Revisiting Szasz: Myth, Metaphor, and Misconception


From Psychology Today: “Szasz’s ideas on psychiatry and mental illness can roughly be summarized as follows. First, mental illness is a metaphor for human problems in living expressed as ‘symptoms’ via a somatic protolanguage. There are no biological tests for mental illness; thus, mental illness is not disease in the literal sense. Secondly, it follows that if mental illness is not literal disease, then persons should not be deprived of liberty and responsibility in the name of mental illness. Szasz opposed all forms of involuntary treatment and the insanity defense. Sociologically, he saw psychiatry as a state-sanctioned mechanism of social control and an omnipotent threat to civil liberty. He termed this association between government and psychiatry ‘The Therapeutic State’.

It is important to note that Szasz’s views on psychiatry were influenced by his libertarian political ideology, formed as a child growing up in Nazi-era Budapest. During his psychiatry residency and later during his psychoanalytic training, Szasz avoided all contact with involuntary psychiatric patients. He never committed a patient involuntarily to the hospital and never prescribed a psychiatric drug. Morally opposed to coercion in psychiatry, Szasz maintained a private practice of psychoanalysis where he practiced what he termed ‘autonomous psychotherapy’, outlined in his 1965 book The Ethics of Psychoanalysis.”

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  1. It is amazing how some so-called learned people can write some pretty good scientific and political summations regarding the significance of someone like Thomas Szasz, AND THEN completely abandon logic and journalistic honesty with a few bogus concluding remarks.

    This author stated the following in his concluding remarks:

    “And the growing research on the pathophysiology of severe mental disorder paints a more complex picture than Szasz let on.”
    “Sixty years ago, Thomas Szasz did the profession—and the world—a great service by pointing out the gross abuses of power perpetrated in the name of psychiatric treatment…. But his claims regarding the nature of mental illness seem to be based on flawed logical and epistemological assumptions. They certainly seem to run counter to the clinical reality.”

    This author provided NO scientific or theoretical evidence to back up his claim of the “pathophysiology of severe mental disorders [sic]” or of the so-called “flawed logical and epistemological assumptions” of Thomas Szasz.

    Yes, Szasz’s “libertarianism” was flawed in many ways, because “libertarianism” is a flawed ideology, but his analysis of psychiatry and psychiatric oppression has essentially stood the test of time and any legitimate scientific analysis.

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    • I just made a similar comment on this story Children on Antipsychotics at Risk for Weight Gain and Diabetes.

      “Behavioral improvements were observed with all treatments.” They make that statement with nothing to back it up and I know its not true.

      I must say though that libertarianism is 100 times less flawed then liberal or conservative ideas posing as ideology !

      Ban guns to save children and fund more abortions ! -Liberals
      We want small government tougher laws and more police and jails ! -Conservatives

      That crap doesn’t even qualify as ideology.

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    • I certainly disagree about libertarianism. The problem with people who argue against libertarianism, and then argue for the liberation of psychiatric prisoners is that the two are intimately connected. Szasz was arguing for other peoples’ (mental patients’) liberty. Libertarian merely means placing a high value on liberty. Regarding those who would free psychiatric prisoners and aren’t libertarian, next question, since you don’t highly value liberty, who would you imprison? And further, since you don’t have a high regard for liberty, why should psychiatric prisoners be freed?

      I completely agree about the conclusion of the article. I would challenge any professional to prove his logic flawed and his epistemology lacking. The clinical reality is a certain pernicious form of unreality, the reality, so to speak, of a zoo. People are being imprisoned due to imputed, and unproven, danger to society. The medical grounds for this detainment is tenuous at best. This takes us back to the libertarian angle, realizing that that clinical reality is somebody’s rationale for depriving people of their liberty. Realistically, we’re so far removed from due process of law, at that point, it isn’t funny.

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    • his analysis of psychiatry and psychiatric oppression has essentially stood the test of time and any legitimate scientific analysis

      Yes, people like this should be forced to take a Szasz 101 course before commenting.

      Szasz’z primary “science” was a working knowledge of language and linguistics, including the ability to recognize when a metaphor is being mistaken for its literal meaning. Which makes all “research on mental illness” unscientific by definition, since starting out with a false premise (i.e. that “mental illness” exists) is not part of the traditional “scientific method.”

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      • Szasz 101 should be a course. Take a look at this organization he helped found, the American Association for the Abolition of Involuntary Mental Hospitalization. Thomas Szasz, Erving Goffman, and George Anderson, that’s how bleak it can get. You have few, if any, defenders of the civil liberties of people threatened by forced psychiatric treatment, outside of those who have been so abused, than you do with the likes of Thomas Szasz himself. His peers were few and far between.

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    • Szasz was a great thinker, but he was a sociologist, not a psychologist and he was nihilist. There’s no psychologists in reality today, because psychologists must to admit that psyche exists and it is not clinical thing it is mythical reality, pagan reality, that’s why church and theologians are destroyers of psyche and the main reason that psychiatry exists as a inquisition in medical disguise. If they don’t do it, if they do not use the phenomenology and phenomenolgical language (Hillman)rather than false empirism (DSM, biological psyche, clinical psyche) they will be destroying psyche and that would be sabotage as it is now. I mean, if the state is to be humanistic and pro psychological there must be psyche not theology/church in the center of reality/of thinking.

      The language is full of theological barbarism which has got nothing to do with psyche and the victims psychiatry are the wictims of theological way of seeing psyche. James Hillman : Re-Visioning psychology and Manufacture of madness, are the HUMAN bibles, because theological view of psyche destroys humanity. We must know the roots of psychiatry the same way Hillman was aware of it. Without this books, there s no REAL knowledge about psyche.

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  2. I do genealogy, and on more than one occasion, I’ve discovered people who in the 19th century died in the state hospital/lunatic asylum. I would tend to think this occurrence less pervasive today than it was then when a person was more likely to spend the major part of their life in a lunatic asylum. If Thomas Szasz had anything to do with why there are fewer people dying in what purport to be mental hospitals, and what are in actuality psychiatric prisons, that is a good thing.

    Mark Ruffalo should pay closer attention to some of the arguments Thomas Szasz made. Ronald Pies arguments are pretty transparently wrong.

    “”If mental illness is indeed a metaphor—and Pies does not think it is—the person said to be mentally ill may still be ill in the literal sense.”

    Sure, but whatever illness that person would have would not be a “mental illness” seeing as “mental illness” is a metaphor, and thus, a figure of speech. Metaphoricity, Pies term, is falsity regardless of whether the equation is made or avoided. A metaphor is not, nor ever will be, a fact.

    His excuse for disputing that brain disease and “mentally illness” are mutually exclusive terms are a few doctors who are working at the hinterlands of either, such as psychiatrists who deal with geriatric cases, or, horror of horrors, pediatric psychiatrists, and doing so doesn’t make brain disease “mental illness”, nor such doctors as specialize in it essential medical personnel.

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  3. Frank

    You said: ” Libertarian merely means placing a high value on liberty.”

    This is both very naive and very wrong.

    You CANNOT abstract Libertarianism from the current way in which the necessities of life in the world are both produced AND distributed throughout society.

    Libertarians worship at the alter of “Free” Market capitalism, and all that goes with this type of economic and political system. This includes the so-called Darwinian social concepts of the survival of the fittest and placing rugged individualism on a cultural pedestal.

    We should ALL know (especially you, Frank) what class in society this type of ideology and philosophy will end up serving. We can all see where this type of thinking has already taken us.


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    • I wouldn’t generalize.

      Although all libertarians place a high value on liberty, not all libertarians embrace laissez-faire economic policies. As a left-libertarian, I don’t worship at the altar of free market capitalism.

      I’m not a member of the Libertarian Party, and I don’t think Thomas Szasz was either, despite his embrace of capitalism, and his criticisms of communal living.

      It is important to separate libertarianism from the Libertarian Party. The Libertarian Party is not such a great thing. In so far as it promotes civil liberties, it is a good thing. In so far as it promotes an unregulated capitalist market, it is a bad thing.

      “”Left-libertarianism (or left-wing libertarianism) names several related, but distinct approaches to political and social theory which stress both individual freedom and social equality.”

      I think you are being naive if you think in your quest for social equality you can neglect personal freedom. You know what happens with most totalitarian systems, don’t you? Given enough time either they crumble out of an inflexible resistance to adaptation when such is the will of the people, or they give into demands for less restrictions, and more freedom.

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        • Yes, while there are a few minor examples of where some people on the Left have used the term “Libertarianism” to define their politics, OVERWHELMINGLY those who promote this ideology are PRO capitalist and worship individual rights OVER the collective whole.

          Just because some Nazis chose to occasionally use the term “National Socialism” as a descriptive term DOES NOT mean there is ANY association between socialism and fascism.


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          • It would be an oversimplification to say that libertarian socialism is a synonym for anarchism as there are also anarcho-capitalists who operate under the libertarian banner.

            You are thinking of libertarianism in the USA. It’s certainly not that way for the rest of the world.

            Most libertarians, specifically left-libertarians, seek to abolish capitalism and private ownership of the means of production in favor of common or cooperative ownership and management, viewing private property as a barrier to freedom and liberty.”

            Emphasis added.


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  4. Since a few people have commented here, I figured I would attempt to clarify some of the statements made in the article. Thank you to those who have taken the time to read and critique the piece.

    Regarding the concept of metaphoricity: When Szasz states that “mental illness” is a metaphor, he implies also that it is “fake disease” (see Insanity: The Idea and Its Consequences). However, Pies perceptively notes that even if mental illness is a metaphor, the person diagnosed as mentally ill may still be ill in the literal sense. If, for instance, we say that “Night’s curtain fell upon the village,” we may indeed be speaking metaphorically, but not falsely–assuming that it did actually go dark in the village. Similarly, even if we speak metaphorically in saying, “Joe suffers from mental illness,” it would not follow that we were making a false statement. On the contrary, Joe might be quite disturbed in the realm of “mental.”

    I encourage you to take a look at the following paper authored by Pies in 1979:

    Regarding my statement on the growing research on the pathophysiology of mental illness: surely, even the purest Szaszians would admit that there has been an abundance of research in the past few decades linking what is called “mental illness” with certain biological changes–to a greater or lesser degree depending on the condition. Without going into the causes of such findings, one must admit that the problems called mental illness are much more complex than simply claiming “metaphor” and alleging that all mental patients are malingering (as Szasz did).

    I have great respect for Thomas Szasz, communicated with him on multiple occasions, and thank him immensely for his contributions to the cause of freedom and for pointing out the many pretensions of psychiatry. But I believe his argument eventually came to rest far too heavily on language.

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    • Respectfully, I think, in agreement with Thomas Szasz, that the language we use is important, and if I were to use a euphemism on a regular basis, someone is going to have to come along straighten out the confusion. In other words, the problem is not that his argument rested far too heavily on language, the problem is that the terminology of psychiatry has in the past, and continues to, diverge too far from the fact as evidenced by our senses. I don’t think his argument came to rest far too heavily on language as received from the dictionary, however, I think the same can’t be said of psychiatry as a rule. This is to say, I have a great deal of doubt about the recent advances you and others have discerned in research results. Results that boil down to something along the lines of, pretty regularly. are we looking at a “mental illness”, or the effects of sedation?

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      • Thank you for your reply. I agree wholeheartedly with your (and Szasz’s) assertion that language matters. Regardless of how we conceive mental illness, the problems exist and have existed long before institutional psychiatry. Pies calls Szasz on the fallacy that psychiatry invented schizophrenia. The term, yes. But the “condition” (as in human condition), hardly. The question then becomes what do we do to help such people. Szasz and I (and I am sure you) are in agreement that coercion must be rejected. And drugs are rarely an answer.

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        • But that’s just it, Thomas Szasz was not concerned with linguistic matters, or language, so much as he was with morality. It was always a matter of being true to his, or, the word. He took on the psychiatry of doctors and patients alike for the evasions that were, and are, being excused by them. Evasions of the responsibility that goes along with the exercise of free choice. I think this could be missed if we simply looked at Thomas Szasz as someone who disagreed at the level of language with mainstream psychiatry. It wasn’t just a surface matter, a matter of words alone, morality was what underlay this quarrel he had with the profession he practiced. That said, sure, he was against coercive practices, and I’m glad to hear that you don’t care for them either.

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          • But that’s just it, Thomas Szasz was not concerned with linguistic matters, or language, so much as he was with morality.

            Can’t agree. The essence of his deconstruction of psychiatry was linguistic — not only that “mental illness” DOES NOT exist but that there is no way it COULD exist without changing the rules of language. This is no way takes away from Szasz’s sense of morality.

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          • I don’t think Thomas Szasz was out to deconstruct a linguistic construct, if that’s the way you see psychiatry. I think, rather, he was going after evasions of responsibility, the responsibility that comes with freedom, and the deceit, including self-deception, that permitted those evasions. This is why I call him a moralist. If “mental illness” is a myth, a dead religion, he asks, why are we still doing homage to it? Making constant reference to this myth is not the first bad habit that people have had a difficult time breaking.

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          • I’m disagreeing with myself now. Cut the first three words in the comment above, OldHead, and to some extent anyway, we could be said to be in agreement. He was out to deconstruct a linguistic construct certainly, but he was also out to do more than just clean up the Bard’s English. I see him as a moralist. You see him as a stickler for words. Perhaps we are both right.

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          • I don’t see a contradiction, though sometimes his morality degenerated into moralism.

            Anyway, it more than being a “stickler for words,” it’s recognizing that, if words mean things, that psychiatry deliberately misuses and distorts what words mean to promote “treatment” for impossible diseases. That in turn would certainly arouse moral indignation.

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          • To paraphrase you, “If there is no moralism, there can be no morality.” And vice versa, or it is? Virtue versa?

            I’m not sure psychiatry is always as deliberate as you make it out to be. I mean you’ve got Pies arguing that Szasz makes too much out of words, and Szasz countering people like Pies with a similar argument of his own.

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          • I’d have to see the quote. I didn’t know they communicated, though I’m sure Szasz kicked Pies’ butt.

            Check the def of the two words, I think you’ll see a difference in meaning. Some of the most immoral people out there are moralistic.

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          • I was referring to Mark Ruffalo’s Psychology Today piece (above) in which Thomas Szasz is featured, and Ronald Pies argument is used to counter the position put forward by Szasz.

            I’m not arguing against isms, that’s you. I’m also not saying the two terms are synonymous.

            Szasz was a very good at ye olde debate. If you’ve ever read the Jeffrey Schaler collection Szasz Under Fire, Szasz takes on all sorts in the psychiatric profession, and, a veritable Kung Fu, he kicks ass. Szasz also tackles Ronald Pies in the Schaler book, and I don’t think Pies arguments have improved. He puts himself up as a defender of his profession, even when his arguments (Remember no psychiatrist in the know would promote the chemical imbalance theory?) are weak.

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          • If it weren’t for morality it wouldn’t matter what one said, one thing being as good as another. Thomas Szasz argues in favor of observation of the law (don’t punish the innocent, nor exonerate the guilty) and for liberty, the liberty that goes along with governance of self (moral agency). It’s not simply that “mental illness” is a figure of speech, it’s that to use a figure of speech in the fashion that it is being used, as if it were not a figure of speech, is to be dishonest, and dishonesty represents a corruption of morals. There’s something corrupt about claiming to be protecting all of the people by disenfranchising some of the people on medical pretexts. We don’t oppose slavery, for instance, because it’s a bad choice of words; we oppose slavery because it’s a bad way to treat people, our fellow men and women. The same principle applied to chattel slavery applies to psychiatric slavery. It’s not a good idea to use treatment as an excuse to take freedom away from a free people. For if you do, where does it end? De ja vu. With the absolute corruption of a tyrannical ruler. With the adult child as head of state. With wholesale slaughter and oppression.

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        • Hi Mark

          Why would you want to continue to quote Ronald Pies as some authority on the issues of whether or not “mental illness” exists?

          He is the same man, who of recent years, has been a major apologist for psychiatry since it has come under much overdo criticism for its pseudo-science and oppressive forms of so-called treatment.

          He is the same man who called the “chemical imbalance” theory an “urban myth,” while he himself has continued to promote his own version of it. And isn’t he the same apologist who said the “chemical imbalance” theory had some pragmatic value as an explanation (to so-called ignorant patients) even though it has NO validity, because it helped convince them of the viability of psychiatric drugs if the doctor deemed them necessary? I suggest you read some of Dr. Philip Hickey’s scathing blogs (here at MIA) directed towards deconstructing Ronald Pies role as an apologist for psychiatry.

          And Mark you said:
          ” even the purest Szaszians would admit that there has been an abundance of research in the past few decades linking what is called “mental illness” with certain biological changes–to a greater or lesser degree depending on the condition.”

          NO, no, no, this is not a true statement. There is still no discovery of so-called “biological markers” for “mental illnesses” or “disorders.” Please show us the evidence of these “biological changes.” Even the pet scan analyses and brain scan analyses that have evolve into some pseudo-scientific explanations have been blown apart by legitimate scientific appraisal.

          The only verifiable biological changes found over the past two decades that make any sense are those in which the “treatment” by psychiatry, with psychiatric drugs and/or Electro-shock, has seriously (if not sometimes, permanently) perturbed brain function and/or other neuro-chemical processes.

          No major anti-psychiatry critic here at MIA (except those few who want to somehow “romanticize” “mental illness”) denies that there are people deeply disturbed by trauma and other stressors in the environment and present themselves with different behavioral and thought manifestations that reflect this level of psychological distress.

          These are NOT “illnesses” that should in any way be treated in a medical sense, nor are they necessarily permanent conditions. And we need NO medical terminology or biological explanations for them. And there is no scientific evidence up to this point (nor will there ever be, in my view) that in any way undermines the essential positions put forth by Szasz that “mental illness” is a myth.

          And Mark, I would ask, are your suppositions that there really is bio-physiological evidence for “mental illness,” more of a HOPE on your part that someday someone will find them?


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          • Richard, thank you for your reply here. I quote Pies because I think he offers the most significant and thoughtful counterargument to Szasz’s claims. To submit that there have been no reputable studies demonstrating brain changes in patients diagnosed with mental disorder runs counter to reality. One can question why the changes have occurred (biological vs. psychosocial), or why they do not occur in all patients, but to state that there is no research demonstrating some biological changes is false and misleading. The genetic research also points very clearly to biological involvement.

            A point that has been reiterated here by several commenters in various forms is Szasz’s assertion that once pathology is discovered, the entity ceases being a mental disease and instead becomes a neurological disease. Thus, it follows that there is no such thing as mental illness.

            However, this claim rests on the faulty assumption that mental disease and brain disease are disjunctive categories. Just as some mental illnesses, such as schizophrenia, may be considered “brain diseases,” some brain diseases–such as Alzheimer’s disease–may manifest as “mental illness.” Mental illness and neurological disease are complementary, not contradictory, terms.

            See, for instance, a 2006 article by Orth and Trimble titled, “Friedrich Nietzsche’s Mental Illness–General Paralysis of the Insane vs. Frontotemporal Dementia”:

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          • Mark

            Thanks for engaging on these question.

            You said: ” To submit that there have been no reputable studies demonstrating brain changes in patients diagnosed with mental disorder runs counter to reality.”

            Mark if somehow you only thought about sex (or engaged in sex) for 16 hours a day for a certain period of time, there might be some sort of change in your brain activity and/or structure. And then after you stopped for a period of time your brain would most likely return to its “normal” state.

            When or if some changes in the brain took place, this proves NOTHING about so-called “mental illness” or “disorders.” It only means that the brain adapts to abnormal circumstances.

            Mark, you said above that there was an “abundance” of evidence for the biological pathology in so-called “mental illness.” Even some staunch Biological Psychiatrists lament the fact that this evidence has NOT yet been discovered.

            I will provide you two links below that refute the biological model and deconstruct the phony evidence provided so far by psychiatry.


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          • “Biological involvement” is only “discovered” in terms of probabilities of people falling into these subjective categories that are not defined by any objective measure. I think Szaz would be very clear that any PHYSIOLOGICAL condition that can CONSISTENTLY be connected to a specific “mental state” could be considered a disease, but that disease (like Parkinson’s) would then be dealt with by diagnosing and treating the actual physiological condition. The fact that some people with physiological issues of some sort HAPPEN to fall into these heterogeneous categories like “major depressive disorder” or “bipolar disorder” doesn’t indicate that these categories are legitimate entities for study, let alone suggest “biological involvement.”

            Naturally, there will be biological correlates that are connected with emotional states, but the research has shown over and over again that none of these correlates are consistently present in ANY “mental illness,” and in fact large numbers of “non-mentally ill” people have the exact same genetic markers or biological indicators as those purportedly “mentally ill.”

            Furthermore, any such correlation is likely to be associated with very general characteristics, such as higher energy levels or emotional sensitivity, which have undoubted survival value for the species and are only problematic when someone is under unnatural levels of stress or is forced into an unnatural situation (like a 5 year old sitting still for hours a day) or is lacking in the basic necessities of social and logistical support that our species is adapted to expect.

            There is no logical reason why we should anticipate that everyone who “fits the criteria” for “major depression” or any other “diagnosis” will have any physiological similarity to each other besides the surface similarities in behavior and/or emotion. That is why these “diagnoses” have to be given up completely before any meaningful research can be effectively done on causality. It may very well be that a certain subgroup of depressed or anxious people DOES have something physiologically wrong with them. But we will NEVER find such a subgroup if we insist on grouping people together based on external manifestations like “anxiety.” It makes about as much sense as seeking a cause for “pain” or for “courage.” There is not and likely never will be a single cause for any DSM disorder, no matter how much reductionistic “science” is thrown at those “diagnosed” by the Bible of the Psychiatric Religion.

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          • Naturally, there will be biological correlates that are connected with emotional states

            There are unique biological correlates to every feeling, thought, perception, utterance and movement, as we’re living in a material universe in physical bodies.

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        • Mark, as to “Pies calls Szasz on the fallacy that psychiatry invented schizophrenia. The term, yes. But the ‘condition’ (as in human condition), hardly.”

          Your belief is actually untrue, Mark. Today’s “schizophrenia treatments,” the neuroleptics/antipsychotics, can actually create both the negative and positive symptoms of “schizophrenia.” The negative symptoms can be created via neuroleptic induced deficit syndrome. And the positive symptoms can be created via antipsychotic induced anticholinergic toxidrome.

          And when a “treatment” can create the symptoms of a “condition,” then the “treatment” is likely to be the primary etiology of such a “condition.” Especially, a “condition” like “schizophrenia,” which has no tests to prove it existed in the first place.

          In other words, psychiatry invented the term “schizophrenia,” to describe the common adverse effects of their “schizophrenia treatments.” But the psychiatrists do also create the “condition,” with their “schizophrenia treatments.”

          Although, that is not to say that other things can’t also cause some of the symptoms of “schizophrenia” as well, like sleep deprivation, street drugs, the ADHD drugs, the antidepressants, steroids, opioids, etc.

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    • even if mental illness is a metaphor, the person diagnosed as mentally ill may still be ill in the literal sense

      Yes, they may have a cold, or cancer. So what?

      even if we speak metaphorically in saying, “Joe suffers from mental illness,” it would not follow that we were making a false statement.

      Yes it would, since minds cannot be “ill” any more than a “sick joke” can be sick. Are you accustomed to people accepting things you say without your backing them up?

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    • Your comments seem confusing or confused. A metaphor specifically uses imagery that is not literally true, otherwise, it’s not a metaphor. Saying, “That bridge looks shaky!” doesn’t mean the bridge is shaking. Saying, “That murderer is SICK!” doesn’t mean he’s sick. It means his behavior is so far outside the norm that describing it as “sick” emphasizes that no “normal” person would act that way.

      This, of course, has ENORMOUS implications for the use of the concept of “mental illness.” There is a good hunk of very consistent evidence that telling people they have “an illness like diabetes” leads to them losing hope and others viewing them as “abnormal,” in very much the same sense as they viewed the killer as “sick.” That’s the impact of that particular metaphor. And of course, to suggest that they are literally “ill” in the sense that it becomes literally dark when “night falls” is a massive distortion. Humans understand literal illness as something that can be identified in the body and that medical intervention can help ameliorate or cure. Psychiatrists, far from using “mental illness” as the metaphor that it is, have spent billions of dollars (along with their handmaidens in the drug industry) convincing people that “mental illnesses” are LITERALLY illnesses in the physiological sense. And yes, sorry, that IS a lie, because they know better, as the estimable Dr. Pies has himself repeatedly pointed out.

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  5. Mark L. Ruffalo, LCSW June 30, 2018 at 10:43 am WROTE even the purest Szaszians would admit that there has been an abundance of research in the past few decades linking what is called “mental illness” with certain biological changes.

    Researchers making lots of money. “A federal report calls for $4.5 billion in funding for brain research over the next 12 years”

    Szasz thought people were moral beings with the ability to chose. Psychiatry transforms morals (sins) into medical problems.

    Again , if the illness is physical in nature ( can be measured unbiased) , then it is no long mental, as in mental illness.
    Szasz” The result of such discoveries is that the illness ceases to be a form of psychopathology and is classified and treated as a form of neuropathology. If all the conditions now called mental illnesses proved to be brain diseases, there would be no need for the notion of mental illness and the term would become devoid of meaning.”

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  6. Ruffalo’s attempt to appropriate Szasz for psychiatric purposes is so off base that it hardly merits a response except to disabuse other readers of Ruffalo’s misinterpretations of Szasz. Ruffalo is right about one thing, however, no figure in the history of American psychiatry has proven to be more misunderstood than the late Thomas Szasz. In fact, Ruffalo’s article gives further evidence of the pervasiveness of misunderstandings of Szasz’ work.

    Rather than elucidate Szasz, Ruffalo does what most psychiatrists and psychotherapists do, and what Szasz ardently opposed: he obfuscates Szasz’ arguments through misuse of language. Ruffalo claims that Szasz’ views on psychiatry were influence by his libertarian ideology. This isn’t quite right. More accurately, Szasz’ views on everything, including libertarianism and psychiatry, were influenced by his commitment to the twin principles of freedom and responsibility. From a young age, Szasz understood that psychiatry directly opposed the twin principles of freedom and responsibility, but he wisely managed to obtain his credentials in psychiatry before publishing his views more widely. Furthermore, Szasz’ views regarding so-called “psychotherapy” are much more nuanced than Ruffalo claims. Even his book “The Myth of Psychotherapy” was not his last word on the matter.

    Historians of psychiatry are notoriously wrong about psychiatry. Most of them would more accurately be called apologists of psychiatry. Accurate histories of psychiatry have been written by Szasz, Breggin, Whitaker, Burstow, and a few others. Psychiatric apologists, on the other hand, frequently attempt to appropriate Szasz in order to bolster their own erroneous opinions on the nature of psychiatry. Such attempts to appropriate Szasz would be laughable if they weren’t so destructive.

    Ruffalo begins his article by praising certain aspects of Szasz’ work. But as soon as he attempts to correct Szasz, he shows his hand as yet another iteration of the false rhetoricians that Szasz so ardently and consistently opposed. Ruffalo claims that most people misinterpret Szasz by supposing that Szasz denied the reality of mental symptoms. In reality, most misinterpretations of Szasz are more closely tied to Ruffalo’s own misinterpretation of Szasz, namely, and in Ruffalo’s own words, that Szasz “ideas in this sense were actually quite similar to Freud’s.” Nothing could be further from the truth.

    In the tradition of Karl Kraus, a man whom Szasz admired greatly, Szasz frequently exposed Freud as the fraud that he was. This is not to say that Szasz was not influenced in any way by Freud, but that those who conflate Szasz with Freud simply have not read or understood most of Szasz’ writings. Szasz was a prolific writer. His views on Freud and psychotherapy developed over the course of his career, and the more they developed, the more clearly he denounces Freud, his teacher Charcot, and others, as the imposters they were.

    Consider, for example, the following statement by Szasz on page 35 of his book “Schizophrenia: The Sacred Symbol of Psychiatry”:

    “The gist of my argument is that men like Kraepelin, Bleuler, and Freud were not what they claimed or seem to be – namely, physicians or medical investigators; they were, in fact, religious-political leaders and conquerors. Instead of discovering new diseases, they extended, through psychiatry, the imagery, vocabulary, jurisdiction, and hence the territory of medicine to what were not, and are not, diseases in the original Virchowian, sense.”

    Ruffalo claims that “Szasz (1965) contended that his ‘autonomous psychotherapy’ was an expansion and refinement of Freud’s original vision for psychoanalysis.” This is a half-truth. Read Szasz’ book “The Myth of Psychotherapy.” In that book, and in no uncertain terms, Szasz reveals the mendacity of Mesmer, the hoaxes of Heinroth, the errors of Erb and Wagner-Jauregg, and the fraudulence of Freud and Jung. Ruffalo claims that Szasz was led to “conceptualize mental illness as resulting from unacknowledged internal motivations.” Again, Ruffalo’s rhetoric is misleading. No one who has read Szasz’ books “The Myth of Mental Illness,” “Psychiatry: The Science of Lies,” “Schizophrenia: The Sacred Symbol of Psychiatry,” “Coercion as Cure,” “The Theology of Medicine,” “The Myth of Psychotherapy,” “The Therapeutic State,” “Psychiatric Justice,” “Psychiatric Slavery,” “Liberation by Oppression,” or any number of his other works can in honesty claim that Szasz conceptualized so-called “mental illness” in the way that Ruffalo supposes. In fact, I would recommend a close reading of Thomas’ Szasz excellent book “Anti-Freud: Karl Kraus’s Criticism of Psychoanalysis and Psychiatry,” in order to gain a better understanding of Szasz’ stance on all things psychiatric, including his ideas on “psychotherapy.”

    Ruffalo bases his arguments on a very narrow reading of Szasz’ ideas regarding psychotherapy. While it is true that Szasz contended vigorously on behalf of the twin principles of freedom and responsibility, in many of Szasz’ writings, he called into question not only the notion of “mental illness,” but the notions of “doctor” and “patient” as well. Szasz saw himself as a noble rhetorician, like Kraus, who was burdened with the task of exposing the errors of the false rhetoricians. Like Kraus, he was often rejected, ignored, or misinterpreted. Unfortunately, Szasz continues to be rejected, ignored, or in the case of Ruffalo’s article, misinterpreted.

    One of the most glaring falsehoods in Ruffalo’s article is contained in the following statement: “While Szasz asserted that mental disorders are only metaphorical diseases, he never closed the door entirely on the possibility that one day the biological origin of a mental disorder will become known.” In reality, Szasz traced the search for the biological and physical causes of so-called psychopathological phenomena to the investigator’s “craving for prestige and power” rather than his desire for “understanding and clarity.” (see “The Myth of Mental Illness, chapters four and five) Allow me to quote Szasz again:

    “Modern psychiatry rests on the false premise that mental illnesses are brain diseases treatable with drugs. Political correctness requires that we accept this premise and the practices it entails as the products of modern neuroscience and the procedures of humane social control. As science, this is bunk, because it confuses personal conduct with biological condition. As social control, it is despotism, subjecting innocent individuals to incarceration.” (Szasz, Liberation by Oppression, p. 57)

    Szasz’s summary statement and manifesto begins with this clear insight:

    1. “‘Myth of mental illness.’ Mental illness is a metaphor (metaphorical disease). The word ‘disease’ denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term ‘mental illness’ refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. As the whale is not a fish, mental illness is not a disease. Individuals with brain diseases (bad brains) or kidney diseases (bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors), like societies with economic diseases (bad fiscal policies), are metaphorically sick. The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment.”

    Ruffalo claims “This leads us to the theoretical possibility that what is called schizophrenia—for instance—is caused by a yet-to-be-discovered physiological disease of the brain.” Nonsense. What did Szasz really have to say about so-called “schizophrenia”?

    “Similarly, if there is not psychiatry, there can be no schizophrenics. In other words, the identity of an individual as a schizophrenic depends on the existence of the social system of (institutional) psychiatry. Hence, if psychiatry is abolished, schizophrenics disappear. This does not mean that certain kinds of persons who might previously have been schizophrenics, or who might like to be schizophrenics, also disappear; there assuredly remain persons who are incompetent, or self-absorbed, or who reject their ‘real’ roles, or who offend others in some other ways. But if there is no psychiatry, none of them can be schizophrenic.” (Schizophrenia: The Sacred Symbol of Psychiatry, p. 136)

    One need not respond to Ruffalo’s references to Ronald Pies, since, as Frank and Richard pointed out, Pies is hardly a reliable source for accurate information. Pies is full of conceptual errors that Szasz would have easily torn apart. Ruffalo writes “If mental illness is indeed a metaphor—and Pies does not think it is—the person said to be mentally ill may still be ill in the literal sense.” Pies has no evidence whatsoever that such a thing as “mental illness” exists, and yet Ruffalo refers to Pies in order to speculate that the “mentally ill” may be ill in the literal sense. I think that Frank has made it clear enough that as soon as a person discovers that he or she has a literal, biological illness, there is no longer any reason (if there were a reason in the first place) to falsely label such a person as “mentally ill.” The myth of “mental illness” and the quest for a biological marker that corresponds with the myth is, as Szasz has repeatedly shown, an effort in futility that springs from the pervasive psychiatric tendency to seek for ways to justify or legitimize a fraudulent “profession.”

    As far as Ruffalo’s point regarding Szasz’ reading of Virchow, even if Virchow didn’t necessarily equate cellular pathology with “disease” in the broader sense, Szasz is still right to conclude that so-called “mental illness” or “mental disorders” are not real diseases, but inventions of psychiatrists. Of course Szasz understood that people may behave in aberrant or irrational ways, and that people may suffer from a variety of problems that manifest themselves in ways that psychiatrists label as “symptoms” of “mental illness.” The problem is that psychiatry, and by extension much of “psychotherapy,” attempts to medicalize human behavior and everyday life to such an extent that there is almost nothing that escapes the purview of the DSM-V.

    Ruffalo gives a back-handed and disingenuous compliment to Dr. Szasz near the conclusion of his article: “No one in the history of psychiatry advocated more tirelessly for the civil liberties of the mentally ill…” This is not what Szasz did. He exposed the myth of “mental illness” for what it was, and he demonstrated with relentless clarity that to categorize people as “mentally ill” is to do them a disservice. He didn’t advocate for the civil liberties of the “mentally ill.” He advocated for the liberty and responsibility of all human beings, particularly those who were labeled as “mentally ill” by exposing the various lies of psychiatry.

    Ruffalo’s article makes it seem as though there are some cases in which “medication” and “psychotherapy” are a necessity. This is simply not true, and Szasz would have exposed this error as well. Ruffalo also attempts to discredit the anti-psychiatry movement with a reference to Szasz. This is a common error among psychiatrists and psychotherapists. The assumption is that since Szasz disapproved of Laing’s version of “anti-psychiatry,” he would have opposed anti-psychiatry today. Nothing could be further from the truth. Szasz grouped Laing and others like him together with other psychiatric frauds. Szasz was often dismissed as an “anti-psychiatrist,” and he rejected the term as “quackery squared” because he didn’t wish to be associated with Laing and his ilk. The difference is that Laing and his ilk were psychiatrists who attempted to perpetuate the abuses of psychiatry under a different name, namely “anti-psychiatry.” Laing’s so-called “anti-psychiatry,” which Szasz rightly rejected, was not anti-psychiatry at all. It was psychiatry by another name.

    Ruffalo claims that “Szasz never sought to ban psychiatry or psychiatric treatment.” This is another half-truth. Although Szasz advocated for liberty and responsibility, he often and persistently argued that psychiatric slavery ought to be abolished. He wrote entire volumes on the subject, volumes that are conspicuously absent from the assessments of Szasz’s work set forth by most psychiatric apologists.

    Perhaps the most egregious error in Ruffalo’s argument comes at the end of his article: “But Szasz’s unwavering focus on the autonomy and self-determination of psychiatric patients may have led paradoxically to the deprivation of their freedom.” Utter nonsense. These are not arguments of someone who has really read and understood Szasz, nor are they arguments of someone who respects Szasz’s work. While Szasz was busy throughout his entire life, working to support the twin principles of liberty and responsibility, Mr. Ruffalo attempts to pin the blame for the horrors that have been perpetrated by psychiatrists on the innocent on the very man who opposed them. For shame. Ruffalo’s article obfuscates Szasz’s real arguments and attempts to discredit his work, but even worse, it employs base rhetoric to blame the very man whose work has been most beneficial to victims of psychiatry. This is nothing new. Like Karl Kraus before him, Szasz suffered the same abuse in his time. Such has always been the case with truth. First it is ridiculed. Then it is violently opposed. Eventually it is accepted as self-evident. Szasz’s defense of self-evident truths will stand the test of time, while his critics will eventually be forgotten.

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    • I’ve got to wonder why people would get into this game of defending the indefensible by trashing a critic of it. Flattering foes are one thing, but I have to wonder about their motives, when doing so is the way of the blatantly corrupt orthodoxy anyway. I was calling Szasz a moralist. Okay. He didn’t confine, he didn’t shock, and he didn’t drug. Not very many “mental health” professionals can make the same claim at all. That means he certainly wasn’t a member of the blatantly corrupt orthodoxy, and, of course, he’s got to be a primary and readily available target for that orthodoxy whenever they need one. I see any siding with them, as in this case, as a particularly low blow. Now is there anybody who wants to praise Thomas Szasz by actually praising him? I figure, as these comments show, Psychology Today could find a number of takers among them if it was looking for them.

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    • Since Slaying’s comment is mostly filled with the typical anti-psychiatry rhetoric, I will address what I see as his (or her) main errors in critique.

      1.) While it is true that Szasz’s ideas on psychotherapy evolved over the course of his career, his early book The Ethics of Psychoanalysis very clearly outlined Szasz’s approach to working with patients. In it, he praises Freud on multiple occasions for opening the door to a completely voluntary helping service and talks about mental symptoms as resulting from unacknowledged conflict. He also speaks of so-called symptoms as a method of communication and applies game-theoretical principles to understand their nature. Any claim to the contrary is simply an attempt to appropriate Szasz for anti-psychiatry purposes. Slaying seems to allege that Szasz completely rejected “psychotherapy” (as in human conversation). This is blatantly false. He practiced it for half a century.

      2.) Szasz would routinely comment on the fact that if schizophrenia were found to be brain disease, it would leave the domain of psychiatry. In these statements and others, he leaves the door open to a biological understanding of what is called schizophrenia. It has been alleged that Szasz’s views on schizophrenia were much more nuanced in private conversations than in his necessarily polemical writings.

      3.) The idea that what is called “schizophrenia” is simply the result of institutional psychiatry has been thoroughly and repeatedly debunked by historians of psychiatry. It is like saying “congestive heart failure” wouldn’t exist without cardiologists. Perhaps the term would not exist, but people would still be dying of heart failure. “Schizophrenia” has an ontological reference that would exist regardless of psychiatry.

      4.) Please see my comments above regarding metaphoricity. Here is a paper by Pies published a few years ago in the Journal of Psychiatric Practice that expands on these ideas:

      5.) Regarding Szasz’s disavowal of anti-psychiatry: Szasz repeated throughout his career some variant of, “If a person wants a lobotomy, he should be able to get a lobotomy.” He never sought to ban anything. Rather, he was committed to the principles of liberty and contract in psychiatry as in his political philosophy. The claim that Szasz would support “modern anti-psychiatry” is not supported by any evidence and is debunked by virtue of the fact that he wanted nothing to do with the movement in the years preceding his death.

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      • Mark L. Ruffalo, LCSW July 1, 2018 at 5:02 am “people would still be dying of heart failure.”

        No one dies from schizophrenia, if they did there would be pathology reports saying so.

        “For if you suffer your people to be ill-educated, and their manners to be corrupted from their infancy, and then punish them for those crimes to which their first education disposed them, what else is to be concluded from this, but that you first make thieves and then punish them.” Thomas More

        Everyone believes psychiatry’s lies of schizophrenia (Thomas More’s make thieves) and then psychiatry punishes ( you call help) the schizophrenic with drugs-chemicals, with societies blessing.

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      • Admirer’s of Thomas Szasz have to be placed on the defensive by some of your statements.

        1. Sigmund Freud tried to justify his practice as medical practice, that is, having a biological base. His biological base being found in what he called the unconscious. Thomas Szasz felt compelled to expose this sort of fraud. He, Szasz, practiced psychoanalysis, not psychotherapy.

        2. Thomas Szasz authored a book entitled Schizophrenia: The Sacred Symbol of Psychiatry. Szasz’s asides aside. Apparently, you worship at the altar of this sacred cow, too.

        3. Not only is schizophrenia not terminal, there is a great deal of question as to whether it exists at all. While “congestive heart failure” is going to exist regardless of whether there are cardiologists, or not, the simple fact of the matter is many examples of “congestive heart failure” would not have occurred without the psychiatrist and his prescription pad.

        4. Metaphoricity has to do with the figurative, not the literal. If something could be said to have a figurative existence, it is at a remove from the facts. It has no more power than the power we invest in it, and this creates the sort of shell spell that nobody need get caught up for an overlong length of time however dazzling a charm might be made out of such illogic. I don’t find it difficult not to be swayed by this form of verbal pixie dust.

        5. Szasz did have a few flaws, for instance, his rationalizing of lobotomy, shock, and institutionalization (but only in non-coercive institutions–“adult orphan asylums”) in accordance with his own version of market based capitalism. It’s a good thing, in my book, that he was too much of a moralist to believe in, or to peddle, imprisonment of the innocent, mutilating brains, or dope dope himself. He didn’t always, in other words, practice what he preached, nor preach what he practiced. Being a psychiatrist himself, I imagine, he didn’t have a problem distancing himself from any official antipsychiatry movement (the movement R.D. Laing called a movement only on paper). Unfortunately, much of his disdain for antipsychiatry is directed at activities on the continent, that is, over there in Europe, and, it seems, had more to do with his anti-communist bias than anything else.

        6. Of course, when you declare “mental illness” a myth, you also expose the science dedicated to it’s prevention, study, treatment, and cure as a hoax, and so I guess antipsychiatry could be said to have reentered the house through the side door.

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        • Sigmund Freud tried to justify his practice as medical practice, that is, having a biological base. His biological base being found in what he called the unconscious.

          Freud maintained that psychoanalysis should not require a medical degree, but also held out the possibility that there might be yet-to-be-discovered biological causes for psychic turmoil. He never suggested any in particular. Then again, many cokeheads start out pretty on the ball, then gradually dissemble.

          Btw “the unconscious” is not a biological or material concept but a metaphysical one.

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          • In Freud, it is a biological or material concept. Perhaps it would have been better if I had used the term neurosis rather than unconscious, but he claimed, at times, a physical base for that as well. Freud said a number of contradictory things.

            “Freud was not interested in scientific proof. He was interested in psychological proof, which is no proof at all. At the same time, though he lacked both the knowledge and temperament for doing real science, he persistently claimed that psychoanalysis is a branch of natural science. Freud was a man of the Enlightenment. Instead of believing in God, he believed in Charcot. The age of medicalization had dawned. Validating fake illness as real illness, psychopathology as neuropathology, Charcot opened the flood gates. Freud proceeded to inundate the world with fake diseases, perverting the epistemology of disease and corrupting the ethics of medicine."

            Psychiatry: The Science of Lies, Thomas Szasz, p. 22 (2008)

            Michel Foucault talking about where Jurisprudence and Psychiatry converge, brings up the matter of instinct in one of his series of published lectures, Abnormal (given 1974-1975, published in English, 1999). He was talking about how psychiatrist experts in court would now make the criminal resemble his crime with such as a personality disorder, or another psychopathology serving as motivation. It’s all about “perverted”, or “twisted”, one might say, “instinct”. I would have to say that, in a sense, what Freud meant by the unconscious was something similar to this instinct.

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          • Instead of believing in God, he believed in Charcot.

            That’s pretty much the story today with atheistic progressives and psychiatry.

            Quoting Szasz’s anti-Freud rhetoric to disprove Freud is probably not he best source with which to impeach Freud. Don’t know if he called “neurosis” (now “personality disorder”) a “disease” or a “condition.” I doubt you’ll be able to find a quote calling the unconscious biological, or located “in” the brain, but if there are any relevant ones you know of regarding neurosis I’m interested.

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          • The key word up above is “natural science”, and I’m not embarrassed to use any book by Thomas Szasz as a reference.

            “Such candor was not Freud’s dish. In 1901, in The Psychpathology of Everyday Life, Freud frames his claim that psychoanalysis is a science as follows: “If the distinction between conscious and unconscious motivation is taken into account, our feeling of conviction informs us that conscious motivation does not extend to all our motor decisions….What is thus left by the one side receives its motivation from the other side, from the unconscious, and in this way determination in the psychical life is still carried out without any gap.” For the rest of his life, Freud worked and reworked this famous claim.”

            Psychiatry: The Science of Lies, Thomas Szasz, p. 49. (2008)

            For a rationalist, like me, Freud’s words are hard to swallow.

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          • This is still a metaphysical analysis, using “unconscious” and “conscious” in specifically defined ways to convey his framework of human behavior; he is not referring to the two sides of the brain but the two “sides” of consciousness, in his conceptualization. I’m not taking sides on the correctness of his methods or conclusions, just maintaining my position that he was analyzing the mind, not the brain. I don’t see Freud as necessarily key to the development of psychiatry, though I could be wrong. He certainly was glommed onto and his theories exploited by psychiatry, which for decades did apparently center its rationalizations on quasi-Freudian concepts.

            I still haven’t come to any conclusions or researched the extent to which Freud seriously perpetuated medicalization in a literal way, as many self-described “Freudians” are nothing of the sort. (Sort of like many people who think they understand Szasz.) I don’t know how often he “diagnosed” and labeled people, or talked about “diseases.” I think the metaphors were recognized but used for their convenience, not as literal truth (unlike today) — i.e. Freud likely spoke of “diseases” that could be “cured” through talking about unconscious motivations, etc. He died before Thorazine so we’ll never know what his take on that would have been. Would he have considered it the “breakthrough” that it was portrayed as being?

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          • As Dragon Slayer pointed out, we owe a slew of “diseases” to Freud given “neurosis”. “Neuroses”, more recently dubbed “minor mental disorders”, and as to how “somatoform” they might happen to be, it depends on who you ask. Also how gullible you are.

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          • No, people had been knocked unconscious long before Sigmund Freud arrived on the scene to disenlighten the planet. The word, of course, was not Freud’s, but he put it to good use in an original context and fashion.

            “On the basis of his early clinical work, Freud had postulated that unconscious memories of sexual molestation in early childhood were a necessary precondition for the psychoneuroses (hysteria and obsessional neurosis), a formulation now known as Freud’s seduction theory. In the light of his self-analysis, Freud abandoned the theory that every neurosis can be traced back to the effects of infantile sexual abuse, now arguing that infantile sexual scenarios still had a causative function, but it did not matter whether they were real or imagined and that in either case they became pathogenic only when acting as repressed memories.”


            “Oh, no. There he goes again. Using that thoroughly disreputable and totally unreliable resource as a reference.” (Of course, you could do some research of your own, and check up on the material, if you had any doubt.)

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          • “In light of his self-analysis…” What a bunch of crap! He recanted his “trauma theory” under intense pressure from the medical community, who was horrified by what he was saying and could not allow him to continue pursuing such a line of inquiry. Probably because so many of them had engaged in or knew about molestation that they didn’t want to have come out. It was a classic example of the power structure continuing to support the powerful at the expense of their victims. To leave that point out of the Wikipedia article reflects a continuing denial of the reality that power politics rather than concern for health drives a lot of what happens in the medical community, and especially in the psychiatric/”mental health” world.

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          • “In light of his self-analysis”, we have his famous Oedipal Complex. Decades upon decades later countered by Deleuze and Gatteri in their book Anti-Oedipus. Volume one of the two volume Schizophrenia and Capitalism.

            There are so-called “false memories”, too. The kind of thing you get sometimes when you interrogate kids about inappropriate touching.

            Freud went from viewing the matter in terms of molestation to making a big deal out of what he called child sexuality. I don’t think pressure from the medical community had a lot to do with that. There’s also been a lot of talk about resistance to those ideas he developed, and now, after the DSM-III, Sir Sigmund could be said to have been toppled from his pedestal entirely.

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          • Frank, the term I was asking about in regard to who invented it was “neurosis,” not “unconscious.” As to Wikipedia, it would help to skip the middleman; why can’t they document their statements with footnotes or something? (Or do they?)

            It seems like Freud is always somebody’s target, but I think he is also the recipient of unfounded abuse of all sorts by those who seize on this or that statement as a basis to project their own assumptions and biases, and political agendas, onto his work.

            Still haven’t heard from anyone on how often Freud actually talked about “mental illness” and various psychiatric disease categories (other than “neurotic,” which seems to be a synonym for “oddball”).

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          • “The term neurosis was coined by the Scottish doctor William Cullen in 1769 to refer to “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century. The meaning of the term was redefined by Carl Jung and Sigmund Freud over the early and middle 20th century. It has continued to be used in psychology and philosophy.”


            Actually, I once was diagnosed with “possible” “schizotypal personality disorder”, meaning I was such an oddball I was in danger of being further diagnosed “schizophrenic”, and that happened a couple of times, too.

            We, the people edit Wikipedia, OldHead. Citing sources is a requirement, but that’s that. Want the sources. They should be there at the bottom of any Wikipedia article..

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        • What’s wrong with something like Brittanica, is there an online version?

          Having facts is only part of having an authoritative reference article, as facts can be used or omitted selectively to create a subliminal narrative which reflect the authors’ biases. With “encyclopedia by committee” this has to apply even more so, and must result in some crazy misconceptions floating around, who knows where…

          Thanks for the info anyway. What’s important to establish I think is whether Freud regularly spoke in “mental illness”/disease terms in his practice or confined this to theoretical discussions with colleagues.

          Did neurosis have sub-categories?

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      • “The claim that Szasz would support “modern anti-psychiatry” is not supported by any evidence and is debunked..”
        Nothing more wrong than that, if “anti-psychiatry” is translated into “anti-coercive-psychiatry”, which it should name itself at the best:
        – E.g. he was a member of
        – He was engaged as the accuser in the “Foucualt Tribunal”:
        – and in the “Russell Tribunal”:
        – I was invited to speak at the Symposium in Honor of Thomas S. Szasz on his 80th Birthday, read my speech here:
        – He accepted the Lunatic-Offensive´s Freedom award:
        – And Thomas Szasz got the 3rd prize in the contest for the best title of this collaboration photo, see:
        “Psychiatric training is the ritualized indoctrination of the young physician into the theory and practice of psychiatric violence.”

        rene talbot
        Chair FOR madness
        Berlin, Gremany (Webpages in English: )

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      • “…mostly filled with the typical anti-psychiatry rhetoric…” Sounds like typical anti-antipsychiatry rhetoric to me. You’re being a tad hypocritical accusing others of propagandizing when you are doing the same thing.

        As for your comments on “metaphoricity,” there have been several very valid challenges to your comments which remain unaddressed. Simply referring people to your earlier comments doesn’t make them any more convincing. If you want to be credible, you’ll need to take on the legitimate points that are raised rather than simply ignoring them.

        It appears that a rational person who is NOT engaging in propaganda could extract the truth from reading both your and Slaying’s comment threads and pulling out commonalities and contrasts. Your comments would be a lot more credible if you gave credit where credit is due (Slaying’s comment is full of quotes from Szaz that contradict some of your earlier comments rather thoroughly) and sought to find agreement instead of dismissing his entire, well-researched post as “antipsychiatry rhetoric.”

        Your comments suggest that you may have a rather large axe to grind, IMHO. This conversation would proceed a lot better if you put it down.

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      • “Since Slaying’s comment is mostly filled with the typical anti-psychiatry rhetoric, I will address what I see as his (or her) main errors in critique.”

        Szasz saw himself as a noble rhetorician, like Kraus, and he wrote as much in his books. While I don’t agree with everything that Szasz wrote, he was a noble rhetorician because he used language in defense of the truth as he saw it. Much of what Szasz wrote, contrary to the opinion of Mr. Ruffalo, was critical of both psychiatry and psychotherapy. Any summary of Szasz that intentionally omits his straightforward denunciations of both psychiatry and psychotherapy is simply an inaccurate summary.

        Szasz’ book “The Ethics of Psychoanalysis” was published in 1965, which was still very early in his career. It is one of his worst books. Szasz was a prolific author, and he denounced Freud in the majority of his works. Psychiatric apologists like to focus on this early work by Szasz because they believe that it lends credence to the psychiatric enterprise. It is a half-truth that Szasz praised Freud and drew from his theories. The full truth about Szasz cannot be gleaned from the narrow reading of one of his early books, and one of his worst books at that.

        “Slaying seems to allege that Szasz completely rejected ‘psychotherapy’ (as in human conversation). This is blatantly false. He practiced it for half a century.” Nonsense. No one who has read Szasz’ book “The Myth of Psychotherapy” can claim that Szasz simply championed and practiced “psychotherapy.” Like Kraus before him, he was unfailingly and unflinchingly critical of both psychiatry and so-called “psychotherapy.” Do I need to quote Szasz again? Evidently I do, because either Mr. Ruffalo has not read Szasz thoroughly enough, or else he has not understood him. Try this one out, for example:

        “My aim in this enterprise has been to unmask the medical and therapeutic pretensions of psychiatry and psychotherapy. I have done so not because I think that medicine and treatment are bad things, but rather because, in the so-called mental health field, I know that the psychiatric and psychotherapeutic mythology is now used to disguise deception and conceal coercion – by psychiatrists, patients, politicians, jurists, journalists, and people in general.” (“The Myth of Psychotherapy,” p. xviii)

        Freud is one of the main culprits in this book, and in many of Szasz’ other books. Szasz’ book “The Ethics of Psychoanalysis” pre-dates his more lucid and mature reflexions on the true nature of psychiatry. If that isn’t enough, consider the following rebukes that Szasz gave to psychotherapy:

        Szasz referred to psychotherapy as “a fake religion” that “seeks to destroy true religion.” (“The Myth of Psychotherapy,” p. 28)

        “In His repeated attacks on the scribes and Pharisees,” Szasz also writes, “Jesus’ role as reformer could not be clearer. ‘Beware of the scribes, He warns, ‘who like to go about in long robes, and to have salutations in the market places and the best seats in the synagogues and the places of honor at feasts, who devour widows’ houses and for a pretense make long prayers.’ Similarly, He might now warn people to beware of psychiatrists who like to go about in the white coat of doctors, and to receive government grants and the best seats in the theater. Naturally, the Jewish priesthood did not relish being denounced in such terms by Jesus, any more than contemporary pillars of society relish such criticism.” (“The Myth of Psychotherapy,” p. 31)

        Either Mr. Ruffalo has not understood Szasz, or he has not really read Szasz. This would not be a problem, except that Ruffalo attempts to appropriate Szasz for psychiatric apologetics. There are many other ways in which Szasz denounced both psychiatry and psychotherapy, but just for the record, perhaps we should include this gem as well:

        “What, then, are psychotherapists and what do they sell to or impose on their clients? Insofar as they use force, psychotherapists are judges and jailers, inquisitors and torturers; insofar as they eschew it, they are secular priests and pseudomedical rhetoricians. Their services consist of coercions and constraints imposed on individuals on behalf of other persons or social groups, or they consist of contracts and conversations entered into by individuals on their own behalf.” (“The Myth of Psychotherapy,” p. 206)

        “Szasz would routinely comment on the fact that if schizophrenia were found to be brain disease, it would leave the domain of psychiatry.” So what? Have you even read “Schizophrenia: The Sacred Symbol of Psychiatry”? Allow me to quote Szasz again:

        “The claim that some people have a disease called schizophrenia (and that some, presumably, do not) was based not on any medical discovery but only on medical authority; that it was, in other words, the result not of empirical or scientific work, but of ethical and political decision making.” (“Schizophrenia: The Sacred Symbol of Psychiatry,” p. 3)

        That’s already on page 3 of his book. Read the rest to discover what Szasz really thought about so-called “Schizophrenia.”

        “It has been alleged that Szasz’s views on schizophrenia were much more nuanced in private conversations than in his necessarily polemical writings.” It has also been alleged that the moon landings were fake and that the earth is flat.

        “The idea that what is called ‘schizophrenia’ is simply the result of institutional psychiatry has been thoroughly and repeatedly debunked by historians of psychiatry.” Nonsense. As I mentioned earlier, psychiatric apologists have written apologetic defenses of psychiatry in the form of pseudo-history. Such pseudo-historians include Edward Shorter and Tom Burns. More accurate histories of psychiatry have been composed by Szasz himself, as well as by Peter Breggin, Robert Whitaker, and Bonnie Burstow.

        “It is like saying ‘congestive heart failure’ wouldn’t exist without cardiologists. Perhaps the term would not exist, but people would still be dying of heart failure. ‘Schizophrenia’ has an ontological reference that would exist regardless of psychiatry.” Nonsense. But this is also beside the point because contrary to Mr. Ruffalo’s claims, Szasz clearly wrote otherwise. The point is that Mr. Ruffalo has misquoted and mischaracterized Szasz. As far as the myth of “Schizophrenia,” there is more ontological reality for Santa Claus and the Easter bunny than there is for so-called “Schizophrenia.”

        I’m not sure why Mr. Ruffalo keeps referring to the charlatan Pies. Hopefully it is clear enough by now that Pies cannot be taken serious because he has repeatedly attempted to defend the “chemical imbalance” hoax and other psychiatric pseudologies.

        “The claim that Szasz would support ‘modern anti-psychiatry’ is not supported by any evidence and is debunked by virtue of the fact that he wanted nothing to do with the movement in the years preceding his death.” Again, this completely avoids the real question. Szasz distanced himself from the “anti-psychiatry” of Laing and his cohorts early on, because people attempted to brand Szasz as an “anti-psychiatrist.” Szasz considered that psychiatry was the science of lies, and that so-called “anti-psychiatry” was “quackery squared.” Why? Because the “anti-psychiatry” of Laing was psychiatry by another name. He rejected both as forms of coercion and state-sponsored abuse. Szasz’ works give ample support to those who oppose psychiatry and even to those who argue for the abolition of psychiatry. But one would have to actually read Szasz’ works in order to know that.

        Szasz’ defense of the twin principles of liberty and responsibility naturally led him to oppose psychiatry because psychiatry stands in direct opposition to both liberty and responsibility. Szasz was one of the most thoughtful and articulate critics of psychiatry, and those who have read and understood Szasz are beneficiaries of his defense of liberty and responsibility. As much as those who oppose psychiatry are indebted to Szasz, however, his was not the last word.

        Psychiatry is a pseudo-scientific system of slavery that thrives on the oppression of innocent men, women, and even children. The history of psychiatry is riddled with stories of abuse, torture, drugging, involuntary incarceration, shock, insulin coma “therapy,” lobotomy, and other coercive measures. Psychiatry has destroyed the lives of millions of innocent people, and it continues to do so to this day. For this, and many other reasons, psychiatry ought to be abolished.

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        • “The history of psychiatry is riddled with stories of abuse, torture, drugging, involuntary incarceration, shock, insulin coma “therapy,” lobotomy, and other coercive measures.”
          You only forgot to mention the systematic mass murder in Germany from 1939-1949:
          The Racism of Psychiatry and the Deadly Connection between German and International Psychiatry
          The murder of human beings in German institutions and the role psychiatry played in these murders can only be understood in the context of the “scientific administration” of populations. This conception of “scientific management” developed at the end of the 19th and beginning of the 20th century and was differently realized depending on national and political contexts. In all Western states, governments focused more and more on two questions..
          Continue to read here:

          rene talbot
          Chair FOR madness
          Berlin, Gremany (Webpages in English: )

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      • Szasz would routinely comment on the fact that if schizophrenia were found to be brain disease, it would leave the domain of psychiatry. In these statements and others, he leaves the door open to a biological understanding of what is called schizophrenia.

        Maybe, by giving the “bio”/”disease” people enough rope to hang themselves. Though “leaving the door open” is your personal interpretation, not a direct quote from Szasz, who never acknowledged an entity known as “schizophrenia.” So far no one has come through that door. I think Szasz would agree that there is no “it” there to be to begin with, hence nothing to label, correctly or incorrectly.

        I’m not wasting any more time trying to educate MR as to the nature of a metaphor, or why to equate “mind” with “brain” is a prejudice of western science.

        In general I don’t think DS needs much backup here, he’s got it covered.

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      • The claim that Szasz would support “modern anti-psychiatry” is not supported by any evidence and is debunked by virtue of the fact that he wanted nothing to do with the movement in the years preceding his death.

        For the sake of the general readership: This is a common, somewhat disingenous claim, and it’s largely a matter of definition. What Szasz didn’t support was straight-up legal suppression of psychiatry for those who sought it “voluntarily.” However he would support the abolition of forcible psychiatry of any sort, and the status given to psychiatrists as “experts” in legal, educational and other publicly-funded settings. I think he would also support decertifying psychiatry as a branch of medicine, though I don’t know if he ever mentioned this himself.

        As Dragon Slayer mentions, Szasz was opposed to the false “antipsychiatry” of Cooper & Laing. But this has nothing to do with what is currently meant by the term.

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        • Szasz said a lot of nonsense in Antipsychiatry: Quackery Squared. Cooper coined, or recoined, the word antipsychiatry (ca. 1967), and R.D. Laing rejected it. This lead to a split between the two of them. If antipsychiatry has evolved it’s been despite R.D. Laing and David Cooper, Cooper having died in 1986 (the year following the great USA government psychiatric survivor movement buy out/sell out), while Laing followed him into posterity with his own demise 3 years later in 1989.

          Szasz, Laing, and Cooper were psychiatrists, and it doesn’t take much to see the glaring contradiction in that situation. On the positive side, none of them can be held responsible for the furious pace of medicalization taking place in the world today, each in his own fashion, being opposed to such a development.

          I seriously doubt Szasz, rationalizing the peddling of shock, drugs, and volunteer psychiatric institutions to stupid people in the name of free market capitalism, would have been for a complete halt in business as usual, however, he did do all he could to expose it’s medical pretenses as utterly bogus. Perhaps, if psychiatry admitted it wasn’t medicine, he would have been a lot more okay with it. Still, a medical degree is, and was, required in order to pursue psychiatry, and I don’t really think that makes it any better than if that requirement were a tin badge.

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    • Thanks for this great reply!
      Just one little remark on your question: What did Szasz really have to say about so-called “schizophrenia”?
      I appreciate the following as the best citation:
      ‘Schizophrenia’ is a strategic label as ‘Jew’ was in Nazi Germany. If one wants to exclude people from the social order, one must justify this to others, but especially to oneself. So one invents a justificatory rhetoric. This is what all these horrible psychiatric words are about: they are justifying figures of speech, a label wrapped around ‘garbage’ – they mean ‘Take him away’, ‘Get him out of my sight’ etc. This is what the word ‘Jew’ meant in Nazi Germany; it did not mean a person with a specific religious belief. It meant ‘Vermin’, ‘Gas it’. I am afraid that ‘schizophrenic’ and ‘sociopathic personality’ and many other psychiatric diagnostic terms mean exactly the same thing; they mean ‘human garbage’, ‘take him away’, ‘get him out of my sight.’
      Source: ‘Interview with Thomas S. Szasz, M.D.’, The New Physician, 18 June 1969, p. 460.

      rene talbot
      Chair FOR madness
      Berlin, Gremany (Webpages in English: )

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  7. THERE MUST BE PHENOMENOLOGY OF PSYCHE IN THE PLACE OF FALSE CLINICAL EMIPIRISM (DSM fallacy, biological psyche fallacy). Psyche must be seen as a value, something that you can not control by medicine, as something greater than small clinical;false assumptions, and the state must be pro psychological, not pro theological. Psyche in the place of church, but without gods, it is not a religion it is politheism, because nature of psyche is polytheistic not monoteistic like the false theological vision of human. Only then, there would be no mentallilnesses, only psychological necessity. Re visioning psychology, and Manufacture of madness.

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    The Practice then moved me to Dr Gordon instead of Dr Simons. I asked Dr Gordon to write me up a brief Mental Health Summary so that I could see my own “Specialist”:-

    This is what I would say about my records and my experience and my delusions:-

    (The “prescription” was 25mg Seroquel per day, which is not prescriptive for any mental health condition).

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  9. I will end here with a few remarks. I believe that most of us here–Slaying, Steve, Frank, Richard, and some of the others–are 90% in agreement. I think that where we disagree is that I tend to read and cite Szasz’s earlier works, e.g. The Ethics of Psychoanalysis, whereas Slaying seems to be most familiar with Szasz’s later works–which admittedly did become much more radical and “anti-psychiatry.” I think that earlier in his career, Szasz was trying to find a balance between mainstream psychoanalysis and libertarianism.

    See Szasz’s quote on page 16 of Ethics: “Freud’s great contribution lies in having laid the foundation for a therapy that seeks to expand the patient’s choices and hence his freedom and responsibility.” Later in the same book, he states that what is addressed in autonomous psychotherapy is very much along the same lines as what was proposed by Freud and the other pioneering analysts. The book even concludes with a chapter giving advice to therapists. Clearly, Szasz believed in psychotherapy as a form of helping and believed that certain “problems in living” could be helped by human conversation.

    I have come to diverge from Szasz on the issue of metaphor since I believe Szasz erroneously asserted that “mental illness” and “brain disease” are mutually exclusive categories. Anyone who has worked in consultation-liason psychiatry knows that a whole host of neurological diseases present with mental symptoms. Such symptoms are no less “mental” than those produced by psychiatric disorder–but none of us question them as legitimate symptoms of disease. Additionally, I do not believe that an entity only becomes disease once its pathophysiology becomes demonstrable. If this were the case, quite of few diseases readily accepted as such would be declassified as disease.

    Furthermore, and in closing, I don’t think one has to fully accept Szasz’s claims about metaphor to reject involuntary hospitalization and coercion in psychiatry. One could leave room for the existence of a category of disease called “mental illness” and still believe that the only ethical approach to these problems is to assist the patient in becoming more autonomous and free.

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    • Fair enough. I appreciate that you appeared to hear my feedback.

      The only place I’d diverge here is that the term “mental illness” has been almost completely co-opted by the psychiatric profession, to the point that if someone has a problem that affects his/her mental functioning, most people will NOT assign that condition the term “mental illness.” In fact, the DSM (prior to the 5) was specific about pointing out that symptoms caused by a medical condition were NOT indicative of “mental illness.”

      I think it’s fair to say that the use of the DSM to categorize these metaphorical “illnesses” based only on external symptoms is the central problem we face in figuring out what to do. When such a mainstream luminary as Thomas Insel comes right out and says the DSM categories lack validity, we’re not talking about an extremist position here.

      Thanks for hanging in there through a challenging discussion. I very much respect you for continuing to communicate even though the conflict level seemed pretty high.

      —- Steve

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    • “whereas Slaying seems to be most familiar with Szasz’s later works–which admittedly did become much more radical and ‘anti-psychiatry.'”

      Not quite. I’m very familiar with this early work by Szasz, and it is not representative of his works as a whole. In fact, it is probably his worst book. His later works are not more radical. They are more reasonable, straightforward, and accurate. I imagine that Szasz was wrestling with the implication of the so-called “profession” in which he found himself. Whatever the case, the inordinate focus on one bad book gives a distorted idea of Szasz’ work as a whole.

      “One could leave room for the existence of a category of disease called ‘mental illness’ and still believe that the only ethical approach to these problems is to assist the patient in becoming more autonomous and free.” Not really. The entire myth of “mental illness” exists as a justification to enslave, torture, abuse, and otherwise molest people who were formerly free. The entire psychiatric system of slavery rests on the false premise of so-called “mental illness.” If you believe in the autonomy, freedom, and responsibility of individuals, then the way to contribute to the expansion of such autonomy, freedom, and responsibility is to refrain from labeling and burdening people with the unjust and untenable epithets of so-called “mental illness.” Psychiatry is the antithesis of freedom and responsibility, and “mental illness” is the myth that sustains the psychiatric enterprise.

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      • It seems the real question is, why do we need a concept of “mental illness” in order to assist people in increasing their levels of freedom and responsibility? Why do we need artificial and heterogeneous categories of metaphorical “illness” to accomplish what are essentially the basic tasks of being a human being in society with other human beings? Don’t all humans struggle with exactly the same questions of freedom and responsibility? Without a clear indicator of physiological ill health, what purpose does it serve to call such people “ill,” other than to distance them from the rest of the so-called “normal” population?

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        • “…why do we need a concept of “mental illness” …?”

          That’s a great question. My response would be because it is a projection through which people can cast their shadow onto another so they do not have to own it themselves and feel it in their own bodies. Scapegoating is so much more convenient.

          Plus, a lot of people seem to have a deep aversion to differences in personality because it takes them out of their comfort zone. And rather than to live and let live, they choose to judge and stigmatize out of fear (again, of their own shadow) and it becomes a treacherous game of social persecution through marginalization.

          A major part of my healing was practicing not identifying with the projection. That was an extremely powerful component in my awakening. There’s a whole other Self underneath all that “labeling and drugging” crap.

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          • My response would be we don’t need a concept of “mental illness”.

            Followed by something Mark Ruffalo wrote, “If this were the case (an entity only becomes disease once its pathophysiology becomes demonstrable), quite of few diseases readily accepted as such would be declassified as disease.”

            If so-called “mental illness” labels are merely a form of scapegoating in action, and I think they are, what we need is more respect for freedom, and tolerance of human diversity and difference instead.

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          • Yes, although no one can force others to practice tolerance and respect. Starts from within, we practice it first on ourselves, then on others, then we become the examples.

            Calling out intolerance and disrespect on an institutional level is also a good strategy for taking steps to make change, except it’s only a beginning step. That’s when the scapegoating either begins or deepens. Still, it is truth so this is where courage comes in.

            The whole process of shifting the paradigm can make a person feel kinda crazy, but this is not a projection, it’s a human feeling and experience, which I’d consider to be “normal” because it’s an inherent part of change. It’s not terrible and it’s not a “condition,” but more so, a state of confusion and disorientation that would be quite natural while core changes are happening. So what? It will pass. And in the meantime, one can learn a lot of really cool stuff that will serve well, and then eventually things come together in a new way. That’s called “transformation.”

            Feeling crazy is part of it, I don’t see how anyone can get away with being part of change without going off center a few times in the process. Big deal, it happens to everyone. Otherwise, we wouldn’t be human.

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      • Slaying, you have stated here a few times that Ethics of Psychoanalysis was one of Szasz’s worst books. But did you know that Szasz ranked it as his favorite book? He says so explicity in the preface of the Syracuse University Press edition released in the 1980s. This also says to me that his thoughts on “psychotherapy” really didn’t change all that much in those 20 or so years. I get the sense that the reason you dislike the book so much is that it gives credence to the idea that Szasz actually felt like there was some benefit to “psychotherapy,” despite his later writings, which I am aware became very hostile and critical towards Freud.

        I believe a careful reading of Szasz–as well as listening to him lecture and interview–reveals pervasively his game-theoretical approach to the problems called mental illness. In other words, Szasz saw the so-called mentally ill person as communicating in a somatic protolanguage that needed to be–if voluntarily undertaken–explored and decoded in a psychoanalysis.

        Despite what you have insisted, I have read nearly every book Szasz ever wrote, from Pain and Pleasure and his early psychoanalytic work, to Psychiatry: The Science of Lies. Whether you feel that I understand them is a different matter, of course.

        Also, my comments above about congestive heart failure reflect my own opinion and deviate substantially from what Szasz offered.

        Steve, I appreciate your words and I also appreciate the cordial manner of debate here. This discussion is much needed and like I said above, I think we mostly agree in principle.

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        • Mark

          I hope you take the time to read some of the above referenced blogs here at MIA that I provided in earlier comments. There is a wealth of valuable analysis in the writings of both Dr. Hickey and Dr. Joseph.

          Nobody has deconstructed modern psychiatry better than Dr Philip Hickey. People cannot, and should not, promote themselves as being knowledgeable, or learned, in this field without a willingness to suffer the cognitive dissonance encountered when reading these writings with an open mind.


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        • “Despite what you have insisted, I have read nearly every book Szasz ever wrote, from ‘Pain and Pleasure’ and his early psychoanalytic work, to ‘Psychiatry: The Science of Lies.’ Whether you feel that I understand them is a different matter, of course.”

          And yet you show absolutely no evidence of having read or understood any of them, nor do you respond to any of the direct quotes from Szasz that I shared.

          “I believe a careful reading of Szasz–as well as listening to him lecture and interview–reveals pervasively his game-theoretical approach to the problems called mental illness.”

          Nonsense. A careful reading of Szasz would include a careful reading of more than just his worst book. In any case, Szasz got a lot of things wrong, and this game theory stuff was just one of them.

          “Slaying, you have stated here a few times that ‘Ethics of Psychoanalysis’ was one of Szasz’s worst books.”

          Yes. That’s right. It is probably his worst book, and yet it is the only book that you care to reference because you think that it supports your narrow reading of Szasz. Please read Szasz’s works before making any further attempts to recruit Szasz as a psychiatric apologist.

          “But did you know that Szasz ranked it as his favorite book? He says so explicity in the preface of the Syracuse University Press edition released in the 1980s.”

          Szasz book “The Ethics of Psychoanalysis” is full of contradictions, and he wrote many things after 1980.

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        • It’s commendable that you don’t support forced treatment, however another part of the problem is medicalization, the idea, it’s certainly no fact, that 20 % of the population, in the USA before the rest of the world, is “sick” and in need of drugs (and/or psychotherapy). Szasz showed a lot of foresight with The Myth of Mental Illness. Today anxiety isn’t just an evolutionary aid to survival, or an instinctual hold-over. No, anxiety is a disease. Ditto, distraction, disobedience, obsession, shyness, grief, anger, and you name it. (There is also the related matter of the use of psychiatry in the judicial system, but that would take me too far afield.) As far as I could see, your Psychology Today post does little more than rationalize this runaway medicalization.

          I had a similar reaction to Dragon Slayer’s on reading The Ethics of Psychoanalysis. I think Szasz much better at critiquing the system than at delineating his own, and rather conventional at that, brand of practice. Thomas Szasz has also been none too friendly to the likes of R. D. Laing, David Cooper, and Loren Mosher when it came to their more communal approach and experiments. Producing a label of his own, which might apply to the Kibbutz or Monastery as well, ‘collectivism’.

          He also came to say, and with reason, that his brand of psychoanalysis could no longer be practiced. He was sued for not following standard practice and drugging a patient after that patient committed suicide. He also had views on confidentiality that would clash, not with HIPAA, what a laugh, but with the courts demand that the psychiatric profession inform on, in their view, potentially dangerous individuals. If the government has files on nearly everybody, you know they had help from psychiatry.

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        • Thanks for that. But I’d really like an answer to that question: why do YOU, Mark, think we need a concept of “mental illness” in order to help people improve their sense of freedom and responsibility? Doesn’t the very fact of saying someone “has a disorder” instantly reduce their sense of responsibility? Why not simply say, “You appear to experience a lot of feelings of anxiety, and it seems you want to find a way to make sense of and get a handle on those experiences?” This enables one to engage in both psychological counseling and lifestyle coaching without any disabling labeling process (and remember we have solid evidence that labeling in and of itself creates a sense of “otherness” and a loss of hope for resolution). Unless one is holding out for a drug or surgical intervention, what possible benefit is there to calling someone’s behavioral or emotional struggles an “illness?”

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          • Thanks, Steve. “You appear to experience a lot of feelings of anxiety, and it seems you want to find a way to make sense of and get a handle on those experiences?” is precisely what I say–almost verbatim! To answer your question: I believe we need a concept called “mental illness” because a careful philosophical inquiry into the meaning of “disease” reveals, in my opinion, that a person can be ill in the literal sense in the realm of “mental”–Szasz’s interpretation of Virchow notwithstanding. However, I agree with you that diagnosis often does more harm than good–and sometimes much more harm. I do believe that some people can be aided by diagnosis in the sense that they can conceptualize their problem more easily and identify with others who have similar experiences. And calling it something might give them hope that some “treatment” might help. I don’t believe that either of these points necessarily undermines personal responsibility, though a practitioner who operates from a solely medical-paternalistic or deterministic approach can very easily use the disease concept to justify coercion. This widespread practice must be stopped.

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          • Hi, Mark,

            Your explanation doesn’t really explain anything to me. Even if I accept your premise about the possibility of “real” mental illness, the fact that we could define such an “illness” doesn’t mean that we should or that it helps. It’s true that it can help people to identify with others and feel less isolated if they know they’re not the only ones experiencing a certain condition, but reframing and normalization can easily done without any illness concept being invoked. IMHO, the purpose of the DSM-III forward was to medicalize mental/emotional/behavioral experiences so that drugs can be sold for them. The APA said as much prior to the DSM-III coming out. They were losing market share and needed to promote something that they could do that other therapists could not. That means drugs. Practitioners who “operates from a solely medical-paternalistic or deterministic approach” are the majority, and justifying this approach is, in fact, the purpose of DSM diagnosis. One could very easily accomplish the same goal as you mention without any reference to diagnosis, and the possibility of such reductionistic justifications would be eliminated at no cost.

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          • Even if I accept your premise about the possibility of “real” mental illness, the fact that we could define such an “illness” doesn’t mean that we should or that it helps.

            That debating whether or not to agree upon the existence of a proposed “illness” is even possible says a lot in itself. This is more akin to the canonization of saints than to the objective evaluation of any medical or scientific discovery.

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        • Talking about psychoanalysis or psychotherapy here is a diversion as, however one defines the terms, they are not the province of psychiatry. Szasz was indeed a practicing psychoanalyst, with psychiatric credentials to boot as they were needed at the time to get a degree in psychoanalysis (though no more). None of this is in the least bit relevant to his historic deconstruction of psychiatry and “mental illness.”

          To answer your question: I believe we need a concept called “mental illness” because a careful philosophical inquiry into the meaning of “disease” reveals, in my opinion, that a person can be ill in the literal sense in the realm of “mental”

          In other words, exactly what you said at the beginning before your hypotheses were dissected and rebutted piece by piece.

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          • Huh? As I understand it there are two primary treatments for “mental illness”, 1. drug therapy, and 2. talk therapy. This being the case, how does psychoanalysis/psychotherapy elude the sphere of psychiatry? The specific discipline, science (cough, cough), set up for the study, prevention, detection, treatment, and cure of said “mental illness”. Sure, some psychotherapists (consider the irony) have psychology and social work degrees, no doubt, but my understanding is that some of psychoanalyists still have psychiatry degrees as well. All of them seem to like the idea that the people they are analyzing or therapeutizing are some how “sick”. If you ask me, that’s relevance.

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          • Nope. You don’t need a medical degree to practice psychoanalysis.

            “Psychotherapy” is a meaningless term, there’s really no reason to say more as there is no consistent definition. If a psychiatrist practices “psychotherapy” it is as “treatment” for a “disease,” otherwise there is no medical degree required and the process is not portrayed as “medical.” If practiced by a social worker, psychologist or anyone else who hangs up a shingle, it remains psychology, not psychiatry. The lines blur when you get into “clinical” psychology and psychologists prescribing drugs however, as they to some extent are subject to the demands of psychiatric hegemony.

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          • Well, a lot people around here are going on and on about “psychotherapy” and “healing” or what not. I would imagine it is because they think somebody is “hurt” and in “need” of “medical” attention, even when they use the word “psychoanalysis”.

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          • Psychoanalysis is at best one form of psychotherapy, which is a catch-all term and basically meaningless. I don’t think all psychoanalysts would call themselves psychotherapists; at any rate relatively few psychotherapists are psychoanalysts. Many psychoanalysts don’t think in disease terms. There are many other things called “psychotherapy”; there is no consistent definition. But I concur that, helpful or not, calling it such perpetuates the mystification characterizing all “mental health” language, and should be eliminated.

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          • I’m not one to engage the services of psychoanalysis, psychotherapy, or whatchamacallit. The same goes for psychiatry. If I visit a doctor’s office, let the doctor be a physician of the corporal body, and my mind will take care of itself.

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    • I believe Szasz erroneously asserted that “mental illness” and “brain disease” are mutually exclusive categories. Anyone who has worked in consultation-liason psychiatry knows that a whole host of neurological diseases present with mental symptoms.

      You still don’t seem to understand the key point, which is not “mere” semantics. Brain diseases are NOT considered “mental illnesses,” they are concrete physical illnesses which sometimes have “mental” components. Again, Szasz 101.

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    • One could leave room for the existence of a category of disease called “mental illness” and still believe that the only ethical approach to these problems is to assist the patient in becoming more autonomous and free.

      We could leave room for the existence of the Easter Bunny too. But why?

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        • Don’t forget that dainty dental delight, the beloved Tooth Fairy. Unlike the myths of the Easter Bunny, Santa Claus, and the Tooth Fairy, however, the myth of “mental illness” has injured, impaired, incapacitated and led to the untimely deaths of untold numbers of innocent people.

          It’s time to quote C.S. Lewis again, before the inherent therapeutic zealotry of psychiatry gets too far out of hand. Ponder this:

          “Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. They may be more likely to go to Heaven yet at the same time likelier to make a Hell of earth. Their very kindness stings with intolerable insult. To be ‘cured’ against one’s will and cured of states which we may not regard as disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals.”

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  10. “I believe we need a concept called ‘mental illness’ because a careful philosophical inquiry into the meaning of ‘disease’ reveals, in my opinion, that a person can be ill in the literal sense in the realm of “mental”–Szasz’s interpretation of Virchow notwithstanding.”

    No. The opposite is true. A careful philosophical inquiry into the meaning of “disease” reveals precisely what Szasz foresaw: the medicalization of everyday life is a powerful weapon in the hand of the therapeutic state. Szasz was right. In former ages, false priests oppressed the ignorant masses under the assumed authority of false religious tenets, bedazzling them with recondite Latinisms. In modern times, psychiatrists and doctors, the new false priests, oppress the ignorant masses under the assumed authority of “medicine,” wielding “treatments” for “mental illness.” In former ages, the ignorant were beholden to the false priests for their supposed religious power and authority. The new false religion of psychiatry imposes its fake diseases upon its victims in order that they flock to the new false priests, psychiatrists and psychotherapists, for their magical “remedies,” namely drugs or psychotherapy.

    The only people who “need” a concept of “mental illness” are psychiatrists and psychotherapists, because “mental illness” is the terrible myth that sustains the pseudo-scientific enterprise of psychiatry. “Mental illness” is the wind beneath the wings of the dragon of psychiatry. It is also the fiery stench that reeks from her filthy maw. We no more need “mental illness” than the people of Laketown needed Smaug.

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  11. I think the striking thing here is that this all erupted in response to an “around the web” item, not a formal blog. MIA should take note, especially as it is currently polling the readership about what they consider important.

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  12. Here’s a slice of what Ruffalo offers as an example of Pies’ supposedly illustrative thinking:

    Some have argued that if and when so-called mental illnesses are exhaustively explained by disturbed brain function or structure, we will no longer need the term “mental illness,” on the supposition that neuropathology and psychopathology are mutually exclusive constructs. The author argues that, on the contrary, the locution “mental illness” is not rendered useless or unnecessary when neuropathology is discovered, nor is the term “mental illness” a metaphor. Rather, it is an instance of “ordinary language” that we apply quite literally to certain types of suffering and incapacity in the realm of thought, emotion, cognition, and behavior.

    In other words, the fact that the term “mental illness” is commonly used demonstrates its legitimacy, or something, and hence the rules of language may be waived.

    Dragonslayer, you still around?

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        • Is that an, “I’m defending Freudian psychoanalysis”, or an, “I’m confused about the relevance of Freudian psychoanalysis to this discussion”? We’ve talked about how Thomas Szasz had no difficulty whatsoever finding fault with Freudian theory while Mark Ruffalo is using Sigmund Freud to take a shot at Thomas Szasz. What I want to know is why it would be any more to the point to excuse Sigmund Freud than it would be to pillory Ronald Pies?

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          • In other words, regardless of Freud’s specializing in what he termed “neurosis” (“minor mental disorder”) [the bug boom Dragon Slayer spoke of at some point previously] rather than “psychosis” (“major mental disorder”), is non-disease any more disease if you use talk to treat it than if you use drugs to treat it, and vice versa?

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          • I don’t even remember how Freud came up, or see its particular relevance to what I see as the overriding issue, which is Pies’/Ruffalo’s redefining “metaphor” to suit their own purposes. However, if Ruffalo tries to use Freud to discredit Szasz in any way (which I guess I missed), it would be ludicrous, considering Freud predated Szasz by some years and probably never heard of him.

            On the last point, I was simply saying that in Freud’s day it was likely that he and other psychoanalysts had a firmer grasp of the metaphors they were using as being metaphors, and knowing the difference between metaphorical diseases and real ones. But it remains just a hunch.

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          • Mark Ruffalo was seeing the influence of Freud on The Ethics of Psychoanalysis (1965). He doesn’t seem so averse to Freudian methods himself. I would question the extent of that influence, if indeed, there was such an influence. Szasz’s critique of Freud goes back to The Myth of Mental Illness (1961). If you’re going to write a book titled Schizophrenia: The Sacred Symbol of Psychiatry (1976), as Szasz did, it’s probably not because you think the “minor mental illnesses” are any less mythic, and therefore, more real, than the “major” ones. This doesn’t render the position of Freud vis a vis that of Szasz irrelevant at all, quite the reverse.

            Google gives us a definition for “neurosis”, Freud’s specialty, as a “relatively mild form” of “mental illness” (remember that thing that Szasz in his most signature piece called myth) “not caused by organic disease”. I’d say we’re at a far remove here from Virchow’s “lesions in bodily organs”, that is, if you can get past the double use of the word disease, “mental illness” PLUS “organic disease”. Szasz was adamant about the first, it wasn’t organic disease, and with regard to the second, it can’t be the first (i.e. counterfeit disease, and thus, a metaphor, or figure of speech, NOT literal.)

            If we were arguing against Ronald Pies the question of relevance might come up, however, Mark Ruffalo was using Pies, just as he used Freud, against Szasz, and, to my way of thinking, that places both on the point rather than beside it. The question of to what extent does Ronald Pies employ Freudian techniques of analysis, talk therapy, and to what extent he falls back on the old biological standard of drug therapy, is another one altogether, but still relevant, as both “treatment” modalities tend to validate the notion of “mental illness” and its diagnosis/invention.

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          • This is making my head hurt. Whatever the particulars, the Freud angle is fairly tangential to what I see as important here.

            The main subject of this “around the web” piece is Ruffalo’s contention (which he apparently lifted from Pies) that “mental illness” is NOT a metaphor and in fact is a useful term. I think he has already been thoroughly refuted. I was just trying to examine his logic further, esp. the apparent contention that regular use of a metaphor changes it into something else.

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          • Wasn’t that, that “mental illness” is NOT a metaphor and in fact is a useful term, Sigmund Freud’s contention as well?

            For Thomas Szasz, a view shared by myself, “mental illness” is a figure of speech rather than a fact of nature until proven otherwise, proof that hasn’t been forthcoming, the bogus and biased easily refutable research song and dance aside. Where is the evidence? As far as I can tell, beyond playing with a trick deck, this verbal game or that, there isn’t any.

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          • If the rules of language (not just English) apply, no one could ever “prove” that metaphors are concrete, and/or that the mind is part of the body, hence subject to “illness.” There’s nothing to “prove” or to “research,” or to speculate about. Words mean things; the “proof” is in the definition.

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        • Words don’t mean things, but I get your drift. Words certainly can mean things.

          No one could ever prove that metaphors are concrete because metaphors aren’t concrete. Metaphors are figures of speech, that’s all.

          Regardless you will still get an argument from the psychiatric establishment. I think it’s a shrug. If you are saying that “mental illness” doesn’t really exist, not literally, I agree.

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    • The skeptic movement, as has been pointed out, although weak when it comes to tackling bio-psychiatry, has no problem critiquing Freud. He wasn’t very, to say the least, scientific. Freud is not the Freud he once was. Not only has the citadel been assailed, but we’re peering through a gaping breech in the wall at the ruins.

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