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  Mar 3, 2012                  
     

DSM-5: Thomas Szasz's ideas about psychiatry

 


  "Malice is pleasure derived from another's evil (..).
     ( Marcus Tullius Cicero)

 

  " We never hurt each other but by error or by malice." 
     ( Sir Robert Chambers, possibly inspired by Dr. Johnson)
 

   "As long as the patient will suffer, the cruel will kick."
     ( Rev. Sidney Smith)
 


  As emeritus professor of psychiatry Thomas Szasz put it:

"Psychiatry does not commit human rights abuse. It is a human rights abuse."

"It's not science. It's politics and economics. That's what psychiatry is: politics and economics. Behaviour control, it is not science, it is not medicine."

"It's an epidemic of psychiatry that we are dealing with. We don't have an epidemic of mental illness, we have an epidemic of psychiatry."

   Quoted in DSM-5: THE PRINCIPLES OF PSYCHIATRIC 
                 NEWSPEAK (PSYCHO-SPEAK) - P.S.

 

Sections

1. Introduction
2. "Thomas Szasz" - Wikipedia quoted
3. My notes to the article "Thomas Szasz"

The following is a long text that may be seen as part of a theoretical defense of patients with ME/CFS against psychiatry; as background and context for what is effectively a series in Nederlog on the DSM-5 and postmodern psychiatry; as one theoretical basis for further criticism of the DSM-5 and postmodern psychiatry; and exposition of the ideas of Thomas Szasz about psychiatry, as rendered on Wikipedia. (*)

It is long - over 215 Kb - but in part that's because it's repetitive, so that you don't need to read all: part 2 gives the text of the Wikipedia lemma, and part 3 quotes the parts I comment on again, followed by my comments, and ended with a "Back" that links to the text at the note's place.

1.Introduction

Having considered the DSM-5 lately, also with some help by George Orwell, and having mentioned professor emeritus psychiatry Thomas Szasz several times in this context, e.g. yesterday, also quoted above, and last year in this link

I now reproduce most of the text on him in the English edition of Wikipedia (status: March 1, 2012), as it appears in the lemma Thomas Szasz, but leaving out out some text indicated by "(...)", leaving out out the notes and the notes numbers, and leaving out all links in the text that do not seem to me relevant to Szasz or psychiatry. And I did some minor reformatting along the lines I use on my site.

Also, I put in some numbers in square brackets, on the pattern "[M1]", that link to notes by me, placed below. under the text taken from Wikipedia.

Otherwise, apart from removing the repeated "[edit]"s in the Wikipedia text without ellipsis, I made no changes in the text that I copied from Wikipedia. I provided a link to the original in the title (dr. Szasz's name).

The reasons to write this are that (1) as often with me, is "Selbstverstaendigung": Clarifying my own position to myself, by writing out the arguments, and doing my own thinking, that (2) it seems to me that Szasz is considerably more right than his critics, that (3) it seems to me that psychiatry is a dangerous pseudoscience, and that (4) psychiatry should be removed from science and medicine, since it is neither, and that (5) the DSM-5 should not be used and should be terminated, if possible, by court order or government intervention, if necessary: it is dangerous and fundamentally malicious "medical" pseudoscience.

There is considerably more on psychiatry, the DSM-5, and related topics in the Nederlogs of 2010, 2011and 2012. Part of my own take - and I am a philosopher and psychologist in his early 60ies - on psychiatry is here:

What follows is the text of the lemma "Thomas Szasz", with links to my notes, that follow the text. As a preparation, check out

2. " Thomas Szasz" - Wikipedia quoted

The following text, between the two horizontal lines, is nearly all of the text - but with some deletions, as explained above - in the lemma for Thomas Szasz on the English Wikipedia on March 1, 2012. The numbers "[M1]" etc. are links to my notes that follow the text.

In case you want to hear and see Szasz himself, here is a link to a video:

In it he says some of the things that are also in the following Wikipedia lemma.


Thomas Szasz

From Wikipedia, the free encyclopedia

(..)
 
Thomas Stephen Szasz ((..) born April 15, 1920) is a psychiatrist and academic. Since 1990 he has been Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He is a well-known social critic of the moral and scientific foundations of psychiatry, and of the social control aims of medicine in modern society, as well as of scientism. His books The Myth of Mental Illness(1960) and The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (1970) set out some of the arguments with which he is most associated. [M1]

His views on special treatment follow from classical liberal roots which are based on the principles that each person has the right to bodily and mental self-ownership and the right to be free from violence from others, although he criticized the " Free World" as well as the communist states for their use of psychiatry and "drogophobia". [M2] He believes that suicide, the practice of medicine, use and sale of drugs and sexual relations should be private, contractual, and outside of state jurisdiction. [M3]

In 1973, the American Humanist Associationnamed him Humanist of the Year and in 1979 he was honored with an honorary doctorate at Universidad Francisco Marroquín.

Contents

Life

Thomas Szasz was born to Gyula and Lily Szasz on April 15, 1920, in Budapest, Hungary. In 1938 Szasz moved to the United States, where he attended the University of Cincinnati for his Bachelor of Arts in medicine, and received his medical degree from the same university in 1944. Szasz completed his residency requirement at the Cincinnati General Hospital, then worked at the Chicago Institute for Psychoanalysis from 1951-1956, and then for the next five years was a member of its staff - taking twenty-four months out for active duty with the U.S. Navy.

In 1962 Szasz received a tenured position in medicine at the State University of New York. Szasz had first joined SUNY in 1956.

Szasz's views of psychiatry were influenced by the writings of Frigyes Karinthy. [M4]

The rise of Szasz's arguments

Szasz first presented his attack on "mental illness" as a legal term in 1958 in the Columbia Law Review. In his article he argued that mental illness was no more a fact bearing on a suspect's guilt than is possession by the devil. [M5]

In 1961 Szasz gave testimony before a United States Senate committee in which he argued that the use of mental hospitals to incarcerate people defined as insane violated the general assumptions of patient- and doctor-relationships and turned the doctor into a warden and a keeper of a prison. [M6]

Szasz's main arguments

As Szasz said, having become convinced of the fictitious character of mental disorders, the frequent injuriousness of psychiatric treatments, the immorality of psychiatric coercions and excuses, he set himself a task to delegitimize the legitimating agencies and authorities and their vast powers, enforced by psychiatrists and other mental health professionals, mental health laws, mental health courts, and mental health sentences. [M7]

Szasz is a critic of the influence of modern medicine on society, which he considers to be the secularisation of religion's hold on humankind. Criticizing scientism, he targets in particular psychiatry, underscoring its campaigns against masturbation at the end of the 19th century, its use of medical imagery and language to describe misbehaviour, its reliance on involuntary mental hospitalization to protect society, or the use of lobotomy and other interventions to treat psychosis. [M8] To sum up his description of the political influence of medicine in modern societies imbued by faith in science, he declared:

Since theocracy is the rule of God or its priests, and democracy the rule of the people or of the majority, pharmacracy is therefore the rule of medicine or of doctors. [M9]

Szasz consistently pays attention to the power of language in the establishment and maintenance of the social order, both in small interpersonal as well as wider socio-political spheres:

"The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed." [M10]

His main arguments can be summarised as follows:

  • The myth of mental illness : "Mental illness" is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behaviour, such as schizophrenia, as an "illness" or "disease". Szasz wrote: "If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic." While people behave and think in ways that are very disturbing, and that may resemble a disease process (pain, deterioration, response to various interventions), this does not mean they actually have a disease. To Szasz, disease can only mean something people "have," while behaviour is what people "do". Diseases are "malfunctions of the human body, of the heart, the liver, the kidney, the brain" while "no behaviour or misbehaviour is a disease or can be a disease. That's not what diseases are". Szasz cites drapetomania as an example behaviour which many in society did not approve of, being labeled and widely cited as a 'disease' and likewise with women who did not bow to men's will as having "hysteria". Psychiatry actively obscures the difference between (mis)behaviour and disease, in its quest to help or harm parties to conflicts. By calling certain people "diseased", psychiatry attempts to deny them responsibility as moral agents, in order to better control them. [M11]

People who are said (by themselves or others) to "have" a mental illness can only have, at best, a "fake disease." [M12] Diagnoses of "mental illness" or "mental disorder" (the latter expression called by Szasz a " weasel term" for mental illness) are passed off as "scientific categories" but they remain merely judgments (judgments of disdain) to support certain uses of power by psychiatric authorities. [M13] In that line of thinking, schizophrenia is not the name of a disease entity but a judgment of extreme psychiatric and social reprobation. Szasz calls schizophrenia "the sacred symbol of psychiatry" because those so labeled have long provided and continue to provide justification for psychiatric theories, treatments, abuses, and reforms. [M14] The figure of the psychotic or schizophrenic person to psychiatric experts and authorities, according to Szasz, is analogous with the figure of the heretic or blasphemer to theological experts and authorities. [M15] According to Szasz, to understand the metaphorical nature of the term "disease" in psychiatry, one must first understand its literal meaning in the rest of medicine. To be a true disease, the entity must first, somehow be capable of being approached, measured, or tested in scientific fashion. Second, to be confirmed as a disease, a condition must demonstrate pathology at the cellular or molecular level. [M16]

A genuine disease must also be found on the autopsy table (not merely in the living person) and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. [M16a] "Mental illnesses" are really problems in living. They are often "like a" disease, argues Szasz, which makes the medical metaphor understandable, but in no way validates it as an accurate description or explanation. [M17] Psychiatry is a pseudo-science that parodies medicine by using medical sounding words invented especially over the last 100 years. [M18] To be clear, heart break and heart attack, or spring fever and typhoid fever belong to two completely different logical categories, and treating one as the other constitutes a category error, that is, a myth. [M19] Psychiatrists are the successors of "soul doctors", priests who dealt and deal with the spiritual conundrums, dilemmas, and vexations  the "problems in living"  that have troubled people forever. [M20]

Psychiatry's main methods are those of conversation or rhetoric, repression, and religion. [M21] To the extent that psychiatry presents these problems as "medical diseases," its methods as "medical treatments," and its clients - especially involuntary - as medically ill patients, it embodies a lie and therefore constitutes a fundamental threat to freedom and dignity. [M 22] Psychiatry, supported by the State through various Mental Health Acts, has become a modern secular state religion according to Thomas Szasz. [M23] It is a vastly elaborate social control system, using both brute force and subtle indoctrination, which disguises itself under the claims of scientificity. [M24] The notion that biological psychiatry is a real science or a genuine branch of medicine has been challenged by other critics as well, such as Michel Foucault in Madness and Civilization (1961), and Erving Goffman in Asylums (1961). [M25]

  • Separation of psychiatry and the state : State government by enforcing the use of shock therapy has abused Psychiatry with impunity. If we accept that " mental illness" is a euphemism for behaviours that are disapproved of, then the state has no right to force psychiatric "treatment" on these individuals. [M26] Similarly, the state should not be able to interfere in mental health practices between consenting adults (for example, by legally controlling the supply of psychotropic drugs or psychiatric medication). The medicalization of government produces a "therapeutic state," designating someone as "insane" or as a "drug addict". [M27]

In Ceremonial Chemistry(1973), he argued that the same persecution which has targeted witches, Jews, Gypsies or homosexuals now targets "drug addicts" and "insane" people. Szasz argued that all these categories of people were taken as scapegoats of the community in ritual ceremonies. To underscore this continuation of religion through medicine, he even takes as example obesity: instead of concentrating on junk food (ill-nutrition), physicians denounced hypernutrition. [M28] According to Szasz, despite their scientific appearance, the dietsimposed were a moral substitute to the former fasts, and the social injunction not to be overweight is to be considered as a moral order, not as a scientific advice as it claims to be. As with those thought bad (insane people), those who took the wrong drugs (drug-addicts), medicine created a category for those who had the wrong weight (obeses). [M29]

Szasz argued that psychiatrics were created in the 17th century to study and control those who erred from the medical norms of social behaviour; a new specialization, drogophobia, was created in the 20th century to study and control those who erred from the medical norms of drug consumption; and then, in the 1960s, another specialization, bariatrics, was created to deal with those who erred from the medical norms concerning the weight which the body should have. Thus, he underscores that in 1970, the American Society of Bariatic Physicians (from the Greek baros, weight) had 30 members, and already 450 two years later.

  • Presumption of competence : Just as legal systems work on the presumption that a person is innocent until proven guilty, individuals accused of crimes should not be presumed incompetent simply because a doctor or psychiatrist labels them as such. Mental incompetence should be assessed like any other form of incompetence, i.e., by purely legal and judicial means with the right of representation and appeal by the accused. [M30]
  • Death control : In an analogy to birth control, Szasz argues that individuals should be able to choose when to die without interference from medicine or the state, just as they are able to choose when to conceive without outside interference. He considers suicideto be among the most fundamental rights, but he opposes state-sanctioned euthanasia. In his 2006 book about Virginia Woolf he stated that she put an end to her life by a conscious and deliberate act, her suicide being an expression of her freedom of choice. [M31]
  • Abolition of the insanity defense : Szasz believes that testimony about the mental competence of a defendant should not be admissible in trials. Psychiatrists testifying about the mental state of an accused person's mind have about as much business as a priest testifying about the religious state of a person's soul in our courts. [M32] Insanity was a legal tactic invented to circumvent the punishments of the Church, which, at the time included confiscation of the property of those who committed suicide, which often left widows and orphans destitute. Only an insane person would do such a thing to his widow and children, it was successfully argued. Legal mercy masquerading as medicine, said Szasz.
  • Abolition of involuntary hospitalization : No one should be deprived of liberty unless he is found guilty of a criminal offense. Depriving a person of liberty for what is said to be his own good is immoral. Just as a person suffering from terminal cancer may refuse treatment, so should a person be able to refuse psychiatric treatment. [M33]
  • Our right to drugs : Drug addiction is not a "disease" to be cured through legal drugs ( Methadone instead of heroin; which forgets that heroin was created in the first place to be a substitute to morphine, which in turn was created as a substitute to opium), but a social habit. Szasz also argues in favor of a drugs free-market. He criticized the war on drugs, arguing that using drugs was in fact a victimless crime. Prohibition itself constituted the crime. He shows how the war on drugs leads states to do things that would have never been considered half a century before, such as prohibiting a person from ingesting certain substances or interfering in other countries to impede the production of certain plants (e.g. coca eradication plans, or the campaigns against opium; both are traditional plants opposed by the Western world). Although Szasz is skeptical about the merits of psychotropic medications, he favors the repeal of drug prohibition. [M34]

"Because we have a free market in food, we can buy all the bacon, eggs, and ice cream we want and can afford. If we had a free market in drugs, we could similarly buy all the barbiturates, chloral hydrate, and morphine we want and could afford." Szasz argued that the prohibition and other legal restrictions on drugs are enforced not because of their lethality, but in a ritualistic aim (he quotes Mary Douglas's studies of rituals). He also recalls that pharmakos, the Greek root of pharmacology, originally meant "scapegoat". Szasz dubbed pharmacology "pharmacomythology" because of its inclusion of social practices in its studies, in particular through the inclusion of the category of " addictiveness" in its programs. "Addictiveness" is a social category, argued Szasz, and the use of drugs should be apprehended as a social ritual rather than exclusively as the act of ingesting a chemical substance. There are many ways of ingesting a chemical substance, or drug (which comes from pharmakos), just as there are many different cultural ways of eating or drinking. Thus, some cultures prohibit certain types of substances, which they call " taboo", while they make use of others in various types of ceremonies.

Szasz has been wrongly associated with the anti-psychiatry movement of the 1960s and 1970s. He is not opposed to the practice of psychiatry if it is non-coercive. He maintains that psychiatry should be a contractual service between consenting adults with no state involvement. In a 2006 documentary film called Psychiatry: An Industry of Death released on DVD Szasz stated that involuntary mental hospitalization is a crime against humanity. Szasz also believes that, if unopposed, involuntary hospitalization will expand into "pharmacratic" dictatorship. [M35]

Relationship to Citizens Commission on Human Rights

In 1969, Szasz and the Church of Scientology co-founded the Citizens Commission on Human Rights (CCHR) with the aim of helping to "clean up" the field of human rights abuses. [M36] Szasz remains on CCHR's Board of Advisors as Founding Commissioner, and continues to provide content for the CCHR. In the keynote address at the 25th anniversary of CCHR, Szasz stated: "We should all honor CCHR because it is really the organization that for the first time in human history has organized a politically, socially, internationally significant voice to combat psychiatry. This has never been done in human history before." Szasz, himself, does not have any membership or involvement in Scientology. In 2003, the following statement, authorized by Szasz, was posted to the official Szasz web site by its owner, Jeffrey Schaler, explaining Szasz's relation to CCHR:

"Dr. Szasz co-founded CCHR in the same spirit as he had co-founded  with sociologist Erving Goffman and law professor George Alexander  The American Association for the Abolition of Involuntary Mental Hospitalization...
Scientologists have joined Szasz's battle against institutional psychiatry. Dr. Szasz welcomes the support of Jews, Christians, Muslims, and any other religious or atheist group committed to the struggle against the Therapeutic State. Sharing this battle does not mean that Dr. Szasz supports the unrelated principles and causes of any religious or non-religious organization. This is explicit and implicit in Dr. Szasz's work. Everyone and anyone is welcome to join in the struggle for individual liberty and personal responsibility  especially as these values are threatened by psychiatric ideas and interventions."

Criticism

Szasz's critics maintain that, contrary to his views, such illnesses are now regularly "approached, measured, or tested in scientific fashion." The list of groups that reject his opinion that mental illness is a myth include the American Medical Association(AMA), American Psychiatric Association (APA) and the National Institute of Mental Health (NIMH). [M37]

According to American psychiatrist Allen Frances, Szasz "goes too far and draws bright lines where there are shades of gray". In particular, Szasz is right that schizophrenia is no "disease", but that doesn't mean schizophrenia is a "myth." Szasz is also right that psychiatric diagnosis can be misunderstood and misused, but that doesn't mean it can be dispensed with, Allen Frances says and adds that Szasz is correct in defining many problems related to psychiatric diagnosis, but he doesnt offer alternative solutions. [M38]

The effectiveness of medication has been used as an argument against Szasz's idea that depression is a myth. In a debate with Szasz, Donald F. Klein, M.D explained:

"It is that elementary fact, that the antidepressants do little to normals, and are tremendously effective in the clinically depressed person, that shows us that this is an illness." [M39]

But as the New England Journal of Medicine reported on January 17, 2008, in published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but perhaps only by a modest margin and for a brief period. In the same debate Frederick K. Goodwin, M.D, asserts:

"The concept of disease in medicine really means a cluster of symptoms that people can agree about, and in the case of depression we agree 80% of the time. It is a cluster of symptoms that predicts something." [M40]

Szasz argues that only mental illnesses are defined based on consensus and symptom clusters. It has been argued this is not the case. Critics claim physical illnesses such as Kawasaki syndrome (a disorder of the heart and blood vessels) and Ménière's disease(a disorder of the inner ear) are similarly defined. [M41]

There is also the criticism that many physical diseases were identified and even treated with at least some success decades, centuries, or millennia before their etiology was accurately identified. Diabetes is one notable example. In the eyes of Szasz's critics, such historical facts tend to undermine his contention that mental illnesses must be "fake diseases" because their etiology in the brain is not well understood. [M42]  


3. My notes to the article "Thomas Szasz" quoted above

In order to keep things readable, part 3 quotes the parts I comment on again, indented, followed by my comments, unindented, and ended with a "Back" that links to the text at the note's place.  


 

[M1] He is a well-known social critic of the moral and scientific foundations
        of psychiatry, and of the social control aims of medicine in modern
        society, as well as of scientism. His books The Myth of Mental Illness
        (1960) and The Manufacture of Madness: A Comparative Study of the
        Inquisition and the Mental Health Movement
(1970) set out some of
        the arguments with which he is most associated.

As I have said, I have degrees in psychology and philosophy. I do not recall Szasz being as much as mentioned in either study, though I have heard rather a lot in both studies about psychiatry, psychotherapies, and clinical psychology.

Most of what I heard or read about these subjects in these studies seemed mostly nonsense to me at the time, and does so still, and I have myself never had any deep interest in either psychiatry or psychotherapy, precisely because most of what I heard and read about these fields from a very young age - ca. 17, having read Patrick Mullahy's "Oedipus: Myth and Complex" - struck me as nonsense if not plainly false, and also dishonest if presented as science.

I also read Szasz "The Myth of Mental Illness" in the late 1960ies or early 1970ies and liked it for the most part, except that it seemed to me there was more to mental illness than Szasz allowed, though I agreed with him on the thesis that "mental illness" is a nonsensical term, on the pattern of "diseased soul": Brains may be ill or diseased, but not minds or souls, since
neither of these is a bodily organ.

And I have not read other books by Szasz, mostly because I was and am not much interested in psychiatry, because that seemed to me a pretended science without a scientific subject, though I also believed and believe that people can get mad, in which case they do deserve help.

I agree about the dangers of the social control aims of medicine in modern society and of scientism, and note that one of the things that makes psychiatry special is that much of it is social control in the name of science and morals by what is in fact a pseudoscience, that often is used immorally and in contradiction with medical ethics ("primum non nocere") and also in contradiction with normal ethics and human rights.  Back.  


[M2] His views on special treatment follow from classical liberal roots which
       are based on the principles that each person has the right to bodily
       and mental self-ownership and the right to be free from violence from
       others, although he criticized the " Free World" as well as the
       communist states for their use of psychiatry and "drogophobia".

With this - the paragraph, up to my note - I quite agree, and indeed I also have described myself since decades as a "classical liberal", by which term I have in mind especially writers like Tocqueville and Mill. Then again, unlike Szasz, I am not a libertarian, and never was, and also find it difficult to think of libertarians (in the US sense of the term) as classical liberals, though there is some overlap.   Back.  


[M3] He believes that suicide, the practice of medicine, use and sale of
       drugs and sexual relations should be private, contractual, and outside
       of state jurisdiction.

I agree mostly with this as well, with the proviso that this does not mean there must not be some form of control on people practising medicine or selling drugs, though what the precise form of such control - such as: inspecting the medicine or drugs are what they are claimed to be, are of good quality, are properly described as regards benefits and dangers, trying to make sure that those offering medicine for sale are somehow qualified etc. etc. - should take is a quite difficult problem. (See my notes to Mill's On Liberty)   Back.  


[M4] Szasz's views of psychiatry were influenced by the writings of
       Frigyes Karinthy.

Whom I had never heard of, but who seems - from Wikipedia and the internet - to be an interesting writer.   Back.


[M5] Szasz first presented his attack on "mental illness" as a legal term in
       1958 in the Columbia Law Review. In his article he argued that mental
       illness was no more a fact bearing on a suspect's guilt than is
       possession by the devil.

The example is a good one, and I agree with Szasz that the term "mental illness" is a tricky and misleading term, since the mind is not a physical organ, and is best understood scientifically as part of what brains do: Produce experience - feelings, sensations, beliefs, desires - in ways that to this day are mostly unknown.

So "mental illness" is at best a metaphorical term, of unclear factual reference and without any clear definition. Then again, it also seems to me that there are mad people viz. those who are clearly deluded or hallucinating or in strong emotion without clear factual reason, and this has been so throughout human history and in many cultures and civilizations.

What to do with such people, and what to think about their experiences, may be a considerable problem, especially if their abnormal experiences or convictions makes them dangerous to others.   Back.  


[M6] In 1961 Szasz gave testimony before a United States Senate
       committee in which he argued that the use of mental hospitals to
       incarcerate people defined as insane violated the general assumptions
       of patient- and doctor-relationships and turned the doctor into a
       warden and a keeper of a prison.

I agree - but there is the problem that some people can get quite mad
and can be quite dangerous to others or themselves. Indeed a widely know example, that is also "understood" to a considerable extent, is being drunk:

One's sensations get blurred; one's motoric capacities get worse; one may say and believe many things one never did or would when not drunk; one can get quite emotional, and so on, where the "understanding" of the condition, indeed for several thousand years, was that these things were so because the person had drunk alcoholic beverages.

To be drunk is one everyday way in which one can be rather evidently and for rather well-known reasons - that in these days include biochemistry - mad or "mad", and for which the various therapies are also well-known since many centuries: If aggressive lock up until sober; and beware of alcohol.

Then again, the problem with forms of madness that are not caused by ingesting alcohol, is that one often has no good idea about what caused them, nor good ideas what to do about them.   Back.  


[M7] As Szasz said, having become convinced of the fictitious character of
       mental disorders, the frequent injuriousness of psychiatric treatments,
       the immorality of psychiatric coercions and excuses, he set himself a
       task to delegitimize the legitimating agencies and authorities and their
       vast powers, enforced by psychiatrists and other mental health
       professionals, mental health laws, mental health courts, and mental
       health sentences.

I mostly agree but I do have problems with "the fictitious character of mental disorders", although this is mostly not Szasz's fault.

Supposing there is madness, as e.g. evinced by being drunk, where the cause seems to be mostly that ingesting alcohol is ingesting something that makes one's brain malfunction, one main problem is that there is no good empirically based  theory of most other deregulated, strange or abnormal behaviours, feelings and thoughts, some of which may also be not desired at all by those who have them. (Phobias, nervousness, fears, sleeplessness etc.) Besides, no has another's experiences: these are inferred from behaviour rather than sensed, which again makes for many problems in properly knowing what another's experiences are like.

Another main problem is that most persons in society do not want to associate with persons with unpredictable or unpleasant behaviours, and want something done about persons who have not enough self-control to seem quite normal.

A third main problem is that psychiatrists have developed whole bodies of doctrine and practice for dealing with persons with behaviour, beliefs, desires or needs that are at variance with the behaviour, beliefs, desires or needs the leaders in society desire, and that psychiatrists have the formal
power to have people locked up, use forced drugs, be physically punished for being or seeming not quite like the average of their kind etc.

A fourth main problem is that most theories of most psychiatrists have no real empirical or rational foundation, even if they are well intended and meant to serve a mad person's interests.

A fifth main problem is that most practices and treatments of most psychiatrists have not been very helpful to the patients they treated.   Back.


[M8] Szasz is a critic of the influence of modern medicine on society, which
       he considers to be the secularisation of religion's hold on humankind.
       Criticizing scientism, he targets in particular psychiatry, underscoring
       its campaigns against masturbation at the end of the 19th century, its
       use of medical imagery and language to describe misbehaviour, its
       reliance on involuntary mental hospitalization to protect society, or the
       use of lobotomy and other interventions to treat psychosis.

I agree with most of that, though it should be remarked that the medical sanctioning of masturbation started earlier than the late 19th C.

And the main problem is that medical men and women, and especially psychiatrists, vastly exaggerated the amount of real scientific empirical
understanding they had of the behaviours they proscribed, and that most of them pretended knowledge they simply cannot and do not have, and yet used this pretended knowledge to mistreat many people in many ways,
"in the name of science", "in the interest of society".

That is, the human weaknesses underlying all of it are greed, dishonesty and duplicity:

If only doctors of psychiatry did not pretend to know what they don't know; if only the non-psychiatric medical doctors would not allow pretence or nonsense as a basis for treating people or locking them up!   Back


[M9] Since theocracy is the rule of God or its priests, and democracy the
       rule of the people or of the majority, pharmacracy is therefore the
       rule of medicine or of doctors.

My problem with this is that it is a play on words. But then that is part of the art of psychiatry, as it has been practised since Freud, at least, and it leads up to a correct point of Szasz.    Back.


[M10] Szasz consistently pays attention to the power of language in the
         establishment and maintenance of the social order, both in small
         interpersonal as well as wider socio-political spheres:

"The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed."

Szasz is right but the italic part has been formulated with too many rhetorical flourishes, for my taste, but the point is good and important:

To define the situation in those terms that serve one's own interest best is the art at which lawyers, politicians, priests and psychiatrists excel, and indeed is by far the greatest part of the pretended "science" of psychiatry:

The pretence that it is a science; the pretence that psychiatrists have insights into mental aberrations or the human mind others don't have; the pretence that their verbal classifications classify something real that they empirically researched; the pretence that they mean well, especially when prescribing anti-psychotic drugs to rowdy small children; the pretence that psychiatry knows the explanations where the rest of medical science has said it can't find one with present knowledge and tools...

...that is just the beginning of a long list of falsehoods that should make it clear that psychiatry is a pseudoscience and that its practitioners are best described as frauds, for by far the best reason for their words and their actions are financial greed and personal dishonesty, while admitting also that there are psychiatrists who mean well, who don't pretend much, and who try to help people with problem, and insisting besides that if they are in any way effective in helping their patients it cannot be on the basis of any deep scientific understanding of their patients' problems, for that does not exist.

Finally, the intelligent reader surely has picked up that all of the last paragraph is true of the priests of any religion (except - of course! - that one sane and true religion you believe in):

They too pretend knowledge of reality they absolutely don't have, and they too tend to be in it for the money or the status, and in their case also not all priests are servants of Mammon, and some priests may do some good to some, but then probably, as with psychiatrists, because they happen to be kind, commonsensical, and moral and also sincerely wish to help someone in problems.    Back.  


[M11] This is a key-paragraph, and I will consider it piecewise, in the order quoted, and quoting with indent:

A. The myth of mental illness : "Mental illness" is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behaviour, such as schizophrenia, as an "illness" or "disease".

As I have said, I read Szasz's book around 40 years ago, and can't find a copy in my bookcases. And as to the rest of this quote: Szasz is right, but then the reply of psychiatrists is along the lines that they "hypothesize" or "theorize" that the behaviour that leads to the diagnosis of schizophrenia, and indeed to other forms of "mental illness", is due to some malfunction in the brain, possibly triggered by personal experiences or social circumstances.

And the psychiatrists are right in this reply, or would be right in this reply, rather, if they were honest and scientific and would admit that all this hypothesizing and theorizing on their part has so far not led to a credible, rational, empirically based causal explanation of schizophrenia, and that in fact they just do not know what causes it, and even do not have really good ideas of where to look for relevant factors.

The problem is again dishonesty, on the part of the psychiatrists:

While effectively having no more true or probable knowledge about the causes of schizophrenia than laymen, they pretend they have, and they pretend to do science because they say they believe mental illnesses have to be explained by reference to the brain, the experiences and the social circumstances of the person, and pretend these are insights, whereas in fact no one in his sound mind has ever denied these tenets, and while in fact also no one in science has succeeded in being any more specific on the cause or causes of schizophrenia, and indeed the causes of almost all other "mental illnesses": They just don't know, but they pretend to know, because they make money that way, and giving it up, although honest and moral, would force them into other ways of making money, that are far less profitable, if also far more honest.

B. While people behave and think in ways that are very disturbing, and that may resemble a disease process (pain, deterioration, response to various interventions), this does not mean they actually have a disease.

Well, yes and no: Yes, in the sense that they may be drunk, may have taken mescaline or eaten other mushrooms, or are merely pretending or just got religion; no, in the sense that their apparently mad (strange, unfamiliar, uncommon etc.) behaviour may be caused by an unknown disease, whether indeed schizophrenia or a brain tumour. And it should also be remarked that, etymologically, if people are - say - unpleasantly hallucinating, for whatever reasons, they are in a state of "dis-ease".

But we come to this, for Szasz does have a good point:

C. To Szasz, disease can only mean something people "have," while behaviour is what people "do". Diseases are "malfunctions of the human body, of the heart, the liver, the kidney, the brain" while "no behaviour or misbehaviour is a disease or can be a disease. That's not what diseases are".

For medical people, the term "disease" should be more precise than it is in natural language, and Szasz's version is fair for medical science, since that - to be really scientific - (1) must explain subjectively painful or unpleasant states of mind (experience) by reference to objectively researchable states of the body, and (2) has only succeeded in doing so in an empirical and rational way when it has empirically demonstrated states or processes in the body that are causally related to some experienced malfunctioning.

The moment you start considering human behaviour, speech, beliefs, or desires as "disease" you are fundamentally confusing behaviour and its  explanation, and are speaking as a policeman, priest or moralist rather than as a medical scientist.

D. Psychiatry actively obscures the difference between (mis)behaviour and disease, in its quest to help or harm parties to conflicts. By calling certain people "diseased", psychiatry attempts to deny them responsibility as moral agents, in order to better control them.

This seems mostly true, for the reason given under C. above, but not clearly expressed: The first statement is quite correct and clear, but the second should put "behaviour of" before "people" to be correct as per the first sentence.

Then again, it also is true that psychiatry calls certain people diseased (or mentally ill) and indeed mistreats them, but then often the fallacy is another: That psychiatry can and does explain the mad seeming behaviour of people, namely by reference to their diseased brain, when in fact it does not, or does so only in a very abstract and remote way, since psychiatry and the other sciences do not have good causal explanations, in scientific terms, of what are called "mental illnesses".

In either way, Szasz is right, that is whether by confusing misbehaviour and disease or whether by pretending causal knowledge where they don't have any, psychiatrists are acting counter to their medical oaths and duties, are misleading the public, and are mistreating their patients, often in very far going ways, such as locking them up and forcing drugs into them, while actually having no good scientific and medical explanation for their supposedly mad behaviours, nor for the effectiveness of the drugs or treatments prescribed (that always do keep psychiatric doctors and nurses in paid employment).    Back.  


[M12] "People who are said (by themselves or others) to "have" a mental
          illness can only have, at best, a "fake disease." "

No, that is not so, or is phrased too misleadingly: At best they have a hypothetical disease. That is: The doctors may be quite right that the mad behaviour (words, beliefs) of a person is due to his brain being somehow diseased, and would be honest if they were to say that they believe his behaviour is due to his brain somehow malfunctioning - but that apart from that general idea, they have no real clue.

Then again, it may also be that they call something "a disease" or "diseased" when the behaviours they object to are merely behaviours that are considered immoral or reprehensible in their society. (Being homosexual in the US until 1971, when the APA ceased believing or pretending that psychiatrists knew that, "scientifically speaking", homosexuality is a disease; or being dissident in the SU from 1950 till 1989, when thinking or valuing differently than the government prescribed easily lead to a Soviet madhouse.)    Back.


[M13] Diagnoses of "mental illness" or "mental disorder" (the latter
         expression called by Szasz a " weasel term" for mental illness) are
         passed off as "scientific categories" but they remain merely
         judgments (judgments of disdain) to support certain uses of power
         by psychiatric authorities.

From Wikipedia:

A weasel word (also, anonymous authority) is an informal term for equivocating words and phrases aimed at creating an impression that something specific and meaningful has been said, when in fact only a vague or ambiguous claim, or even a refutation has been communicated.

Indeed, one of the radical innovations of both DSM-5 and ICD-11 seems to be that the term "illness", that at least suggested - in medicine - the assumption on an underlying physical cause, possibly unknown, will be replaced by "disorder", that is both a weasel word and one that takes leave of even hypothetical science, and is a moral, political or legalistic term rather than medical or scientific term.

But that is how the APA wants it: There are far more "disorderly" people than there are "mad" people, and governments of all kinds are willing to pay lots of money to put a stop to "disorderly" behaviour or speech.

In brief, to replace "illness" (hypothetical) by "disorder" (APA-defined, consult the DSM-5) is Soviet-psychiatry rather than science, though I am willing to believe for the APA it is about money rather than about ideology.

Incidentally, while I agree with Szasz that many psychiatric diagnoses and terms are based on "judgments of disdain", this need not be so while still being reprehensible or immoral: What matters most, intellectually speaking, is whether the judgments of psychiatrists are based on real scientific knowledge and provable empirical fact. Most psychiatric judgements are not, and therefore psychiatry is not a real science, even if one were to agree - say, as chief of police - that all judgements of APA-approved psychiatrists are correct and laudatory, and just what the state needs to make society or its leaders safe from being disturbed.    Back.


[M14] Szasz calls schizophrenia "the sacred symbol of psychiatry" because
         those so labeled have long provided and continue to provide
         justification for psychiatric theories, treatments, abuses, and
         reforms.

I take it he spoke in irony, about the use psychiatrists and policemen have made of the label "schizophrenia", that suggests knowledge but is, for the most part, merely a label, that often serves as a pretext to lock people up.

In any case, what does "provide justification for psychiatric theories" is not so much that particular label but the fact that psychiatrists - in the US, in Brezhnev's SU, in Mao's China - have been accepted by the public, by real scientists, and by the state as having scientific knowledge and understanding of people, where they had no real scientific knowledge of any kind, and in fact abused their medical authority and credit to help the state lock up people who did things the leaders of the state or the laws forbid.    Back.


[M15] The figure of the psychotic or schizophrenic person to psychiatric
         experts and authorities, according to Szasz, is analogous with the
         figure of the heretic or blasphemer to theological experts and
         authorities.

In some cases this is so, but I doubt it is generally true, since I suppose most people who have been locked up with a psychiatric diagnosis in the West (it may be different in the Soviet-Union or China) were disturbed
("not in their right mind") and not of any political or religious importance.

Also, I should say that I am not dealing with Szasz's own texts, but with a paraphrasis of his ideas by others.

And indeed, the really important point follows the present point:    Back.


[M16] According to Szasz, to understand the metaphorical nature of the
         term "disease" in psychiatry, one must first understand its literal
         meaning in the rest of medicine. To be a true disease, the entity
         must first, somehow be capable of being approached, measured, or
         tested in scientific fashion. Second, to be confirmed as a disease,
         a condition must demonstrate pathology at the cellular or molecular
         level.

The second and third statements seems to me to be quite correct: If one has no testable hypothesis or no demonstrated pathology, at the very best all one has is an unsupported hypothesis. And any unsupported hypothesis, also those entertained by real scientists, is not science but a mere guess. And one should not lock people up or force drugs into people on the basis of mere guesses, and indeed only lock up people if they broke the law, and the law merits them being locked up, not because they are mad, though they may be, but because they did something forbidden by law.

The first statement I don't agree with as stated: One can understand quite well that much of psychiatry is not real science without knowing much or anything of medical science, or indeed of science. The same applies in fact to religions: One can understand quite well that these are not scientific and are intellectually quite doubtful and probably no more than faith or deception, without knowing much of science. But then none of this is very important to Szasz's other points.    Back.

[M16a] A genuine disease must also be found on the autopsy table (not
           merely in the living person) and meet pathological definition instead
           of being voted into existence by members of the American
           Psychiatric Association.

Yes indeed, or perhaps demonstrated in otherwise, but must be demonstrated empirically as something malfunctioning in a body so as to be part of medicine, rather than part of literary fiction or theology that pretends to be science or rational knowledge.

Also a list of behavioural so-called "symptoms" of a supposed but not empirically demonstrated bodily malfunctioning is not a list of symptoms of a disease, but is only a description of some behaviour that is asserted but in now way proved to be about something real that causes such behaviour.   Back.  


[M17] "Mental illnesses" are really problems in living. They are often "like a"
         disease, argues Szasz, which makes the medical metaphor
         understandable, but in no way validates it as an accurate description
         or explanation.

The basic problem with the term "mental illness" is that it is used dishonestly:

Since there is no adequate understanding of how the brain generates any of the human experiences that make human beings human - selfs, meanings, ideas, ideals, desires, values - at best the term "mental illness" is a guess about the experiences of someone (not necessarily the person having them) viz. that they are due to some malfunctioning, that may be due to an unknown brain disease or other disease.

There would be far fewer problems if psychiatric terms were used honestly, which is usually as a label for something mostly not understood in a scientific way.

The real problem is named and addressed next:    Back.  


[M18] Psychiatry is a pseudo-science that parodies medicine by using
         medical sounding words invented especially over the last 100 years.

Quite so. And the basic reason for this is that there simply was not and is not any adequate knowledge about how the human brain produces the experiences human beings have.   Back.


[M19] To be clear, heart break and heart attack, or spring feverand
         typhoid fever belong to two completely different logical categories,
         and treating one as the other constitutes a category error, that is, a
         myth.

I agree there are many category errors at the basis of many psychiatric terms, diagnoses and theories, but the basic category error is the one that made psychiatry a science, and psychiatrists medical scientists

Psychiatrists have as little knowledge of their subject - a hypothetically diseased or malfunctioning brain, possibly also functioning in hypotheticially diseased circumstances, and possibly supported by hypothetical false beliefs or unfounded emotions - as theologians, for their terminological "explanations" of their postulated fictions ("the id", "the unconcious", "the Oedipus complex", etc.) that are are for the most part as solidly reality-based as are the succubi and incubi of medieval theologians explaining madness.

Their hypotheses are not scientific; their methods not empirical; their knowledge is only of postulated fictions; and their pretended knowledge and insight are bogus, dishonest and fraudulent. The "evidence-based" science they pretended to do, published in pseudoscientific journals of psychiatry, peer reviewed by psychiatrists, are mostly only methodologically flawed "studies" that obscurely relate vague psychiatric terms to statistical rehashings of the outcomes of ill-formulated questionnaires. They prove nothing, except that the writers of such reports are dishonest or incompetent, and that it is easy to deceive persons with little knowledge by bogus terminology and bogus "empirical science".

There is no knowledge of the brain that can support their hypotheses, for the same reason as there is no knowledge of succubi and incubi: The posited fictional entites are not scientific but theological or ideological, and serve to justify the treatments of heretics by the inquistion and the treatment of madmen by the psychiatrists. (See: Malleus maleficarum - the DSM-5 of medieval psychiatry.)   Back.
 


[M20] Psychiatrists are the successors of "soul doctors", priestswho dealt
         and deal with the spiritual conundrums, dilemmas, and vexations -
         the "problems in living" - that have troubled people forever.

Yes, I mostly agree, also historically and as a matter of history of ideas, and indeed terminology: Psychiatrists ("alienists") started out as doctors of the soul and mostly deal with what are problems in living for their patients.

It is quite possible these problems in living, in various cases, are due to various forms of disease/malfunctioning in the brain, that in turn may have been caused by social circumstances or beliefs, but for the most part there is no real scientific evidence for such hypotheses, for lack of knowledge of
how the brain generates experiences.

Hence, someone who pretends knowledge of such hypothetical diseases when a medical doctor is a fraud, a liar, and a dishonest person who is abusing science by pretending insight that then is used for enriching himself and/or is used for locking up someone who committed no crime but whose freedom to move,  speak or think are inconvenient to the authorities, for various reasons, that maybe morally justified or grossly immoral.    Back.  


[M21] Psychiatry's main methods are those of conversation or rhetoric,
         repression, and religion.

Next to drugs, whether or not enforced, whether or not well-understood, whether or not well-tested, whether or not safe for the patient, and next to forced or semi-forced imprisonment in "asylums", "clinics", "hospitals" and "health-care institutions", next to prisons, special or not.

The main underlying problem of psychiatry is that most of the judgments, decisions and theories of psychiatry are not based on real science but on pseudoscience, and the main underlying problem of psychiatrists is that they know this:

They know they are in fact frauds and charlatans, because in fact their science is not a real science, and their pretended knowledge is mostly deception or delusion, and they are not so stupid as not to know this.

They may object against the terms "fraud" and "charlatan", but these are descriptively correct: If they pretend their interventions as doctors of psychiatry into the lives of patients are justified by real scientific knowledge, they almost always lie, and grossly exaggerate their relevant knowledge and competence.

Finally, this does not mean there are no psychiatrists who mean well, do well and help their patients, for there undoubtedly are: it means that psychiatrists have no real scientific theory that justifies their interventions. Then again, one does not need a scientific theory to be able to do well. Back.  


[M22] To the extent that psychiatry presents these problems as "medical
         diseases," its methods as "medical treatments," and its clients -
         especially involuntary - as medically ill patients, it embodies a lie and
         therefore constitutes a fundamental threat to freedom and dignity.

Quite so:

The problems are basically social or personal problems, that may have a hypothetical explanation in terms of disease, but those explanations are almost always unscientific for lack of knowledge of the brain that is claimed to have these diseases, usually without any good specific evidence.

The methods are basically deception, by trying to have the patient accept a verbal explanation for his problems that the psychiatrist approves of, but had no basis in real science; medication, by the enforced or suggested prescription of drugs that are at best known to have some chance of modifying some behaviour that is, for good or bad reasons, supposed to be related to the supposed "disease" or "disorder"; and physical maltreatment, by locking up patients, and causing them pain, or doing operations on them without their freely given and informed consent and usually without real scientific foundation, that maybe very dangerous or harmful, like electro-shocks or prefrontal lobotomies.    Back.


[M23] Psychiatry, supported by the State through various Mental Health
         Acts, has become a modern secular state religion according to
         Thomas Szasz.

That seems a bit exaggerated to me: It's not so much a state religion as

(1) a policing instrument under cover of pretended science, and
(2) a propaganda instrument under cover of pretended science.

It is the former when psychiatrists assist the law courts with excuses to lock people up that have committed no crimes and may not be mad at all but may be political or religious dissidents; it is the latter when psychiatric
judgments are used to effectively smear, slander, and libel persons, so as to be better able to lock them up, force them to work, or debase their ideas, whether political, religious, or artistic.

All of these have been done on a large scale, and by very prominent psychiatrists: See Donald Ewen Cameron (Wikipedia) for a horrific example of the large scale and systematic abuse of psychiatry in the name of science by a psychiatrists who must have been a sadist.    Back.


[M24] It is a vastly elaborate social control system, using both brute force
         and subtle indoctrination, which disguises itself under the claims of
         scientificity.

Quite so.

Again, the basic - huge - problem is that while there may be some legal or moral justification to lock up some clearly mad and dangerous persons, psychiatrists have been very willing to serve as justifiers of the state's repression of all manner of persons for all manner of reasons, that, when psychiatrists became involved, were in fact pseudoscientific excuses for
enforced imprisonments and enforced drug- or physical therapies.    Back.  


[M25] The notion that biological psychiatry is a real science or a genuine
         branch of medicine has been challenged by other critics as well, such
         as Michel Foucault in Madness and Civilization (1961), and Erving
         Goffman in Asylums (1961).

Yes: As it stands now and as it stood then, fifty years ago, "biological psychiatry" is pretend-science, mock-science, fake-science, pseudo-science.

There just is no science of the brain, done and finished, rather than hypothetical and wished for, to be sure, that could underpin it, so to claim that there is a biological psychiatry as science, that does underpin the judgments of self-styled biological psychiatrists, like Ewen Cameron, is pure fraudulence and medical malfeasance.    Back.  


[M26] If we accept that " mental illness" is a euphemism for behaviours
         that are disapproved of, then the state has no right to force
         psychiatric "treatment" on these individuals.

Actually, we don't even need to accept the hypothesis:

A state has no right to force psychiatric "treatment" on individuals in principle, and should not have it either, in law (if mad people refuse treatment and are dangerous they should, perhaps, be locked up, but then because it is provable fact that they are dangerous to others); and a state has no right to enforce or indeed suggest any kind of treatment on anyone if that has no good scientific foundation and  proven effectiveness, and should not have it either.    Back.


[M27] Similarly, the state should not be able to interfere in mental health
         practices between consenting adults (for example, by legally
         controlling the supply of psychotropic drugs or psychiatric
         medication). The medicalization of government produces a
         "therapeutic state," designating someone as "insane" or as a "drug
         addict".

I mostly agree, for reasons given earlier. It seems to me psychotropic drugs, whether alcohol, marihuana, LSD, or heroin (etc.) may be somehow be made subject to legal restriction (that have a huge risk of making a big problem from a small problem, as with the prohibition of the selling of alcohol in the US, that didn't stop people drinking and much helped criminal gangs), but then only on the basis of proven dangers to others (as with drunken driving) and not on moral or religious grounds disguised as psychiatry to give it a semblance of science or reason.    Back.  


[M28] In Ceremonial Chemistry (1973), he argued that the same
         persecution which has targeted witches, Jews, Gypsies or
         homosexuals now targets "drug addicts" and "insane" people.
         Szasz argued that all these categories of people were taken as   
         scapegoats of the community in ritual ceremonies. To underscore
         this continuation of religion through medicine, he even takes as
         example obesity: instead of concentrating on junk food (ill-nutrition),
         physicians denounced hypernutrition.

This seems mostly true, and the underlying problem is again that psychiatrists and also other medical doctors have been very willing tools of state policies or of pharmaceutical companies programs to sell certain kinds of drugs or medicines and to repress or not study or not prescribe others.

Again, it is the abuse of medicine in a fallacious way: As authority, and namely where it is not, either because the judgement it falsely supports with medical authority is not in fact a medical judgment but a moral or policy judgment, or else because the judgements it falsely supports with medical authority are not in fact a medical judgments but medical pseudoscience.    Back.


[M29] As with those thought bad (insane people), those who took the
         wrong drugs (drug-addicts), medicine created a category for those
         who had the wrong weight (obeses).

Yes - and the reader should also note that in each case, some authorities,
usually from both the state or religion and from "medical science", that may but need not be "psychiatric science", pretend that they know better than
the citizens they try to enforce behaviour on, "in the name of science" - as
if citizens should not be free to think or eat as they please, if what they think or consume can only affect their own chances on happiness or survival.    Back.  


[M30] Mental incompetence should be assessed like any other form of
         incompetence, i.e., by purely legal and judicial means with the right
         of representation and appeal by the accused.

Yes, indeed: One should not be locked up in a madhouse because psychiatric doctor Creep testified on oath that, in his scientific medical opinion, one is "a paranoid schizophrenic", or whatever, but only because
there is good legal (not: psychiatric) proof that the person to be locked
up is a serious danger to others' chances on being alive, being free from threats or violence, and trying to become happy by their own deeds according to one's own criterions.

Likewise, one should not be locked up because one is a Jew or a Calvinist in a predominantly Catholic country, or a Catholic in a predominant Calvinist country, even though all the theologians that appear in court plead they have certain sure "knowledge" the person is mad, bad and a blight in God's
eyes.    Back.


[M31] In an analogy to birth control, Szasz argues that individuals should be
         able to choose when to die without interference from medicine or the
         state, just as they are able to choose when to conceive without
         outside interference. He considers suicide to be among the most
         fundamental rights, but he opposes state-sanctioned euthanasia.

I agree: These should be individual rights of persons, and no person working for a state or church should have the ability to prescribe pregnancy or death to another, nor interfere when another's desires to die: There should be no duty for a person to be alive, and persons must be allowed to escape the indignities and horrors of dying slowly from untreatable cancer, or being incarcerated in an iron lung.    Back.


[M32] Szasz believes that testimony about the mental competence of a
         defendant should not be admissible in trials. Psychiatrists testifying
         about the mental state of an accused person's mind have about as
         much business as a priest testifying about the religious state of a
         person's soul in our courts.

I agree, and specifically because both priests and psychiatrists lack the knowledge to be competent to judge: They judge on the basis of pretended
science that is not about provably existing real things.    Back.  


[M33] No one should be deprived of liberty unless he is found guilty of a
         criminal offense. Depriving a person of liberty for what is said to be
         his own good is immoral. Just as a person suffering from terminal
         cancer may refuse treatment, so should a person be able to refuse
         psychiatric treatment.

Quite so, and the reason is that persons have and should have individual
rights, and other persons generally are neither authorized nor should they
be authorized to decide how another person should think of behave or
decide what manner of ends or ideals another should have.    Back.  


[M34] Although Szasz is skeptical about the merits of psychotropic
         medications, he favors the repeal of drug prohibition.

I agree: The "war on drugs" has only helped the drugs mafia to be even more profitable; the only way to control the use of psychotropic drugs is to repeal drug prohibition, and to control quality and prices - which also would make the state profit from taxes on the drugs, rather than the mafia through artificial high prices because of the state's prohibitions.    Back.


[M35] A. Szasz has been wrongly associated with the anti-psychiatry
         movement of the 1960s and 1970s. He is not opposed to the practice
         of psychiatry if it is non-coercive. He maintains that psychiatry
         should be a contractual service between consenting adults with no
         state involvement.   

I agree. It may be mostly baloney in a sauce of bullshit and psychobabble,
but then many things that are on sale are sold or bought on the basis of deception or delusion. Also, it may help to be able to talk to someone who
is not a family member nor a friend, and who has some knowledge or proven expertise that may help to resolve a problem one has.

         B.  Szasz also believes that, if unopposed, involuntary hospitalization
         will expand into "pharmacratic" dictatorship.

Yes, to a considerable extent it is, though I do not have good statistics, but
very many persons have been locked up for very long times, and forced into all manner of invasive treatments, on grounds that are fundamentally unscientific and immoral, and that also should be illegal.

Besides, there is another danger: Plain dictatorship and slavery, in that
there are at present large private prisons were inmates are exploited
economically by the owners. This too may be enforced with the help of psychiatric pseudoscience, as it is now being used in England to force
people with "medically unexplained symptoms" to work, on threat of
being denied dole, and on the basis that psychiatry is asserted, by psychiatrists, to have proved that "medically unexplained symptoms"
are not due to unknown diseases but to malingering of hypochondria.

And in this manner of case - that may cost many lives of genuinely ill people - the bureaucrats forcing ill people to forced labour will wash their hands in innocence, because they only did what psychiatrists told them they could do, while the psychiatrists will wash their hands in innocence because they only told what they claim is science and because they did not take the bureaucrat's decisions.

See also Aktion_T4: The medical murder on those unfit to work, to help Our People's Community, under Nazism.    Back.


[M36] In 1969, Szasz and the Church of Scientology co-founded the
         Citizens Commission on Human Rights (CCHR) with the aim of helping
         to "clean up" the field of human rights abuses.

I have read material by scientologists and about scientologists (e.g. " Cults of Unreason", by Christopher Evans) and deeply deplore that decision of Szasz: Teaming up with scientologists is like teaming up with the Catholic Inquisition to destroy the Calvinists: If it works, you end up with possibly even more frightful nonsense and insanity. Besides: It makes no rational  sense to fight pseudoscience with pseudoscience.

Also, my guess is that this has much harmed Szasz's ends: From 1969 he could be written off as being in league with scientology, that any informed right thinking medical or other scientist knew to be dangerous nonsense.    Back.


[M37] Szasz's critics maintain that, contrary to his views, such illnesses are
         now regularly "approached, measured, or tested in scientific fashion."
         The list of groups that reject his opinion that mental illness is a myth
         include the American Medical Association (AMA),
         American Psychiatric Association (APA) and the
         National Institute of Mental Health (NIMH).

A much more adequate way to sum up the science of psychiatry than psychiatrists do is as the pseudoscience of medical weasel words and the art of manipulation and deception.

It's no great miracle the APA and the NIMH are against Szasz's ideas: Both their personal income and their personal characters and intelligences are in the line of his fire. Why the AMA agrees with the APA and the NIMH I do not know, but presumably it has a lot to do with their all being "doctors of medical science" and with fellow feelings and solidarity, and besides non-psychiatric medical doctors rarely made a serious study of the works of psychiatrists, and tended to take psychiatry on trust, like most ordinary folks do.    Back.  


[M38] A. According to American psychiatrist Allen Frances, Szasz "goes too
         far and draws bright lines where there are shades of gray".

My problems with that are that the shades of gray are manufactured on purpose, and cover an enormous and frightening amount of very dishonest pseudoscientific pretending to understand things. (See: Bullshit and Weasel words and Pseudoscience.)

What Frances oversees or prefers not to mention is that even if the judgments of pychiatrists are surrounded by "shades of gray", the judgments of judges, bureaucrats and GPs are not, and convict persons to madhouses,
to forced treatments, or to no treatments whatsoever other than psychiatric treatments, are all based on the
pseudoscience of psychiatry, the perpetrators of which carefully talk and write in terms of "shades of gray" because they do not want to be found out and do their trade by weasel words, deception, pretense, fallacies and lies.

B. In particular, Szasz is right that schizophrenia is no "disease", but that doesn't mean schizophrenia is a "myth."

I have known several "schizophrenics" - heard voices, had hallucinations, had delusions, were quite unhappy, were hard to deal with, some were dangerous - and they seemed clearly "mad" to me (in commonsensical terms. "sans prejudice", as lawyers write) and indeed, except when in a psychotic phase, were aware of and unhappy with their condition, also before it was identified for them as "schizophrenia". I have also known several people with bipolar disorder, including one artist who refused to take medicines because he liked the manic phases so much, though his depressive phases were quite horrible.

So I believe there are "mad" people, and they may need help, and society may need protection. But then I don't know whether Szasz said "schizophrenia" is a "myth", though he may have.

And indeed, by implication, if "mental illness" is a myth, and "schizophrenia" is a mental illness, then Szasz did say so, logically speaking. If he did so specifically about schizophrenia, he probably meant that none of the theories about it make much sense, as indeed they don't. (This is a subject in which I am fairly well-read, having had schizophrenic friends, and wanting to find out what science said about their condition.)

Then again, I fail to see why "schizophrenia", or some of its forms, cannot be (caused by) a disease of the brain, indeed of unknown aetiology, and I have seen schizophrenics who needed locking up, and indeed were. (One was a friend, who attacked his neighbours with an axe because of what he thought he heard them think inside his own head. I tried to help him at the time, and he knew quite well his thinking and feeling were "diseased", but then he couldn't control himself.)

C. Szasz is quite right that psychiatric diagnosis can be misunderstood and misused, but that doesn't mean it can be dispensed with, Allen Frances says and adds that Szasz is correct in defining many problems related to psychiatric diagnosis, but he doesn't offer alternative solutions.

The first half of the statement at the very least is quite misleading:

Similarly, it might be argued (and has been argued) that while Granville Sharpewas "quite right that" slavery " can be misunderstood and misused, (..) that doesn't mean it can be dispensed with", e.g. (so it was argued, by British judges) because Britain's welfare depends on it.

That is, if it is true that psychiatric diagnosis can be misunderstood and misused something should have been done about it, instead of letting psychiatrists pretend that their pseudoscience is real medical science: It is not.

As to the second half: Why should Szasz offer solutions? That's a plain fallacy: Szasz's criticism is correct, or not, independent from what he might want to put in place of what he criticizes. And if many psychiatric diagnosis are problematic, incorrect, unfounded, or immoral, those are all reasons to be against psychiatric diagnoses, and against psychiatrists making such diagnoses.     Back.


[M39]  In a debate with Szasz, Donald F. Klein, M.D explained:

"It is that elementary fact, that the antidepressants do little to normals, and are tremendously effective in the clinically depressed person, that shows us that this is an illness."

That's a - again - a set of plain fallacies, also apart from the fact that it seems to have been shown that anti-depressives are much more effective than placebos, as mentioned in the Wikipedia article. Also, it seems to have been shown that quite a few antidepressants have long-term and side-effects that are quite unpleasant and dangerous, also in people who are not depressed.

Finally, the set of plain fallacies are that, even granting - incorrectly - that Klein M.D is factually correct:

Firstly, it is the post hoc ergo propter hoc fallacy; secondly, it is the fallacy of weasel words / biased terminology: it doesn't show depression is an illness, only that depression may be removed by certain drugs; thirdly, it is the fallacy of begging the question (that it is an illness again, as depression also may be a healthy reaction to certain experiences or circumstances); fourthly, "elementary" and "tremendously" are manipulative terms.

If Klein M.D had formulated differently, say "that antidepressants seem to help quite a few people supports the notions that depression is real and an illness", he would have had a rational argument. And it still would not be worth much without cleared definition of "depression" and "illness".    Back.


[M40] In the same debate Frederick K. Goodwin, M.D, asserts:

"The concept of disease in medicine really means a cluster of symptoms that people can agree about, and in the case of depression we agree 80% of the time. It is a cluster of symptoms that predicts something."

More fallacies.

First, "The concept of disease in medicine really means a cluster of symptoms" is an arbitrary redefinition of what "disease" means: It does not mean "a cluster of symptoms" at all.

That is either a plain lie or quite dangerous gross incompetence: Symptoms are the visible marks of disease, and allow its diagnosis, but do as little coincide with the disease as fingerprints, that allow identification, coincide with the person they are the prints of.

Second, "that people can agree about" is mere misleading waffle: People can agree or disagree about anything. Besides, the problem with "symptoms" that Goodwin M.D seems to be not even aware of is whether they really are good markers of the disease they are said to be symptoms of, or not, which they often are not, especially in such vaguely defined conditions as "depression".

Third, that "we agree 80% of the time" is more waffle: Who are "we", and so what? If 80% of cardinals agree the pope is infallible because he has a direct phone line to the divinity, does that make it a fact, or does that agreement - all but 2 agreed, in 1871, when the pope was declared infallible - the theory rational?

Fourth, that "It is a cluster of symptoms that predicts something" is again both waffle and - if meant - dangerously incompetent: It is not "a cluster of symptoms that predicts something": It is always a theory, in which such symptoms figure, and then, if rational, as symptoms of a certain disease, that may or not exist, and that may or may not be well-understood, and the existence of which may or may not be a well-founded facr, that allow the making of predictions.    Back.


[M41] Szasz argues that only mental illnesses are defined
         based on consensus and symptom clusters. It has been
         argued this is not the case. Critics claim physical illnesses
         such as Kawasaki syndrome (a disorder of the heart and
         blood vessels) and Ménière's disease(a disorder of the
         inner ear) are similarly defined.

So what? is my response to the unspecified "Critics":

If Szasz is right that most or all "mental illnesses are defined based on consensus and symptom clusters", as indeed is the case with heretics in religion (though torture will undoubtedly clarify the "symptom clusters" that identified the heretical culprit), and if other illnesses are rarely or never defined on a basis of "consensus and symptom clusters", there is a major and important difference between anything called a "mental illness" and all known other illnesses, that normally require an empirically demonstrable pathology, a bodily malfunctioning.    Back.


[M42] There is also the criticism that many physical diseases
          were identified and even treated with at least some
          success decades, centuries, or millennia before their
          etiology was accurately identified. Diabetes is one
          notable example. In the eyes of Szasz's critics, such
          historical facts tend to undermine his contention that
          mental illnesses must be "fake diseases" because their
          etiology in the brain is not well understood.

First see [M12]: I think the term "fake disease" should have been replaced by "hypothetical disease". Taking that for granted, the last sentence is again a fallacy or several fallacies, namely of generalization and equivocation - and besides, Szasz does not say that hypothetical or fake diseases should not be treated: he says they should not be lied about, and and should not presented as factually understood real diseases unless the evidence for that can be demonstrated in a pathology lab or other sound experimental way.    Back.




P.S.
Corrections, if any are necessary, have to be made later.

Mar 3, 2012: I have some problems getting the text fitting in
the tables. The present version seems to work, but needs
reviewing.

Mar 4, 2012: Corrected some, and added some links, but I need
to do more reformatting.

Mar 28, 2012: There was a problem getting the text to fit properly in the textwindow. I hope it is sorted now: It seems to have derived from a setting on the Wikipedia-text I copied.

 

As to ME/CFS (that I prefer to call ME):
1.  Anthony Komaroff Ten discoveries about the biology of CFS (pdf)
2.  Malcolm Hooper THE MENTAL HEALTH MOVEMENT: 
PERSECUTION OF PATIENTS?
3.  Hillary Johnson The Why
4.  Consensus of M.D.s Canadian Consensus Government Report on ME (pdf)
5.  Eleanor Stein Clinical Guidelines for Psychiatrists (pdf)
6.  William Clifford The Ethics of Belief
7.  Paul Lutus

Is Psychology a Science?

8.  Malcolm Hooper Magical Medicine (pdf)
9.
 Maarten Maartensz
ME in Amsterdam - surviving in Amsterdam with ME (Dutch)
10.
 Maarten Maartensz Myalgic Encephalomyelitis

Short descriptions of the above:                

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who understa, but nds ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:
http://www.youtube.com/watch?v=4ErEBkj_3PY&feature=player_embedded

7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.
9. I tell my story of surviving (so far) in Amsterdam/ with ME.
10. The directory on my site about ME.



See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.
 

 
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