Thomas Szasz (MH Topic 3) Flashcards
(14 cards)
Summary & Background
Szasz published essay ‘Myth of mental illness’ in 1960 and 2011 article is an update of his views (50 yrs later).
He points out a ‘conceptual error’ in way unwanted behaviours are defined as mental illness & psychiatry is based on set of fundamental beliefs which are FALSE.
Causes of mental illness assumed to be biological/genetic when families, institutions and state have just as much influence.
Supports alternative NOT medical model. Supports free will.
His original article in 1960- mental patients were confined to institutions, seen as ‘incurable’ or they sought private treatment.
Updated article 2011 (key research)
Szasz suggests medical model has been validated by government & established in law to protect patient from ‘himself and others’.
No other legally valid approach to mental illness in current US society.
Szasz says politics of mental illness is that it is treated as a disease like any other, ‘virtually all mental healthcare is now responsibility of government’ and anyone working with mentally ill has responsibility for protecting them from self & others.
Szasz argues mental illnesses are not like biological diseases- diagnosis not based on scientific research & is used to hospitalise & control ppl without their consent. Suggests mental hospitals & treatment like ‘prisons’ not medical care & list of diseased that can be diagnosed is growing, deprive people of freedom.
Diagnosis also based on subjective judgement by psychiatrist- not verifiable like taking temperature/blood test.
Szasz’s alternative
To try understand reasons behind patient’s behaviour, respect, understand, try to help.
Medical model is inhumane, we should look more at socio economic and psychoanalytic explanations.
Szasz says patients should have right to control & define own lives- Psychiatrists should NOT even deprive ppl freedom to take own life.
Since Szasz original 1960 article
Latest DSM does take into account more global functioning of a patient- diagnosis much more carefully made, patients have more rights & power, large institutions have closed, many inhumane treatments e.g lobotomies have stopped.
Szasz’s argument
Argued since 1960 that concept of mental illness is a ‘myth’ and society should abandon effort to judge people as sane or insane.
Claimed no real evidence for biological causes of mental illness- person labelled mentally ill was essentially victim of a political act. Person perceived as threat to society- according to Szasz this was real reason they were likely to be locked away in mental hospital, no rights/freedom.
Szasz argued strongly that it was dishonest to label people mentally ill and wrong to use illness as excuse to deprive people of their rights.
One of Szasz basic argument
‘Mental illness is a myth’.
He was critical of medical model for understanding human struggles & difficulties.
He saw use of diagnostic systems such as DSM as wrongly implying presence of actual disease.
According to Szasz mental illness is a myth not a disease that can be scientifically proven.
Diagnosis based on subjective judgement of psychiatrist, not verifiable.
He saw such efforts as medicalising morality and typical dilemmas and struggles of human life.
‘fictitious mental diseases’
e.g body dysmorphia, multiple personality disorder, frotteurism- mocking tone- for example shoplifting behaviour called ‘kleptomania’ arguing interpretation of behaviours as pathological entities for one thing makes an assumption that individuals actions are outside their control, continue.
According to Szasz government decides what illnesses exist- highlighting how mental illness not real phenomenon, if it were it would not change so easily.
Medicalisation hands responsibility for such behaviours away from individual- concerned to physicians.
Biological explanations of abnormal behaviours
Increasingly common, brain scanning, genetic analysis, knowledge of transmitters have all led to increasingly biological emphasis in diagnosis & treatment of severe psychiatric disorders.
Szasz suggests while some mental illness may be discovered to have physical cause, means they were never ‘mental illnesses’- instead undiagnosed physical illnesses.
Why did Szasz claim mental illness = myth?
Claimed mental illness still a myth because minds do not get sick.
What is labelled mental illness is behaviour- specifically harmful to others, disapproved by society.
We do not label people with brain diseases ‘mentally ill’ if they act normal, so label should be recognised as political/moral judgement, not medical judgement.
He believed so-called mentally ill people should have same rights & responsibilities as everyone else. Insane person should also have same responsibilities as every other citizen and not exempt from moral/legal blame for deviant behaviour.
What was Szasz against?
The insanity defence in our legal system, with its implication that people who fall into ‘insane’ category should be exempt from punishment of illegal behaviour.
If persons behaviour endangered others, should be arrested and sent to jail- if did not endanger, person should be left alone.
Argued regardless of mental illness diagnosis- individuals always responsible for their conduct. (Free will)
mental illnesses referred to as ‘problems in living’
Szasz didn’t deny humans have difficulties, preferred to refer as ‘problems in living’ NOT as mental illnesses or diseases.
He did not deny psychiatrists role in assisting individuals with problems, ideal relationship between psychiatrist & patient should be based on consensual contract rather than coercion (persuasion) according to Szasz.
Psychiatrist also cannot claim only they have expertise to help people experiencing problems in living- others can help too such as family.
Medical model as dehumanising
According to Szasz medical model is inhumane, dehumanising, medical treatments do not work- they only suppress symptoms.
Should look more at socio-economic and psychoanalytic explanations.
Patient should have right to control & define own life, we should be understanding, help patient help themselves.
Influences of Szasz’s radical position- modern day.
Lots of ppl agreed with his argument on freedom & responsibility, eventually laws of US changed- resembled his recommendations.
Many states passed legislation making illegal to put people in mental hospitals against will unless presented danger to others.
If someone does pose danger, likely to be put in prison not mental hospital (caused problems for prison system & mentally ill people who end up there)
Criticism: His central view that mental illness is a myth has been dismissed
American Medical Association, Psychiatric Association and National Institute of Mental Health.
Dr Allen Frances- critic of modern diagnostic approach himself said Szasz ‘goes too far’.
Kety 1974 responded to Szasz statement- concluded ‘if schizophrenia is a myth, it is a myth with a strong genetic component’.
