On the Legacy of Thomas Szasz: A Reiteration of The Myth of Mental Illness and Response to Recent Criticism

2018 ◽  
Vol 19 (3) ◽  
pp. 150-160
Author(s):  
Paul Counter ◽  
Robert Spillane
Keyword(s):  
Mental Illness ◽  
British Journal ◽  
50Th Anniversary ◽  
Mental Illnesses ◽  
Recent Criticism ◽  
Anniversary Issue ◽  
Legal Fictions ◽  
Recent Editorial ◽  
The Brain ◽  
Thomas Szasz

In the 50th anniversary issue of The Myth of Mental Illness, Szasz conceded that, conceptually, his argument had been ignored because of the promulgation that mental illnesses are diseases of the brain. Responding to a recent editorial by T. Benning in the British Journal of Psychiatry Bulletin, which is somewhat critical of Szasz’s conceptual arguments, we argue that such criticisms are inaccurate. We highlight how no mental illness stands up to pathological scrutiny, yet treatments can cause iatrogenesis. In addition, we elaborate on how Szasz argued that the false concept of mental illness results in legal fictions. It is therefore important to defend and restate Szasz’s main thesis and conceptual arguments in light of recent criticism.

scholarly journals Metabolic phenotyping reveals a potential link between elevated faecal amino acids, diet and symptom severity in individuals with severe mental illness

2021 ◽  
Author(s):  
Jack Jansma ◽  
Rogier van Essen ◽  
Bartholomeus C.M. Haarman ◽  
Anastasia Chrysovalantou Chatziioannou ◽  
Jenny Borkent ◽  
...  
Keyword(s):  
Amino Acids ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Symptom Severity ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Therapeutic Interventions ◽  
Schizophrenia Spectrum Disorders ◽  
Potential Link ◽  
The Brain

The brain-gut axis is increasingly recognized as an important contributing factor in the onset and progression of severe mental illnesses such as schizophrenia spectrum disorders and bipolar disorder. This study investigates associations between levels of faecal metabolites identified using 1H-NMR, clinical parameters, and dietary components of forty-two individuals diagnosed in a transdiagnostic approach to have severe mental illness. Faecal levels of the amino acids; alanine, leucine, and valine showed a significant positive correlation with psychiatric symptom severity as well as with dairy intake. Overall, this study proposes a diet-induced link between the brain-gut axis and the severity of psychiatric symptoms, which could be valuable in the design of novel dietary or therapeutic interventions to improve psychiatric symptoms.

The Myth of Mental Illness: 50 years after publication: What does it mean today?

2010 ◽  
Vol 27 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Brendan D Kelly ◽  
Pat Bracken ◽  
Harry Cavendish ◽  
Niall Crumlish ◽  
Seamus MacSuibhne ◽  
...  
Keyword(s):  
Mental Illness ◽  
Mentally Ill ◽  
50Th Anniversary ◽  
Cartesian Dualism ◽  
Specialist Registrar ◽  
Considerable Controversy ◽  
Human Responsibility ◽  
The Right ◽  
Criminal Conduct ◽  
Thomas Szasz

AbstractIn 1960, Thomas Szasz published The Myth of Mental Illness, arguing that mental illness was a harmful myth without a demonstrated basis in biological pathology and with the potential to damage current conceptions of human responsibility. Szasz's arguments have provoked considerable controversy over the past five decades. This paper marks the 50th anniversary of The Myth of Mental Illness by providing commentaries on its contemporary relevance from the perspectives of a range of stakeholders, including a consultant psychiatrist, psychiatric patient, professor of philosophy and mental health, a specialist registrar in psychiatry, and a lecturer in psychiatry. This paper also includes responses by Professor Thomas Szasz.Szasz's arguments contain echoes of positivism, Cartesian dualism, and Enlightenment philosophy, and point to a genuine complexity at the heart of contemporary psychiatric taxonomy: how is ‘mental illness’ to be defined? And by whom? The basis of Szasz's doubts about the similarities between mental and physical illnesses remain apparent today, but it remains equally apparent that a failure to describe a biological basis for mental illness does not mean there is none (eg. consider the position of epilepsy, prior to the electroencephalogram). Psychiatry would probably be different today if The Myth of Mental Illness had not been written, but possibly not in the ways that Szasz might imagine: does the relentless incarceration of individuals with ‘mental illness’ in the world's prisons represent the logical culmination of Szaszian thought?In response, Professor Szasz emphasises his views that “mental illness” differs fundamentally from physical illness, and that the principal habits the term ‘mental illness’ involves are stigmatisation, deprivation of liberty (civil commitment) and deprivation of the right to trial for alleged criminal conduct (the insanity defence). He links the incarceration of the mentally ill with the policy of de-institutionalisation (which he opposes) and states that, in his view, the only limitation his work imposes on human activities are limitations on practices which are conventionally and conveniently labelled ‘psychiatric abuses’.Clearly, there remains a diversity of views about the merits of Szasz's arguments, but there is little diminution in his ability to provoke an argument.

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.

How Does ECT Work?

2010 ◽  
Author(s):  
Max Fink MD
Keyword(s):  
Mental Illness ◽  
Mood Disorders ◽  
Epileptic Seizures ◽  
Mental Illnesses ◽  
Behavioral Effects ◽  
Brain Waves ◽  
Moving Strip ◽  
Character Pathology ◽  
Therapeutic Event ◽  
The Brain

The major puzzle in ECT is its mechanism of action. How do seizures, which can be dangerous and damaging when they occur spontaneously, change a dysfunctional brain into one that performs normally? Why do repeated epileptic seizures relieve psychiatric disorders? The originator of the therapy, Ladislas Meduna, believed in a biological antagonism between mental illness and seizures, an antagonism we no longer consider credible. But though we may smile at this belief, we acknowledge that it led Meduna to devise methods to induce seizures safely, select patients who were likely to benefit, develop a plan for a successful course of treatments, demonstrate the safety of inducing seizures, evaluate the merits and risks of seizures as treatment, and convince others to continue his work. His observations have been repeatedly verified, leaving little doubt about the effectiveness of ECT in treating mental illnesses. We know a great deal about the essential features of a successful course of ECT. The generalized brain seizure is the central therapeutic event. The biochemical and physiological consequences of the seizure are the basis for the behavioral effects; neither anesthesia nor electric current alone is useful, nor, except rarely, is a single seizure. To be of benefit, seizures must be repeated two or three times a week for many weeks. The more recent the mood, thought, or movement disorder, the more fully it can be relieved. Illnesses involving lifelong problems, character pathology, neuroses, and the mood disorders secondary to the abuse of drugs are not amenable to this treatment. We know how to avoid the risks of anoxia, unmodified convulsions, and prolonged seizures, and we recognize that these aspects of the treatment course do not explain how ECT works. Two aspects of the brain seizure have been extensively studied. The EEG records electrical activity of the brain under electrodes that are symmetrically placed over the scalp. Immediately after the stimulus, the “seizure” EEG is recorded on a moving strip. The electrical waves show a sharp buildup of frequencies and amplitudes, then the frequencies slow, mixtures of slow brain waves and sharp spike-like waves appear, with ever higher amplitudes and slower waves in runs and bursts.

Thomas Szasz and the language of mental illness

Thomas Szasz ◽  
2019 ◽  
pp. 155-166
Author(s):  
Ronald W. Pies
Keyword(s):  
Mental Illness ◽  
Clinical Work ◽  
Mental Illnesses ◽  
Brain Diseases ◽  
The Road ◽  
Diagnostic Categories ◽  
Scientific Investigations ◽  
Mental Language ◽  
On The Road ◽  
Thomas Szasz

Szasz famously declared mental illness a “myth” and a “metaphor,” arguing that psychiatry’s diagnostic categories are only temporary stops on the road to “real” and “legitimate” bodily diseases. He argued that conditions once regarded as “mental illnesses” would rightly be reclassified as “brain diseases,” insofar as scientific investigations would uncover their neuropathology. Based on a critique of six foundational claims in Szasz’s writings, the author of this chapter argues that psychopathology and neuropathology are complementary rather than contradictory or disjunctive. Just as some mental illnesses may be considered brain diseases, some brain diseases may manifest as “mental illness.” The locution, “mental illness,” remains useful, albeit imperfect, shorthand to describe a particular kind of suffering and incapacity, usually affecting cognition, emotion, reasoning, or behavior. Even if all mental illnesses were conclusively and causally linked to specific brain abnormalities, we would still need “mental language” in both ordinary discourse and the vocabulary of clinical work.

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.

scholarly journals The problem of double diagnoses in psychiatry and addictology: leaving reality, or the stage of integration?

2019 ◽  
pp. 35-43
Author(s):  
Andrey Viktorovich Antsyborov ◽  
Irina Vladimirovna Dubatova
Keyword(s):  
Mental Illness ◽  
Social Stress ◽  
Special Section ◽  
Mental Illnesses ◽  
Family Burden ◽  
Psychoactive Substances ◽  
New Paradigm ◽  
Brain Disorder ◽  
The Brain ◽  
High Comorbidity

The article points out that the existence of the problem of double diagnoses (DD) in psychiatry and addictology means recognizing the fact that «addiction» is a mental illness and, therefore, a brain disorder. There are common areas in the brain that are responsible for the formation of addictive pathology and for the development of other mental illnesses. It explains the high comorbidity between disorders associated with the use of psychoactive substances, and other mental illnesses. The factors of predisposition to the development of addictive pathology include: family burden with addictive pathology, early onset of use of psychoactive substances, social stress situation, and mental illness. The artificial separation of psychiatry and addictology into two services in Russia is a historical mistake. A new paradigm of dependent disorders emphasizes the need to create a special section on double disorders, with the revision of this archaic model.

scholarly journals The Boundaries of Medicine

2019 ◽  
Vol 4 ◽  
Author(s):  
Sofia Lopez
Keyword(s):  
Mental Illness ◽  
Social Control ◽  
Mental Illnesses ◽  
Human Suffering ◽  
Social Deviance ◽  
Clear Separation ◽  
Practice Of Medicine ◽  
Medical Involvement ◽  
Thomas Szasz

A valid concern regarding medicine in society is the medicalization of social deviance as a form of social control. Peter Conrad writes about this concern as we become more dependent on physician judgement of what is and isn’t illness. We are faced with determining what is inside and outside the realm of medicine, and what the limits of medical involvement should be. I explore two instances that reveal that medicine should be involved in cases of human suffering, though should never carry all the societal burdens of alleviating suffering. Whether or not medicine should be involved in mental illness is a view contested by Thomas Szasz in an argument that aims to establish that mental illness is outside the realm of medicine. His argument relies on the clear separation between somatic and mental illnesses, which I show are not clearly separated at all. Ultimately, I argue that as complex—and undoubtedly human—as the practice of medicine is, it is a discipline with a wide array of applications that are critically important for treating mental illness.

Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

Somatechnics ◽  
2019 ◽  
Vol 9 (2-3) ◽  
pp. 291-309
Author(s):  
Francis Russell
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Justice ◽  
Cultural Theory ◽  
Human Experience ◽  
Mental Illnesses ◽  
False Consciousness ◽  
The Subject ◽  
Biological Ontology ◽  
Health Discourse

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

Effective e-health design for those with, and without, mental health disorders: shallow navigation, concentrated contents, modest number of links, one screen area for links. (Preprint)

2018 ◽  
Author(s):  
Armando Rotondi ◽  
Jonathan Grady ◽  
Barbara H. Hanusa ◽  
Michael R. Spring ◽  
Kaleab Z. Abebe ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Success Rate ◽  
Fractional Factorial ◽  
Mental Illnesses ◽  
Schizophrenia Spectrum Disorders ◽  
Design Elements ◽  
Website Usability ◽  
Schizophrenia Spectrum ◽  
Health Applications

BACKGROUND E-health applications are an avenue to improve service responsiveness, convenience, and appeal, and tailor treatments to improve relevance, engagement, and use. It is critical to user engagement that the designs of e-health applications are intuitive to navigate. Limited research exists on designs that work for those with a severe mental illness, many of whom infrequently seek treatment, and tend to discontinuation medications and psychosocial treatments. OBJECTIVE The purpose of this study was to evaluate the influence of 12 design elements (e.g., website depth, reading level, use of navigational lists) on the usability of e-health application websites for those with, and without, mental health disorders (including severe mental illness). METHODS A 212-4 fractional factorial experimental design was used to specify the designs of 256 e-health websites, which systematically varied the 12 design elements. The final destination contents of all websites were identical, only the navigational pages varied. Three subgroups of participants comprising 226 individuals, were used to test these websites (those with schizophrenia-spectrum disorders, other mental illnesses, and no mental illness). Unique to this study was that the 12 design elements were manipulated systematically to allow assessment of combinations of design elements rather than only one element at a time. RESULTS The best and worst designs were identified for each of the three subgroups, and the sample overall. The depth of a website’s navigation, that is, the number of screens/pages users needed to navigate to find desired content, had the strongest influence on usability (ability to find information). The worst performing design for those with schizophrenia-spectrum disorders had an 8.6% success rate (ability to find information), the best had a 53.2% success rate. The navigational design made a 45% difference in usability. For the subgroup with other mental illnesses the design made a 52% difference, and for those with no mental illness a 50% difference in success rate. The websites with the highest usability all had several key similarities, as did the websites with the poorest usability. A unique finding is that the influences on usability of some design elements are variable. For these design elements, whether they had a positive or negative effect, and the size of its effect, could be influenced by the rest of the design environment, that is, the other elements in the design. This was not the case for navigational depth, a shallower hierarchy is better than a deeper hierarchy. CONCLUSIONS It is possible to identify evidence-based strategies for designing e-health applications that result in a high level of usability. Even for those with schizophrenia, or other severe mental illnesses, there are designs that are highly effective. The best designs have key similarities, but can also vary in some respects. Key words: schizophrenia, severe mental illness, e-health, design, website, usability, website design, website usability, fractional factorial design.

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