In 1960, The American Psychologist published a highly controversial and daring paper from the Hungarian- American Psychiatrist Thomas Szasz- The myth of mental illness. In an age when mental illness was much more stigmatized than it is now, Szasz’s dissent is in every bit the voice of the devil’s advocate. Yet, in it’s all provocative paradoxes, it rises up to save us from the fallacy of a group think about something which we collectively dread- our own minds and their health.
Szasz begins by questioning the existence of mental illness. Placing mental illness on an existential crisis opens up a discussion on the validity of mental illnesses. If it is a concrete problem of the brain, Szasz asks how the symptoms could be abstract. If it is a problem of social harmony, Szasz asks how medicine can promise a cure for it. In his reiteration of the dilemmas of Cartesian dualism, Szasz offers, perhaps one of the earliest critiques of the biomedical model.
Normality is the great neurosis of civilization.Tom Robbins, Even Cowgirls Get the Blues
Szasz’s questions don the rebellious reverberence as they challenge the authority. He calls into question the foundations of the norms, the reliability of clinical judgment and the agency of the psychiatrist. This bold dissent, like the critical contemplation of Georges Canguilhelm, holds true in the modern era of Psychology and allied sciences, that remain captive to monopolistic governing bodies and self proclaimed authorities.
As Szasz delves deep into the crux of the issue, he tries to portray how these conceptual and pragmatic flaws stem from a total disregard for the inherent value of being human by reductionist doctrines. He observes that the doctrine of Psychiatry arbitrarily avoids conversations around values and goals. This stands in stark contrast to the subject of Psychiatry as “anything that people do—in contrast to things that happen to them (Peters, 1958)—takes place in a context of value”. From all these Szasz wonders if mental illness, the way we conceptualize it, is a mere mask to cover up the genuine difficulties of being human.
Cover art of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life by Allen J Frances (Chair of DSM-IV Task Force), 2013. [DSM is a globally popular diagnostic manual for mental illnesses by the American Psychiatric Association. It is currently in its 5th edition.]
Szasz draws comparisons between the idea of mental illness and the myths of witches demons, both acting as social tranquilizers encouraging hope for a state of order. Yet he quickly points out how this can promote the logical fallacy of defining mental health as an absence of mental illness. This line of thought dismisses the inherent suffering of life, that as Frankl said, adds meaning to life. However Szasz notes that the suffering of the “mentally ill” is real and valid and that only the approach in defining it is flawed. He concludes by offering an alternative that would dignify the ordeals of being human, through a paradigm shift in the conceptualization of mental health issues- from illness to problems of living.
Szasz’s seemingly modest, yet ambitious arguments are not without flaws. For instance Kendell (in Schaler, 2005) argues that along the line of Szasz’s understanding of “disease” migraine and torticollis would fail to be diseases. Also, the idea that disease is also suffering and is a part and parcel of life’s suffering is ambiguous in his writings. Nevertheless, Szasz’s cognizance of the layered narrative of diagnosis is timely and it will remain a timeless warning to the guardians of mental health.