It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mental illness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It presents (...) a defence of the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)

Thomas Szasz wrote over thirty books and several hundred articles, replete with mordant criticism of psychiatry. His works made him arguably one of the world's most recognized psychiatrists, albeit one of the most controversial. This book critically examines the legacy of a man who challenged the very concept of mental illness.

Because psychiatry deals specifically with ‘mental’ suffering, its efforts are always centrally involved with the meaningful world of human reality. As such, it sits at the interface of a number of discourses: genetics and neuroscience, psychology and sociology, anthropology, philosophy, and the humanities. Each of these provides frameworks, concepts, and examples that seek to assist our attempts to understand mental distress and how it might be helped. However, these discourses work with different assumptions, methodologies, values, and priorities. Some are in (...) dispute with one another. At various times in the history of psychiatry, a particular form of understanding has become dominant and worked to marginalize .. (shrink)

Szasz argues that the threat of harm to self or others cannot be understood as a symptom of mental illness, and that there is an irresolvable tension between the traditional medical ethical duty to heal, and any notion of a medical duty to protect the public.1 I think these are two distinct arguments which could each be the subject of extended analysis, and this commentary is of necessity limited.Professor Szasz has consistently raised concerns about the political abuse of (...) psychiatry as a way of controlling dissidence. Many of his arguments remain as cogent and unanswered as when they were first put 30 years ago. But as sympathetic as I am to some of his criticisms, it seems to me that many are too sweeping; especially the first claim that there is no such thing as mental illness, but only persons whose expressed intentions involve taking a stance which is contrary to certain social rules.I do not propose here to discuss the so called “hard” problem of consciousness—that is, exactly how brain states give rise to intentional psychological experience, or indeed, the extent to which “brain” and “mental” can be used synonymously. If we accept that mental states give rise to intentions, then different mental states will give rise to different intentions, and there is no reason not to think that there might be abnormal mental states that might give rise to abnormal intentions. The question then is what we mean by the word “abnormal”. Clearly it is possible for abnormal to be defined as “socially inappropriate”, which is Szasz’s concern. In that case, political and social dissidence is then turned into a symptom by the language of medicine, and thus becomes not a social matter, but an individual’s personal problem.But “abnormal” could be defined with reference …. (shrink)

This study of the "radicalization" of psychiatry analyzes the writings of Laing, Foucault, Szasz, and Goffman, constructs a model for understanding mental illness, and emphasizes collective responsibility for the care of the mentally ill.

In Patricia Churchland's 2006 essay on free will, she cites the case of a middle-aged man who, without any prior history of misbehavior, suddenly became obsessed with child pornography and started to molest his 8-year-old stepdaughter. He was subsequently discovered to have a brain tumor affecting the frontal lobes, and when it is successfully treated his aberrant behavior stopped.Thomas Szasz is famous for his denunciation of the concept of mental illness, and his critique is partly responsible for instigating an (...) enduring philosophical discourse about the nature of mental disorder. Szasz's key insight was the recognition that we find it important to distinguish between situations that are characterized by... (shrink)

In a recent paper, it was argued forcefully by Thomas Szasz that it is crucial to the scientific credibility of psychiatry that it abandon talk of the behaviour of the mentally “ill” in terms of causes: such behaviour is not caused by their condition—it simply has reasons, which are discounted by the medical model. It is argued in this paper that Szasz's theory is incomplete for two reasons: first, in assuming that reasons are radically different from causes, it (...) cannot account for the possibility that “sane” behaviour might be just as much caused as “insane”; and second, it tacitly assumes that the origin of behaviour always lies with the agent—a view that arguably is an accident of grammar. Hence while there is no mental illness, this is because there is nothing that could be ill—and this means that there is no such thing as mental “health” either. (shrink)

In this book, psychiatrist Thomas Szasz returns to familiar subjects—the collusion between state and medical authorities, the social construction of mental disease—linking them with some other recent topics: so-called False Memory Syndrome and the modern erosion of individual responsibility. Szasz’s central and unifying thesis is that there is no such thing as the mind; he recommends, rather, that we focus on the concept of minding, where this encompasses a host of cognitive operations, including intentionality, thinking, remembering, pondering, and (...) reasoning. Misunderstanding “the” mind as an entity encourages mind-brain identification, gives rise to the concepts of mental illness and disease, thereby legitimating various treatments, and serves to prevent the attribution of responsibility to those who are, in fact, responsible for their behaviour. In a discussion that sweeps from the ancient Greeks through the Middle Ages to Descartes, and finally to contemporary neuroscience, Szasz contends that we have shifted from attributing minding to too much in nature to failing to attribute minding at all. He charges that a combination of brain research and bad philosophy—the Churchlands come in for considerable criticism—has rendered the concepts of the person and of personal responsibility close to otiose. (shrink)

Recent Contributions to the Sociology of Sex: The Limits of Sex by Celia Haddon, London: Michael Joseph, 1982, pp 202, £7.95 Sex. Facts, Frauds and Follies by Thomas Szasz, Oxford: Basil Blackwell, 1981, pp xii + 194, £3.95 Sexual Fiction by Maurice Charney, London: Methuen, 1981, pp xii + 180, £2.95 The Sexual Fix by Stephen Heath, London: Macmillan, 1982, pp191, £4.95.

Maxime F. Giguère Cet article propose une nouvelle stratégie pour écarter la conclusion sceptique, mise de l’avant par Thomas Szasz, selon laquelle la psychiatrie est illégitime. La conclusion sceptique repose sur une démarcation radicale entre troubles mentaux et somatiques. Afin de minimiser cette démarcation, Jerome Wakefield emploie une analyse conceptuelle stipulant que les troubles mentaux et somatiques sont tous les deux des dysfonctions préjudiciables. De récentes critiques ont toutefois montré que son analyse bute sur la difficulté pratique de distinguer (...) les fonctions normales des dysfonctions. En raison de ce problème, l’analyse de Wakefield ne permet pas d’écarter la conclusion sceptique. Une nouvelle stratégie ne nécessitant pas de résoudre le problème reconnu par ces critiques s’annonce alors préférable pour écarter la conclusion sceptique. (shrink)

Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz’ claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz’ discussion of psychotherapy in order to uncover the strongest version of his case for (...) thinking that it is a myth. As we’ll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

Thomas Szasz''s emphasis on goal-oriented behavior and moral responsibility has raised profound theoretical questions about an ancient and enduring problem in philosophy, the relationships amongfree will, determinism, and moral responsibility. Two early thinkers, Jonathan Edwards and Aristotle, have both contributed to an understanding of this dilemma. Edwards (1754) demonstrated that the concept of man as a moral agent and the doctrine of philosophical necessity are inextricably intertwined, in opposition to the tenets of contingency, moral indifference, and self-determining volition. However, (...) his argument rested on efficient causationalone. For further light on the problem we can turn to Aristotle''s writings, notably the distinguishing criteria of the practical sciences (including psychology) as opposed to the theoretical and the productive sciences; and multiple causation, one of the most powerful tools for intellectual analysis ever invented, which includes material, formal, and final causes as well as the efficient cause. The implications of Szasz''s work force a re-examination of the contributions of both Edwards and Aristotle and make them relevant to contemporary psychiatry. (shrink)

Thomas Szasz's emphasis on goal-oriented behavior and moral responsibility has raised profound theoretical questions about an ancient and enduring problem in philosophy, the relationships amongfree will, determinism, and moral responsibility. Two early thinkers, Jonathan Edwards and Aristotle, have both contributed to an understanding of this dilemma. Edwards (1754) demonstrated that the concept of man as a moral agent and the doctrine of philosophical necessity are inextricably intertwined, in opposition to the tenets of contingency, moral indifference, and self-determining volition. However, (...) his argument rested on efficient causationalone. For further light on the problem we can turn to Aristotle's writings, notably the distinguishing criteria of the ‘practical’ sciences (including psychology) as opposed to the theoretical and the productive sciences; and multiple causation, one of the most powerful tools for intellectual analysis ever invented, which includes material, formal, and final causes as well as the efficient cause. The implications of Szasz's work force a re-examination of the contributions of both Edwards and Aristotle and make them relevant to contemporary psychiatry. (shrink)

Thomas Szasz, the radical critic of state-supported psychiatry, and root and branch sceptic about mental illness, died in September 2012. Based on the obituary1 and editorial comment in The Lancet2 and the response his work commonly elicits, it is evident that there will be mixed reviews of his impact and of the cogency of his position.Certainly, some have seen him as a notable figure from the past. There is a sense in which, as far as Szasz's critique of (...) psychiatry goes, it did not really change at all in its essence from the time it was first explicitly expressed in his writings of the 1960s right up to his last publications and talks in the 2010s. He started his 1960 paper The Myth of Mental Illness3 with the assertion that there is no such thing as mental illness, and this has been an underlying pedal note to all his many pronouncements in this area ever since. Personally, I have always found his written interventions in debates right up to the present to be highly readable and intellectually sharp; he was adept at creating variations on the Szaszian theme. In one of his earlier book length texts, The Manufacture of Madness,4 he likens the contemporary idea that people have mental illness to the historical idea that some people were witches, and he parallels the institutions of modern state-supported psychiatry to those of the Inquisition. In articles he later published in the Journal of Medical Ethics, he likened mental illness to ‘phlogiston’—the non-existent substance that supposedly explained combustion5 and claimed the term ‘mental …. (shrink)

Thomas Szasz has wrestled with the following question: Does mental illness even exist? Here, I sketch two provocative papers by Szasz and detail his reasons for criticizing the concept ‘mental illness.’ I will proceed to highlight where I think Szasz’s writing is philosophically dubious, despite its role in forcing us to think critically about ‘mental illness.’ I will conclude that his argument is best left behind as an antiquated take on neurodivergence. Finally, I will propose what I (...) think is a more promising alternative to Szasz’s view that there is a myth around mental illness. There is a myth indeed, and it involves what is often meant by ‘mental.’ With new developments in embodied cognition, I will ask us to revisit the concept of ‘mental illness,’ to correctly diagnose the problematic myth that must be confronted by the psychiatric community, and to explore what the myth of the mental means for neurodivergence. (shrink)

The paper by Szasz is about mental illness and its meaning, and like Procrustes, who altered hapless travellers to fit his bed, Szasz changes the meanings of words and concepts to suit his themes.1 Refuting the existence of “mental illness”, he suggests that the term functions in an apotropaic sense. He submits that in this sense it is used to avert danger, protect society, and hence justify preventive detention of “dangerous” people.But his arguments misrepresent the precise meaning of (...) the term “apotropaic”, which is an adjective, defined in Webster’s, Chambers and the New Shorter Oxford dictionaries as averting or turning aside evil. It is possible that amulets and incantations ward off evil, in the same way as garlic repels vampires, but evil and danger are different concepts. Yet Szasz talks of using phrases like ‘“dangerousness to self and others’ as apotropaics to ward off dangers we fear”, and the word “evil” does not appear in his paper.I will argue that “dangerousness to self and others” and “psychiatric treatment” have a prosaic rather than an apotropaic function.The word “danger” is familiar rather than arcane, and includes many risks. A predatory paedophile is usually both dangerous and evil, but many dangerous people are not evil. For example, a child who plays with a box of matches is dangerous, as is a demented person who drives a car, or a schizophrenic who, acting on delusional beliefs, arms herself with a knife and roams the streets believing she is an avenging angel.Suppose …. (shrink)

In his response to Szasz' Secular Humanism and Scientific Psychiatry, the author considers the use of rhetorical devices in Szasz' work, Szasz' avoidance of acknowledging psychiatry's scientific distinctions, and Szaszian libertarianism versus liberalism.

Hayek's substantial contribution to theoretical psychology has been addressed in the work of Thomas Szasz, Gerald Edelman, and Joaquin Fuster.

The present paper constitutes a development of the position that illness, whether bodily or mental, should be analyzed as an incapacitating failure of bodily or mental capacities, respectively, to realize their functions. The paper undertakes this development by responding to two critics. It addresses first Szasz’s continued claims that (1) physical illness is the paradigm concept of illness and (2) a philosophical analysis of mental illness does not shed any light on the social and legal role of the idea. (...) Then, in reply to Wakefield, the aim is to defend the account as an interpretation of Aristotle and to argue that this Aristotelian view of mental illness is preferable to one that rests on a supposed value free account of human function. More generally the discussion points to the fact that both Wakefield and Szasz rely on a number of metaphysical assumptions about the supposedly empirical nature of medical diagnosis, about the relation between facts and values, and about mind and body (among others), which are open to challenge. In particular the paper indicates an aristotelian approach to the fusion, in the natural world, of so-called facts and values, and the relevance of this fusion to the analysis of the concept of illness. This suggests the debate over distinct conceptions of that concept must both illumine and be illuminated by these deeper metaphysical questions. (shrink)

Whether psychopathy is a mental disease or illness can affect whether psychiatrists should treat it and whether it could serve as the basis for an insanity defense in criminal trials. Our understanding of psychopathy has been greatly improved in recent years by new research in psychology and neuroscience. This illuminating research enables us to argue that psychopathy counts as a mental disease on any plausible account of mental disease. In particular, Szasz's and Pickard's eliminativist views and Sedgwick's social constructivist (...) account of mental illness that might exclude psychopathy are not plausible, and there is no reason to exclude psychopathy under Boorse's and Scadding's biomedical accounts, Wakefield's harmful dysfunction account, and the DSM-IV-TR objective harm account of mental disease. The basic reason is that psychopathy involve neural dysfunction that increases risk of serious harm and loss to people with psychopathy. (shrink)

A venerable view, still very much alive, holds that human action is to be explained at least in part in terms of beliefs and desires. Those who advocate the view expect that the psychological theory which explains human behavior will invoke the concepts of belief and desire in a substantive way. I will call this expectation the belief-desire thesis. Though there would surely be a quibble or a caveat here and there, the thesis would be endorsed by an exceptionally heterogeneous (...) collection of psychologists and philosophers ranging from Freud and Hume, to Thomas Szasz and Richard Brandt. Indeed, a number of philosophers have contended that the thesis, or something like it, is embedded in our ordinary, workaday concept of action. If they are right, and I think they are, then insofar as we use the concept of action we are all committed to the belief-desire thesis. My purpose in this paper is to explore the tension between the belief-desire thesis and a widely held assumption about the nature of explanatory psychological theories, an assumption that serves as a fundamental regulative principle for much of contemporary psychological theorizing. This assumption, which for want of a better term I will call the principle of psychological autonomy, will be the focus of the first of the sections below. In the second section I will elaborate a bit on how the belief-desire thesis is to be interpreted, and try to extract from it a principle that will serve as a premise in the argument to follow. In the third section I will set out an argument to the effect that large numbers of belief-desire explanations of action, indeed perhaps the bulk of such explanations, are incompatible with the principle of autonomy. Finally, in the last section, I will fend off a possible objection to my argument. In the process, I will try to make clear just why the argument works and what price we should have to pay if we were resolved to avoid its consequences. (shrink)

This chapter examines naturalistic accounts of mental disorder: accounts that define disorder as biological dysfunction. There are three such accounts: an eliminativist account ; a forward-looking or goal-contribution account and a backward-looking or evolutionary account. I argue first, and contra Szasz, that biological functions can be attributed at a mental level. But our mental architecture might simultaneously support many different ways of attributing function claims, which might undermine a strong naturalism about mental disorder. Second, I argue that Boorse's forward-looking (...) account of disorder as dysfunction is not value-free. Third, I argue that Wakefield's backward-looking account does not accurately map onto our disorder judgments or medical purposes. I conclude that whilst Boorse's forward-looking account of disorder as dysfunction tracks medical usage better than Wakefield's evolutionary account, a truly value-free account of mental disorder cannot be sustained. (shrink)

The problem of names of illnesses is both a problem of words and values that should address not only the classification of disorders, but also a fundamental question both for medical sciences and humanities: can psychiatric nosology and classifications fit with the ontological constitution of human beings? This paper aims to discuss the so-called “psychiatric object” and its language and it intends to provide a hermeneutical-phenomenological account to mental health. In doing so, the paper will firstly examine the “psychiatric object” (...) and its language; secondly, it will show the difference between taxonomy and ontology, both of interest for the psychiatric object; third, it will insist on the critique of the epistemological status of psychiatry conceived from a natural point of view following three main paths: a metaphysical one (Heidegger, Jaspers), a social one (Szasz, Foucault, Basaglia), and an ethical one (Laing). Finally, it will clarify why phenomenology and in particular hermeneutical-phenomenology can illuminate the understanding of the psychiatric object and its implications in a cultural context, in order to achieve a more humanistic psychiatry. (shrink)

This chapter offers a novel defence of Szasz’s claim that mental illness is a myth by bringing to bear a standard type of thought experiment used in philosophical discussions of the meaning of natural kind concepts. This makes it possible to accept Szasz’s conclusion that mental illness involves problems of living, some of which may be moral in nature, while bypassing the debate about the meaning of the concept of illness. The chapter then considers the nature of schizophrenia (...) and the personality disorders (PDs) within this framework. It argues that neither is likely to constitute a scientifically valid category, but that nonetheless their symptoms can be scientifically explained. It concludes with a discussion of the way in which Cluster B or ‘bad’ PDs involve failures of virtue or character, and argues that this does not preclude them from being appropriately treated within contemporary, multidisciplinary, mental health services. (shrink)