If you asked a psychiatrist what he thought of Thomas Szasz’s work he would most probably say ‘he’s mad!’ This in itself illustrates Szasz’s argument that labels such as ‘mad’ are used to stigmatize people whose behaviour or thoughts offend or disturb us. According to Szasz mental illness is nothing but a ‘myth’ that’s purpose is to disguise the bitterness of reality! Szasz suggests that collaboration between psychiatrist and the government has successfully disguised this ‘social problem’ and presented it as a ‘medical problem’, a ‘disease’ of the brain. How true are these claims made by Szasz? This essay will go on to explore further into the validity of this argument made by Szasz.
Many contemporary psychiatrist, physicians and scientist hold the view that some even if a very subtle, neurological defect will be found for all disorders of thinking and behaviour. All mental illnesses are an attribute to physiochemical processes. The difference they see between a mental and a physical disease is that a mental disease manifest’s itself by mental symptoms. Szasz argues, what central nervous system symptom would correspond to a skin eruption or a fracture? It would not be some emotion or complex bit of behaviour. Rather it would be blindness or paralysis of some part of the body’, Szasz (1960). He suggests that there are diseases of the brain like ‘Parkinson’s disease’ but they can not be a disease of the ‘mind’.
There is some scientific evidence to show that schizophrenia is a biological disease caused by genetic factors, an imbalance of chemicals in the brain, structural brain abnormalities or abnormalities in the prenatal environment. Studies have found that children of schizophrenic parents have a high chance of developing the disorder by up to 13 per cent and those with two schizophrenic parents have a 46 per cent chance.
This increased risk is found to be present even when children are adopted. Scientist suggest that excess activity of the neurotransmitter dopamine is the cause of schizophrenia. This hypothesis is supported by the effectiveness of antipsychotic drugs in reducing psychotic symptoms of schizophrenia. This drug works by blocking brain receptors for dopamine. Brain imaging techniques have also found brain abnormalities in some schizophrenics.
The brain ventricles appear to be enlarged and there is a smaller volume of brain tissues in comparison to mentally healthy people. Adoption studies have provided some evidence of a genetic role in depression. These studies show that children of depressed people are vulnerable to depression even when raised by adoptive parents, Mueser, K.T (1998), CD-Rom. A higher than normal level of hydrocortisone can be found in many depressed people. This supports the theory that depression is caused by an imbalance in hormones
Szasz is chiefly arguing that disease or illness can only affect the body and not a person beliefs and thoughts; hence there is no such thing as mental illness. What psychiatrist suggest are symptoms of mental illness are actually a person’s reactions to ‘problems in living’. Szasz uses the example of Andrew Goldstein and John Hinckley Jr. Both of these committed horrendous crimes, for which they pleaded ‘insanity’. Can a brain disease really be the cause of these planned, complex, co-ordinated behaviours?
Szasz argues that this is not possible. According to Szasz the whole concept that ‘disease’ of the mind are disease of the brain’ is used to support the rationality in drug treatment which keeps psychiatrist employed, and to justify the demand for equal insurance coverage for mental disorders, as they be for physical disorders. Szasz uses the example of the signing of the ‘Mental Health Parity Act 1996’ by Pres. Clinton in the US, which ended the long-held practice of providing less insurance coverage for mental illness than is provided for physical disorders. Szasz states that this shows the influence such ideas have on society and further promotes the concept that mental illness is a disease of the brain hence a ‘medical condition’.
Critics argue that medicine is and has never been concerned with known bodily etiology. The mission of medicine is to care for those within society who are suffering. It is argued that szasz exaggerates the difference between mental and physical illness. Ausubel (1962) claims there are commonalities between diagnosis of certain physical and mental symptoms, Guitheil, G.T (2002) On-Line. Also szasz ignores that psychiatrist do not us the term ‘disease’. They use the term ‘disorder’, which addresses their acknowledgment that conditions with no physiological proof of the underlying mechanism can not be termed as ‘disease’ rather they are ‘disorders’.
In Szasz’s view that actual concept of ‘illness’ in itself implies ‘deviation’ from some set of norms, which are defined by the person who considers himself as deviating from a norm or defines by legal authorities and society in general. Mental illness is found when a deviation from psycho-social, ethical and legal norms is seen. Szasz found it logically absurd that deviations from such norms are sought to be corrected by medical action. He couldn’t find the reason behind why psychiatrists are hired to treat a person in order to correct such deviations. Hence solve a problem whose very existence has been defined and established on non-medical grounds.
Social constructionist hold Szasz’s theory on the social nature of metal illness as too limited. Although Szasz claims that ‘mental illness’ is a socially constructed myth, he makes no references to physical illnesses and excepts that they are a biological reality presenting no argument for why he makes this distinction. Schoenmeman, T.J (2002) On-Line, argues that Szasz’s theory redefining mental illness as ‘problems in living’ is based on weak historical evidence.
Because Szasz believes mental illness is a ‘problem of living’ psychiatry is therefore a discipline concerned with problems in human relations and not with diseases of the brain which are problems for neurology. The analysis and interpretation of problems in human relations can only be given within social and ethical contexts, and psychiatry so we see that psychiatry can not be separated from ethics. So a psychiatrist’s socio-ethical orientation influences his ideas on what is wrong with a patient. The following quote from Szasz, T. (1960) On-Line illustrates what this idea further
“In other words a psychiatrist does not stand apart from what he observes, he is a ‘participant observer’. This means that he is committed to some picture of what he considers reality, and he observes and judges the patients behaviour in the light of these considerations.” Szasz proposes that the officially forbidden truth behind psychiatry is that they refer to as a condition is in fact referred to as a strategy.
Terms which are used as though they are descriptions of a psychopathological condition from which individuals suffer, are in fact prescriptions for how an individual should be treated by others. Psychiatrist decide what to do about a person first, and than they decide on an appropriate diagnostic label which they will use to justify their decision. Take for example; if a psychiatrist wants an individual to be acquitted of a criminal charge by reason of insanity, he discovers that the individual was suffering from a mental illness at the moment that the criminal act was committed. Szasz. T (1987)
Critics assert that Szasz sees psychiatrists in the same way the Jews, Jewish literature and Jewish science is seen? If Szasz’s views were to be followed patients would be denied their need for help with their disorders, as these mental disorders would be though of as ‘problems in living’. Szasz holds an extremely careless view. Especially when one take into account the number of suicides committed by those suffering from a mental disorder. If these people where to be left to their own devises and given no help, no doubt this number would increase drastically. Psychiatry plays an important part in the prevention of suicide. Anti psychotic drugs are found to reduce symptoms in 80 to 90 per cent of schizophrenics.
According to szasz mental diseases are invented and than given a name and added to the Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM), which is though of as a pseudo-scientific bible. In this manner psychiatrist have successfully persuaded the scientific community that mental disorders are diseases, and pretend that the terms they construct are descriptions of brain diseases. Few in political power challenge this. Therefore in a sense psychiatrist have much power, as they can label anyone with a mental disorder and this will be socially verified.
It is argued that if internist can classify internal diseases based on their knowledge of them, than why can’t psychiatrist create a classification of mental disorders. Because we may not no the cause of something does not mean it does not exist. We did not know about epilepsy 100 years ago. We don’t know what the causes of migraine are today, yet is still a classified medical condition. Szasz’s advocacy for private psychiatry for which patients have to pay is also questioned.