The scientific concept of illness refers to a bodily lesion, that is, to a material — structural or functional — abnormality of the body, as a machine. This is the classic, Victorian, pathological definition of disease and it is still the definition of disease used by pathologists and physicians as scientific healers.
The brain is an organ — like the bones, liver, kidney, and so on — and of course can be diseased. That’s the domain of neurology. Since a mind is not a bodily organ, it cannot be diseased, except in a metaphorical sense — in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc. In other words, talking about “sick minds” is analogous to talking about “sick jokes” or “sick economies.” In the case of mental illness, we are dealing with a metaphorical way of expressing the view that the speaker thinks there is something wrong about the behavior of the person to whom he attributes the “illness.”
Thomas Szasz on Freedom and Psychotherapy
ReplyDeleteby Randall C. Wyatt
http://www.psychotherapy.net/interview/thomas-szasz
The phrase “the myth of mental illness” means that mental illness qua illness does not exist. The scientific concept of illness refers to a bodily lesion, that is, to a material — structural or functional — abnormality of the body, as a machine. This is the classic, Victorian, pathological definition of disease and it is still the definition of disease used by pathologists and physicians as scientific healers.
ReplyDeleteThe brain is an organ — like the bones, liver, kidney, and so on — and of course can be diseased. That’s the domain of neurology. Since a mind is not a bodily organ, it cannot be diseased, except in a metaphorical sense — in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc. In other words, talking about “sick minds” is analogous to talking about “sick jokes” or “sick economies.” In the case of mental illness, we are dealing with a metaphorical way of expressing the view that the speaker thinks there is something wrong about the behavior of the person to whom he attributes the “illness.”
In short, just as there were no witches, only women disapproved and called “witches,” so there are no mental diseases, only behaviors of which psychiatrists disapprove and call them “mental illnesses.” Let’s say a person has a fear of going out into the open. Psychiatrists call that “agoraphobia” and claim it is an illness. Or if a person has odd ideas or perceptions, psychiatrists say he has “delusions” or “hallucinations.” Or he uses illegal drugs or commits mass murder. These are all instances of behaviors, not diseases. Nearly everything I say about psychiatry follows from that.
I’ll start at the end, so to speak. If you use language carefully and are serious about libertarianism and psychiatry, then the term “libertarian psychiatrist” is, quite simply, an oxymoron. Libertarianism means that individual liberty is a more important value than mental health, however defined. Liberty is certainly more important than having psychiatrists lock you up to protect you from yourself. Psychiatry stands or falls with coercion, with civil commitment. Non-coercive psychiatry is also an oxymoron. This is one of the main reasons why I never considered myself a psychiatrist — because I always rejected psychiatric coercions.
ReplyDeleteNow, in term of political philosophy, libertarianism is what, in the 19th century, was called liberalism. Nowadays it’s sometimes also called “classical liberalism.” It’s a political ideology that views the state as an apparatus with a monopoly on the legitimate use of force and hence a danger to individual liberty. Contrariwise, the modern “Liberal” view regards the state as a protector, a benevolent parent who provides security for its citizens as quasi-children. To me, being a libertarian means regarding people as adults, responsible for their behavior; expecting them to support themselves, instead of being supported by the government; expecting them to pay for what they want, instead of getting it from doctors or the state because they need it; it’s the old Jeffersonian idea that he who governs least, governs best. The law should protect people in their rights to life, liberty, and property — from other people who want to deprive them of these goods. The law should not protect people from themselves.
This means that, as far as possible, medical care ought to be distributed, economically speaking, as a personal service in the free market. There is much wisdom in the adage, “People pay for what they value, and value what they pay for.” It’s dangerous to depart too far from this principle.
Economists and epidemiologist have shown, beyond a shadow of a doubt, that the two variables that correlate most closely with good health are the right to property and individual liberty — the free market. The people who enjoy the best health today are people in the Western capitalist countries and in Japan; and those in the poorest health are the people who enjoyed the blessings of 80 years of paternalistic statist, Communism. In the Soviet Union, where people’s political liberty and economic well being were systematically undermined by the state — where they enjoyed “equal misery for all” — life expectancy dropped from more than 70 years to about 55 years. During the same period, in advanced countries, it increased steadily and is now almost 80. And medical care has little to do with it, since Russia had access to medical science and technology. It’s primarily a matter of life style — of what used to be called good habits versus bad habits. And of good public health, in the sense of having a safe physical environment.