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The Myth of Mental Illness
Submitted by Scott Scheule on Mon, 2008-01-07 12:48.
Bryan Caplan's a proclaimed Szaszian, which I take it means he believes mental illness is mythical. To that end, he draws our attention to an example.
The LA Times recently ran a front-page story on Tiffany Sitton, a 23-year-old schizophrenic girl. Its official position, of course, is that Sitton is a victim of a disease. But the details of the story paint a different - and rather Szaszian - picture.
If you read the story, you'll notice that this "victim" is strikingly self-motivated. Sitton's hallucinations and delusions strangely fail to affect her ability to do the things she really wants to do - like obtain narcotics:
After Tiffany got out of juvie, she ran away, hitchhiking to Los Angeles, where she lived on the streets, eating uncooked ramen noodles and using any street drug she could find.
...
The article notes, of course, that drug abuse is common among schizophrenics:
Like many schizophrenics, she had also been a serious drug abuser: heroin, Vicodin, by her account just about anything that came along.
If schizophrenia were "just another illness," this would be an amazing - and strange - correlation. If, however, schizophrenia is a linguistic excuse for bad behavior, largely focused on relatives who won't exercise their exit option, it makes perfect sense.
Even as anecdotal evidence, Caplan can't wring the conclusion he wants out of this example. Just because a schizophrenic is able to function and achieve certain goals--in this case, obtaining and utilizing drugs--does not come close to disproving (or redefining) the disease. Epileptics, autistics, and depressives all function well, too--is epilepsy simply a "linguistic excuse" for people who like to jerk their limbs about?
I'm not even sure what Caplan's actual position is. Does he believe that the young lady here was lying about the ghosts that whispered malignant orders to her or the spiders that burrowed under her skin? (Note Caplan doesn't mention these symptoms.) Or that she's telling the truth, but this isn't properly categorized as a disease? Or that such voices and arachnids are really tormenting her? Does he believe she's simply a drug addict who behaves poorly--does he believe that's what schizophrenia is?
Far more plausible that schizophrenics take drugs as a means of coping with their illness.
I'm perfectly willing to hear an argument for Caplan and Szasz's position: at present, it sounds ridiculous. Even if one girl lies about hearing demons, it's nonsense to believe this explains the entirety of diagnosed schizophrenics. Alternatively, Caplan thinks the girl is telling the truth but doesn't want to call it a disease--but c'mon, she feels non-existent spiders itching around subdermally. If that's not an illness, please, what is?
(Note Caplan is a strenuous advocate of deferring to experts. Given what I imagine is the consensus of psychologists--i.e., schizophrenia is real--it is curious he has seized such an odd example to ignore his own advice.)
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An interesting question
The idea that people are wrong in the head has been abused in the past and will be abused in the future. This leads some of us to ask: what, if any, constitutes a mental illness - as opposed to, say, an inconvenient personality type, or undesirable behavior? We've been through this with homosexuality. Homosexuality was at one time considered a disorder, but today is considered an orientation - one which some people dislike (the same ones who, presumably, were previously behind the idea that it was a disorder). Now it is the dislikers who are marginalized in polite society ("homophobes"), not the homosexuals. Maybe the tables will be completely turned and "homophobia" might be thought of as a treatable mental disorder.
Caplan's blog has some comments which argue that there is such a thing as a genuine mental disorder. Here's one argument:
"Not only has schizophrenia been shown to have a strong biochemical component; abnormal brain activity is visible on modern imaging instruments."
This type of argument, however, runs in circles. What makes the brain activity "abnormal" is its association with symptoms we consider abnormal. Doubtless people who have different personality types often have measurably different brain structure and chemistry. How do we go about drawing a line and calling one particular structure/activity/chemistry "abnormal"? Surely we in fact do so on the basis of its association with observable behavior that we consider to be abnormal. So the argument from abnoraml activity/chemistry/structure simply does not fly. It just runs in circles.
Normality
Any definition of an illness has to focus on a definition of normality. This is true for mental illness, but I think also for the common cold or the flu. The cold is considered an illness because we cough abnormaly, produce an abnormal amount of mucus, display an abnormaly high temperature, and our cells spend time reproducing abnormal code. All of these can be abnormal behaviors could very well be labelled as different body preferences. Given that I have a cold, my body prefers to produce mucus.
The immediate objection is that in the case of the cold, there is an identifiable external agent that creates this change of preference. But
a) Not all physical illness is caused by an external agent (genetically inherited diseases)
b) Not all mental illness are endogenic
Therefore the distinction is artificial and we land back on having to define normality. The human body's norm is to live without the cold virus, therefore our reaction to it can be labelled an illness.
Claiming that mental illness are "alternative preferences" is merely tautological.
Darn you Arthur
By replying while I was adding (yet more) bits to my comment you blocked me from adding stuff. So I will add it here:
Now, one might argue that the same might be said of a physical illness.
Indeed. But in the case of a physical illness, it really doesn't matter
how we classify it, because what really matters in any case is the
patient's desire. If the patient is in state X and desires to be in
state Y, then that's all the doctor really needs to go on. X might be
"cancer". Most people do not want to have cancer. They would rather be
cancer-free. Given that they feel this way, it hardly matters whether
cancer is an "illness". It is something the patient wants to be rid of.
That should be enough.
So what's different about mental illness? As far as I can tell, the
key issue is coercion. Mentally ill patients are subjected to coercive
control. That is not what happens to cancer patients. Mentally ill
patients are coercively controlled presumably because their capacity to
choose is itself "disordered". Anyway, I think that's key and has to be
kept in mind.
For what it's worth, people
For what it's worth, people with infectious diseases are sometimes coerced, not for their own benefit, but for the benefit of others. I say this only to demonstrate that the issue of coercion isn't unique to mental illness, but to physical (non-mental) illness as well. And further, the issue of coercion can be distinguished from the issue of determining the legitimacy of mental illness diagnoses as well.
Maybe so
But the same issue does not arise, because we would have the quarantine even without any diagnosis of "physical illness". A purely factual description of the infectiousness and the symptoms, without any judgment of whether this constituted an "illness", really is all that is needed to determine whether or not a quarantine is necessary. Adding that these symptoms constitute an "illness" really doesn't add anything. Compare:
Statement A: "If you stand next to this person for one hour, there is an X percent chance that you will begin bleeding profusely and then be dead within a day."
Statement B: Same as statement A with the addition that this constitutes an "illness".
Statement A is sufficient reason to quarantine the person. The question of whether a set of symptoms constitutes an "illness" really doesn't enter into it in any fundamental way. And so the question of whether the infectious disease is a "disease" or an "illness" is moot, superfluous. It's unimportant.
If you look at the concerns that Szasz has, you'll see that he's interested in cases where the diagnosis of illness is key to the political outcome. The mere description of the behavior is not enough by itself to trigger any particular political result.
You might, of course, argue that the mere description of the symptoms, without any presumption that those symptoms constitute a "mental illness" of any sort, would be enough to trigger political results. Maybe. However, that would need to be argued.
Reply to Arthur's comment
OK, here's an actual reply to your comment.
As you might guess from the continuation which you so rudely interrupted, the key to the cold and the flu is that the patient wants to be rid of it. The key is the patient's will. If a virus made me smarter, I would not want to be rid of it. If it made me live longer I would not want to be rid of it. So what matters is not its alienness, nor does its "abnormality" matter (a person who will live to be 200 is "abnormal" in the sense of departing from an identifiable "norm" but is unlikely to consider himself "ill" - not unless there are undesirable side-effects of the life-extension, in which case the key here is undesirability. Thus the key is, once again, the patient's will, the patient's choice.
Normality is not it.
Brain slug
Assume you are attacked by a brain slug. Should I remove it ?
More realistically, some parasites are known to alter behavior, some species are made suicidal by Toxoplasma gondii. If there were such a parasite for humans, should we treat it?
Depends who you ask
I could contract with you now to remove the brain slug in case I am attacked. But if you're not quick enough, the me-with-brain-slug may contract with an agency to prevent you from removing the slug.
Similarly, if homosexuality is caused by a virus, does that make it an illness? Should homosexuals be reversed? Even if they don't want to be?
Like I said, it's an interesting question.
Addition - I am not in favor of coercively preventing suicide. If someone feels suicidal but wants my help, that's another story. A lot of people are depressed, and a lot of those choose to be treated for their depression. Depression is not a state that they want to remain in.
That is indeed an
That is indeed an interesting question. I remember you mentionned in an argument about people's preference in a previous thread. The contract you mention would be considered invalid by Rothbard because of the inalienability of the will, but, like Block, I don't buy that argument.
I do not think it is relevant however to analyse the szaszian claim that they are no mental illness. You define an illness as an unwanted behavior of the mind or the body.
- This might not be a definition fitting the intuition of an illness. Someone who wants to commit suicide because he got infected by a worm can obviously be considered ill.
- One can have unwanted mental behavior. I crave for fat and sugary foods all the time and I would like to get rid of that desire.
Awards!
Quickest jump to the topic of brain slugs in a comment thread ever! I believe our previous record was a brief 3 hours--soundly demolished today!
Just to clarify
You define an illness as an unwanted behavior of the mind or the body.
My intention was not to define "illness". My point was that the question is largely moot, because people will ask professionals to treat undesirable conditions (e.g., cancer, sagging skin). The distinction between treating an illness and plastic surgery surely exists in ordinary language, but my point is that it's not a critically important distinction from the point of view of what people do. People who want condition X to be treated will get condition X treated; people who don't, will not. In every case, the patient's will, his/her desire, is being respected and catered to.
Where it becomes critically important is in the case of a mental illness which is presumed to affect the will. And the reason it is critically important is that it is part of the practice of treating mental illness to disregard the will of some of the mentally ill, to coerce them. I think a serious discussion of mental illness really should keep that in mind.
Whether you call an ugly nose an "illness" is not really all that important, because it doesn't really affect our decisions all that much. Whether you call someone mentally ill is (potentially) extremely important, because it may determine whether you incarcerate him against his will, treat him against his will, etc.
Howver, to the extent that diagnosing a mental illness does not decide whether a person's will is disregarded, then the need to make a decision about where to draw the line is not so critical.
So I think this is about coercion.
Mental illness is political
To decide whether a person is mentally ill is (sometimes) to decide whether to coerce them. So, it is to make a decision about when to apply coercion. Questions about when to apply coercion are political questions.
At least, for many years in my mind this has been the essence of politics. Politics is about when to apply coercion. That point occurred to me years ago, and I was not thinking at all about mental illness, I was just trying to boil down the topic of politics to its essence. Anyway, to my mind, this has been pretty much the definition of politics. (A more usual definition about politics is that it is about "the state", and what the state does; however, when I started seriously considering the possibility of anarchy, I needed to come up with a more general concept of politics.)
Anyway, I hope that this idea, that politics is about when to apply coercion, does not seem too alien to whoever is reading this. Anyway, if you agree with this idea, then it follows immediately that a decision about whether a person is mentally ill is (sometimes - often?) a political decision.
If we leave this decision in the hands of "experts", then we are handing experts political authority. We are allowing them to make political decisions. This is a political stance.
Does this mean we're closer
Does this mean we're closer to having religion defined as a mental disorder?
Har
Doubt it. So far as the more wild strains of it go, one's already considered crazy by everyone except Caplan and Szasz. If you're seeing angels where no one else is seeing angels, you're probably nuts. But the religious are more than able to present more reasonable variants of their belief--easily ducking the DSM-IV.
Re: The Myth of Mental Illness
Scheule: Even if one girl lies about hearing demons, it's nonsense to believe this explains the entirety of diagnosed schizophrenics.
I can't vouch for Caplan's views, but certainly Thomas Szasz has never claimed anything of the sort.
Scheule: Alternatively, Caplan thinks the girl is telling the truth but doesn't want to call it a disease--but c'mon, she feels non-existent spiders itching around subdermally. If that's not an illness, please, what is?
Smallpox is a disease. Feeling non-existent spiders itching around under your skin is a hallucination, not a disease.
Depending on the breaks, the hallucination may be a symptom of some identifiable neural disease. Or it may not be. Lots of well-defined neuropathologies can result in hallucinations, such as Parkinson's disease, or brain tumors, or for that matter the syndromes that result from certain kinds of drug abuse. But lots of unpleasant things can also happen to your body without being to anything that you could call a "disease." If you intend to bring in the medical model, it's up to you to explain what the disease actually is and produce some evidence that it's present in this case.
You might say, "Oh, well, the disease here is schizphrenia." But just referring back to a term explicitly defined through a grab-bag of loosely-related symptoms, rather than in terms of etiology, doesn't cut much ice. Since schizophrenia is defined in terms of things like the experience of hallucinations, citing it as the explanation for hallucinations is either tightly circular, or at best an unbacked promissory note for a physiological explanation, rather than the explanation itself. It's hard for me to see what function, if any, pseudomedical terms like "schizophrenia" serve in helping us to understand what's going on with someone like Tiffany Sitton.
I can't vouch for Caplan's
The wikipedia entry on Szasz clearly states he believes schizophrenia is a "fake disease." It may be wrong; please let me know if it is. If what you mean is that Szasz doesn't claim that all diagnosed schizophrenics are liars, then what is the alternate explanation? That they really see spiders, no? So either Szasz believes what I characterized him as believing, or, he believes seeing spiders that aren't there isn't a disease (or symptomatic of a disease). Either way, the position seems ridiculous.
If you want to get into the semantic niceties of the difference between a disease and a symptom, then you go for it, and you go for it alone. I'll pass: it seems neither useful nor fun.
My point remains that seeing spiders that aren't there is not, as Caplan claims, merely "bad behavior." Do you, or Szasz, disagree?
Fake diseases
Yes, he does, as do I. But you seem to have grossly misunderstood what that means.
Szasz does not deny that there are people who really have hallucinations. As a practicing psychiatrist he has often treated people who had persistent hallucinations. What he denies is the popular pseudomedical theory that mainstream psychiatrists use to explain those experiences--the theory that they are "symptoms" of a single, identifiable disease, called "schizophrenia."
Back in the 19th century, psychiatrists believed that there was a mental illness called "hysteria," which they used to explain all kinds of experiences that many women of a certain class reported having -- emotional fragility, psychosomatic reactions, inability to enjoy sex, etc. Nowadays most psychiatrists regard "hysteria" as a bogus diagnosis. That doesn't mean that they deny that many woman experienced certain kinds of emotional fragility, or psychosomatic reactions, or were unable to enjoy sex. Rather, they now realize that there were various explanations for these experiences, some personal, some medical, and some cultural, and that these experiences were not best understood as common symptoms of some single, identifiable disease. Szasz believes the same thing about "schizophrenia," and in fact about the category of "mental illness" broadly.
I don't want to be rude, but Szasz has spent a great deal of time making this point carefully in his writing, both in articles and in book-length treatments of the topic. Maybe you would be better off engaging with what he says there, rather than trying to puzzle out his views from the brief descriptions in a WikiPedia article?
The claim that hallucinations aren't necessarily symptoms of an underlying disease is certainly not ridiculous; in fact it's true, and easily demonstrated. For example, you can get hallucinations right now, without having anything that could be identified as a "disease." For example, by depriving yourself of sleep for a long period of time, or by consuming a lot of liquor.
Now, for all I know, and for all that Szasz says, it may well be that there is some neural disease that explains Tiffany Sitton's hallucinations. But if so, then it's incumbent on those who propose that explanation to give a description of the disease, its etiology, and its causes, and to give some evidence that Tiffany Sitton has it. For the reasons I explained, just saying "schizophrenia" doesn't count as such giving such a description. "Schizophrenia" is defined in such a way that that does no more explanatory work than if you had said, "Tiffany Sitton has hallucinations because she has the hallucination-causing disease."
This is a crude strawman. Caplan doesn't claim that having hallucinations is "bad behavior." If you think that he has, you have misread him very badly. What he suggested is that "schizophrenia is a linguistic excuse for bad behavior." Again, the issue here is the use of the category "schizophrenia," not the specific experiences that she reports having. What he's challenging is the use of a psychiatric diagnosis to excuse specific behaviors (e.g. drug abuse and inflicting emotional suffering on her mother). Not the claim that she really does have hallucinations about spiders.
Szasz
"But you seem to have grossly misunderstood what that means."
I read some Szasz once and he's one of those writers who seems to go out of his way to be misunderstood. You are making a hell of a lot more sense than what I was reading directly from Szasz. I don't remember the book or article unfortunately. I did get the distinct impression he was pushing the idea that their isn't any such thing as being crazy. So I can see where others would "misinterpret" his ideas.
Oh, and on that note. When I was reading Ayn Rand I took her at her word that she didn't mean "selfishness" but instead "enlightened self interest" when she used the term selfishness. Which made her texts make a lot more sense. However, I could see where someone might not be able to get past that to see where she was being semi-reasonable. Unfortunately, upon reading some biographies of people who actually experienced her behavior first hand I reassessed my understanding of what she was saying. I read it giving her less benefit of the doubt. It turns out she really did mean "selfishness" after all, which is made her entire philosophical enterprise not merely wrong but in a way evil.
So I don't trust writers who go out of their way to be misunderstood.
Your writing does not have the flavor I got from Szasz.
Caplan doesn't claim that
Ah. That makes more sense.
As to badly misreading him--that may well be, but in my defense, I'm not the only one to do so.
Are You Schizophrenic or Crazy ?
Perhaps the name schizophrenia is an example of pseudo- explanation. Giving something a name serves two purposes. It enables multiple persons to refer to a phenomenon and at least have some idea that they are talking about something in common. It also serves the purpose of putting something which is inexplicable it an intellectually and emotionally satisfying cubbyhole. As Rad Geek points out,this can be meaningless because it is circular.
I have experiences being puzzled by something I saw and believe me it is uncomfortable to be in that position. Then someone will come along and say,that is X. This really feels good. Now whenever I see that I will call it X.
Medicine is full of these descriptors. Examples include purpura simplex. (Skin hemorrhages of no apparent cause) Utero-placental insufficiency. (Baby is born dead for no apparent reason.) ,and Drapetomania ( a mental condition causing slaves to run away)
The first two have no political implications and are hence non-controversial even if non- explanatory. The last is obviously an abuse of science for political purposes. Is schizophrenia an example of the latter? The suspicion that it is has vaulted Szasz to fame.
If you read a medical textbook instead just the works of Szasz, you will not think that is just a frivolous made up condition. It is a cause of major suffering which can usually be alleviated by medicines and counseling. It takes years off of the lives of many people.
I have had contact with several "schizophrenics"
1.) A guy becomes hyper-religious, thinks he can communicate with god. He is later found sitting staring into space. Diagnosis-Catatonic Schizophrenia.
2.) A very pleasant young man imagines he is able to go around town having sex with other men’s wives and girlfriends while they sleep. He begins believing all the airplanes he sees in the sky are piloted by those men out to get him. He knows it is irrational but can’t shake his morbid fear of airplanes. Diagnosis: Paranoid Schizophrenic.
3.) Man goes to a gas station. He pulls a gun and shoots a customer for no earthly reason. He is sentenced to life in prison. His defense, “I’m schizophrenic.”
4.) Man goes to bus depot. He finds an elderly woman there. He brutally beats her and impales her on a broomstick. He is sentenced to death. On appeal he is sent to state mental institution. He is declared a mentally retarded schizophrenic, unable, to understand the charges against him or participate in his defense.
5.) Black Vietnam vet, released from VA. He was diagnosed as, paranoid schizophrenic. He stops at a redneck bar. A patron calls him a bad name. He kills said patron and is sent to jail. Patron’s family sues VA hospital. Federal Judge declares incident, racially tinged barroom brawl. No award given.
6. ) I take tour of a state mental hospital. The psychiatrist demonstrates three
“schizophrenic” women.
One loudly berates the female psychiatrist for wearing “powder and paint” and says she is going to hell. Another neatly dressed oldster shows off her aprons upon which she has sewn perfect clocks, which are unlike any earthly clock. She had also poisoned her husband to death. The third is sitting apathetically in a rocking chair behind us and then you hear a sound like a cow urinating on a flat rock.
Oh yes, schizophrenia is just a fake disease. Those shrinks are just making it all up. As you can see from these examples there is much variability so schizophrenia is really a name for people who are just really crazy in a characteristic but highly variable way.
Dave
The myth of the myth of mental illness
My 2 cents:
In 2008, saying that mental illness is a myth is a lot worse than saying evolution is false. It's backwards, anti-science, and ignorant. A lot of harm is done from people believing that depression, schizophrenia, and bipolar disorder aren't real.
Thomas Szasz is an embarrassment to libertarianism.
Value of dissent
I think the opposite. I want people to dissent. I want people to go out on a limb with their dissent. I'm glad there's a Szasz. We're better off with vigorous dissent than without it. Much of it is wrong, but if you want to argue, "it's okay to dissent when you're right but when you're wrong you need to toe the line", you're getting it backwards. Dissent always seems to most people to be wrong. This is what makes it dissent. So if we base the judgment of what is or is not wrong on (say) scientific consensus, then there will simply be no dissent at all. But if not consensus, then what? Who's going to sit in judgment? Jonathan Wilde?
I think the opposite Don't
I think the opposite
Don't take it bad, but I'm starting to think you have a strong contrarian bias.
No I don't
:-)
Oh boy I was so looking
Oh boy I was so looking forward for that answer :)
Ambiguity in the Marketplace of Ideas
When you say that you want people to dissent, do you mean you want people to be free to dissent, or that you think we need more people out there spreading dangerous and harmful ideas - that the spread of such ideas is itself a good thing, apart from the freedom to do so?
I think J.S. Mill made the argument that it's important to keep bad ideas around just so that we don't forget how to rebut them. But that can be (and is) achieved through dispassionate academic study of bad ideas, without actually having anyone around who still truly believes in and advocates the bad ideas.
I don't think anyone here believes the freedom to dissent is a bad thing. But shouldn't one of our goals be truth? And if truth is good for us individually, isn't it also good for us collectively? Wouldn't you rather your friends and neighbors know the truth as well, both for their own benefit and for whatever positive externalities might spillover on to you? In which case, it's difficult to take much pleasure in watching people get something totally and utterly wrong.
Assuming Jonathan is correct in his analysis of Szasz (I haven't read enough on the subject to have an informed opinion), it does make sense to claim that denying the validity of mental illness (again, assuming Jonathan is correct in saying Ssasz denies this) could have much worse consequences than denying the validity of evolution. If people who suffer from mental illnesses believe (or are convinced by believing friends and family) that mental illness is a myth, they may not get the help they need, and suffer greatly as a result. Whereas the harmful consequences of denying evolution seem less concrete in comparison.
The culture of science already has systems in place that allow for and encourage dissent. Evolutionary biology doesn't benefit much--if at all--from the existence of dissenting creationists and IDers. Again, I don't know enough about Szasz to determine whether the comparison to ID is valid, but if it is, so much the worse for us libertarians for teaming up, through Szasz, with the Scientologists.
Encourage dissent
When you say that you want people to dissent, do you mean you want people to be free to dissent, or that you think we need more people out there spreading dangerous and harmful ideas - that the spread of such ideas is itself a good thing, apart from the freedom to do so?
I am happy that he dissents because dissent from the view tests the view.
I think J.S. Mill made the argument that it's important to keep bad ideas around just so that we don't forget how to rebut them. But that can be (and is) achieved through dispassionate academic study of bad ideas, without actually having anyone around who still truly believes in and advocates the bad ideas.
Does not work. You need a passionate advocate who truly believes the idea. Nobody can be trusted to be an advocate for a view if he does not really believe the view. The temptation is far too great to caricature the view. It's not even necessarily intentional.
And if truth is good for us individually, isn't it also good for us collectively? Wouldn't you rather your friends and neighbors know the truth as well, both for their own benefit and for whatever positive externalities might spillover on to you? In which case, it's difficult to take much pleasure in watching people get something totally and utterly wrong.
In my view, there is a priori always a chance that someone in the position of a Szasz either is wholly right or has some very valuable and important points. This is why I am glad he speaks.
Assuming Jonathan is correct in his analysis of Szasz (I haven't read enough on the subject to have an informed opinion), it does make sense to claim that denying the validity of mental illness (again, assuming Jonathan is correct in saying Ssasz denies this) could have much worse consequences than denying the validity of evolution.
In stating my position on Szasz, I do not assume that Jonathan is correct.
The culture of science already has systems in place that allow for and encourage dissent.
And that's what I am doing, and what you are not doing. I am encouraging dissent. Jonathan is discouraging it, and you are arguing on Jonathan's behalf.
Again, I don't know enough about Szasz to determine whether the comparison to ID is valid, but if it is, so much the worse for us libertarians for teaming up, through Szasz, with the Scientologists.
Sounds like, "let's distance ourselves from the unpopular girl so that her unpopularity does not rub off on us." That's not a basis on which I make decisions.
Two points
Micha,
Two things.
1. You write: "If people who suffer from mental illnesses believe (or are convinced by believing friends and family) that mental illness is a myth, they may not get the help they need, and suffer greatly as a result."
But Szasz's views, if implemented, would not deprive the people currently labeled "schizophrenic," "bipolar," "depressed," etc. from "getting help" for their problems. The notion that it would is based on a common but extremely careless misreading of Szasz's argument. Szasz is quite explicit that the symptoms on which a diagnosis of these pseudo-"diseases" are based are quite real, and pose real problems for people's lives. What he objects to is the philosophical and political leap of organizing the understanding and "treatment" of those symptoms under pseudomedical terms like "schizophrenia," "bipolar disorder," "depression," etc., which ultimately have a lot more to do with the legal requirement that someone have a diagnosed "disease" in order to get most drugs, than they do with any real scientific basis for the claim that all these symptoms trace to a single, identifiable disease.
In Szasz's ideal society, people who are suffering from what is now mistakenly called "mental illness" would in fact have far more access to help than they have now, since the abolition of pharmaceutical laws and government licensure laws would remove a couple of the major barriers to entry and price floors on psychiatric "help."
Szasz also believes that psychiatrists should not have the power to force "help" onto their "patients" against those patients' wills. But the power to force "help" on unwilling "beneficiaries" is quite a different issue from the ability to "get help" when one needs it.
2. You write: "But shouldn't one of our goals be truth?"
Sure. But summary dismissal of an argument based on an unsubstantiated assertion that it is "backwards, anti-science, and ignorant" is not, as I see it, a reliable method of getting to the truth. Especially not when there are specific historical reasons to be cautious of "consensus" in the field in question, and when the person whose arguments are being thus dismissed without discussion is in fact a dissenter within the same community of experts whose authority is supposedly being referred to. (In this respect, Szasz's position, as a professionally trained medical psychiatrist, is quite different from that of creationists who have no training in paleontology and evolutionary biology, or Holocaust deniers who have no training in history. That makes an appeal to authority, rather than an critical engagement with Szasz's specific arguments, rickety in the extreme.)
Science!
Well, hell, if someone in a white lab coat says it, it must be true.
Certainly there is no reason to be cautious of appeals to scientific consensus in this field. There are certainly no prominent examples of
appeals to scientific authority, or to psychiatry in particular, that had little to do with science and lots to do with providing cover for coercive normalization, inhuman "treatment" of so-called "patients," or torture and brain damage posing as "cures." No need to think for yourself, citizens; the experts have already done it for you.
Meanwhile, we can just safely ignore Szasz's actual arguments, ignore the extent to which common criticism and "embarassment" over Szasz is based on easily refuted strawmen (such as the claim that he believes that hallucinations are "made up"), and substitute an appeal to authority and an ad hominem (abusive form).
Yep, science
This is a very common argument I run into in leftist circles: look at history instead of science and make your conclusion. For example, because the study of race was used in the past for nefarious purposes, discount any current data on race, even if it means potentially more effective medications for people of certain races.
The science says mental illness is real. I'm not making an appeal to authority or scientific consensus. I've read the research. You can (and should) do this yourself.
I'm not going to provide the details here (I don't have the time or energy), though I may in the future. I only made my original post because I am a visible member of this blog and felt like I had to make it known that I don't agree with such backwards views.
not being fair
In that statement rad geek is not asking you to ignore but to be cautious. Very different. Caution is not left wing.
She blinded me with science
How would you know how much or how little of "the research" on this topic I have read? The short answer is that you have no idea, because you haven't begun to engage with the arguments at hand. If you want to demonstrate that there are important facts of which I am not aware you will have to, you know, actually point them out, and not just wave your hands at The Science and The Research without discussing any concrete findings.
Jonathan: For example, because the study of race was used in the past for nefarious purposes, discount any current data on race, even if it means potentially more effective medications for people of certain races.
This is a strawman. Nobody suggested that you should "discount any current data" on so-called "mental illness." I said that the history of psychiatric abuse is a good reason for caution in appeals to consensus, which is something different. Similarly, people certainly should be cautious of research on racial difference, given the history of racialist pseudoscience. The epistemic authority of a scholarly community depends (in part) on its reliability in getting to the truth, and when there's a long history of pseudoscience being promoted in order to provide ideological cover for prejudice, there is nothing logically askew in exhibiting a healthy degree of skepticism.
This is hardly ancient history. For example, Homosexuality was a recognized "disorder" until 1974, and so-called "Gender Identity Disorder" remains in the DSM to this day. Walter Freeman was still cutting up people's brains not 40 years ago.
Of course, if you have an actual argument or empirical data to present, rather than just an appeal to The Science, then that argument and that data can and should be evaluated on its own merits, independently of whatever historical worries one may have. But since you have produced nothing of the sort, there is nothing to be assessed on its own merits; we have only the appeal to authority.
Jonathan: I'm not making an appeal to authority or scientific consensus.
Dismissing an argument on the grounds of an assertion, without further evidence, that its conclusion is "backwards, anti-science, and ignorant" is one of two things. Either it's (1) an appeal to authority, which can sometimes be a cogent form of argument in the right context, or (2) simple abuse in place of an argument, which never is. I took the more charitable interpretation of supposing that you intended for your remarks to be (1), and so gave an argument as to why the appeal is misplaced, in this context.
If I misunderstood you, and should have adopted the less charitable interpretation, well, I guess I apologize.
How would you know how
I infer it from your comments in this thread such as:
It gives me an idea of how much you know about the topic. Perhaps I am wrong to infer based on these comments.
You're right. It was unfair. However, I still believe that if someone's primary objection to an issue of science is to repeatedly point out historical context, there's something very wrong with his argumentation.
You pointed out my own lack of detailed scientific counter to Szasz in a blog comment. My response is that my intention was not to provide a thorough analysis of why he's wrong, but rather, to publish a "political platform", a proclamation, of my disagreement with what I consider a backwards point of view. A similar phenomenon is occurring across libertarian blogs in which some people like David Boaz are saying, to paraphrase, "It's time for respectable libertarians to tell the world, 'Those letters do not represent libertarianism.'" Similarly, my only goal was to distance myself from Szasz views, which I consider outdated, 'paleo' if you will, in 2008.
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