The Myths of Mental Illness: A Thomas Szasz Appreciation, Part Two
In a recent essay on the U.S. government’s lurch into invoking “mental illness” as grounds for curtailing the gun ownership rights of American citizens, I reopened a topic of great interest to me, namely the politically convenient fallacy, or rather deliberate sophistry, inherent in the modern concept of mental illness. In response to my claim that there is essentially no such thing as mental illness, in the modern understanding of the term, a great friend, who always knows what to ask, and has no fear of asking it as forcefully as possible, challenged me on a central aspect of my account, thus affording me an excellent opportunity to dig a little further into an issue that lies at the heart of one of our age’s defining spiritual calamities, the reduction of the discipline of psychology to a politicized pseudoscientific instrument for the systematic, worldwide draining of souls.
Perhaps the best way to enter into this discussion is to begin by simply quoting the relevant passage from my previous essay, noted above, in its entirety:
Mental illness, as the term is commonly used, comprises a list of conditions of the soul which may or may not be manifested in association with certain bodily states, but most of which conditions are not identifiable with any physical fact susceptible to being repaired, or alternately judged irreparable, according to principles of medicine. The materialist biases and presuppositions of modern psychology, as with all social sciences, are theoretical presuppositions, interpretive models, and not facts of the sort one may observe under a microscope. And even as a materialist hypothesis, the concept of mental illness is intrinsically dependent on some theoretical construct of what constitutes “mental health.” For example, we know that blindness is a disability or deficiency, because we know what the organ of sight is supposed to do, and therefore we know that an eye which cannot perform this proper function is deficient. That is, we can clearly define the standard of health against which disease or disability may be measured. To say someone is blind is an empirical judgment, based on physical properties and propensities definitive of the human eye.
To say someone is mentally ill, by contrast, is a moral or metaphysical judgment, based not on any physical standard of health, but on a theoretical position regarding the proper operations of the human mind. To use judgments of mental illness as grounds for overriding specific rights the state is pledged to protect and defend is effectively to make the government the official and final arbiter in moral and metaphysical questions concerning the proper workings of the soul.
And this language of mental illness is designed, in modern legal discourse, precisely in order to be exploited in this way. As Thomas Szasz has famously explained, the phrase “mental illness” suggests that there is such a thing as a literal disease of the mind, an inherently incoherent notion based on an implicit identification of the mind with the physical brain, as though the only causes of emotional or other mental abnormalities or anomalies were neurophysiological causes, i.e., as though the mind (as distinct from the brain) were in no way affected by the individual’s personal judgments or understanding of particular external events. This implicit assumption is intrinsic to modern materialist psychology, and it has allowed that academic discipline to develop as a tool or handmaiden of political ideology, vastly distant from, and essentially unrelated to, the classical study of the soul (“psychology” in the literal sense) which was once the heart of properly philosophical investigation.
My friend and frequent devil’s advocate, who happens to be a physician, took issue with the above summary on two related points.
First (to paraphrase his argument), are there not cases where a specific physical ailment of the brain, such as a tumor pressing against it, has very direct effects on the mind’s functioning, such that these cases may be called “mental illness” in the strict modern sense, i.e., diseases of the mind with recognizable physical causes?
Second, while it is true that in many cases of what is called mental illness, there is no clearly identified causal connection between a particular brain condition and a particular mental condition, does it necessarily follow from this that no such causal links may ever be discovered? In other words, might it be possible for medical science to find such links in a future stage of development, thus vindicating the reduction of mental illness to physical illness, or rather the diseased mind to the diseased brain?
To begin with the first point — Are there not cases where abnormal mental functioning may be directly linked to a physical abnormality of the brain? — I must point out that in my original description of the issue, I did say “most” cases of what is called mental illness cannot be identified with a physical disorder. Of course there are literal diseases of, or injuries to, the brain, which have a direct effect on mental functioning. However, to call the mental results of such brain diseases “mental illness” only works as long as we are clear that this is strictly a metaphorical expression, a kind of elliptical way of describing the brain disease as a cause of abnormal mental functioning. The mental malfunction, in these cases, is categorically of a different sort from the majority of instances that are now subsumed under the term mental illness.
Furthermore, in such cases, the disrupted mental operations — for example the memory loss and uncontrolled outbursts of rude or random language associated with the physical pressure of a cancerous tumor upon the brain — cannot properly be identified as a disease of the mind at all, since they are really just symptoms of a brain ailment. By analogy, when you wake up with a sore throat after contracting a cold virus, you would never think it appropriate to say you have a “throat disease,” because this phrase would imply an illness essentially or primarily afflicting the throat itself. You have a cold, of which a sore throat is merely one of the secondary manifestations or symptoms. Likewise, for that matter, if I take post-operative pain medication which has nausea as a side effect, no one would describe my nausea as a “disease of the stomach,” because this would be highly and dangerously misleading; my stomach problem is merely a secondary event resulting from a physical occurrence elsewhere in my bodily system (in this case the pain medication’s operations) which is the primary event.
Hence, the use of the phrase “mental illness” in cases such as tumors or other identifiable physical ailments of, or injuries to, the brain, is not merely applying the term to cases of a different nature from most instances of what is called mental illness, thus rendering the term misleadingly broad; it is also, due to this excessive breadth of application, a convenient rhetorical cover for the psychological profession, which may hide behind these verifiable cases of physically-caused mental malfunctions as a means of obscuring or justifying the much wider application of the same term to all those cases in which direct physical causality is not only unverifiable, but fundamentally implausible.
In fact, the very reason I follow Szasz in insisting on this hard distinction between mental abnormalities caused directly by diseases of the brain, and those (the vast majority) caused by non-neurophysiological conditions, or what Szasz, in accordance with the older and more serious tradition of his profession, aptly calls “problems in living,” is that in contemporary psychological jargon, the two types are treated as essentially the same, which is to say that all abnormal or troubled or simply unusual thought processes or emotional states are reduced to “brain diseases,” leading to many dangerous results from a political point of view, and extremely harmful ones from a moral and spiritual point of view.
It is the loose, reductionist modern notion of “mental illness” (most of which, remember, is not caused by observable illnesses or injuries of the brain) that has made modern clinical psychology the catastrophic soul-mangling racket it is. Once the notion is generally accepted, not merely by the “uneducated public,” but especially within the scholarly and pseudoscientific realm of the experts, that mental illness is just another category of physical illness, pernicious results necessarily follow. The reductionism and its implications for our understanding of what the mind is, become so ubiquitous and deferentially accepted by “the masses” that eventually the implicit theoretical presuppositions of this view – which are purely philosophical in nature and can have no materialist scientific basis whatsoever – become commonplace beliefs, leading to practical effects in all areas of social and political life.
For an example of such a presupposition, as well as one of the preeminent examples of the corruption of modern psychology, there is the belief which underlies the easy and widespread prescription of psychological medication today, namely that a certain kind of emotional equilibrium or “stability” – the patient no longer being upset – is the de facto “healthy condition” for all minds, such that if that goal is achieved, by whatever medicinal means are required, we may assume the “mentally ill” person has become healthy again, or at least that the drug is effectively and beneficially simulating the healthy condition, as, by analogy, Synthroid simulates the healthy functioning of the thyroid gland.
For a more concrete example, a student I taught in a class last fall came to visit me late in the semester for some winter vacation reading recommendations. I learned in conversation that her mother had died that past summer, and later learned that the death was a suicide, and further that the student herself had found her mother’s dead body. In the weeks immediately following this family nightmare, the young woman, reasonably enough, urged her family members to see a reputable counselor for help getting through the shock and complicated feelings. The counselor gave them tranquilizers, and told my student to use them.
Why did she need a brain-altering drug? Was there something wrong with her physical brain? No, of course not; she was in shock over the sudden and unexpected loss of her mother – not hysterical, not suicidal, not even weeping uncontrollably. Just sad and confused. In truth, I’ve probably never met a more grounded, self-controlled, level-headed twenty-four-year-old woman, regardless of life conditions, so I know what the psychologist was looking at. And yet this clinician, an expert in this field, was immediately certain, within the timeframe of an initial consultation, that there was something wrong with her that required medicine – in other words, something physically wrong with her.
Why? The reason is simple: It is now the standard operating assumption of clinical psychology, overriding all common sense to the contrary — although clinicians will still occasionally conflate the old (commonsensical) and new (pseudoscientific) paradigms rhetorically — that all emotional problems are in fact physical problems. If you tried to explain to this counselor that what was “wrong with” the girl was that she was sad because her mother had just died, he would undoubtedly have smiled condescendingly, and then patronizingly explained that yes, in layman’s terms, she was sad “because” her mother had died, but scientifically speaking what was wrong was that she needed to have her emotional state realigned to a more “stable condition” (though she was not outwardly unstable at all) by chemically altering her brain. That is to say, the underlying assumption here, all pseudoscientific reductionism aside, is a purely philosophical assumption (and quite a paltry and psychologically superficial assumption), namely that emotional stability is the default — i.e., healthy — condition of every mind at all times, and hence that restoring something that (to the clinician) resembles stability, by whatever means necessary, is the most urgent “medical” necessity in every circumstance.
Thus, while it is true that in a small minority of cases, what is (misleadingly) called mental illness is actually caused by a specific physical ailment of the brain, it is much more common today that what is called the treatment for mental illness (“stability”-inducing medication) is in effect an artificially-induced brain injury or disruption, designed to curtail and eradicate what might well have been the natural and healthy functioning of a mind trying to solve its problems. Problem-solving of the soul-developing sort is often painful and confusing, and necessarily so. In such cases, to subvert or short-circuit the natural path of pain and confusion may be to undermine any hope of the person reaching a truly restorative or life-enhancing resolution to his or her problem.
With regard to the concrete example I have noted, I can say this much for certain. The student of whom I am speaking eventually tried one of the tranquilizers, more out of curiosity than belief in it, and quickly decided never to touch another one. On the other hand, she spent her winter vacation reading several books I recommended, and then visiting or e-mailing me periodically to discuss them enthusiastically. (I chose well.) Near the first anniversary of her mother’s death, she came to my office to talk for a few hours, during which she told me all the details of that day which she had never told me (or anyone) before. A week later, she sent me the most meticulously handwritten and folded three-page letter you’ll ever see from any young person today – straight out of the era of Jane Austen — describing, in her very direct, unsentimental way, how much she had appreciated my help in expanding her horizons and sorting out her thoughts over the past year. All I did for her, apart from recommending good books suited to her temperament, was give her someone to talk to occasionally who was outside of the framework of friends and family, and who would listen carefully and ask her useful questions. That, after all, was what she was hoping to get from the professional counselor in the first place. But they rarely do that anymore, or they do it only in conjunction with an aggressive chemical assault on your brain, thereby causing exactly the kind of mental problem which results directly from an abnormal brain state — but an abnormal brain state imposed, in this case, by the supposed health providers themselves. Worst of all, today’s leading psychological experts define such medicinally-induced mental problems, their artificial short-circuiting of the mind’s often painful but necessary winding path of self-discovery, as “healthcare.”
I turn now to my friend’s second challenge, namely whether medical science might, at some point in the future, actually discover the physical-mental causal links that are not now apparent in most cases of “mental illness,” thereby invalidating my claim that mental illness, in the modern sense of the term, entails a false reduction of the mind to the brain, by implying that there are literal diseases of the mind (or soul), in the sense in which there are diseases of the body. My friend notes that although he is not prepared to concede the inevitability of such a complete reduction, there are “some who no doubt would maintain that all of those things that we call conditions of the soul may some day turn out to be the product of abnormal brain structure and other cellular or genetic disease.”
In fact, there are not merely “some” who would maintain this; all maintain this, though not always with the same degree of assertiveness. Thomas Szasz was a formerly respected member of his profession who died essentially in professional exile, because at the peak of his career he dared to draw out the full implications of this reduction of mental illness to physical disease, and explained why it is so forcefully defended by the psychological community and the legal and political establishment, against all logic and common sense. Aldous Huxley had already explained more or less this same phenomenon much more forcefully in Brave New World.
Here is a key expository passage from Szasz’s seminal 1960 article, “The Myth of Mental Illness,” one which warrants a careful reading and rereading:
The concept of illness, whether bodily or mental, implies deviation from some clearly defined norm. In the case of physical illness, the norm is the structural and functional integrity of the human body. Thus, although the desirability of physical health, as such, is an ethical value, what health is can be stated in anatomical and physiological terms. What is the norm deviation from which is regarded as mental illness? This question cannot be easily answered. But whatever this norm might be, we can be certain of only one thing: namely, that it is a norm that must be stated in terms of psycho-social, ethical, and legal concepts. For example, notions such as “excessive repression” or “acting out an unconscious impulse” illustrate the use of psychological concepts for judging (so-called) mental health and illness. The idea that chronic hostility, vengefulness, or divorce are indicative of mental illness would be illustrations of the use of ethical norms (that is, the desirability of love, kindness, and a stable marriage relationship). Finally, the widespread psychiatric opinion that only a mentally ill person would commit homicide illustrates the use of a legal concept as a norm of mental health. The norm from which deviation is measured whenever one speaks of a mental illness is a psycho-social and ethical one. Yet, the remedy is sought in terms of medical measures which — it is hoped and assumed — are free from wide differences of ethical value. The definition of the disorder and the terms in which its remedy are sought are therefore at serious odds with one another. The practical significance of this covert conflict between the alleged nature of the defect and the remedy can hardly be exaggerated.
To say that we may someday find all “abnormal” mental conditions to be the products of abnormal brain structure or other physical diseases is to say that someone feeling sad because her mother, whom she loved, has just died, is unreasonable. It is to say that feeling lonely and lost because you live in a society that encourages universal conformity to standards of life and belief that offend your sensibilities is unscientific. It is to say that feeling uncomfortable in normal social situations because one feels pushed to indulge in pleasures or behavior one finds morally or spiritually corruptive is a superficial explanation. The implication being, of course, that the reasonable, scientific, and profound explanations for these mental conditions (sadness, loneliness, social discomfort) will and must always be explanations which identify physical causes in the subject. Personal practical experiences being filtered through one’s moral perspective, one’s peculiar temperament, or one’s intellectual position of social or philosophical dissent, can never be allowed as primary explanations of painful or confused mental states. According to modern psychology, such explanations are, at best — or rather at worst — merely laymen’s language used to name “mental illnesses,” i.e., abnormal thoughts and feelings of the sort that involve emotional discomfort, intellectual confusion, or in general a feeling of isolation from the stable daily life of the society around you.
By definition, these isolating mental states are identified by the progressive social science of modern psychology as evidence of disease, which, although the experts are careful to avoid admitting that this is what they are really saying, means nothing other than that modern psychology believes these states are wrong — which is a philosophical judgment with no scientific basis whatsoever. These states must therefore be corrected, i.e., eliminated.
Thus closes the nice, tight circle of reductionist absurdity: External events do not occasion unpleasant mental states; physical anomalies cause them. Emotional stability, meaning a lack of unpleasant or abnormal (i.e., isolating) mental states, is the overriding standard of mental health. Any medical intervention aimed at stabilizing the immediate emotional state of the subject by altering his current physical states is therefore beneficial.
The fantasy that someday everything we now call “mind” or “soul” will be explained by physical causation is the crux of the modern scientific materialist dream, and means nothing less, in theory and in practice, than the literal annihilation of the human race as a species of living beings who experience and think. This, as I have written elsewhere, is modernity’s great self-contradiction, and will be the source of its ultimate disintegration.
A final note. I absolutely agree with Szasz’s argument that, apart from the myth of physical causality per se, the biggest fallacy of the modern notion of mental illness lies in the premise that the items identified by modern psychology as illnesses are being so identified on medical or scientific grounds. They are, as he says, always and necessarily identified as illnesses on non-scientific grounds: according to ethical standards, social standards, legal standards, and so on. Apart from all the other dangerous implications of this well-hidden fallacy, I am particularly interested in its effects in the area of assessing people of what used to be called different temperaments. Reductionism always means simplification, which in turn means that once one has determined one’s norm or standard of mental health — for example, feelings of stability within one’s social milieu, and a lack of (“unhealthy”) isolating feelings or thoughts — this standard may be used to assess and treat everyone. This is why it becomes so easy for modern psychology to dismiss grief and confusion as mere illnesses to be cured, rather than natural (in the sense of humanly beneficial) responses to externally-imposed conditions, to be accepted, guided, and allowed to pass through to their proper and fruitful resolutions, which will be forms of spiritual growth. That sadness is an “unhealthy” mental state, for example, is one of the purely ethical judgments Szasz mentions which pretends to be a medical diagnosis. It is through this conflation of the implicit, unscientific presupposition with quasi-scientific language, that, as we have seen, we end up with professional clinicians who knee-jerkingly prescribe brain-altering drugs to a person whose mother just committed suicide, as though the person’s problem were physical in nature — or more precisely, as though her sadness under the circumstances indicated any kind of mental problem at all.
This opens out on a broader issue, beyond the materialist reductionism itself, which is the psycho-social intentions of the professionals and their public advocates, with regard to the implications of this reductionism. I end here by citing one example of what I mean, to which I will return in a subsequent installment of this series — perhaps the definitive example when all is said and done. Consider the shift in modern psychological language from the ancient term “melancholy” to the modern, vaguely medical-sounding “depression.” The traditional language of spiritual abnormality has thereby been shifted into the language of sickness. In other words, the abnormally taciturn and socially-unfit temperament — the philosophical temperament, as traditionally understood — is now redefined as intrinsically mentally ill, implying the necessity and desirability of immediate and direct physical intervention to combat, i.e., cure, the illness, the “depression.”