No such thing as mental illness? Critical reflections on the major ideas and legacy of Thomas Szasz

Arguing in The Myth of Mental Illness: Foundations of a Theory of Personal Conduct that they are merely ‘indirect forms of communication’,1 Thomas Szasz posited that so-called mental illnesses cannot legitimately be categorised as diseases. This launched an argument that Szasz would elaborate over the course of a prolific writing career that spanned more than 50 years. Szasz repudiated psychiatry’s misappropriation of concepts such as ‘illness’, which he took to be relevant to medicine and its ‘physicalist framework’2 but not to matters of mind and human conduct. In The Myth of Mental Illness,1 after arguing that virtually any entity can have a counterfeit version, Szasz articulated his views with characteristic iconoclasm, contending that only physical illnesses are real and that mental diseases are ‘counterfeit and metaphorical illnesses’ (p. 34). Illnesses are understood, according to Szasz,3 with respect to deviation from a norm, and in the case of physical illness the norm refers to the structural or functional integrity of the body or some aspect of it. But the norm – deviation from which results in so-called mental illness – is altogether more problematic for Szasz; this

But the norm – deviation from which results in so-called mental illness – is altogether more problematic for Szasz; this norm is a ‘psychosocial and ethical one’.3 With this as the case, first, the search for a medical remedy seems poorly justified, and second, the points where diagnostic lines are drawn are bound, according to Szasz, to be somewhat arbitrary.

Szasz did not deny that humans have difficulties but he preferred to conceptualise them not as mental illnesses or as diseases, but as ‘problems in living’.1 Nor did he deny psychiatrists a role in assisting individuals with problems. Psychiatrists could have a legitimate role to play but the ideal relationship between psychiatrist and patient, for Szasz, should be based on consensual contract rather than coercion. Second, the psychiatrist cannot justifiably claim that only he

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