Thursday, 3 January 2013

The Myth of Mental Illness and Other Stories

I've been given a Christmas gift that may well turn my worldview upside down. A book called The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, by Thomas Szasz. Now while the gift was a tongue in cheek jab at my chosen profession, I'm actually very grateful, because while I'm familiar with some of the arguments Szasz made, I haven't yet read any of his work.

I agree with some of Szasz' arguments - it's hard to disagree given the barbarities that have been carried out in the name of 'curing' mental health issues. While we may have (mostly) moved on from believing that epilepsy is due to demonic possession, it isn't so long ago that people were locked away for 'illnesses' such as hysteria (read: women who disobey a man) being gay, being a bit different or having a learning disability. To  this day, we still have to fight for equal treatment for many of the above groups, and there are dangers inherent in labelling a certain behaviour as a mental illness without accounting for biology, culture and social factors.

I firmly believe that there are medical and biological reasons for many, if not most mental illnesses. To take the post below about psychopathy, we can now see a difference in the brain structure of psychopaths thanks to brain imaging technology, and even isolate contributing genes. Psychopathy is not a myth. I feel confident that as our technology and understanding increases, we will discover far more about the true underpinnings of biologically based illnesses, and also about "problems with living", to borrow a term from Szasz, that may arise as a result of personal difficulties or social factors of our complex and highly social species.

I personally view the purpose of a diagnosis as an attempt to medicalise conditions that would have previously been written off simply as 'crazy'. The idea is to remove the stigma, and view problems with the brain with the same legitimacy as we do heart disease or diabetes. It becomes a tool because we can then tailor treatment and offer the right resources to help that person. This is a comfort to many, but does also carry the risk of labelling people as malfunctioning, and removing aspects of their free will, by enforcing help that they may not want, with the authority and legitimacy of experts and doctors. Even with the best of intentions, and without a conscious effort to exert social control, we could easily slip into overconfidence in our 'medical diagnosis' and 'psychological expertise', believing it to be for the persons own good. We've done it before, and it's distinctly possible that we may continue to do it.

I'm a little nervous about picking up this book, since my very expensive degree is based on going into the mental health field! However, I'm also excited about it. One reason I am driven to go into psychology professionally is that I've spent five years or so working as a support worker for adults with learning difficulties, many of whom also have autism; a neurological difference which has in its short history since the original description and classification been subjected to much pseudoscience and damaging 'treatments' aimed at 'fixing' the people diagnosed with it. While I love the work and the people involved, I see many flaws in the system that I was powerless to change while a lowly support worker. As a psychologist, I may be able to do more to fight the  inequalities within the system.

If nothing else, it's about time I read some books by Szasz, given his influence on society. Who knows, if it has a strong impact on me, I may be handing out copies to people next Christmas myself.


  1. Jazz> isn't so long ago that
    Jazz> people were locked away for
    Jazz> 'illnesses' such as ... being
    Jazz> gay...

    Whenever I suspect myself of becoming smug or complacent about the humanitarian credentials of western liberal democracies, I remind myself that I was 15 when the process of decriminalising male homosexuality in Britain began, 30 when it reached all major jurisdictions within the union, and still has some way to go on detail in my 61st year. (Also that, while some were ahead of the UK, some were even slower.)

  2. Jazz. You have done the deed. You have published an insightful post that is coherent, well written and addresses some of the basic problems of your field. Some of the issues you bring up could be the basis of long threads, if you wished. As an aside, consider the proposal in the U.S. that all those who purchase firearms be screened for "mental illness." Sounds benign, doesn't it? Reasonable since we don't want no crazy people getting guns. Except, defining mental illness. A significant proportion of the adult population is on antidepressants. Are they "mentally ill"? Oh, the can of worms this uncovers. So, go for it. Keep thinking. There are lots of other examples, as Felix points out. And, of course, your prior work. Autism is, thank god, a spectrum. But where do you draw the line as to where someone is "mentally ill.?" Where do you put Temple Grandin?