The Illegitimacy of the “Psychiatric Bible”
“Mental health experts ask: Will anyone be normal?” So read the title of a July 27 Reuters report. The “experts” warned that the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for publication in 2013, “could mean that soon no-one will be classed as normal. . . . [M]any people previously seen as perfectly healthy could in future be told they are ill.”
This is not news. More than 200 hundred years ago Johann Wolfgang von Goethe (1749–1832) warned: “I believe that in the end humanitarianism will triumph, but I fear that, at the same time, the world will become a big hospital, each person acting as the other’s humane nurse.”
Moreover, Goethe foresaw the moral hollowness of the “humanitarian science” on which such therapeutic tyranny would rest: “I could never have known so well how paltry men are, and how little they care for really high aims, if I had not tested them by my scientific researches. Thus I saw that most men only care for science so far as they get a living by it, and that they worship even error when it affords them a subsistence.”
The depths to which such men would happily sink when worshiping error brings them fame and fortune became obvious only in the twentieth century.
Joaquim Maria Machado de Assis (1839–1908), the great Brazilian novelist and playwright, advanced the prescient literary satirization of the dark art of psychiatric diagnosis and the engine that drives it: the phony expert’s insatiable vanity and thirst for controlling his fellow man. His short story “O alienista” (1882, “The psychiatrist”) is a fable of a celebrated doctor retiring to a small town to pursue his scientific investigation of the human mind, gradually finding more and more of the townsfolk insane and needing to be incarcerated in his private asylum. Eventually he alone is left at liberty. As soon as modern psychiatry became a legitimate branch of medicine, Machado de Assis recognized and exposed its quintessentially unscientific-sadistic character.
It remained for the French playwright Jules Romains (1885–1972) to call public attention to the corruption of modern medicine by political power. “It’s a matter of principle with me,” declares his protagonist, “Dr. Knock” (1923), “to regard the entire population as our patients. . . . ‘Health’ is a word we could just as well erase from our vocabularies. . . . If you think it over, you’ll be struck by its relation to the admirable concept of the nation in arms, a concept from which our modern states derive their strength.”
Sigmund Freud (1856–1939), too, has played an important part in persuading people that health is an abnormal state. This old joke is illustrative: “If the patient is early for his appointment, he is anxious; if he is on time, he is obsessive-compulsive; if he is late, he is hostile.”
Particular psychiatric diagnoses have not escaped professional criticism. Wishing to make a name for themselves as psychiatrists, “critics” object to one or another diagnosis (homosexuality)—or to “overdiagnosis” (ADHD)—but continue to respect the American Psychiatric Association (APA) as a scientific organization and regard the various incarnations of the DSM as respectable legitimating documents. This is dishonest. Confronted with the DSM, the challenge we face is to delegitimize the authenticators, the APA and DSM, not distract attention from their fundamental phoniness by ridiculing one or another “diagnosis” and trying to remove it from the magical list.
I have consistently rejected this piecemeal approach. In my essay “The Myth of Mental Illness,” published in 1960, and in my book with the same title that appeared a year later, I stated my view forthrightly. I proposed that we view the phenomena conventionally called “mental diseases” as behaviors that disturb others (or sometimes the self), reject the image of “mental patients” as helpless victims of patho-biological events outside their control, and refuse to participate in coercive psychiatric practices as incompatible with the foundational moral ideals of free societies. In short, I rejected the authority of the APA as a legitimating organization and of the DSM as a legitimating document. I believe nothing less can undo the mischief wrought by the successive editions of the “psychiatric bible.”
Settled by Political Power
But times have changed. Fifty years ago it made sense to assert that mental illnesses are not diseases. It makes no sense to do so today. Professional debate about what counts as mental illness has been replaced by political-judicial decree. The controversy about the nature of so-called mental diseases/disorders has been settled by the holders of political power: They have decreed that “mental illness is a disease like any other.” Political power and professional self-interest have united in turning false beliefs into lying facts: “Mental illness can be accurately diagnosed, successfully treated, just as physical illness” (President William Clinton, 1999). “Just as things go wrong with the heart and kidneys and liver, so things go wrong with the brain” (Surgeon General David Satcher, 1999).
The claim that “mental illnesses are diagnosable disorders of the brain” is not based on scientific research; it is a deception and perhaps self-deception. My claim that mental illnesses are fictitious illnesses is also not based on scientific research; it rests on the pathologist’s materialist-scientific definition of illness as the structural or functional alteration of cells, tissues, and organs. If we accept this definition of disease, then it follows that mental illness is a metaphor, and asserting that view is stating an analytic truth not subject to empirical falsification.
For centuries the theocratic State exercised authority and used force in the name of God. The Founders sought to protect the American people from the religious tyranny of the State. They did not anticipate, and could not have anticipated, that one day medicine would become a religion and that the alliance between medicine and the State would then threaten personal liberty and responsibility exactly as they had been threatened by the alliance between church and State.
The Founders faced the challenge of separating the cure of souls by priests from the control of people by politicians. Today the therapeutic State exercises authority and uses force in the name of health. We face the challenge of separating the consensual treatment of patients by medical doctors from the coercive control of persons by agents of the State pretending to be healers.
When psychiatry was in its infancy the belief that all human “dysfunctions” are manifestations of brain diseases was a naive error. In its maturity the mistake was treated as a valid scientific theory and the justification for a powerful ideology and the powerful institutions based on it. Today, in its senescence, psychiatry is deceit and self-deceit—coercion concealed as objective science (“medical diagnosis”) and benevolent help (“medical treatment”). As a result, paraphrasing Orwell, telling the truth becomes “a revolutionary act.”
Comment by Jay Owen on 24 November 2010:
The mania for belief has become more important than the truth of the science.
Comment by martin on 24 November 2010:
The minor caveat that I have here is that I see the religion as the Central State, the modern lay religion. Medicine and psychiatry are part of the butressing, legitimising priestly castes and doctrines, along with the whole panolpy of political priestly castes which make up this edifice and its theology.Regarding medicine and its partner in crime, psychiatry as a religion apart, seems to me to put the cart before the horse.Stateism is the religion, and medicine/psychiatry the theological, priestly acholytes, at one and the same time feeding at the trough of state power, and giving it legitimacy.
Comment by Abraham L. Halpern on 24 November 2010:
Re: “Confronted with the DSM, the challenge we face is to delegitimize the authenticators, the APA and DSM, not distract attention from their fundamental phoniness by ridiculing one or another “diagnosis” and trying to remove it from the magical list.”
Any attempt to delegitimize the DSM in one fell swoop is an exercise in futility. Ridiculing or exposing the sham of the “scientific” underpinning of the existence of most “mental disorders” is the only way to go.
For example, the proposed DSM-5 diagnosis of “Hypersexual Disorder” is not only ridiculous; it poses a danger to society. I ask Professor Szasz to send in an e-mail to the recipients of his outstanding essay my commentary on “Hypersexual Disorder” which I am including in my e-mail message to him today.
Comment by Bruce Wiseman on 24 November 2010:
Beyond Brilliant!!
Comment by Andy Williams on 25 November 2010:
“My claim that mental illnesses are fictitious illnesses is also not based on scientific research; it rests on the pathologist’s materialist-scientific definition of illness as the structural or functional alteration of cells, tissues, and organs. If we accept this definition of disease, then it follows that mental illness is a metaphor, and asserting that view is stating an analytic truth not subject to empirical falsification”
His overall message about being skeptical of unintentionally coercive scientific communities is absolutely on point, but I fear that he makes a dire factual error. Unfortunately it seems Dr. Szasz is not up to speed on the latest research regarding observable (i.e. “real”) structural and chemical differences in the brains of those with certain mental disorders. Recent technology such as MRI scanning and positron-emission topography has revealed that certain conditions do actually exist and are caused by physical aspects in the brain.
Comment by Nelson Borelli on 25 November 2010:
I would care less about what the American Psychiatric Association (APA) or anyone else has to say about mental illnesses or normalcy if it were not for the fact that the APA has been successful in engaging the power of the State in enforcing its agenda.
Nor would I mind having a “nurse”, provided I would remain free to fire the nurse anytime.
Nor would I care less about what any religious organization wishes me to do, provided none of them get the power of the State to force me to accept it.
All Szasz’s writing departs from the idea of freedom from State’s unjustified arrest.
Comment by Nelson Borelli on 25 November 2010:
Andy Williams: if there is something wrong in the brain you have to call it brain or neurological illness.
Comment by Dr Ron Roberts on 26 November 2010:
Professor Szasz is in fact well up to speed. No evidence exists from neuroimaging of diagnosable “mental health” conditions. For example enlarged ventricles – one of the most frequently cited instacns of such evidecne are also obsserved in pregnant women, those with water retention and is also assocaited with heavy drinknng to name but a few. To repeat there are no biological tests for “mental disorders”.
Comment by Sem Lor on 26 November 2010:
To Andy Williams, commenter above who makes all sorts of claims about MRI scanners. Hear this…
If psychiatry could replicate that rubbish, it would be performing an MRI on every one of its subjects.
It doesn’t. Because it is unreplicated garbage what you’re referring to.
London taxi drivers show ‘differences’ in MRIs compared to people who haven’t memorized the London road maps, what this proves about ‘disease’ is exactly NOTHING.
The sheer fact you’re ok with your neighbor being locked up and forcibly drugged because you mistakenly believe you are ‘up with the latest research’, is shocking.
Comment by Jacqueline Roig on 26 November 2010:
War is a group’s passionate attempt to overrule others and gain liberties as deemed necessary to fulfill its self-perceived rightful place. Forget that the agenda of the combatants, particularly those on the offense, is self-serving and self-righteous, and the rights of those on the other side not considered valid. This is the same as the APA, DSM, et al. who say things often and loudly enough that they begin to believe it is “the way”, and others begin to believe, and live by, the propaganda. Szasz has taken a stand in opposition and stayed firm, despite great odds that serve to belittle his well-researched and very SANE statements. The general public does not want to believe him because he threatens the status quo, and that status quo has become appealing. If I do not have to own my actions that others do not like, I am off the hook, and it’s the devil that makes me do it…the devil that is my brain.
Comment by Tristano Ajmone on 26 November 2010:
As always, in over 50 years of struggle against psychiatric coercion and fraud, Szasz is right and makes his point crystal clear: There are no mental illnesses and there are never going to be any — no matter what scientific effort to measure them and pin them down — because behaviours are motivated and can’t be sick.
Behaviours can be morally disagreable (according to one’s values) and the whole rethoric of the DSM is social control masquerading as medical interventions, and the sole purpouse of psychiatric diagnoses is to preserve social values and standards through coercion of “mentally dissident” citizens — and it should come as no surprise the fact that in its declaring “sick” al excesses (eating/speaking/engaging in sex too much or too little, ecc.) it performs a function of social-levelling, trimming off all that is too much or too less.
There are no mental diseases as there is no mind nor soul — there is only the PERSON. This aspect of Prof. Szasz’s political message is a high challenge to our society and, indeed, to “modern man” — for we have forgotten how to relate to the tragical side of life and to our fellows as human-being.
We are so much so victims of the psychoanalitic and psychiatric outlook on man that we can’t accept the simple fact that any person — no matter how terrible he might turn out to behave — represents an aspect of the human potential which is common to all men and render us humans all alike (potentially). Potentially, the other one could always have been me.
Seeking for biological markers in order to explain behavioural differences is an act of cowardice. It’s part of our failure to accept that there is no human nature (neither prone to be good nor evil) awaiting the right conditions to be unleashed. Failure to accept that some people make choices that are counter to our expectations and values — no matter how hard we strive to educate them to be like us. So we turn to science seeking a scapegoating theory that could blame the failure on some mental-illness or the genes, just as once we’d blame it on the Devil.
Life is tragic and people will always engage in tragic behaviours, this is a simple fact and we have to accept it and cease to search for super-natural explanations. There’ll never be any cure nor exorcism which can free us from the burden of dissapointments in this respect.
We have to accept that even though we have done our best in being loving parents, good friends or teachers, our beloved ones might still turn out to be unlike we expected — a murderer, a raper, and so on. Today we’ve reached the point where we can’t even accept that our kids are distracted in school, and we blame it on ADHD. It’s just too hard to admit that the failure (if any) might be in the school system, or that our beloved kid wants it none of education.
Szasz’s message is a deep one and those who know his monumental work know that he takes his moves from a profound vision of the human condition and the social theatre of life. He finds no excuses for turning his back to the tragic consequences of life.
The very mind-set that produces the DSM is what has to be challenged and replaced by an outlook on life that doesn’t allow medicine (religion, ecc.) to stand between Man and his freedom — ie: libertarianism. And it’s not a scientific challange.
No MRI test nor medical theory should veil us from seing what psychiatry is REALLY doing to people. Psychiatrist say that they are curing minds, what I see in an ECT is people with power (psychiatrists) using social power to submit a person (the patient) to a so-called mental cure (electricity through the body). The same applies to the Inquisition putting at the stake heretics: they’d call it curing the soul.
The dishonesty which Szasz mentions hasn’t got anything to do with being “up to date” with the latest scientific research, it’s the dishonesty which allows scientists to hide behind the pseudo-medical jargon while carrying out cruel acts on coerced people (patients). This dishonesty can be measured by the gap of what really happens in a psychiatric ward and that which doctors write in the records that has been done. Torture is translated into “cure”, incarceration into “civil-commitment”, prison into “hospital”. One needs not to be a scientist to see the utter lies and dishonesty of all this.
Comment by Louis Wynne on 27 November 2010:
There are many methodological weaknesses underlying statements that the brains of the so-called mentally ill are different from the brains of normals. Here is just one: in my 40 years of working with so-called schizophrenics as well as the other “diagnoses” I have never met one who was not immediately put on neurotoxic drugs.
However, I have yet to see a study that controls for such drugs because that would require that someone diagnosed as “schizophrenic,” etc., would have to be ab initio free from such drugs, and the fact that he was free would have to be kept from the researchers.
In other words, whatever differences are observed might be the effects of the Haldol, Seroquel, etc.
Comment by Nicolas Martin on 27 November 2010:
The general lack of opposition to psychiatric tyranny remains the glaring shame of the libertarian movement.
Comment by S. Randolph Kretchmar on 29 November 2010:
Every psychiatric diagnosis is an after-the-fact justification for a chosen treatment. Most often, but not necessarily, the treatment is chosen by someone other than the patient.
As an attorney, I represent and advocate for individuals who want to refuse psychiatric diagnoses and treatments but are not allowed to do so. Most of my clients are violent criminals adjudicated not guilty by reason of insanity.
I can make it very costly for psychiatrists whom a court has put in charge of one of my clients, to “treat” their “patient” against his will according to the state’s preferred plan, which is almost always psychotropic meds.
Once the time and expense of litigation is established with reality, and if my client avoids threatening people, these “doctors” have no problem changing any diagnosis to justify some treatment the patient will accept without costly legal process.
It’s a bureaucratic, budgetary decision. It’s not scientific medicine.
Pingback by Weekly Articles « Interned In Northfield on 3 December 2010:
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Comment by jsb on 20 December 2010:
To Andy Williams re. structural and chemical changes in the brain…
The myth of the media today is that such “organic” changes are “causes”.
Correlation is NOT causation. when my muscles get big because I work out, that does not mean this muscle increase has caused a disease called exercise.
When one exercises the brain through various means of coping – whether they be expressed as agitation, happiness, withdrawal, excitement, sadness, etc… the brain and its chemistry will correspond and adapt in its chemistry and structure.
That does not mean these states or traits are diseases nor does it mean they are caused by the brain changes.
Thomas Szasz and I seem to agree that there is will, there are social structures, and these also are correlative if not causative to brain states. I don’t believe there is ever one cause, but rather multiple correlated structures, processes and events for every state.
Which brain chemistries and structures we call “pathological” or diseased correlates precisely with deviance from what is broadly considered socially normative and cooperative and therefore is not intrinsically pathological but rather a social construct.
Read: Peter Conrad’s “Deviance and Medicalization: From Badness to Sickness”.
Comment by Wendy Manto on 22 December 2010:
If mental illness does not exist, why do certain individuals respond to appropriate drug treatment? Why is response to those drugs any different from the patient with high blood pressure and his response to drugs to reduce it?
The fact that we cannot measure mental health in as clear a way as we can measure blood pressure seems to scare certain people and to lead them to conclude that mental illness is a myth. What a shame that is indeed and how sad in my opinion is it many people cannot thank modern science for developing medications that are helping many individuals as I write this.
But let’s keep things in perspective here. While I and many others believe that psychotropic medication has its place, medication needs to be used judiciously and by individuals with the correct training. Today’s overprescription of psychotropic drugs, particularly among children, is indeed a problem.
Perspective is what is needed here, not the black and white attitude that I believe is being espoused in most of these posts.
Comment by 1 on 31 March 2011:
A commenter above said … “If mental illness does not exist, why do certain individuals respond to appropriate drug treatment? Why is response to those drugs any different from the patient with high blood pressure and his response to drugs to reduce it? ”
Tranquilizer drugs that disable brain function, disable it in all people. People will shut up and stop acting a certain way when tranquilized, just as you may drown your sorrows from a divorce with liquor. Drugs work to alter behavior. Is this news to you?
A drug designed to alter behavior and the brain is very much different from a drug designed to alter blood pressure.
You are clueless.
Comment by Louis Wynne on 4 June 2011:
Wendy Manto: your argument was anticipated by Valenstein in his book, Blaming the Brain, in which he labels it “ex juvantibus” reasoning. This is saying that, just because something “works” (whatever that may be taken to mean), the mechanism of that working must parallel the presumed mechanism of the drug. Example: if someone “gets better” on a drug classified as an antidepressant, that must mean that s/he was indeed depressed to begin with.
Have you noticed that all (and I do mean all) statements by psychiatrists seem to start with: “In people with (schizophrenia, bipolar disorder, etc., etc.) . . .” In other words, the existence of mental illness and its various diagnoses are accepted as GIVENS. It is here that our attack must be made, and not on whether certain drugs “work.”
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