Déja vu 20 February 2001

Anthony Stadlen, BCP Reg, UKCP Reg,
Existential psychotherapist in private practice; teacher of psychotherapy.
London Centre for Psychotherapy; Regent's College School of Psychotherapy and Counselling, London.

Send response to journal: http://bmj.com/cgi/eletter-submit/322/7278/95

Re: Déja vu

Email Anthony Stadlen, BCP Reg, UKCP Reg:

Dr Summerfield's paper (1) contains some reasonable ideas. The most telling response has been that of Grace Heckenberg, who asks: "After being cast into a subhuman role by perpetrators and sometimes also those who witnessed the abuse without taking steps to rescue the victim, why would victims of abuse seek more dehumanization through psychiatric judgments which require that self respect be completely stripped away?" (2)

But it is bizarre, and a disgrace to scholarship; shocking, though not surprising; that neither Dr Summerfield's paper nor any of the responses to it mentions the work of Professor Thomas Szasz. It is Szasz who has revolutionized thinking on so-called 'mental illness'. He published his groundbreaking book, 'The Myth of Mental Illness' (3), more than forty years ago. He referred to so-called PTSD, for instance, in his 1987 book, 'Insanity: The Idea and its Consequences' (4, pp. 205-6). Indeed, he discussed and denounced not only the alleged 'mental illness' PTSD but also another alleged 'mental illness', namely, 'factitious PTSD'. This latter 'illness' was said to cause those whom it struck to claim, falsely, that they were suffering 'symptoms' due to their having been in combat in Vietnam; some had never even been in Vietnam! Szasz quotes the psychiatrists, Edward Lynn and Mark Belza, discussing the "etiologies of the disorder and the underlying pathology and . . . recommendations for diagnosis and treatment" (5).

I telephoned Dr Summerfield to ask why he made no acknowledgement of Szasz's seminal work in this field. Dr Summerfield confirmed his awareness of Szasz's writings, such as 'The Manufacture of Madness' (6) and a 1991 paper (7) in 'The Lancet', with the title, 'Diagnoses are not diseases'. I pointed out that Dr Summerfield's own paper contained the 'summary point': 'A psychiatric diagnosis is not necessarily a disease'. I asked whether this was not an almost unchanged, unacknowledged quotation of the title of Szasz's 'Lancet' paper of 1991. Dr Summerfield's reply was: "Well, it's also a quotation from me."

Eventually, Dr Summerfield did show some remorse, and said that my rebuke was justified. But he tried to justify the omission of Szasz by arguing that the 'British Medical Journal' was not for experts. However, it is surely above all for non-experts that the leading figures in the field should be indicated; though decency, honesty and scholarship require this in any case. Did this not occur to anyone at the 'British Medical Journal'? What function does the failure to cite Szasz (of which Dr Summerfield's failure is merely the latest instance) serve for medicine and psychiatry?

I notice that Dr Summerfield's paper is listed under the heading, 'Imitation is the sincerest flattery', at The Thomas S. Szasz, M.D. Cybercenter for Liberty and Responsibility (8).

1. Summerfield, D. (2001) The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. British Medical Journal, 322: 95-98.

2. Heckenberg, G. (2001) Appreciation from a survivor. BMJ rapid response to Summerfield (1). (29 January 2001).

3. Szasz, T. S. (1961) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Paul B. Hoeber.

4. Szasz, T. S. (1987) Insanity: The Idea and its Consequences. New York: John Wiley.

5. Lynn, E. J. and M. Belza (1984) Factitious posttraumatic stress disorder: The veteran who never got to Vietnam. Hospital and Community Psychiatry, 35 (July 1984): 697-701.

6. Szasz, T. S. (1970) The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. New York: Harper Row.

7. Szasz, T. S. (1991) Diagnoses are not diseases. The Lancet, London, 338 (December 21/28): 1574-1576.

8. http://www.szasz.com/imitation.html