"'The myth of mental illness': No phrase has had as profound an impact on public attitudes toward the mentally ill as this provocative title of a 1960 [sic] book by maverick psychiatrist Thomas Szasz . . . Szasz's views were greeted with enormous enthusiasm in the sixties (p. 607) . . . Involuntary hospitalization should be restricted to those who threaten harm to others or who are suicidal (P. 608) . . . But Szasz's challenges have been met. Schizophrenia is an illness because it meets the usual definitions of one. ... it can be reliably diagnosed using clearly defined criteria. Schizophrenia is no myth. What is true for schizophrenia is also true for other forms of mental illness (P. 612) . . . How could Szasz and his disciples have been so wrong about the existence of mental illness? Many of them were bright people; a fair number, like Szasz himself, even had direct contact with the mentally ill.... In part, they were the victims of their time...(P. 614) . . . We can no longer ignore the fact that one of the symptoms of severe mental illness is in many cases a denial that something is wrong. ... Mentally ill persons cannot always be relied upon to seek help when they need it."(P. 615.)--Paul S. Appelbaum, "Mental Illness: No Longer a Myth," The World & I (Washington Times), November 1987, pp. 607-615.

"In principle, the duty to protect is difficult to reject, especially for members of a profession dedicated to assisting others in need. Indeed, I suspect that ... by seeking to guard potential victims of their patients from harm, clinicians as a group would endorse the trend toward broader duties to rescue (P. 104) . . . Mental illness by definition calls the soundness of the mind--and therefore the legal competence--of the actor into question. This perspective ...accounts (in part) for the traditional assumption that consent for treatment need not be obtained from the mentally ill (P. 119)

"Now, more than three decades later, Scheff, Szasz, Laing, and their colleagues are no longer fixtures in psychology and sociology courses. Most college and graduate students have never heard of them or their argument that mental illness is a socially derived myth. Academic critics have picked their arguments apart, and though Szasz, for one, is entirely unrepentant, many theorists who denied the existence of mental illness three decades ago are somewhat embarrassed now about their former beliefs. (p.7) . . . The most extreme views of this sort--often called 'anti-psychiatry'--would have led to much more sweeping changes than actually occurred. Civil commitment would have been abolished rather than restructured, voluntary as well involuntary treatment would have been prohibited . . . " (pp. 213-214). --P.S. Appelbaum. Almost a Revolution: Mental Health Law and the Limits of Change. New York: Oxford University Press, 1994.

"The right to refuse antipsychotic medication is now more than a decade old. ... [R]efusal is not uncommon, but refusing patients appear almost always to receive treatment in the end. These findings point up the essential illogic of allowing committed persons to refuse treatment that would permit their freedom to be restored. " (Pp. 413-414) --Paul S. Appelbaum, "The right to refuse treatment with antipsychotic medications: Retrospect and prospect," American Journal of Psychiatry, 145: 413-419 (April), 1988.

Todd Seavey, formerly of ABC's 20/20 with John Stossel, attacks Szasz and Schaler as "Director of Publications" for the American Council on Science and Health" [cf Transcript of Voice of America Broadcast pitting Schaler v. Elizabeth Whelan and Gilbert Ross, May 31, 2001

[Note: Click here to view a scanned image of the original letter below. "Szasz under fire" refers to Schaler, J.A. (Ed.)(In press.) Szasz under fire: Thomas Szasz faces his critics. Chicago: Open Court Pub. Publication expected in 2002]

HARVARD MEDICAL SCHOOL
DEPARTMENT OF PSYCHIATRY

MASSACHUSETTS MENTAL HEALTH CENTER
74 FENWOOD ROAD
BOSTON, MASSACHUSETTS 02115
TELEPHONE: 617-734-1300 EXT. 476

THOMAS G. GUTHEIL, M.D.
PROFESSOR OF PSYCHIATRY
DIRECTOR OF MEDICAL STUDENT TRAINING
CO-DIRECTOR, PROGRAM IN PSYCHIATRY AND THE LAW

April 18, 2001

Jeffery A Shaler, Ph.D.
School of Public Affairs
American University
4400 Massachusetts Ave. NW
Washington DC 20016

Dear Dr. Shaler:

Dr. Harold Bursztajn passed on to me the invitation to write for Szasz under fire and I in turn have tried to interest others in this, alas, without success. The reasons given are listed below, which may or may not be helpful to you.

Most of Szasz's ideas of the mythical nature of mental illness have been rendered obsolete by genetic studies, imagin, cross-cultural anthropology and the like. While many legal scholars see him as important to that field, the damage he has done to care of the mentally ill has not been carefully assessed and cannot be overestimated. Well-meaning but misguided advocates following his leads have trashed mental health delivery systems in state after state and have clearly contributed to the adversarialization of the mental health advocacy systems. More clearly venal forces from Ronald Reagan to Scientology have been able to draw on his "teachings" to support their causes, again to the detriment of patients.

My own view is that he was popular as a sixties kind of guy, an anti-establishment rebel where the facts he distored were not a problem for the political force of his claims; any smidgin of value he could have had is long eclipsed, and, except as a trip down memory lane, I can see no reason whatsoever why he deserves a book like this, even a mixed one with opposing views. Dr. Szasz is simply no longer worth it.

I regret that neither I nor Dr Burstajn was able to help, nore were our recruiting attempts successful to get any one else to care enough to do it.

Regretfully,
(signed)
Thomas G. Gutheil, MD.

( FLAWED ARGUMENT )
by Arieh Shalev
23 February 2001, posted 24 April 2001

Frankly, I find the Szasz argument flawed, superficial, demagogic and immoral.

It is flawed because since when is medicine exclusively concerned with diseases with known bodily etiology? I have learned that the mission of medicine, within society, is to care for those who suffer. What have we known about epilepsy 100 years ago? How much do we know about migraine at the present day? Should we wait for anatomical proof before we treat a patient with law back pain? And what if X-Rays do not reveal abnormal findings - wouldn't we alleviate the pain ?

It is superficial because it assumes a yes/know type of biomedical knowledge, whereas the truth is that most knowledge is relative - and new mechanisms are being discovered as new technologies emerge. Neuro imaging, in fact, has already 'objectified' some of the processes that underlay mental disorders.

It is demagogic because it emphatically uses concepts out of their proper context. If it is right that Internists will classify internal diseases, based on their knowledge of them why is it wrong that psychiatrists will create a classification of mental disorders. I'll tell you what is the demagogic essence of the argument here: 'Psychiatrists' are inherently bad and therefore should not be trusted with classifying their observations. Whatever 'psychiatrists' see is inherently flawed. Have you heard similar arguments regarding Jews ? Jewish literature ? Jewish Science ? It is also demagogic in that it ignores the fact that psychiatrists do not use the term disease but rather disorder. I personally explain it to each medical student in my department: we call these conditions 'disorders' because we don't have a final physiological proof of their underlying mechanisms

Finally it is immoral because along with claiming high humanitarian standards it offers no relief to humans who suffer (and please, please don't tell me that schizophrenics do not suffer). Indeed, the best that has ever been done for schizophrenics was when, based on presumed bodily dysfunction, people started to look for medication that alleviate their symptoms - and have quite nicely succeeded. I feel amazed, embarrassed and ashamed that passages such as the one that I been sent yesterday (Szasz, 2000) can still seduce intelligent minds.

One thing is to discuss the right of mental patients for freedom and self regulation. Another thing is to deny their need for help and the veracity of their disorder.--Arieh Y. Shalev, M.D., Professor of Psychiatry, Head, Department of Psychiatry, Hadassah University Hospital, Jerusalem, 91120, Israel, Phone (972) 2 6777184, Fax (972) 2 6412642, e-mail ashalev@cc.huji.ac.il

"Another group of critics of addiction are libertarians, who believe that all behavior is intentional and that alcoholism is unfounded at its roots since people choose each drink and exposure to drugs. In other words, there are no grounds on which to separate intensive drug use - or compulsive behavior of any sort - from ordinary intentional behavior (see Schaler, 1999). Peter Cohen (this issue) represents a point of view that has elements of nominalism and libertarianism called constructivism. This view, focusing on data showing that use of powerful drugs like cocaine is so relative, so subject to change, so often controllable or able to be brought under control, agrees with libertarians that addiction is nonexistent, a fabled concept with no real referent.

However, these critics must run for cover when confronted with individuals like David Kennedy (deceased son of Robert Kennedy), Jason McCallum (deceased son of the actors David McCallum and Jill Ireland), or Robert Downey, Jr., who report being addicted and who do not cease their drug use under the most dire threats or actual endangerment of their lives up to and including death. What should we call it when someone like Jim Morrison, of the Doors, repeatedly pours alcohol nonstop down his throat for hours and dies of a heart attack in his twenties? And there are noncelebrity examples of similar behavior. To confront a radical critic who claims addiction does not exist with such a self-destructive individual is to reveal the critic as an academic completely unprepared to deal with addicts.

It is unwise and unnecessary to deny the reality of people's experience - experience that can have crucial, even life and death, effects. People experience compulsions and enact them, leading to serious injury to themselves and others. This is not to excuse such behavior criminally or to accept that it is biologically foreordained. But a notion of addiction is required to respond to critical realities of drug use. Such an addiction concept also serves as a template - as one extreme of a continuum which, while rarely fully realized, sets up a typology the opposite end of which is controlled use. It is also helpful to have this concept in one's repertoire when required to deal with extreme cases of substance abusers - resisting the danger, again, of reifying this into the idea that such a person's behavior is immutable (which may actually exacerbate the problem behavior - Kennedy, McCallum, and Downey had collectively been through chemical dependence treatment many times)." --Stanton Peele, What Addiction Is and Is Not: The Impact of Mistaken Notions of Addiction. Addiction Research, 8:599-607, 2000

"In his May 21 letter commenting on the article ''My Brother Might Kill Me'' (Op-Ed, May 6), Dr. Thomas Szasz writes that the behavior of Jane Doe's brother ''epitomizes the human propensity to injure and kill - in a word, violence.''

Such a statement perpetuates the myth of ''the death instinct,'' long associated with psychoanalysis - which has been irreverently described as the study of the id by the odd - and is a belief of quite ancient vintage. When I was a boy it went by the name of ''innate depravity,'' which placed one particularly at risk on those interminable Sundays so oppressively full of intangible restraints, which somehow made it sinful to listen to secular music or take a walk in the park.

However, as a scientist who has made a lifelong study of the nature of human nature, and especially of the alleged innate aggressiveness of humankind, I find, as many of my colleagues have, that there exists no evidence whatever to support the notion of a ''human propensity to injure and kill.''

It is easy enough to attribute such aggressive behavior to ''propensities,'' and, of course, it explains everything. But the truth is that it is a false view of the origins of human violence, and very damaging, leading to such absurdities as Professor Szasz's recommendation that what criminals need is punishment.

That precisely is what criminals do not need. What they need is understanding - understanding of the conditions that caused them to become criminals together with the correction of those conditions so that there may be no more criminals. Building more jails for punishment is less than helpful; it is to ignore the problem.

What is needed is the building of a society that satisfies the basic behavior and physical needs of every child for growth development and fulfillment, epitomized in the need for love. But how many of us really understand the meaning of that word and its significance for the survival, no less, of our species? It is in the failure to answer that question that our problem lies." --ASHLEY MONTAGU, Princeton, N.J., May 22, 1987, "There Is No Innate Human Propensity to Kill," Letters to the Editor, The New York Times, p. 28, June 7, 1987.

Cathy Young, Contributing Editor, REASON Magazine, on Thomas Szasz and the myth of mental illness.

"On Myths and Countermyths" [PDF file] by Ronald Pies, M.D., excerpt from Archives of General Psychiatry,33:139-144, 1979.

"Unlike Szasz . . . I believe psychiatric disorders distort thought, mood, and judgment, limiting informed choice and leading to outcomes that would not occur in the absence of a potentially treatable illness. Psychiatric disorders, not physicians or families, restrict informed choice in these instances."--Andrew E. Slaby, M.D., Ph.D., clinical professor of psychiatry at the New York University and New York Medical College and past president of the American Association of Suicidology in a review of Fatal Freedom: The Ethics and Politics of Suicide by Thomas Szasz, Psychiatric Services, Volume 52, No. 1, pp. 114-115, January 2001.

"Since mental illness negates our assumption of rationality, we do not hold the mentally ill responsible. It is not so much that we excuse them from a prima facie case of responsibility; rather, by being unable to regard them as fully rational beings, we cannot affirm the essential condition to viewing them as moral agents to begin with. In this the mentally ill join (to a decreasing degree) infants, wild beasts, plants, and stones--none of which are responsible because of the absence of any assumption of rationality." --Michael S. Moore, "Some myths about mental illness," Archives of General Psychiatry, 32: 1483-1497 (December), 1975; p. 1495.

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