipolar has nothing to do with it.
    Contrast this with the police, who have no such responsibility until the crime is committed. Meanwhile, their motto is “Protect and Serve.”
    There’s your mission creep.

  3. My understanding of the recent phenomenon of ‘social phobias’ is that they are in large part propelled by the pharmaceutical industry, in that it is more profitable to treat such disorders, than other less ‘sexy’ conditions. But I feel it only fair to declare a certain bias on my part.
    Best wishes

  4. It is so completely obvious to anyone who works with the mind that the whole field of psychiatry is a fraud.

    Unless of course you are on the profit end,then you have to unsuccessfully attempt to discredit Szasz and go against obvious common sense.

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