
A psychiatrist who didn’t believe in mental illness (2013) - mastazi
https://aeon.co/essays/the-psychiatrist-who-didn-t-believe-in-mental-illness
======
elbasti
Szasz's "The Myth of Mental Illness" is one of those works which is completely
and utterly misinterpreted simply because of the title.

I don't have the book available at the moment, but in the introduction he says
something to the effect of "I don't regret writing this book, but I regret
calling it what I did, because people judge it without reading it."

The gut-reaction to such a title is to think the writer is saying "depression
doesn't exist" or "schizophrenia doesn't exist" or "manic depressives are
lying."

This isn't what he says in the book at all. Rather, his argument is more along
the lines of:

1\. The word "illness" should be used to represent a _cause_ \-- and resolving
the cause should _cure_ the illness. Cancer, the flu, hyperparathyroidism--all
map to _causes_.

2\. The conditions which we call mental illness don't have a knowable cause.
They are symptoms which we pattern match against.

3\. Corollary: Illnesses should be hypothetically curable. There may _be_ a
cure for cancer. But there _cannot_ be a "cure" for most "mental illnesses"
because there is no shared, physical cause that underlies say, all cases of
"bipolar disorder".

3\. So we shouldn't call them "illnesses". We should call them something else.

Unfortunately that's about as much as I remember of his argument, but it's
very different than the common accusation... And it also strikes me as
accurate.

The problem with naming things is that it makes them real. I think often the
hacker news crowd forgets how ill-informed most of the world is, and the
degree to which people crave certainty.

When a person is told by a psychiatrists "Your 8 year has depression so we'll
put her on X pill" or "You have bipolar type 2, so I recommend Y medicine", it
has a certain finality.

Most people don't think "The _doctor_ is telling me that my behavior matches
some patterns. That is it. She does not know why, and we may never know why,
there may not even be a reason why. So we should think about what we can do to
mitigate this."

No. The we think "I've been diagnosed with a disease. (Sorry I'm being an
a-hole|I won't go to your party|didn't get out of bed), I suffer from bipolar
and there's no cure".

~~~
yellowstuff
The book "The Emperor of all Maladies" doesn't put it in those exact terms,
but makes it clear that essentially the same is true of cancer. Cancer is a
symptom of many kinds of health problems, not a single disease that responds
to a single treatment.

If we understood bleeding as poorly as we understood cancer, then everything
from R&D for better bandages to public campaigns to reduce gun violence would
be lumped together as "treatment for bleeding."

~~~
astazangasta
There is a difference, that cancer has a biological cause (a genetic lesion).
"Mental illness", e.g. schizophrenia, has no such origin in a bodily
abnormality.

~~~
amanaplanacanal
What? How do you know that? That doesn't seem like something you can say is
known.

~~~
astazangasta
How about, "after decades of searching using all of the best available tools,
none has been found".

~~~
amanaplanacanal
We know that some mental illnesses have a genetic component. How would that
happen if there were not something physical?

Just because we don't know now, doesn't mean we will never know. That's how
science works.

~~~
astazangasta
I'm obviously not rejecting materialism, I'm merely attempting to distinguish
between "mental" and "physical", i.e., the cause of your 'mental illness' is
"nutrient deficiency" vs. "your wife left you". If, on balance, people
experience mental distress when they experience extreme emotional turmoil
without any significant accompanying physical event, we can't posit a physical
cause and therefore shouldn't seek a purely physical solution (drugs).

People have 'mental illness' because of mental problems, not physical
problems.

Also: everything has some genetic component, this is trivially true. Genetics
are what separates humans from dogs and plants. It doesn't necessarily help us
to explain the phenomenon adequately.

Also also: another way science works is its inability to prove negatives.
Therefore, saying, "someday we might discover this" can be said for pretty
much anything that remains unproven.

~~~
amanaplanacanal
I suspect I don't understand exactly what you are distinguishing here.

If your identical twin has schizophrenia, there is a 48% chance that you will
have it too. This is compared to the chance of the general population, which
is something like 1%. This feels like something is physically wrong in those
who are schizophrenic. I don't know how else you would get that kind of
result.

~~~
astazangasta
Yes, twin studies have often been trumpeted to demonstrate that schizophrenia
has a strong genetic basis. However, we've yet to find any actual genetic
variation strongly associated with schizophrenia, which, with such a high rate
of concordance, should be a snap. Twin studies themselves are suspect in a
number of ways - the assumption of environmental equivalence between twins and
the general population is suspect, for example. Fraternal twins also show
higher concordance than siblings, even though their genetics should be the
same.

------
tcj_phx
The quakers figured out that most people could recover from what are now
called "psychotic breaks" by being put in a safe place ("asylum") and provided
4 meals a day [2].

Much of the current problems of Psychiatry stem from the split of neurology
and psychiatry [0]. Over the last 60+ years investigators have found many
physiological considerations for the so-called "mental" disorders. The core of
the resistance against psychiatry (slandered as "antipsychiatry") are the
experiences of patients whose conditions deteriorate from medications that do
not address the cause of their conditions.

Stress is one of the most important factors in every psychiatric diagnosis.
Malnutrition is a type of stress; emotional stress and genetic mutations [1]
creates a need for more of certain nutrients.

[0]
[https://en.wikipedia.org/wiki/Neuropsychiatry](https://en.wikipedia.org/wiki/Neuropsychiatry)

[1] [https://www.gxsciences.com/methylation-
testing-s/2.htm](https://www.gxsciences.com/methylation-testing-s/2.htm)

[2]
[https://en.wikipedia.org/wiki/Moral_treatment#England](https://en.wikipedia.org/wiki/Moral_treatment#England)

I appreciate Szasz's comment about the crucifixion of Ignaz Semmelweis, the
Hungarian obstetrician who had the audacity to suggest that his fellow doctors
should wash their hands between autopsies and childbirths:

"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." (emphasis added)

The enduring mistreatment of those labeled as "mentally ill" is one of the
great tragedies of our time.

edit: added reference [2] edit2: extraneous words removed

~~~
themodelplumber
Most people do not know a lot of basic but important things about stress.

\- Change increases stress

\- To-Do list items are also known as "stressors"

\- Implementing someone else's suggested "happiness plan" in your life could
easily kill you, simply because it's new to _you_ and requires dramatic change

To be "right" as per Szasz means to fit into and apply a preferred template in
order to bring about that template's preferred outcome more than it means to
be true. It is the difference in template that causes the fatal dynamic, not
any difference in truth. More true does an individual feel, the more their
acted-out template matches their own psychology, and the more they see the
template benefiting others who are amenable to its way of framing things. More
do they demonstrate alarming symptoms, the more their preferred, best, most
trusted template is overridden both objectively and within their subjective
experience.

To make all of HN go "mentally ill" simply confine its membership to Facebook
fashion groups or the neighborhood butcher shop or the religious cult. The
method of or reason for confinement or the place of confinement will always
differ, but the result will be the same--absolutely devastating symptoms and
strange diseases, etc. Just change, and unknowingly set at an unsustainable
pace right from the start.

The illness model has its leverage points in e.g. its natural provision for
quick social exits, but other models also contribute much to our self care and
other-care.

~~~
jacobush
\- Stay in an abusive (doesn't even have to look too bad) relationship and try
to live the other's "happiness plan"

~~~
themodelplumber
Good example! And a deep topic...

------
pizza
Szasz's opinions on addiction and 'the therapeutic state' were some of the
most clear of any from the field of psychiatry I've heard yet.

[https://en.wikipedia.org/wiki/Thomas_Szasz#Szasz's_main_argu...](https://en.wikipedia.org/wiki/Thomas_Szasz#Szasz's_main_arguments)

~~~
TheOtherHobbes
This is fine as far as it goes, but some psychotic people really are
dangerous. A percentage become murderous and violent, and criticising the
admittedly poor state of psychiatric understanding doesn't make them less
likely to harm themselves or others.

Of course the problem is related to wider social issues about permissive
violence. If one person murders another because of their delusions, it's a
crime and a medical failure. If an entire country declares war on another for
similar reasons we assume we're in the realm of politics and history, not mass
mental illness.

We're far too harsh on individuals and far too lenient on mass systems of
thought and belief that have horrific outcomes.

~~~
coldtea
> _This is fine as far as it goes, but some psychotic people really are
> dangerous. A percentage become murderous and violent_

Sure, but then again most non-psychotic people are as well. It's not like the
majority of murders is done by psychotic people.

~~~
eigenstuff
In fact, those with psychotic disorders are far more likely to be VICTIMS of
violence than perpetrators. Psychosis comes in a wide variety of flavors. I
have a psychotic disorder and have occasional psychotic episodes. It feels
like my brain is short circuiting and my thoughts become too rapid fire and
disorganized for me to do anything but stare into space and just ride it out
and go to bed. Its pretty frightening to feel like you've lost control of your
own brain like that if you don't know what's happening. About once a year or
so I'll have a paranoid episode, I just get really combative and accusatory
and start trying to pick (text, verbal) fights with my friends but fortunately
it's so out of character for me that everybody can tell something is wrong.
The next morning I'll wake up just fine and dandy like it never happened,
minus feeling really embarrassed and apologizing profusely to whoever I was
trying to pick fights with.

------
gmfawcett
I wish I could remember the title and author, but this reminds me of an
(unrelated) book on pain management, where the author's thesis is that most
musculoskeletal pain is psychosomatic: you can essentially will yourself out
of chronic pain once you accept this statement as fact. Does anyone recall the
book I'm talking about?

~~~
wiry-bulb
[http://www.neuroplastix.com/styled-4/aboutus.html](http://www.neuroplastix.com/styled-4/aboutus.html)

Maybe Dr. Moskowtizs. His technique is the subject of chapter 1 in Norman
Doidge’s “The Brain’s Way of Healing”

~~~
gmfawcett
Thank you for this.

------
Legogris
An article on the book from 1970:
[https://jamanetwork.com/journals/jama/article-
abstract/35656...](https://jamanetwork.com/journals/jama/article-
abstract/356561)

------
a_parrot
It's a pretty simple equation, and you feel the business end of it when you
question a medical doctor regarding something as simple as an antibiotics
prescription.

Fields are designed to protect the degreed professional. The words are crafted
as weapons forged in the defense of each thesis.

Everything you confront is the product of some long-dead intellectual chess
match conducted in an ivory tower, and from that moment forward concepts are,
by turns, weaponized.

This principle extends to all fields, economics, sociology, psychology,
biology, chemistry, physics, math. Don't believe me? Try on the "divide by
zero" argument for size.

It's just notation, to communicate expressions, that relay ideas.

If you were to have nothing, and hypothetically cut nothing into a number of
parts, you'd still have nothing. If you have something, and divide it into
zero parts, then that too, is nothing.

But people have a professional stake in fighting such compromises. Having won
an argument in the past means their reputation rests on defending that stance
until they finally die and get out of the way.

It's pretty easy to let an expression that communicates division with zero
exist. But because we have an academic norm standing in the way, the
conversation of whether or not we _should_ serves better to reveal the
brainwashed drones, parroting their instructors until death.

------
honkycat
Of course the #hustle obsessed hacker news crowd would love this title.
"Mental illness is fake! Mentally different people are just whiny and
inferior, not a legitimate illness. Depressed people need to just stop it."

What a load of crap.

This article does a poor job of laying out Szasz's actual beliefs. Szasz
sounds like a right-wing wonk and little else.

He has since been proven completely wrong in the 50 years since publication:
There is a biological component to mental illness.

It focuses on his persecution complex as a right-wing libertarian in a laregly
liberal field.

They bring up the completly irrelevant Semmelweis to attach an air of
legitimately to his crackpot beliefs. They do it again with Arendt.

~~~
dang
Can you please stop posting rants to HN? They're not what this site is for,
and you've done it a lot, unfortunately. Your non-rant comments are fine.

HN is for intellectual curiosity—see
[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html).

~~~
austinjp
Personally I read their comment as impassioned rather than ranting.

~~~
dang
What I meant is that it was unsubstantive (i.e. contains little information)
and calls names. That's what makes it a bad comment for HN.

------
bellerose
The more I read of psychiatry makes me lean towards the majority of it being
pseudoscience. Finances play the most important role in suicidal ideation but
nothing is ever done for the people suffering from suicide attempts besides
placing them in a facility for an extended period and medicating them. Some of
the drugs have even been shown to induce gambling. How in the world does
someone escape a life where all the cards are dealt against them is unknown to
me. In this world you spend more money when poor to live healthy than if
starting out rich and it’s harder to save or increase your holdings while
poor. Stress is definitely the deciding factor in if a person can stay happy
and happiness is the only factor to really care about; besides physical health
but they come hand in hand. I think the field is improving but I have a bias
by living in a progressive city where the old beliefs are highly questioned
and rarely followed. I think psychiatry will go down in history next to the
holocaust. Too many people were ruined compared to being helped.

~~~
Bjartr
> Stress is definitely the deciding factor in if a person can stay happy

You make some interesting points, but I will say that you can absolutely
become, and remain, unhappy even while living a stress-free life. So while
stress is absolutely an important factor, it is not "the deciding factor"

