Wednesday, October 23, 2019

Comments by Michael Fontaine, PhD

Showing 14 of 14 comments.

  • I too read Shrinks this past week with an eye to reviewing it, but I think Mr. Whitaker’s discussion above renders the effort unnecessary. Anyone who does read the book will see that Dr. Lieberman makes no attempt to distinguish between a patient who asks for his help from a person whose relatives bring her to him asking for his help. Which is, I would have thought, a significant distinction.

    I will, however, cry foul on one assertion that you make in the book, Dr. Lieberman. You write (emphasis added),

    Dr. Fuller Torrey, a prominent schizophrenia researcher and leading public spokesperson for mental illness, told me, “Laing’s convictions were eventually put to the test when his own daughter developed schizophrenia. After that, he became disillusioned with his own ideas. People who knew Laing told me that he became a guy asking for money by giving lectures on ideas he no longer believed in. Same with Szasz, who I met several times. He made it pretty clear he understood that schizophrenia qualified as a true brain disease, but he was never going to say so publicly.”

    Lieberman, Jeffrey A. (2015-03-10). Shrinks: The Untold Story of Psychiatry (p. 113). Little, Brown and Company. Kindle Edition.

    I do not believe you. I wonder if by “he made it pretty clear,” Dr. Lieberman, you mean “he said.” Can you please explain what you meant?

  • A short article by T.M. Luhrmann in this past Sunday’s New York Times shouldn’t pass by this context unnoticed.

    According to the article, the British Psychological Society just released a report effectively confirming everything Szasz argued for 50 years:

    ***

    TWO months ago, the British Psychological Society released a remarkable document entitled “Understanding Psychosis and Schizophrenia.” Its authors say that hearing voices and feeling paranoid are common experiences, and are often a reaction to trauma, abuse or deprivation: “Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.”

    The report says that there is no strict dividing line between psychosis and normal experience: “Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.”

    The report adds that antipsychotic medications are sometimes helpful, but that “there is no evidence that it corrects an underlying biological abnormality.” It then warns about the risk of taking these drugs for years.

    It’s a pity Luhrmann didn’t bother to mention Szasz’ name. After all, those are all his ideas.

  • You are more than on to something when you say “I think the US government for example, identifies very much with ancient Rome in many ways.” Actually, it’s much odder than that. After getting rid of colonial rule amid the American Revolution the Founders had to come up with a new political system. They cast about for all kinds of models and settled on the Roman Republic of 1800 years past (conventionally dated 509 – 27 BC).

    That is really quite weird if you think about it. The world and especially Europe provided many models the Americans could have emulated, but instead they chose to consciously imitate a form of pre-Christian government from long in the past. That is one reason why the US is usually considered the Enlightenment project par excellence.

    We call Rome back then – and that is precisely the time that Plautus (254-184 BC) was active – a “republic” but it’s really an imperial republic. That’s to say, it was a government characterized by representative democracy for its citizens, but it controlled non-citizen territories that were imperial-like. Not so different, some say, from the US today.

    All that said, ancient Rome had nothing like institutional psychiatry. Back then if you were considered mad you were kept at home by your relatives. Scholars right now are digging into the evidence but it doesn’t look like most of what we’d call mental illness today was considered a medical matter. The Roman court system considered it a social matter, as a brand-new paper I’ve just read points out.

    You ask about the Hippocratic school’s development and you’re spot-on. It flourished in the ancient world and was spreading to Rome at exactly the time Plautus’ play was staged, where it met resistance and suspicion. A famous Roman writer named Cato the Elder wondered why doctors would need to swear any kind of oath. We think the Hippocratic Oath is a great thing; he thought it was some kind of conspiracy and that the doctors would kill you. (Romans had traditional cures already, of course, so in rejecting Hippocratic medicine that doesn’t mean they were rejecting medicine entirely.)

    Hippocratic medicine was consolidated in the Greek writings of Galen, a medical doctor from the early part of the Roman empire. Those writings formed the basis of bodily medicine until about 1800, give or take. But with the rise of Christianity in Europe, mental illness mostly became a matter of sin or virtue, so the medical writings weren’t relevant. With the decline of the Church in the Enlightenment, people began to look and find material (bodily) explanations for some of those sins.

  • I want to thank those of you who have watched and commented so far and to raise a general and open-ended question here that I don’t in the video. It’s this:

    What do you make of the fact that mental illness is being medicalized 2000 years ago? What does that fact say to you?

    I ask because as many of you know already, that’s not invariably the case in the ancient world (Greece, Rome) and wasn’t usually the case, as far as we know, before the Enlightenment.

  • Thank you, Boans. I know Kafka’s Trial but did not know the term “Kafka trapping.” I’ll have a look at that link.

    You raise a more general issue that I sometimes discuss with a class I do. What’s the difference between delusion and collusion? It’s easy and tempting to see collusion–witness any conspiracy theory–where it’s probably a case of delusion. That doesn’t make the outcome any less tragic, though it can certainly make it more tragic. How we decide people are colluding against us rather than are deluded in acting as they do, is a question that you’re likely to answer based on whether you sympathize with or against the person. I think Rosenhan was right to say doctors are more likely to call a healthy person sick than a sick person healthy. In most aspects of life that kind of caution is a good thing. It’s obviously not so in all aspects of life.

    Thanks again for your thoughts.

  • Thanks, Theinarticulatepoet. You are right to bring Postel into this context. Dr. Szasz discussed his activities in one of his last books, Psychiatry: The Science of Lies, pp. 82-3, in comparison with and immediately after his critique of Rosenhan. Szasz also reminds readers in those pages of Donald Naftulin’s “Dr. Fox” pretense. (There’s a wikipedia page, http://en.wikipedia.org/wiki/Dr._Fox_effect, but it’s not very informative — I refer you to Szasz’s critique).

  • Let me revisit the point Szasz made about witches/psychiatrists/patients briefly. In Anti-Psychiatry: Quackery Squared (2009, p. 130) he quotes Foucault’s endorsement of his argument in Manufacture of Madness:

    “What’s strong and important in Szasz’s work is to have shown that the historical continuity doesn’t go from witches to madness, but from the institution of witches to the one of psychiatrists.”

    The fact that Szasz does not comment on or correct Foucault’s statement suggests to me he agreed with it. This matches my recollection of the argument of the book. As I recall (though I don’t have the book nearby to check) in Manufacture of Madness Szasz disputed Zilboorg’s traditional interpretation that the mental patients of today were identical with the witches of the early modern period.

  • Thank you for your reply, Dr. Farber. Let me address some of your points in the same order you did.

    I published my thoughts on Dr. Szasz’ suicide in a letter just uploaded to Szasz.com. In choosing the time and means of his death I believe he was self-consciously acting in the tradition of Socrates. You can find my reasoning here: http://www.szasz.com/szaszfesttwo.pdf.

    In the second instance you object to the same sentence that an earlier commenter did, which I agree was badly worded (and which I replied to above). You write, “I read at least 15 books and many articles by Tom and I think he very strongly and very clearly advocated his belief in autonomy”. You raise a good point. Did Szasz value autonomy or freedom more highly? Are the two words simply synonymous, the one Greek and the other Saxon? It would be helpful to find a statement from him on the matter.

    From your description of “Constantinian religion”, a notion with which I’m familiar only from your comment here, as well as the sweeping Marxian analysis of history and notion of “the Mad” that you offer, I will respectfully disagree. Of course power is at stake, as I thought I made clear — insufficiently so, evidently.

    On your final point, I didn’t suggest, nor meant to suggest, that Szasz ever did or should have abandoned his advocacy. As I make clear in the letter linked to above, I believe his suicide was the final act of his lifelong advocacy.

    I thank you again for your critique.

  • “Isn’t the Epicurean motto: moderation in excess?”

    I’m not familiar with this formulation but it sounds like a spoof or caricature of the Epicurean ideal. Epicurus advocated moderation as the ideal way to live. The expression “the golden mean” is one ancient expression of that ideal, and Epicurean poets in antiquity — Horace, Virgil, probably Catullus — celebrated it repeatedly. Like the Epicurean ideal of pleasure, however, it was easily caricatured by his opponents. That is why the name Epicurean today typically conjures up associations with eating deliciously or excessively.

  • Thanks for your comment, Mr. Blankenship. Regarding the relationship of mad-doctoring to coercive institutional psychiatry (your first sentence), I believe we are saying the same thing, though I now see I may have worded my statement poorly. I simply meant that his focus on the coercions inherent in institutional psychiatry tended to draw attention away from the real-world implications of just what “freedom” means (since freedom and responsibility are the “positions,” or rather ideals, that he advocated). Szasz certainly did say that freedom won’t necessarily make you happy; he only said so much less often than he might have.