Thomas Szasz receives the Rollo May Award for 1998 from the American Psychological Association

 

From: tgreening@igc.org (Tom Greening)
Subject: Szasz

Psychohistory might have something to do with medicine if it traced the psychological history of various medical theories, practices, fads, etc. Medicine is much more than a science or an applied science. It includes anthropology, folklore, myths, economics, politics, etc.

To acquaint you with Szasz, here is some stuff--

Introduction of Thomas Szasz

Presented at the 1998 American Psychological Convention, San Francisco. Sometimes I wish I had never heard of Thomas Szasz, or could get rid of him. He has disrupted my life and career, caused me to alienate friends and colleagues, tarnished my reputation, and in general driven me crazy. I've been trying to get his ideas out of my mind for decades. They have become intrusive thoughts, and sometimes lead to compulsive behaviors. I wonder if there is a psychoactive drug that can cure me of this Szasz illness.

For example, I remember once being at a conference at Esalen Institute on the political psychology of Soviet-American relations. Esalen is a place very hospitable to innovative and radical thinkers seeking more humane ways to live individual lives and run the world. One of the conference participants was a psychiatrist whose work I have greatly admired for years. He brings brilliant psychoanalytic insights to international relations, and works creatively on conflict resolution. As we were walking to lunch one day I brought up my interest in Szasz's critique of the myth of mental illness and his ideas about responsibility and autonomy. The psychiatrist scoffed at the mere mention of Szasz, saying he wasn't worth serious consideration. I felt like Szasz and I had just been nudged off the Big Sur cliff.

In my craven and desperate attempts to re-enter the mainstream of American psychology I read whatever I can find that disputes Szasz's critique of the ideology and treatment of "mental illness." I try to follow his opponents' reasoning, the research reports, the case histories, the drug company promotional literature, the heartfelt appeals from the National Alliance for the Mentally Ill, the glowing announcements from the National Institute of Health about new breakthroughs in the biomedical account of human woe.

But all my efforts have been in vain, and I fear I am a hopeless cult convert. That may be why I have been asked to appear here today to accept this award on behalf of Thomas Szasz, who had a previous commitment. Those of you who are interested in the sad story of my deranged attempts to consider intelligently the attacks on Szasz's theories and the rebuttals to these attacks may wish to pick up a copy of a handout I have brought.

Having declared myself mentally incompetent to speak further, I will now present some remarks Dr. Szasz wrote for me to deliver to you.

============================================

August 1, 1998

Ladies and Gentlemen,

I wish to express my gratitude to the American Psychological Association, and in particular to the Committee on the Distinguished Humanistic Psychologists Awards, for the honor of bestowing upon me the Rollo May Award for 1998. I sincerely regret that, because of a long-planned family commitment, I am unable to accept the award in person. I thank Dr. Thomas Greening for his willingness to do so in my stead. Inasmuch as Dr. Greening has generously agreed to represent me here today and will offer comments of his own, I will be brief and simply restate what I see as the gist of my efforts as a "humanistic psychologist." Surely, treating persons as human beings ranks high among the core meanings of the adjective "humanistic." To me this has meant, among other things, a moral obligation to reject treating persons as the carriers of stigmatizing diagnoses and a willingness to take a stand for the many practical implications of that position. The most important of these implications is opposing -- mainly on moral and legal grounds -- the twin pillars of psychiatry and clinical psychology as institutions of social control:

1) Civil commitment, which I regard as a base rhetorical device (euphemism) for depriving innocent persons of liberty -- in the name of mental health;

2) the insanity defense (and similar defenses, such as diminished capacity), which I regard as a base rhetorical device (euphemism) for diverting persons guilty of crimes from the criminal justice system to the mental health system -- in the name of mental illness.

I consider these propositions as self-evidently true and as morally valid as the proposition that black-skinned persons are human beings. It took a long and bloody struggle to abolish slavery. It will take a long -- I hope bloodless -- struggle to abolish psychiatric slavery.

Thank you very much.

Thomas Szasz

======================================================

Thomas Greening, Ph.D.
1314 Westwood Boulevard, Suite 205
Los Angeles, California 90024
Phone: 310-474-0064. Fax: 818-784-8715.
Email:
tgreening@igc.org

 

Myths about the "Myth of Mental Illness" Revised 8/3/98 Critiques of Szasz's arguments, followed by rebuttals.

Comments welcome.

1. These theories minimize the complexity and severity of mental illnesses. Calling them merely "disorders" or "problems in living" does not do justice to the enormity of these illnesses.

Rebuttal: Not necessarily. Suffering is suffering, disorder is disorder.

"Problems" can be devastating, deadly.

2. People like Szasz and his proponents don't care about the mentally ill, their families, or the citizens they sometimes victimize, and would just turn them loose to fend for themselves, even if that means suffering as homeless vagrants. These radical, libertarian ideas about "freedom" and "rights" produce chaos, suffering, and an abdication of responsibility for our fellow beings.

Rebuttal: We can (and, I urge, should) act compassionately and caringly toward troubled, homeless people without resorting to the medical model. If someone is very upset, sad, poor, cold, hungry or homeless, I have a choice of models to use in viewing them and a choice of behaviors in response to their suffering. Do I need to label them "ill" before I can feel enough compassion to intervene? If so, are they or I more "ill"? Labeling people "ill" or "diseased" may produce a fatalistic attitude in them and others, and create a self-fulfilling prophesy.

3. Some "mentally ill" people are dangerous and commit murders. They should be identified, diagnosed, and involuntarily confined and treated to protect innocent citizens and the social order.

Rebuttal: Society should enact laws to define and control illegal behavior. This is a legal and police issue, not a psychological or psychiatric issue. In the process, the Constitution and civil rights must be respected. Using statistical prediction to identify potential violent offenders would lead to imprisoning more young, poor black men than persons labeled "schizophrenic."

4. These theories ignore the compelling scientific evidence from PET scans etc. that schizophrenic patients have something distinctly dysfunctional in their CNS. These patients really have something wrong with their brains.

Rebuttal: The evidence is not scientifically compelling. And if it were, then these patients should be described as having brain diseases, not "mental illnesses," and should be treated accordingly. Neurologists don't accept the "mental illness" model, so psychiatrists try to invent "neuropsychiatry." Most of the brain correlates of psychopathology are descriptive, not explanatory, and give no evidence of causation. There is also much inconsistency entailing false positives and false negatives.

Critics have found serious flaws in the CNS, PET scan, MRI, SPECT, twin studies research: It is impossible to sift out how much brain pathology is a result of some psychological disorder or medication mis-management, and how much is a cause. Even if it were proven that organic brain pathology is causative in certain cases, to what extent can it be overcome by psychological interventions and social support? Is as much thought, effort and money being directed in studying those factors? Here is just one among many relevant references: "Childhood-Onset Schizophrenia: Brain MRI Rescan After Two Years of Clozapine Maintenance Treatment." American Journal of Psychiatry, 153:4, April, 1996 p. 564 - 566. A line from the abstract: "Caudate enlargement in patients with childhood-onset schizophrenia who are taking typical neuroleptics appears to be secondary to medication exposure."

5. In contrast to Szasz's orientation, an advantage of the illness model is that it destigmatizes the mentally ill. Szasz, Laing and others who hold theories that involve psychodynamic and family dynamic causation stigmatize the patients and their families, putting counter-productive guilt and blame on them. Such theories stigmatize these patients as being "crazy" or "anti-social" or "deviant" and their families as "schizophrenogenic" or "dysfunctional."

Rebuttal: We don't have to blame and stigmatize people with problems, or their families. Everyone will benefit most if we can learn more about the true causes of these disorders, not invent comforting theories. I suspect NAMI and some schizophrenia researchers of being driven by (unconscious?) needs to find genetic and biological causes and to deny other possibilities. Why might they be doing that? Do they have a need to direct our attention away from familial, psychodynamic or ontological factors? Or is it just that in 20th century America the medical model, biological "science," and the search for the magic bullet are powerfully and seductively appealing, and rewarding in terms of grant money, career advancement, etc? See Margaret Brown's discussion of Torrey in her Saybrook Graduate School dissertation.

6. Other theories that claim mental illnesses are caused by social, political, economic, or other forms of oppression, stress and hardship merely shift the blame to vague, intangible, abstract forces that cannot be dealt with medically and scientifically. Many people endure such stresses without becoming mentally ill, and many people from comfortable circumstances do become mentally ill.

Rebuttal: There are studies showing the effects of social, political, and economic oppression on rates of mental disorders.

7. Another contrasting advantage of the mental illness, medical, biogenetic, model is that it provides a legitimate basis for attracting treatment and research funding.

Rebuttal: Diverts money and effort from other research. Mean-end fallacy--a dishonest or erroneous theory won't produce valid results.

8. The mental illness model, even if it is just a "myth," is a harmless and useful metaphor for describing and attracting help for these patients.

Rebuttal: No--it leads to chemical and electrical interventions and damage, to involuntary hospitalization and loss of civil rights and responsibilities, and to neglect of other more humane approaches. It also leads to broadening and diluting the definition of "illness" until it becomes meaningless and ridiculous. For example, the brochure of the Sierra Tucson rehabilitation center states: "The Sierra Model defines disease as a dysfunctional state with characteristic form, whether that form is a mental health disorder, an addiction or a physical problem. Tuberculosis is a disease. So is depression." Under this definition the following would be diagnosable and treatable as "diseases:" Reckless driving; poor hand-writing; bad grammar; batting slumps; inadequate record-keeping and late filing of income tax returns; inability to believe in, understand and use the DSM-IV. Especially when backed by coercive and invasive interventions by the state, the "mental illness" model is dangerous. It also may provide a self-fulfilling, passive fatalistic resignation to the ""diagnosis" and undermine patients' and caregivers' motivation to test creatively the limits of constructive change.


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