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Dropping the medical metaphor
  From "New Statesman," 17 August, 1979
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Anthony Stadlen, MLCP, BCP Reg, UKCP Reg 

From "New Statesman," 17 August, 1979

"Dropping the medical metaphor"
(A response to R.D. Laing's "Round the bend")

Dr. R.D. Laing (NS 20 July) writes: 'But suppose we do drop the medical metaphor. If the rest of us could recognise that what Szasz is propounding are, of course, eternal verities, then psychiatry would disappear, and with it what he calls anti-psychiatry. What exactly would happen next?' He gives Szasz's answer: 'Specifically, involuntary psychiatry, like involuntary servitude, would be abolished, and the various types of voluntary psychiatric interventions would be reclassified and reassessed, each according to its true nature and actual characteristics. Some of these practices might then reemerge as medical interventions, perhaps vis-a-vis persons who do not suffer from demonstrable bodily illnesses -- a practice by no means limited to psychiatry. Most psychiatric practices, however, would either disappear or reappear as ethical and political interventions.' Laing comments: 'It sounds as though it would all be much the same. It makes one wonder what he is making all the fuss about, whether he is not making a sort of fetish out of the medical model, and a scapegoat out of psychiatry.'

Dr Laing's new role as the 'perfectly decent' defender of psychiatry against Szasz's 'insulting and abusive' 'fuss' calls for comment. Laing is saying, unequivocally, that 'it would all be much the same' to him whether involuntary psychiatry be retained or abolished. He is saying 'it would all be much the same' whether voluntary interventions, including his own, are intended as medical treatments for illness or as interpersonal counselling, ethical exploration, existential analysis. He implies quite clearly that he is one of the 'rest of us' who do use the medical metaphor. For one like myself who has never used the medical metaphor in my practice it would indeed be exactly the same if the medical metaphor were dropped. But this is not Laing's position.

I am indebted in my work to Szasz's pioneering work The Myth of Mental Illness (1961) and to Laing and Esterson's Sanity, Madness and the Family (1964) where Szasz's book is acknowledged. Laing and Esterson present eleven 'schizophrenics', first from the medical 'dis-vantage point' and then from a social phenomenological viewpoint. The difference is revelatory. As they say: 'We can now begin to make sense of what psychiatrists still by and large regard as nonsense.' They claim with justice: 'We believe that the shift of point of view that these descriptions both embody and demand has an historical significance no less radical than the shift from a demonological to a clinical viewpoint three hundred years ago.' Dr Laing's present position clearly implies that he now believes his work of 1964 to be gravely mistaken. What reasons have led him to this remarkable conclusion?

Anthony Stadlen, MLCP, BCP Reg, UKCP Reg
64 Dartmouth Park Road 
GB - London NW5 1SN 
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E-mail: stadlen@aol.com

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