Agency, mental illness, and psychiatry: A response to Thomas Szasz

Thomas Szasz ◽  
2019 ◽  
pp. 65-81
Author(s):  
Robert W. Daly
Keyword(s):  
Mental Illness ◽  
Clinical Psychiatry ◽  
Mentally Ill ◽  
Medical Specialty ◽  
Mental Illnesses ◽  
Problems In Living ◽  
The Relationship ◽  
Thomas Szasz

Szasz’s understanding of persons as agents underwrites his ideas about mental illness and clinical psychiatry as a medical specialty. He asserts that the phenomena of mental illnesses, including suffering, signal “problems in living” or difficulties in determining the best use of one’s agential powers. The goals of the relationship are to enhance the client’s knowledge of his or her personality, to refine his intentions and sense of responsibility for his “symptoms” and other actions, and to achieve his aims and satisfy his desires, as long as he does not, by his actions, harm others. For the author of this chapter and other clinicians, the experience of phenomena exhibited by persons judged to be mentally ill are, to some extent and sense, apprehended as events that happen, rather than as actions authored by the person as agent. These untoward activities suggest a undesirable organismic condition of a person as agent, a diminution of the agent’s capacity for living a life, the signal of a organismic disorder, a problem with the human organismic equipment for living a life—not solely a problem about the best use of that equipment (as Szasz contends) but a state of ill health and a suffering person in need of treatment.

Mental health v. mental illness: Commentary on … Ethics and Economics

2010 ◽  
Vol 16 (6) ◽  
pp. 474-475
Author(s):  
Denise Coia
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Paradigm Shift ◽  
Medical Specialty ◽  
Mental Illnesses ◽  
Medical Specialties ◽  
Ethics And Economics ◽  
Mental Diseases ◽  
The Relationship ◽  
Special Case

SummaryThis commentary focuses principally on the semantics of using the term ‘mental health’ rather than ‘mental illness’ and the effect this has in creating a paradigm shift in psychiatry in relation to other medical specialties. The consequences, intended or unintended, are demonstrated and the relationship between ethics and economics in mental health is discussed. The view that economic evaluation is methodologically unsound in ‘mental health’, that it is a special case because of its complexity, does not acknowledge the significant paradigm shift that has occurred. Casual acceptance of the term ‘mental health’ in a serious economic debate about resources for people with mental illnesses is worrying and further diminishes the medical specialty of psychiatry that deals with mental diseases.

scholarly journals Psychiatry and the dark side: eugenics, Nazi and Soviet psychiatry

2014 ◽  
Vol 20 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Jason Luty
Keyword(s):  
Mental Illness ◽  
Mentally Ill ◽  
Psychiatric Treatment ◽  
History Of Psychiatry ◽  
Mental Illnesses ◽  
Dark Side ◽  
Nazi Regime ◽  
The Usa ◽  
History Of ◽  
Thomas Szasz

SummaryPsychiatrist Thomas Szasz fought coercion (compulsory detention) and denied that mental illness existed. Although he was regarded as a maverick, his ideas are much more plausible when one discovers that between 1939 and 1941, up to 100 000 mentally ill people, including 5000 children, were killed in Nazi Germany. In the course of the Nazi regime, over 400 000 forced sterilisations took place, mainly of people with mental illnesses. Other countries, including Denmark, Norway, Sweden and Switzerland, had active forced sterilisation programmes and eugenics laws. Similar laws were implemented in the USA, with up to 25 000 forced sterilisations. These atrocities were enabled and facilitated by psychiatrists of the time and are only one example of the dark side of the profession. This article reviews some of these aspects of the history of psychiatry, including Germany's eugenics programme and the former USSR's detention of dissidents under the guise of psychiatric treatment.

Mental illness is not a myth: Epistemic favoritism in research funding

Thomas Szasz ◽  
2019 ◽  
pp. 224-236
Author(s):  
Mona Gupta
Keyword(s):  
Mental Illness ◽  
Clinical Practice ◽  
Mentally Ill ◽  
Research Funding ◽  
Disease Model ◽  
Clinical Manifestations ◽  
Mental Illnesses ◽  
Research Interest ◽  
Clinical Practices ◽  
Problems In Living

Szasz noted that how we define mental illness determines ethical responses to those considered mentally ill. He insisted that mental illness cannot be a disease because disease must be grounded in pathophysiology, that what we call “mental illnesses” comprise “problems in living” and ought to be addressed through voluntary, confidential conversations between therapist and patient. Implicitly, perhaps unwittingly, psychiatric researchers have embraced Szasz’s quest to link clinical manifestations of mental illnesses to underlying pathophysiological mechanisms. Preoccupation with the disease model has been accompanied by a lack of research interest in clinical psychiatric interactions. Many aspects of clinical practice are taken for granted without much conceptual or empirical substantiation. Researchers and clinicians know little about how or when habitual clinical practices ought to be used. Paradoxically, Szasz’s analysis may have pushed psychiatry to prove him wrong at the expense of knowledge that might enrich the very types of care that he supported.

Offenders with Mental Illness in Prison

2016 ◽  
Author(s):  
Sarah M. Manchak ◽  
Robert D. Morgan
Keyword(s):  
Mental Illness ◽  
Mentally Ill ◽  
Justice System ◽  
Mental Illnesses ◽  
Future Research ◽  
Mentally Disordered Offenders ◽  
Prison Management ◽  
Mentally Disordered ◽  
Prison Environment ◽  
Offenders With Mental Illness

This essay describes trends in the number of mentally disordered offenders in prison and the unique challenges posed by them in terms of prison management and service delivery. The essay first explores why persons with mental illnesses are overrepresented in the criminal justice system, then discusses efforts to rehabilitate this population should not take place within the prison environment (and, if they do, what changes in current practices are necessary to adapt to the prison setting). How the challenges posed by mentally ill inmates are managed is also covered, with critical discussions of these strategies. Finally, an analysis of the changes that are needed to improve conditions for inmates with mental illness in prisons is presented, with a description of one promising program for treating these offenders. Suggestions for future research with this population that will help inform and improve prison conditions for offenders with mental illness are also provided.

scholarly journals Level of compliance and factors associated with non-compliance to treatment among the mentally ill patients

2012 ◽  
Vol 10 (2) ◽  
pp. 113-117 ◽  
Author(s):  
S Lama ◽  
K V Lakshmi ◽  
P M Shyangwa ◽  
P Parajuli
Keyword(s):  
Mental Illness ◽  
Mentally Ill ◽  
Mental Illnesses ◽  
Psychiatric Ward ◽  
Psychiatric Medication ◽  
Drug Compliance ◽  
Treatment Access ◽  
Related Factors ◽  
Factors Associated ◽  
Compliance To Treatment

Background: Mental illnesses are treatable and need medication and other therapies i.e. counseling, psychotherapy etc for the better outcome. Poor adherence to psychiatric medication regimens is a major obstacle to the effective care of persons who have chronic mental illness.Objectives: The study aims to identify the level of compliance and factors associated with non-compliance to treatment regimen.Methods: This was a hospital based cross sectional study carried out in psychiatric ward and OPD at B.P.Koirala Institute of Health Sciences, Dharan Nepal. A total of 150 patients were included as study samples using purposive sampling technique. Data was collected using self developed, pre tested, semi structured Pro forma by interview method.Results: Half of the patients showed average compliance. Thirty seven percentages of patients had good compliance and only 13% showed poor compliance. There was no association between drug compliance and demographic variables (p> 0.05). Drug compliance was significantly associated with factors such as drug related aspects, treatment access related factors, quality of interaction with treating team, family support, attitude towards mental illness and relatives' insight towards mental illness (p<0.05 ).Conclusion: The findings of the study highlighted the various factors such as drug related, social support, and treatment access related factors are influencing the drug compliance among the mentally ill patients.DOI: http://dx.doi.org/10.3126/hren.v10i2.6577 Health Renaissance 2012; Vol 10 (No.2); 113-117 

scholarly journals Tensions and Paradoxes of Stigma: Discussing Stigma in Mental Health Rehabilitation

2020 ◽  
Vol 17 (16) ◽  
pp. 5943
Author(s):  
Jenny Paananen ◽  
Camilla Lindholm ◽  
Melisa Stevanovic ◽  
Elina Weiste
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Professionals ◽  
Mentally Ill ◽  
Media Coverage ◽  
Mental Health Problems ◽  
Mental Illnesses ◽  
Rehabilitation Centers ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

Mental illness remains as one of the most stigmatizing conditions in contemporary western societies. This study sheds light on how mental health professionals and rehabilitants perceive stigmatization. The qualitative study is based on stimulated focus group interviews conducted in five Finnish mental health rehabilitation centers that follow the Clubhouse model. The findings were analyzed through inductive content analysis. Both the mental health rehabilitants and the professionals perceived stigmatization as a phenomenon that concerns the majority of rehabilitants. However, whereas the professionals viewed stigma as something that is inflicted upon the mentally ill from the outside, the rehabilitants perceived stigma as something that the mentally ill themselves can influence by advancing their own confidence, shame management, and recovery. Improvements in treatment, along with media coverage, were seen as the factors that reduce stigmatization, but the same conceptualization did not hold for serious mental illnesses. As the average Clubhouse client was thought to be a person with serious mental illness, the rehabilitation context designed to normalize attitudes toward mental health problems was paradoxically perceived to enforce the concept of inevitable stigma. Therefore, it is important for professionals in rehabilitation communities to be reflexively aware of these tensions when supporting the rehabilitants.

The Relationship Between Insight and Internalized Stigma in Persons With Sever Mental Illness

2016 ◽  
Vol 33 (S1) ◽  
pp. S453-S453
Author(s):  
D. Szczesniak ◽  
I. Wojciechowska ◽  
M. Kłapciński ◽  
E. Zwyrtek ◽  
J. Rymaszewska
Keyword(s):  
Mental Illness ◽  
Psychotic Disorders ◽  
Cross Sectional Study ◽  
Mental Illnesses ◽  
Internalized Stigma ◽  
Related Factors ◽  
Cross Sectional ◽  
Stigma Of Mental Illness ◽  
The Relationship ◽  
Insight Into

IntroductionStigma is a multistage process that makes person marked by the stigma to be perceived as diminished or even as “not fully human”. The internalized stigmatization is seen as one of the levels of stigma to be present in persons with mental illness. A new perspective to mediation models between internalized stigma and illness-related factors is needed.AimTo assess the relationship between insight in mental illness and internalized stigma, as well to verify the knowledge of illness-related factors on the phenomenon of internalized stigma among patients with severe mental illnesses.MethodsA cross-sectional study design conducted among participants of both sexes between 18 years old and 65 years old with diagnosis of psychotic disorders (F20–29) and mood disorders (F30–39), who after reading the information about the study, give their written consent to participate. Among used methods were: a questionnaire of Internalized Stigma of Mental Illness (ISMI) by Ritsher [Boyed] et al. translated into Polish version and self-prepared interviews. Insight into mental illness was assessed using the Positive and Negative Syndrome Scale.ResultsThe preliminary results showed patients with the insight into the mental illness have significantly higher scores on the ISMI scale. Moreover, inpatient participants and those with the diagnosis of depression were characterized by higher level of stereotype endorsement compared with outpatients and psychotic patients.ConclusionsThe obtained results may contribute in the clinical and therapeutic fields, assuming that insight and the type of treatment are strongly linked with the process of recovery and the internalized stigma.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals THE RELATIONSHIP BETWEEN AFFECTIVE AND OTHER PSYCHIATRIC DISORDER WITH CREATIVE ACTIVITY AND SOME OF THEIR NEUROCHEMICAL MECHANISMS

2017 ◽  
pp. 5-9
Author(s):  
V.O. Bedlinskyi
Keyword(s):  
Mental Illness ◽  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Mentally Ill ◽  
Creative Activity ◽  
Creative Ability ◽  
Neurochemical Mechanisms ◽  
Biochemical Mechanisms ◽  
The Relationship

The article is based on the study for the relationship between affective and other psychiatric disorders with the creative activity of an individual. The historical and contemporary views on this problem were analyzed, considering  modern data on neurochemical mechanisms, which play a big role in the process of creativity, and in the development of mental illness. The role of dopaminergic neurotransmission as one of the main biochemical mechanisms of providing creative ability was highlighted. It was concluded that studying and taking into account the relationship between psychiatric disorders and creative activity, including the role and features of the functioning of neurotransmitter systems, can serve as a means of improving the treatment-diagnostic, preventive and reabilitation care of this category of mentally ill.

scholarly journals Insanity in a Sea of Islands: Mobility and Mental Health in Aotearoa New Zealand’s Pacific Sphere

2021 ◽  
Author(s):  
Jacqueline Leckie
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mentally Ill ◽  
Pacific Islands ◽  
South Pacific ◽  
Mental Illnesses ◽  
Historical Evidence ◽  
The Pacific

This article builds upon the fragmentary historical evidence of mental illness and mental health within South Pacific societies to explore the nexus with migration and mobility. The focus is on the Pacific territories that were under Aotearoa New Zealand’s jurisdiction. The article explores concepts of mental health and mobility within Pacific societies that became entangled with European concepts to designate insanity. The paper then discusses how mental illnesses were exacerbated or induced through migration and travel across the Pacific. The last section explores the transfer of mentally ill patients from some Pacific islands to Aotearoa. This article is based upon the 2018 J. D. Stout Lecture at Victoria University of Wellington.

Between Sanity and Madness

2019 ◽  
Author(s):  
Allan V. Horwitz
Keyword(s):  
Mental Illness ◽  
Mentally Ill ◽  
Ancient Greece ◽  
Mental Illnesses

Between Sanity and Madness: Mental Illness from Ancient Greece to the Neuroscientific Era traces the extensive array of answers that various groups have provided to questions about the nature of mental illness and its boundaries with sanity. What distinguishes mental illnesses from other sorts of devalued conditions and from normality? Should medical, religious, psychological, legal, or no authority at all respond to the mentally ill? Why do some people become mad? What treatments might help them recover? Despite general agreement across societies regarding definitions about the pole of madness, huge disparities exist on where dividing lines should be placed between it and sanity and even if there is any clear demarcation at all. Various groups have provided answers to these puzzles that are both widely divergent and surprisingly similar to current understandings.

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