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Tuesday, 13 May 2014

'The Myth of Mental Illness' - Mad, or Bad? Even in the decade of dissent, Thomas Szasz stood alone when he attacked the concept of madness from the political right by Holly Case

Professor Thomas Szasz died in 2013

    Mad, or Bad?

    Even in the decade of dissent, Thomas Szasz stood alone when he attacked the concept of madness from the political right

    by Holly Case

    Stir crazy: Jack Nicholson in the 1975 film of Ken Kesey's book One Flew Over the Cuckoo's Nest.
    Photo by Rex

    Holly Case is associate professor of history at Cornell University and the author of Between States: The Transylvanian Question and the European Idea during the Second World War (2009).

    In 1961, a young psychiatrist initiated a one-man insurgency against his own profession. ‘Psychiatry is conventionally defined as a medical specialty concerned with the diagnosis and treatment of mental diseases,’ he wrote. ‘I submit that this definition, which is still widely accepted, places psychiatry in the company of alchemy and astrology and commits it to the category of pseudoscience. The reason for this is that there is no such thing as “mental illness”.’

    Fifty years after his book The Myth of Mental Illness: Foundations of a Theory of Personal Conduct first ventured this uncompromising view, its author Thomas Szasz visited Cornell University in upstate New York. He was there to speak to an audience of students, many of them coerced or bribed by their professors to attend, plus a few local lawyers and psychiatrists. His subject was ‘The Insanity Defence: The Case for Abolition’. The talk started late because a man in a wheelchair was being positioned near the front of the lecture hall. Szasz greeted him enthusiastically; the audience would later learn that he was Ronald Leifer, a psychiatrist who had been denied tenure at the Upstate Medical Center at Syracuse in 1966 for defending Szasz and his iconoclastic ideas against practically the whole of the psychiatric profession.

    When it finally started, the lecture was heavily anecdotal and lasted barely half an hour. The 91-year-old psychiatrist spoke in a quiet voice and with a thick Hungarian accent. Students shifted in their seats. Then came the Q&A. Although the subject was the insanity defence, the audience was more interested in Szasz’s assertion that there was no such thing as mental illness. ‘What about schizophrenia?’ ‘How can you be a practising psychiatrist if you don’t believe in mental illness?’

    One student asked him: ‘Are you trying to say we all have different brains?’ The lecturer seemed unsteady on his feet. ‘Yes,’ he replied, ‘we do.’ Another student put it to him that we might be determined by our neurological make-up. ‘I think you and I have different brains,’ Szasz replied. That got a laugh from the audience. It was clear that being the only one in the room with a brain like his was part of his persona; being contrarian was his way of being right. Throughout his career, even friendly co-optation irked him. When scholars started associating him with the anti-psychiatry movement, he wrote a book entitled Antipsychiatry: Quackery Squared (2009).

    Szasz liked to present himself as a dissident. And yet, when he began dynamiting the foundations of psychiatry in the 1960s, rebellion was in vogue, and he seemed very much a man of his time. Along with so many other radicals of the decade of dissent who got half of what they wished for, he has largely been forgotten, his troubling declarations defused by decades over which he worked as an academic and a practising psychiatrist.

    After the talk at Cornell, he confided over a stiff drink that he generally did not give talks anymore. ‘I’m too old,’ he told me. ‘Plus, not many people know I’m still alive.’ Indeed, not long after our conversation, Szasz died, last fall. But did his ideas die with him? On the contrary, it might be that the world has only recently come around to his way of thinking.

    Near Szasz’s school in Budapest there stood a statue of Ignaz Semmelweis, a Hungarian obstetrician who found posthumous fame as a 19th-century martyr of science. To Szasz, the sickly and discontented young son of a Jewish businessman, Semmelweis became something of a hero. The late doctor’s claim to fame had been the discovery that it was possible to practically eliminate the often-fatal ‘childbed fever’ common among new mothers in hospitals if doctors simply washed their hands before assisting with childbirth — especially if they had just been performing autopsies. When his findings became more widely known in the 1840s, he expected a revolution in hospital hygiene. It didn’t come, and Semmelweis grew increasingly outspoken and hostile towards doctors who refused to acknowledge his discovery. Vitriolic academic exchanges ensued, and he was eventually lured to a mental hospital where his opponents had arranged for his incarceration. He was beaten severely and put in a straitjacket. He died within two weeks. Echoing Voltaire, Szasz recalled the doctor’s tragic life in an autobiographical sketch in 2004:

        It taught me, at an early age, the lesson that it can be dangerous to be wrong, but, to be right, when society regards the majority’s falsehood as truth, could be fatal. This principle is especially true with respect to false truths that form an important part of an entire society’s belief system. In the past, such basic false truths were religious in nature. In the modern world, they are medical and political in nature.

    Szasz was still a teenager when his Jewish family left Hungary, and just preparing for college when they settled in the US in 1938. He later confessed that his knowledge of America prior to his arrival was sketchy, and largely based on reading The Adventures of Tom Sawyer (1876) by Mark Twain. He had heard the ‘usual tales’ about ‘the land of movies, money, and the mistreatment of blacks’. When he enrolled in the University of Cincinnati in the winter of 1939, he discovered that discrimination against Jews, ‘not to mention blacks and women’, was ‘perhaps even more intense’ than it had been in Hungary.

    Though he earned a degree in medicine, Szasz was much more interested in politics and philosophy. He chose training in psychoanalysis in Chicago, then a centre of the psychoanalytic craze, over a career as a medical doctor. Demonstrating textbook psychoanalytic ambivalence, he was simultaneously attracted and repelled by the prevailing image of psychoanalysts as the elect. In the same autobiographical sketch from 2004, published as part of the collection Szasz Under Fire: The Psychiatric Abolitionist Faces his Critics, edited by Jeffrey Schaler, he recalls:

        The analysts passionately believed that they were treating real diseases, never voiced objections against psychiatric coercions, and believed that criminals were mentally ill and ought to be treated, not punished. These beliefs were an integral part of their self-perception as members of an avant-garde of scientific, liberal intellectuals.

    His fellow psychoanalysts, with their ‘left-liberal “progressive” prejudices’, fanatically denounced Republicans as ‘either fascists or sick or both’. As a practising psychoanalyst, an academic psychiatrist (with tenure) and a staunch Republican, Szasz felt he belonged to an embattled minority, an elect of a different sort. It was the ideal position from which to deliver his dissident strike.

    It came in 1961 with the publication of The Myth of Mental Illness, wherein Szasz asserted that psychiatry, unlike medicine, could demonstrate no physical basis for the ‘diseases’ it identified and ‘treated’.

    ‘To speak of elevated blood pressure and hypertension,’ he wrote, ‘of sugar in the urine and diabetes, all as “organic symptoms”, and to place them in the same category as hysterical pains and paralyses is a misuse of language; it is nonsensical.’ Masquerading as scientists, psychiatrists abused scientific concepts and deluded their patients.

    Worse still, they acted as henchmen for society and state. ‘[T]herapeutic interventions have two faces,’ Szasz wrote; ‘one is to heal the sick, the other is to control the wicked’. Yet the standard for wickedness is always subjective and variable, and so the psychiatrist inherited from the Inquisition the task of quarantining society’s dangerous elements. It was not a coincidence that, even decades after the word ‘psychiatrist’ entered English in 1890, practitioners were often called ‘alienists’, derived from the French aliéné, meaning both ‘alienated’ and ‘insane’. First, Szasz wrote, it was ‘God and the priests’ who kept the unruly in check. Then came ‘the totalitarian leader and his apologists’, along with ‘Freud and the psychoanalysts’.

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