So I was talking to my new therapist the other day and he said I might find the work of Thomas Szasz, a psychiatry prof at SUNY, interesting, so I looked him up on Wikipedia (can't link to it because I'm a new member still, just google "Thomas Szasz"

I know his arguments might be very unpopular on a psych board but I have to admit they make a lot of sense. Describing behavior as an "illness" or a "disease" doesn't make any sense. A disease is something that "must demonstrate pathology on a cellular or molecular level", a disease is something you have, not something you do.

From the Wiki page:

"A genuine disease must also be found on the autopsy table (not merely in the living person) and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. "Mental illnesses" are really problems in living. They are often "like a" disease, argues Szasz, which makes the medical metaphor understandable, but in no way validates it as an accurate description or explanation. Psychiatry is a pseudo-science that parodies medicine by using medical sounding words invented especially over the last 100 years. To be clear, heart break and heart attack, or spring fever and typhoid fever belong to two completely different logical categories, and treating one as the other constitutes a category error, that is, a myth. Psychiatrists are the successors of "soul doctors", priests who dealt and deal with the spiritual conundrums, dilemmas, and vexations — the "problems in living" — that have troubled people forever."

I've been told I have a chemical imbalance in my brain that results in depression. That sounds logical, but no one can measure the levels of neurotransmitters in the synaptic gaps between my neurons, so they (doctors) come to this conclusion by deduction. Give a drug that inhibits the re-uptake of one neurotransmitter and see if she feels better. If so, that must be it. Okay. I can live with that. Maybe someday they'll be able to operationalize this theory more scientifically, but now the possibility that I have "borderline personality disorder" is something different. That's not neurotransmitters, that's learned behavior and I can do this thing called Dialectical Behavioral Therapy (DBT) to learn other ways of thinking and behaving. I'm okay with that too (in fact I like it better than the idea of messing around semi-haphazardly with my natural brain chemistry).

I'm not saying that different levels of different neurotransmitters in your brain don't result in people feeling depressed, manic or whatever. And I'm not saying that coping mechanisms/behaviors that we developed as children in response to specific situations in our childhoods don't sometimes become un-helpful as behaviors when we are adults... but there is something to this guy's argument that when we view these things as "diseases" of the "mind" (brain) that can be "cured" there are all sorts of unpleasant ramifications ranging from patronizing and disempowering patients by doctors to social ostracization and victimization by society in general.

(Szasz also talks a lot about how the "disease" perspective decimates individual liberty and the right of people to decide various things for themselves such as the right to end one's own life).

Just to be clear, he's not against psychiatry or against any kind of therapy that people willingly undertake, just against the characterization of these things as "disease" and against any kind of coerced treatment such as forced hospitalization etc.

So I was just wondering what others' thoughts are on his ideas and if anyone has read any of his books.

[FooZe]

Hi LostinDC, welcome to Psych Central!

It's been a while since I read anything by Szasz and I don't remember very many of the details. I do remember appreciating some of the points he made but also, hearing from quite a few others who did not.

Personally I think he's talking about an area where paradoxes abound. People can easily get caught up in "believing" one side of a paradox and vigorously arguing for it against the other(s): that mental illness is (or isn't) all about brain chemistry, for instance.

To simplify the heck out of it, suppose I point out to you that I'm standing on my left foot and you tell me, "No you're not! There's your right foot, in solid contact with the ground!" Well of course I'm standing on both feet, and we get into difficulty when we focus on one or the other. I'd say it works the same way with "It's all about brain chemistry" versus "It's not"; with "I have an illness" versus "I'm stuck in making choices that don't work for me"; and with "It's my fault that I'm the way I am" versus "I'm not responsible, someone or something did it to me."

I'd say we stand to learn a lot from a conversation where we recognize that we're talking about different ways of looking at a paradox; or to learn much less if we each decide the other is mistaken and we have defend our point of view against them.

I wikied the guy and the issues are not as easily discounted as they appear. i figured that. The quotes in your article are just some of his stuff condensed to garner reaction amongst the masses it seems. Wow...just noticed you took that from the wiki page. I was reading the criticism section there a while ago and when I was done I looked for a correspondong section to see who stood behind him. There wasn't any. Wiki almost seems to steamroll him concerning those writings. Maybe he was steamrolled a fair bit from the outset? Wiki makes it sound rather poor for his case tho. Well they do state it's an ongoing debate but there is little evidence of his validity. This stuff is almost too heavy for my fuzzy head. I had to have a glance though. Quizzickle right? That's all I can offer for now. It sounds really interesting what with the relationship betwix language ethics and and the mechanics involving the two. Hoo boy LiDC, I don't pick my topics well. There's no bloody way I own the concentration to really learn the guts of his views even though I'm interested in it. I wz a poor schoolboy. Grrr! I find most mental health issues fascinating stuff tho.

Thanks FooZe. That summary helped some. I guess my post was just a bit of background about the whole dichotomy and the consensus concerning the debates. A little history filler from the wiki page.

[roads]

I think it is very dangerous to have a single "litmus" test for anything, including whether something is or isn't a disease.

This was the crossroads AA faced when I was first seriously trying to quit drinking back in the early 1980s. Swords were drawn: it's a disease! It's a weakness of the will! Disease! Will!

While the adversaries argued it out, millions of us alkies followed along from our neighborhood bars .

I finally went into a hospital-administered AA-styled program that helped me get sober without ever having to answer the question of whether alcoholism was a disease or not. I still don't have a definitive answer, 40+ yrs down the road.

Suffering from depression is a significant problem. Please don't let some academic's publication track complicate your life any more than it already is.

Find a prescribing psychiatrist who will listen to you and work hard to find the best med for you, not simply one that is "good enough." You may need a mood stabilizer in combination with an anti-depressant for the optimum effect for you.

These meds need to be adjusted periodically. With this done, life's good.

Take best care.

Roadie

[capricorn57]

One can get into an 'intellectual' debate as to whether mental illness is a 'myth' but ultimately there are people whose functioning in one or more domains,be it occupational or social, can be impaired by the set of symptoms they present with.
These people need help be it medication and/or therapy to improve their functioning and for most debate about whether mental illness is a myth is a distant afterthought.
Such debates, though interesting, are not what helps most people,on a practical level, to function better .

It's all too easy to intellectualise while missing the fact that symptoms have very profound effects on people.

[Morghana]

Interesting. You know, I'm studying anthropology in college, and there is a field known as medical anthropology which holds that illness is a cultural perception. It's easy for western scientists to balk at this idea and plead that there is real scientific data proving illnesses...but ultimately, I think the way we define pathology is very cultural, especially in terms of mental illness, because part of the definition is that we don't act or feel the way we're "supposed to". If you watch documentaries or read biographies about dictators or geniuses, you see a lot of modern scientists trying to explain why these people were different by giving them modern diagnoses--Asperger's syndrome in particular is a popular guess. In a way, I think the western culture does this because we need an easy way to explain divergent behavior. It's not OK in our society to be anti-social. It's not OK to be sad for no reason. Our culture doesn't allow us to accept these things as natural parts of life. But these things don't have to be considered illnesses. Only a few short years ago, they were often ignored or rarely diagnosed.

In non-Western societies, many mental disorders go undiagnosed or are explained in other ways, some of them religious. For example, in Malaysia during the 1980s, these women who worked in factories began to have fits--they'd destroy parts of the factory, become very excited, and seize on the floor. They considered themselves possessed by ghosts and they were cured by being exorcised. If these people lived in America, say, our doctors would suppose that they had a stress-related breakdown, since working in factories in Malaysia was a stressful experience for most people.

I'm not saying that there is no scientific basis to our mental illnesses. But I think defining illness only based on the criteria this fellow suggests ignores the fact that much of illness is defined culturally and is a matter of individual perception.

It's not a new argument. Since I was diagnosed (1998) I realised and read there is some controversy around the term 'social phobia' because many believe it shouldn't be called a phobia as it doesn't meet the traditional definitions of such.

I'm happy to call it a social anxiety disorder though.

And with mental illness, I'm happy to call my depression something other than a disease. I don't bother with the semantics.