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Thursday April 26 2007

Quote from this:

From the left marched battalions of self-styled mental health “liberation activists” steeped in the writings of Scottish psychiatrist R.D. Laing. Though he denied being opposed to his own profession, Laing’s notion that madness could be a reasonable reaction to an unjust society, or even a vehicle for spiritual transformation, helped fuel the anti-psychiatry movement of the post Love-In era. The most radical of Laingians carried revisionism one step further: Not only wasn’t psychosis a bad thing, it was evidence of a superior level of consciousness.

The libertarians were fueled by Thomas Szasz, an iconoclastic psychiatrist who was, and remains, an outspoken foe of virtually every aspect of his chosen specialty. Hungarian-born in 1920, and witness to vicious state exploitation of medical practice by the Nazis and the communists, Dr. Szasz pushed an absolutist dogma of individual choice, finding ready converts among members of the Do-Your-Own-Thing generation. Though his early essays offered much-needed critiques of the Orwellian nightmares that can result when autocracy corrupts health care, Dr. Szasz devolved into something of a psychiatric Flat-Earther, insisting in the face of mounting contrary evidence that mental illness simply does not exist. Currently, he serves on a commission, cofounded with the Church of Scientology, that purports to investigate human rights violations perpetrated by mental health professionals.

This is one of the aspects of libertarianism - perhaps “offshoots of libertarianism” would be a better way of putting it - that I have always had a problem with.  My prejudice about Thomas Szasz is (a) that he thinks that mental illness does not exist, and I further believe (b) that this is an absurd opinion for anyone to hold.  But (a) has only been a prejudice, which I acted upon by not reading much of Szasz’s actual writing.  (I have never made any fuss about Szasz being on the Advisory Council of the Libertarian Alliance, as I suppose I might have done.) So I am kind-of relieved that someone who has obviously studied Szasz and his opinions with somewhat greater care than I has arrived at the same conclusion, i.e. (a) above.  He clearly also agrees about (b) as does anyone with any sense.

Whether or not Szasz himself really does hold it, the opinion that mental illness does not exist seems to me, as I say, absurd.  Every other part of our bodies is capable of malfunctioning, so why not our brains?  What conceivable reason can there possibly be to suppose that our brains are incapable of getting damaged, by all the kinds of things that damage our livers, hearts, muscles, bones, skin, blood, breathing, and so on, until every bodily organ or function has been listed?  The idea is ridiculous.

Which is not to say that all behaviour diagnosed as brain damage through injury or illness is necessarily that.  “Laing’s notion that madness could be a reasonable reaction to an unjust society” is surely reasonable, provided you are careful to include that “could”, and don’t say that all behaviour diagnosed as mad is actually sane, no matter how self-evidently mad.

Meanwhile Laingism/Szaszism (by which I mean the habit of not making the above distinction nearly carefully enough) has done terrible damage and caused terrible unhappiness, not only by closing the asylums and turning mad people loose on the world, to cause misery for themselves and for others, but also by blaming the families of mad people – the parents especially - for having caused the madness, on top of all the other miseries they had to contend with.

I suspect that this cruel folly is an example of one those great Bad Ideas that I like to spot - the truth is obvious and the fixed quantity of wealth fallacy being two of my other favourites.  This Bad Idea states that, if something is extremely hard to measure, to understand, to find the right words for, to distinguish between some thing or person being or having that something, and not being or having that something, it therefore follows that the something in question doesn’t exist.  I am sure that all that has been said before and said far better, but by whom, and more to the point: how?  I wonder if it is to be found in this list.

I read quite a bit of both Laing and Szasz in my misspent youth and I think there is a big difference. Laing seemed to think that mental problems were largely a manifestation of family trauma, and that what was needed was “social change”.
Szasz, so far as I’m aware, never said that mental problems don’t exist ( so your prejudice A is unfounded ). Nor that there couldn’t be a physical component. He did however tend to argue that this was never an excuse to lock people up just because they are nutters, nor did it absolve nutters of moral culpability.
I think what tended to wind people up was that he kept emphasising the latter point like a broken record, so that it looked like he never thought of anything else.
On the other hand, you could equally blame his critics, who only concentrated on this point, to the latter of all his other points.
This tends to happen to famous people quite a lot, I think.

Posted by Peter Briffa on 27 April 2007

If this is a fallacy (as opposed to mis-reporting) then it falls into that particularly annoying category of Libertarian Fallacies, or fallacies frequently held by libertarians.

Another example, is the sunspot fallacy - the idea that if global warming is caused by sunspots then that is somehow better than if it were caused by humans.

Posted by Patrick Crozier on 27 April 2007

There is a difference between accepting that people can have very difficult and extremely anti-social psychological problems and the utterly bogus, and epistemologically authoritarian idea of ‘mental illness’.

It is also an error to conflate brain diseases, of various sorts, with ‘mental illness’.

Indeed I cannot see what the invention of the catagories of ‘mad’ and ‘sane’ is practically supposed to achieve apart from an authoritarian power grab by the ‘therapeutic’ state.

I would also add that anyone who thinks differently clearly has a screw loose.

Posted by Paul Coulam on 27 April 2007

Paul, I wish you’d stop sugar-coating your views for us.

Seriously, though, I am very interested in the reasons why ‘mental illness’ is a mere authoritarian construct. I do indeed have a screw loose, but I’ve also never heard these arguments, and I would like to very much.

Posted by Jackie Danicki on 28 April 2007

Hi Jackie,

Unlike Brian, I am one of those libertarians who is a denier of the existence of mental illness. A view Brian seems to think, like most others in this day and age, is absurd. With one or two caveats I am a follower of Thomas Szasz in this. He has written dozens of books debunking the ideas of ‘mental illness’ and ‘insanity’, most notoriously his ‘The Myth of Mental Illness’. I highly recommend it as well as his other main book ‘Insanity’ many of his others are a mixed bag some are just repetitious and some are poor. I’d be happy to chat about these ideas with you when next we meet.

The ‘screw loose’ bit at the end of the last post was, of course, just a little jest. Since no one has ‘mental illness’ or is ‘insane’ it follows that no one holding a contary view to mine on this could have a screw loose - they are just simply in error.

Posted by Paul Coulam on 30 April 2007

Thanks, Paul. In that case, I hope I get to see you at the end of May when I am back in London, because I’m very curious about all this. (Antoine says he thinks Szasz’s best book is “The Psychiatric Holocaust.") I’m intrigued as to whether conditions such as schizophrenia are mental illness or not. All of this is sounding like something a behaviorist would say...no such thing as a mental state in the first place, so how can one have a mental illness? Thanks for, as ever, making me think, Paul.

Posted by Jackie Danicki on 01 May 2007

Paul, I can assure you that mental illness does exist. I know, because I suffer from one. They are not very well understood, but if the brain’s chemical balance is upset the results are most unpleasant, I assure you.

Posted by Scott Wickstein on 01 May 2007

But Scott what you’re describing there is a physical illness not a “mental” one. Paul has laid out the case that conflating mental and physical illness is a category error; I don’t believe that is necessarily a behaviourist view. You don’t have to deny the existence of mental events to think that minds cannot exhibit disease, let alone a disease you can only cure by talking to it.

Something else should be said about mental hospitals; the Rosenhan experiement proved that they weren’t very good at doing the thing they were supposed to, namely diagnosis and cure rather than mere incarceration. I suspect that as brain states are becoming better understood Szasz will ultimately be proved right.

Posted by Lysias on 01 May 2007

Lysias, you seem to be making a finer distinction then is necessary- Occam’s Razor suggests that we define illnesses of the brain to be called mental illnesses.

In most contexts in which mental illnesses are discussed, the differences to the rest of the range of medical conditions are great enough to support making a distinction.

Posted by Scott Wickstein on 02 May 2007

One major problem is that people tend to think of chemicals as somehow isolated from non-chemical phenomena. People falsely assume that chemical problems can only be corrected with chemical solutions. This works out very well for the drug companies.

BUT studies even show that the brain goes through sometimes vast chemical changes when you think different kinds of thoughts. This even begs the question of whether these problems are caused first by the chemicals or if the problems start with the thought processes and that generates the chemicals.

If we want to talk seriously about “mental illness” then there should be chemical tests, brain scans, or gene tests for it and in all cases a positive reading should correspond with some kind of psychological distress. Otherwise it is just some institution’s subjective stamp-of-disapproval on another’s mental state. BUT it turns out two people can have the same brain chemistry and one might feel fine and the other feel terrible. Who are we to tell the former that there is something wrong with them or the latter that they should just be happy with what they got?

The authoritarianism of psychiatry is two-fold, someone who is happy with their life the way it is in spite of a psychiatric diagnosis is “in denial” someone who is distressed and finds they can fix their problems whether its depression, lack of confidence, or anything with the aid of chemicals is a “drug abuser” unless of course their choice of chemical happens to be an occassional drink of alcohol or a cup of coffee to give them the energy to make it through work.

Psychology should focus itself around the client and the needs of the client, ask what is troubling the client, and then offer possible solutions chemical and nonchemical (and explain the risks) to fix what ever is distressing to the client all without judgment or any labelling.

Posted by Adam Tango on 13 May 2010

It is obvious that there are people with mental problems and it is silly to deny it.  Whether you call such people mentally ill or just psychologically unbalanced isn’t really the issue.

The question is whether people with serious mental problems can be forcibly treated, something which would not be permitted with a non-mental illness.

Szasz says No, not under any circumstances. I think that’s his real objection to the mental illness label - that it ends up with adults having things done to them without their consent and “for their own good”. Where have we heard those words before? Certainly we need to be very cautious indeed before using the label of mental illness to justify forcible treatment.

On the other hand, if you have a young man sitting in a pile of his own excrement babbling about UFOs, it seems a bit hard-line to deny the right of his loving parents to get him treated, even if he doesn’t want it.

Hmm. Dunno.......

David

The question is whether they should be treated against their wGovernments or well-meaning friends and relaithird parties) should be entitled to treat people or lock them up against their will It is obvious that there are people who have mental problems

Posted by David Goldstone on 14 May 2010

Well, bluntly, to be “normal” involves doing lots of bizarre and barely sensible things that have no practical purpose and are a consequence of evolutionary pressures that are no longer relevant or evolutionary accidents that never were, filtered through sensory perceptions that are a very imperfect way of looking at the world. “Normal” human behavior a lot of the time strikes me as very, very, odd, and at times quite distressingly so.

I’m not a fan of turning unusual personality types into medical syndromes, because most of the time the behaviour of people unusual personality types are no more or less weird than the behaviour of everybody else. More “normal” people have the consolation of showing a certain amount of solidarity in their weirdness. That is all.

As long as someone can find a niche in which he or she can survive and function then then absolutely nothing should be done to them without consent. (Large cities are good, as they provide many, many niches and often allow extreme personality types to prosper). People in such situations might have their life improved by various kinds of treatment (or they might not) but it must be a choice.

However, if people cannot survive and function by themselves, then there is a point where things do have to be done without consent. If mentally ill people are actually violent, then the consent issue is at least partially addressed. (We accept that violent people must be prevented from being so with other violence. The question is what form that other violence should take. Punishment or treatment. Still not always easy, but you have accepted “something"). If the person is not violent but just unable to function, then it becomes tricky. The idea of treatment without consent makes me shudder regardless of circumstances, so I go for “as few instances as can possibly be managed”.

The overuse of psychiatric drugs on children troubles me even more, in truth. I am aware of situations (in the US) where parents have been legally classified as negligent parents for refusing to administer Ritalin to their children due to the fact that teachers in their compulsory state schools have considered them disruptive, which simply horrifies me. Even when the parent thinks such a thing is a good idea, the lack of consent on the part of the child when the drugs can have long term affects into adulthood is something I find deeply troubling.

Posted by Michael Jennings on 15 May 2010

I wonder if this is the sort of thing that motivates Szaz:
http://www.dailymail.co.uk/femail/article-480201/My-baby-taken-moment-born.html

“Her problems appear to have begun when she was raped by an acquaintance at the age of 14. Diagnosed with a borderline personality disorder, she was discharged from a therapeutic facility in 2002, where she had spent 13 months, and spent nine months as an outpatient.”

That sounds like the sort of mental illness that doesn’t exist, and years later, “a child protection case conference recommended that Fran’s baby should be taken away at birth”.

I can certainly see how a libertarian would have problems with psychiatry.

Posted by Rob Fisher on 18 May 2010
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