The Myth of Mental Illness – Foundations of a Theory of Personal Conduct

by Thomas Szasz

A classic work that has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. "Bold and often brilliant."--Science

Genres: Psychology, Nonfiction, Philosophy, Mental Health, Science, Psychiatry, Medicine

368 pages, Paperback

First published January 1, 1961

About the author

Thomas Stephen Szasz (pronounced /sas/; born April 15, 1920 in Budapest, Hungary) was a psychiatrist and academic. He was Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He was a prominent figure in the antipsychiatry movement, a well-known social critic of the moral and scientific foundations of psychiatry, and of the social control aims of medicine in modern society, as well as of scientism. He is well known for his books, The Myth of Mental Illness (1960) and The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement which set out some of the arguments with which he is most associated.

Reviews

[Tucker · Rating 3 out of 5]

Seen in the best possible light, this is a well-read, illuminating presentation of a relativistic theory of cultural norms. The author says that those who break these norms, the "mentally ill," do so for certain reasons, usually because it benefits them to do so. Classifying them as "mentally ill" creates a model in which it is easier for them to continue being "sick". Instead, they should be treated as competent adults who can change their lives for the better. By way of illustration, the author refers to diagnosed cases of "mental illness" that can be reduced to "a man worried about his job and life-goals [who:] seeks medical attention for hyperacidity and insomnia." (p. 153) When presented this way to the reader, it is obvious that acid reflux and disrupted sleep should not ordinarily require psychiatric medication. The author's argument is validated.

But there is no serious and sustained mention of severe psychological disturbances. For example, in this 300-page book, the words "addiction" or "homicide" appear only once or twice in passing. There is a brief mention of a man who, incidentally to a description of his psychoanalysis, happens to be an unreformed sexual exhibitionist. There is no mention of homelessness, prison, crippling depression, post-traumatic stress, pathological lying, anorexia or other forms of self-harm, domestic violence, obsessive-compulsive behavior, hallucination, or persistent delusions of grandeur. "Suicide" does not appear in the index. Nor does the book anywhere acknowledge the impact of such extreme behavior on family and caregivers. The scope of the book is not explicitly defined to exclude these more dramatic cases, and one wonders how it could possibly have been an oversight.

I find this eloquent assertion that I can analyze my personality and control my public behavior to be personally compelling. But I am not mentally ill. Severely disturbed people, even if they can read this book or have the concepts presented to them, will most likely be unable to benefit from the gentle, vague instruction that they should find better methods of communication. I understand the idea behind re-framing human behavior so that all behaviors can be interpreted as choices rather than as symptoms of illness. I just question the practicality of doing so, particularly for people dealing with acute and severe crises. Not everyone can be talked back to his senses, and even if he can be, his personal best behavior and self-awareness will not necessarily meet social standards for reasonable, moral, and safe conduct.

The author, an M.D., says in his conclusion: "It is customary to define psychiatry as a medical specialty concerned with the study, diagnosis, and treatment of mental illnesses. This is a worthless and misleading definition. Mental illness is a myth. Psychiatrists are not concerned with mental illnesses and their treatments. In actual practice they deal with personal, social, and ethical problems in living." (p. 296) I wonder, then, if he thinks a two-year degree in social work would have been sufficient for his career.

Thomas S. Szasz. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Delta, 1961.

[Owlseyes · Rating 5 out of 5]

"In 1938 when I came to the United States, there were 13 epileptic colonies in the country, housing tens of thousands of inmates"
In "Cruel compassion" by Thomas Szasz

"Sometimes famous persons are said to be mentally ill-for example Adolf Hitler, Ezra Pound, Earl Long. At other times the label is attached to the most likely and unfortunate members of society, especially if they're accused of crime. The popularity of psychotherapy, and people's alleged need for it, is rapidly increasing."
Thomas Szasz, Syracuse, New York, June 30, 1960.




This, for sure, will ever be a must-read. I know some of the strong arguments [points] of doctor Szasz:

1-Diagnosis is a tool used by psychiatrists to control and stigmatize people.

2-Hysteria and misbehavior and attention deficit disorder...are not diseases; thyphoid fever is,....spring fever is not.

3-Labeling is a stigmatization; treating with drugs is poisoning.

4-Mental disease is a metaphor,...a fable, a mythology. The DSM* is a joke.

5-"Psychiatrists are more and more away from human touch". It's a matter of politics and economy.

6-When Szasz went to medical school, 60 years ago, there were 6 or 7 mental diseases. Now they're more than 300.

7-"No behavior (or misbehavior) is a disease or can be a disease".

8-"There is no medical, moral, or legal justification for involuntary Psychiatric interventions. They are crimes against humanity" (page 268 of the book)

He's got a point, obviously. More than one.



UPDATE

I've just found this letter he wrote to The Economist back in 1995 (in the September 30th issue). It said: "Sir-You reinforce the fundamental fallacies on which modern psychiatry rests. (...) Hence, psychiatrists resembled jailers and mental hospitals resembled prisons.(...) Is it any surprise that the house of cards we call 'psychiatry' is in a permanent state of economic and professional collapse? (...) So long as we refuse to view psychiatry as a branch of moral philosophy and law, and not as medicine, we cannot even begin to grapple with the problems your two pieces describe".

So, is psychiatry medicine?


UPDATE

"Diagnoses listed in the DSM—the Diagnostic and Statistical Manual of Mental Disorders, the so-called bible of psychiatry—do not cause anything. They are not things. They are agreed-upon labels—a kind of shorthand—for describing symptoms."
In: https://www.psychologytoday.com/us/bl...


UPDATE

Is the field of the "normal" "shrinking"?

https://pursuit.unimelb.edu.au/articl...

UPDATE

https://www.youtube.com/watch?v=fcdxC...

UPDATE

"For example, antipsychotic medications, the primary line of long-term treatment for schizophrenia, have side effects that can negatively impact service users’ quality of life and even lead to early death."

AND

“A more agnostic and scientific psychiatric gaze would allow for recognition of the fact that DSM-5 is NOT based in science,..."

in: https://www.madinamerica.com/2022/06/...


UPDATE

Recommended Reading: Cracked: Why Psychiatry is Doing More Harm Than Good
by James Davies

On YouTube: Psychiatry & Big Pharma: Exposed - Dr James Davies, PhD

UPDATE

https://www.therapyroute.com/article/...

UPDATE

https://www.nytimes.com/2022/09/20/op...

UPDATE

https://www.economist.com/science-and...

----
*The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association

[Alo · Rating 5 out of 5]

If you think this book is dangerous then I'm not sure you understood it.

[Zora · Rating 5 out of 5]

I've read three of Szasz's books and will limit myself to commenting about this one, which is both outdated at some points and still far too radically ahead of its time to be considered fairly today by many (particularly including those whose income depends on perpetuating these very myths or whose sense of self-worth is somehow tied up in them).

To simplify some of Dr. Szasz's ideas that I find appealing:

1) We need to be very skeptical about the entire concept of "mental illness" and the practice of psychiatry, and we should subject it to the same scientific rigors we subject claims about subatomic particles, plate tectonics, or any other bit of reality. Insofar as 99% percent of diagnoses in the DSM have no biological basis, are they actually real illnesses? To say a drug or a therapy "cured" someone, we need clearly defined and testable diagnostic criteria. (E.g., if anxious people's brains look like this and are different than non-anxious people's brains in z ways; after x drug, the brain scans normalize, there may be something to the concept of "mental illness" in this case; but there's no such proofs for most "mental illnesses.") Since studies have shown many times over the years that drugs, talk therapy and placebos have about the same "felt" effect over large populations (though any individual may feel one works better than the next), what can we say about these various approaches? We needn't get all atwitter and overemotional and defensive in asking and answering this; we need to function as scientists, stay disinterested and do careful work in trying to find the real answers. Not the convenient answers...not the profitable answers. The true ones.

2) In treating psychological/emotional discomfort with drugs, the best drug is one that the patient herself selects after trying various ones. Prescription drugs are not holy and street drugs evil; drugs are drugs are drugs, and absent a clear test of efficacy along the lines of a brain scan, readable in absence of interested parties by a pathologist, the patient's sense of what works to alleviate emotional pain and what doesn't is the best measure of drug efficacy. The US model of big pharma drug decisions made only by costly doctors plus a war on street and home-grown drugs is infantilizing, insulting, and ineffective. Let people have a variety of drugs to choose from and let them choose, as happens in most countries on earth that aren't out-of-control plutocracies.

Add Szasz to feminist, gay, and other thoughtful challenges about how psychiatry has been used to promote specific social and economic agendas at the cost of the health and longevity and finances of its (at worst) victims, and you have a useful, skeptical vision of what might in fact become an efficacious arm of medicine or what might in fact be shown up in 100 years to be a awful sort of witch doctoring, with its lobotomies and shock treatments and drug-triggered suicides (as we now see the "bleeding" of TB sufferers last century as ineffective and a form of torture). Perhaps in 50 years, a patient will go to a doctor and say "I'm depressed," and they'll get a brain scan and the doctor will say, "you are" or "you aren't," and give them a list of drugs to try, and poor people will be able to access the same list and try them on their own without the expense of an M.D.

But if you compare the treatment of, say, depression today to the treatment of, say, diabetes, you'll see how one is based in science and one really is not. We didn't have these answers about what "mental illness" is and how to treat it in 1960 when Dr. Szasz was first published; we still don't have these answers now; but we need to look for them in a more careful and unbiased way.

Still crucial questions to ask...not many willing to ask them...many financial interests desperate for them not to be asked. If you enjoy radical ideas (in the literal sense of that word, "at the root,") that overturn your assumptions and make you think critically, give Szasz a try.

[Miguel Cisneros Saucedo · Rating 2 out of 5]

I must say that I am deeply disappointed by Szazs comments on Christianity. On page 169, Szasz cites Luke 18:18-30 to claim that Christianity goes against being "healthy, independent, rich, proud".
So, is this passage really endorsing the "sick, poor, dependent, and humble"? Let's find out.

In this passage (Mat. 19:16-26), it should be known that only God is good. Only God, and not good works, is the only source of eternal life. In dictating to "keep the commandments" Jesus wants people to recognize that they are sinners. No one, except Jesus, could be able to keep the commandments of the law. The commandments only serve to reveal sin. They are not to be fulfilled or please God. In verse 21, Jesus now reveals the problem of that specific man: because of his greed he did not keep the commandments. This demand of Jesus is NOT an absolute requirement for discipleship (Zacchaeus offering only half of his possessions; Luke 19:8-9). There is nothing in this entire passage that refers to "sickness" or claims of lack of health.
However, Christ can rightfully make requisitions in regard to giving up earthly possessions and distributing them as donations, in short, Jesus can denounce anything that prevents the person from recognizing himself as a sinner and criminal before God, and assume that divine wrath was poured out on the cross for his/her injustices.
The central point of Jesus is that wealth gives a false sense of security in this life, which prevents the tranquility granted by a spiritual state of surrender.
Finally, Jesus demanded that the young man sell his things, not give them away! For me, this is a clear invitation to the free market and philanthropy. Here Szasz assumes without any justification that not being "wealthy" is in some way humiliating, "painful" and "self-damaging". Nowhere can we see Jesus demanding that men must be "sick, poor, dependent, humble".

Then, Szasz quotes the famous, and often misinterpreted, sermon on the Mount as illustrating Bible rules "fostering dependency and disability". He says: "This passage articulates most clearly the basic rules by which the Christian God plays His game with Man". First of all, Szasz "paraphrases" the passage from Matt. 5:1-12. His resulting interpretation is, then, that man should be "stupid, submissive, not smart, well-informed, or assertive; passive, weak, not self-reliant; naive, unquestioningly loyal and no entertain doubt".

Okay, first of all, Szasz eliminates the word "Blessed" to fit his narrative, and this is because in each case Jesus says that those whom the world considers unhappy or unlucky are actually blessed because a reward awaits them. Jesus describes the characteristics of those who will inherit the kingdom of heaven because they respond to the gospel with faith. Here the poor, what they do not have is the egoism and arrogance of people like Szasz who believe that their efforts and merits have given them a special social position.
By "meek" Jesus is referring to those who are not arrogant because they understand that they are sinners, not better than anyone else and that only through repentance and faith can they be saved.
By "pure of heart" Jesus is referring to those whose sins have been forgiven through the sacrifice of Christ when he received all the divine justice and punishment that all sinners deserved.

So, NO, Jesus never claimed anything that Szasz mentioned. In fact, it is Sasz who is naive, pusillanimous, and emotional, just like Freud, Sartre, and Nietzsche.

[Thom Dunn · Rating 2 out of 5]

Roy Porter discusses Szasz in the opening pages of his "Madness: A Brief History". Amazon has NO hardcover in stock. Zero. Zip.

For my part ? "He jests at scars that never felt a wound." @ Szasz : Here is my curse on you, Thomas: May you suffer ten minutes of acute clinical depression. Ten minutes in that "over-heated room", that "bell-jar", that "bed of nails" which we sufferers know when the nerve synapses in the basal ganglia are leeched of neurotransmitters through a too-rapid re-uptake of same....10 minutes....Then we'll talk.

[kereru · Rating 1 out of 5]

shut the fuck up

[Elyssa · Rating 2 out of 5]

I read this in college for "Human Health and Behavior" class. The seminar that ensued was lively! The author makes some valid points, but they are enshrined in an extreme and fundamentalist tone, which was alienating and made it difficult to fully endorse his ideas. In addition, he is not a very skilled writer, so it takes a lot of effort to uncover his points. I hope to re-read this soon and revise this review, but for now I can only give the book 2 stars.

[Nick · Rating 5 out of 5]

Incredibly eye opening book. Shows how the majority of "mental illnesses", except those of clear neurological basis, are not illnesses at all. Mental illness is a metaphor. This isn't to say that what we normally refer to as "mental illness" doesn't exist, clearly these many psychological experiences do exist...but they are not genuine illnesses and when they are assumed to be this can lead to profound misunderstanding.

[Amir · Rating 5 out of 5]

نه می توان با گوشی پزشکی آن را سمع کرد، نه در سی تی اسکن و سونوگرافی ردی از آن وجود دارد. آزمایش خون نشانه ای از آن به دست نمی دهد و بررسی امواج مغزی هم کمکی به پیدا کردن آن نکرده. اما ما به آن باور داریم و معتقدیم همانطور که دیابت و سنگ کلیه و گرفتگی عروق کرونر به مثابه علت بسیاری از رنج های ما وجود دارند، آن هم "وجود" دارد. خانم ها و آقایان، به این موجود مرموزِ از دیده ها پنهان بیماری روانی گفته می شود.

نام نویسنده توماس ساس (ژاژ) است. روانپزشکی آمریکایی که معتقد است اولین کسی بوده که با صدای بلند فریاد‌ کرده که پادشاه لباس ندارد. پادشاه که بود؟ رشته روانپزشکی شاخه ای از طب. کدام لباس؟ لباس خیالی بیماری روانی.

توماس ساس در کتاب اسطوره بیماری روانی سوالی اساسی مطرح می کند. آیا بیماری روانی وجود دارد؟ ایا همانطور که از بیماری های کبدی، قلبی و کلیوی حرف می زنیم، می توانیم از بیماری روانی هم صحبت کنیم؟ آیا همانطور که گرفتگی عروق کرونر می توانند "علت" درد های فشاری و تیرکشنده قفسه سینه باشند و سنگ حالب می تواند باعث درد در کشاله ران شود، چیزی تحت عنوان بیماری روانی می تواند "علت" رفتار های نابهنجار یک فرد باشد؟

توماس ساس معتقد است چیزی تحت عنوان بیماری روانی وجود ندارد. ما وقتی از روانِ بیمار (ill) حرف می زنیم، در حال سخن گفتن به زبان استعاری هستیم؛ همانطور که گاهی از اقتصاد بیمار حرف می زنیم. او نشان می دهد که در آغاز تاریخِ روانپزشکی، مفهومِ بیماری روانی برای توصیف ضایعات نورولوژیک ناشی از سفلیس و زوال عقل و تضاهرات رفتاری آنها، توسط نورولوژیست به کار گرفته شد و دقیقا این خط آغاز تمام سوتفاهم هاست. سفلیس و زوال عقل بیماری های مغز هستند نه بیماری های روان. روان انسان، عضوی از بدن انسان نیست همانطور که لوزالمعده و قلب ارگان های بدن هستند، و نمی توان از بیماری روان سخن گفت همانطور که از بیماری های قلبی و عروقی و ... حرف می زنیم‌.

اما دلیل موضع گیری ساس علیه روانپزشکی به عنوان نهادی که متولی "تشخیص" و "درمان" بیماری های روانیست چیست؟ یک لحظه نقش عمیق پزشکی را در زندگی هرروزه تان تصور کنید. از لحظه تولد که در بیمارستان  (یا در راه بیمارستان) چشم به جهان باز می کنیم و تا آخرین لحظه که در بیمارستان (یا در راه بیمارستان) چشم از جهان فرو می بندیم، زندگی ما در چنبره پزشکان یا دستورالعمل های آن هاست. بسیاری از نوشیدنی ها، خوردنیها، حرکات و رفتار ها توسط پزشکی و پزشکان یا منع می شوند یا توصیه. به نظر می رسد پزشکی هر روز بیش از پیش راهی برای مداخله کردن در زندگی ما پیدا می کند. فرایندی که در فلسفه پزشکی تحت عنوان medicalization یا پزشکی شدن از آن یاد می کنند. اینکه هر چیزی می تواند موضوعِ پزشکی قرار بگیرد و سایه قضاوت پزشکان بر سر آن بیافتد، برای ساس، ایده ترسناکی است.

ساس با نفی مفهوم بیماری روانی و زیر سوال بردن رشته‌ی روانپزشکی، قصد ندارد ادعا کند که مشکلاتی که مراجعه کنندگان به روانپزشک با آن دست و پنجه نرم می کنند وجود ندارد؛ بلکه او معتقد است این مشکلات بیماری نیستند و بلکه معضلاتی اخلاقی، اجتماعی و سیاسی هستند و نباید آنها را درمان کرد بلکه باید به آن ها اندیشید و راه حلی اخلاقی، سیاسی و اجتماعی برای آن ها یافت. ساس ادعا می کند بر خلاف تصورات فروید که روانکاوی و روانپزشکی را رشته‌‌ای علمی می دانست و به دور از قضاوت ارزشی، در اصل کار روانپزشک در واقعیت دست و پنجه نرم کردن با قضاوت های ارزشی است.

برخلاف مفهوم بیماری در سایر رشته های پزشکی، در روانپزشکی، مشاهده گر بی طرف نیست بلکه مداخله گر نیز هست. اوست که نرم ها را تعیین می کند و تصمیم میگیرد که چه کسی را باید بیمار روانی به حساب آورد و چه کسی را نه. روانپزشک می تواند کاری کند که دروغ هایی که شما به خودتان و دیگران می گویید، دروغ هایی درباره زندگیتان و سرشتگی ها و سردگمی ها و تعارضات اخلاقی ای که به آن گرفتارید، به علتِ بیماری ای روانی است که مبتلایش هستید. در اصل، روانپزشکی از زندگی انسان اخلاق زدایی می کند و در دوران مدرن که قراردادِ بین پزشک و بیمار، برخلاف دوران باستان، طرف سومی به نام‌ دولت دارد، می تواند تبدیل به ابزاری برای مهندسی اجتماعی شود‌. در بند کردن انسان ها به نامِ سلامتی و بیماری روانی، و سلب اختیار از آن ها، قدرتی وسوسه انگیز است که دولت ها به سختی می توانند از آن صرف نظر کنند.

ایراد کار روانپزشکی برای ساس آنجاست که روانپزشکان دائما دو مفهوم عمل (action) و رخداد (event) را با یکدیگر خلط می کنند. عمل، فاعلی انسانی دارد. فاعلی دارای اراده آزاد که می تواند از بین چند انتخاب یکی را برگزیند. اما رخداد چیزی است که بنابر ضرورت در طبیعت رخ می دهد. همچون افتادن سیبی از درخت به علت جاذبه یا دردهای کولیکی ناشی از سنگ های کلیه و یا سردرد ناشی از تومور مغزی. در اصل، بیماری ها در دسته رخداد ها قرار می گیرند نه عمل ها.

ساس در این زمینه، از بیماری هیستریک مثال می آورد که از درد هایی رنج می برد که هیچ‌ علت پاتوفیزیولوژیک ندارند و بنابر ادعای روانپزشکی به "علت" بیمای روانی هیستری رخ می دهد. اما از آنجایی که هیچ بیماری‌روانی ای وجود ندارد، دردِ بی علت یک خانم هیستریک را نباید ناشی از نوعی بیماری دانست که برای او رخ داده‌، بلکه درد او وسیله است که او تلاش می کند بوسیله آن از دیگران کمک بخواهد. دردِ او، زبان اوست و او به زبانِ درد متوسل می شود چرا که نمی تواند با شوهرهش، که موقعیتی نابرابر با او دارد، به زبان روزمره سخن بگوید‌. چرا که در رابطه ای نابرابر زبان روزمره قدرتِ خودش را از دست می دهد. او حتی می تواند مادری خانه دار باشد که از یکطرف فداکاری های بی شمار برای اعضای خانواده اش به تنگ‌ آمده و از طرف دیگر خود را به عنوان یک مادرِ فداکار برای این به تنگ آمدن، مستحق سرزنش می بیند. برای او نیز دردهای هیستریک می تواند آخرین سنگری باشد که از آنجا فریاد های کمک خواستن او به گوش دیگران برسد.

ساس فرضی پنهان در پس روانپزشکی را آشکار می کند. فرضی که معتقد است زندگی انسان ها در کنار یکدیگر، به شکلی ذاتی، در هماهنگی بی نقصی قرار دارد هر چند ممکن است هر از چندگاهی انحرافاتی نیز دیده شود که به لطف روانپزشکی می توان آن ها را درمان کرد. ساس می گوید این فرض خوشبینانه درباره زندگی بشر سنگ بنای روانکاوی و روانپزشکی ای است که مراجعه کننده خود را بیمار می بیند.
برای تک تک انسان ها واضح است که زندگی به هیچ وجه خالی از تنش و چالش نیست. هر کدام ما از هر طرف، در رابطه با دوستان، همکاران، والدین و فرزندانمان، در معرض فشار های روا��ی بسیاری هستیم. فشار های روانی ای که گاهی ادامه زندگی را بر ما سخت می کنند و گاهی ناممکن. اما تجربه این رنج و سختی و واکنش های گاها نامتعارفی که ما دربرابر این رنج و سختی ها داریم به این معنی نیست که بیمار هستیم و نیاز به درمان داریم.

ساس معتقد است زندگی از بازی های فراوانی تشکیل شده که هر کدام قواعد خاص خودش را دارد. قواعدی که شاید خیلی اوقات از وجود آنها اگاهی نداشته باشیم هر چند که بازی زندگی همچنان ادامه دارد و باخت های سختی به ما تحمیل می کند. او از روانپزشکی ای دفاع می کند که به اصطلاح خودش "فانوس دریاییِ" ناامیدانِ دریای متلاطمِ زندگی از ساحل امنِ آرامش باشند. روانپزشکی که تلاش می کند با آگاهی بخشیدن به بیمارش او را در جان به دربردن از ناملایمات زندگی رهنما باشد  به جای آنکه با خود را پزشکی ببیند که این حق را دارد در جایگاهی بالاتر از بیمارش، با مداخلات گاه و بیگاه، بیمارش را تا جایگاه شی ای پایین بیاورد که نیاز به روانش نیاز به تعمیر پیدا کرده است.

[Michael Burnam-Fink · Rating 3 out of 5]

Szasz makes a frontal assault on the power of psychiatry, arguing that mental illness is a myth and that the power accorded to psychiatrists to decide if people are legally responsible for their actions, have them committed to hospitals, and prescribe various psychotropic medications is fundamentally misfounded. The basic premise of his argument is that only organs can be sick, and the mind is not an organ. Rather, what we see as mental illness are the results of rule-breaking behavior by "mentally ill" people, an attempt to game their social interactions to receive the socially beneficial role of a "sick person" as accorded by Judeo-Christian morality and modern standards of care.

While there is some benefit to challenging the hegemony of mental illness (a recent paper says "Almost half of college-aged individuals had a psychiatric disorder in the past year."), Szasz's argument fails on two major grounds.

The first is modern understanding that cognitive events are linked to neurological events, or in other words, that mental illness are in some way brain disorders. We can draw a spectrum from something totally neurological--Parkinson's disease, to something totally psychological--Borderline Personality Disorder, say, and put things like schizophrenia, depression, bipolar, and their related pharmacological treatments and neurological origins somewhere between them. It's unfair to hold a book published in the late 1960s to modern beliefs, but again, Szasz doesn't have much to say about this.

The second problem is more damning: even if we accept Szasz's belief that the mentally ill are just playing the game of life by different rules, what is to be done with them? As any good historian of mental illness knows, the lines between insane, criminal, and sinful are far from clear. Psychiatry is the modern way of dealing with malcontents, of offering a source of power and authority that people can draw on to change their lives and social behaviors. Szasz might be right in his argument that psychiatry probably isn't medicine, and it certainly isn't science, but he doesn't engage with the notion that psychiatry is something, and that it performs a socially necessary role. Rather than assailing psychiatry as an evil system of fraud that makes people crazy, we must ask how unhappy people can be helped, how their complex problems can be untangled, and what resources are necessary for that to happen.

[Jamie · Rating 2 out of 5]

One can usually find some redeeming qualities in any book, yet this made me struggle to even do that much. I have determined this to be a convoluted piece of garbage. Please don't waste your time or money on a book that does not belong in your archive but rather in the trashcan. Time is precious, so please spend it making memories with family and friends rather than reading tripe from a misinformed, hippy "psychiatrist."

This particular book only furthered my desire to research and uncover the truth...which is that mental illness continues to be as real as cancer and is not a myth. Furthermore, if you are a clinician that believes that mental illness is like the "Easter Bunny"(and is not real) than in my honest opinion you need to leave this profession. There are countless clients that would feel completely invalidated that you opine that their mental illness is not real. Please cease doing damage and address the real issues at hand. You can start by learning to care.

- Jamie Hannah Oliver

[Tiago F · Rating 5 out of 5]

Szasz argues viewing psychiatry as a medical speciality is misleading. In fact, the very concept of mental illness is incoherent. Disease is defined by a physical pathology, but if one has a brain lesion, then by definition it's part of neurology. Psychiatry is by its nature what doesn't belong to neurology. Mental illness is a metaphor that became so ingrained that people take it literally.

A large part of the book is dedicated on how mental illnesses are categorized, and its inherent social fabrication, and the reasons for its creation and propagation. With extreme detail, it touches on the role that patients, psychologists, psychiatrists, politicians and institutions play in keep the whole field alive and expanding.

He advocates for this view to be dropped completely. He's not against psychiatry in the sense of having therapy between two consenting adults, but the paradigm of viewing the clients as having a disease must be dropped. The "mentally ill" are simply people who have personal, social, and ethical problems. This doesn't undermine their suffering, but instead, it's simply honest about its origin.

In addition to his critique of psychiatry, he provides a brilliant insight into human social behaviour and human nature in general. Borrowing Piaget's concept of games, he explains social living in terms of a collection of games, some of which include "mental illness", both from the perspective of the patient and the psychiatrist. At its core, the fact that social action is embedded into games isn't very revolutionary by itself, but the depth that Szasz goes into is fascinating.

A classic in psychiatry and a must-read for anyone interested in the field.

[Leabelle · Rating 1 out of 5]

I find this book extremely troubling and somewhat irresponsible.

[Andre Graham · Rating 2 out of 5]

I don't think that I can add anything that other reviewers have written more eloquently than I about this book. However there are a few points I'd like to make:
Modern psychiatry is a minefield of mixed positive and negative motives, methods and outcomes. To be totally for or against it ( as szas is against) seems to be incredibly naive. Szas seems to be trapped in asserting and repeating his view that medical illness doesn't exist and whereas he does point out compelling facts such as the arbitrary nature of disease selection and the tenable arguments of Freud to make his case he fails to address the issue of people who have genuine distress from mental illnesses and actually gives no real solutions to the negative aspects of psychiatry.
There needs to be a more balanced point of view. Szas has actually fallen into the trap of being inflexible with his theories in order to win a "game" ... Something he accuses his psychiatric peers of doing.
Ironically enough this book has helped me to realise the depth pf the complex interplay between mental and physical realms by pointing out that there is no real for or against in psychiatry just a lot of different opinions.

[Teresa · Rating 1 out of 5]

Mental illness is a myth according to the Author, who to me is an narcissistic idiot.

With a mother, father and sister who were mentally ill and who all committed suicide, I never saw them have any gain.

Sheer idiocy.

[Claire · Rating 1 out of 5]

I can't finish this book. I thought it would involve insightful, valid criticisms of the institute of psychiatry, and while at the start I could entertain some of the concepts even though I disagree with them - such as the idea that medicine for profit will somehow improve care and strengthen therapeutic relationships (ignoring the massive inequality in standards of care - or even basic provision of care - that this would lead to), and the fact the arguments are based on a fundamentally dualistic notion of the body and mind, ignoring the influence of social and psychological processes on physical diseases, and the effect of neurological disease on behaviour. I drew the line when it came to Freud and Breuer - I can't take critical appraisal seriously whenever the standards aren't applied to someone like Freud, calling Freud compassionate and claiming that his patients were lying about their symptoms is a disgusting thing to do, considering there is established evidence that Freud's assessment of his patients ignored physical symptoms in order to identify hysteria, that he diagnosed hysteria in a child who - it turned out - had a massive tumour causing their paralysis. Claiming Freud set aside his pride in order to rule out physical symptoms is an outright lie, and the fact Sasz accepts this claim at face value says plenty about his own biases. Sasz clearly does not like patients with a psychiatric diagnosis, his hatred for these patients oozes out of the pages. I thought it was going to be about validating people's experiences, the medicalising of human behaviour - but it amounts to Sasz calling anyone with a psychiatric diagnosis as a liar, and praising a man who actively harmed seriously ill people in order to sustain his own ego as 'compassionate'

[Lozz · Rating 5 out of 5]

“There is no blood or other biological test to ascertain the presence or absence of a mental illness, as there is for most bodily diseases. If such a test were developed…then the condition would cease to be a mental illness and would be classified, instead, as a symptom of a bodily disease.” —Dr. Thomas Szasz, Professor Emeritus of Psychiatry, New York University Medical School, Syracuse

Also, I thought this would be relevant. These are from a recent United Nations report:

86. An assessment of the global burden of obstacles alarmingly suggests their burden may be heavier than any burden of 'mental disorders'. The crisis in mental health should be managed not as a crisis of individual conditions, but as a crisis of social obstacles which hinders individual rights. Mental health policies should address the 'power imbalance' rather than the 'chemical imbalance'

87. The urgent need for a shift in approach should prioritise policy innovation at the population level, targeting social determinants and abandon the predominant medical model that seeks to cure individuals by targeting 'disorders'.

[Elari · Rating 2 out of 5]

Szasz departs from the idea that mental illnesses are no more than strategic categories invented to stigmatize persons with peculiar behaviors but with no underlying physical abnormalities. He uses this as an unquestionable premise and never bothers to back it up, leaving me utterly confused as I have never encountered any case of mental disorder that is unaccompanied by some kind of bodily 'disorderliness', be it directly in the brain or in the immune or digestive systems. I realize the book is almost sixty years old and so largely precedes the boom in molecular science research. Still, the logic used here is precarious at worst, obsolete at best.

It baffles me that the author managed to write such an unscientific book after allegedly studying for a decade or so to become a psychiatrist. It took me tremendous willpower to keep reading past this quote: "In my opinion, this sort of search for the biological and physical causes of so-called psychopathological phenomena is motivated more by the investigator's craving for prestige and power than by his desire for understanding and clarity." I personally think it's impossible to have even a rudimentary understanding of biology/neuroscience AND to agree with the claims presented here. These cannot be but mutually exclusive. There is no need to argue any further: just take an excursion to PubMed, set up camp, spend some time, have your fun, and change your mind, for crying out loud (hinting at hysterical bodily signs).

It should be clear by now that I believe this is a bad book—even dangerous, the kind that might lead some to believe that "medication is not therapy, jogging in nature is!" and to finally end up in the emergency room, many years and mood episodes later, with cut wrists or a bodyful of pills. It isn't a pleasant price to pay for devoting oneself to a pseudoscientific falsehood. Having said this and with all cautiousness, I still concede that The Myth of Mental Illness is a classic book of the anti-psychiatry movement, and might be an essential read for anyone interested (hence the second star). Consider the review preceding this recommendation both a disclaimer and an apology for the time you're going to waste, and tread carefully across the minefield.

________________________________

Edit 1: forget the second star. I'm too irritated to be generous.


Edit 2: the second part of the book had some redeeming qualities. I still feel aggravated, but I'll give the damn book its two ill-deserved stars.

[William Adams · Rating 4 out of 5]

Spring fever is not really a fever, homesickness is not really sickness, and mental illness is not really illness. That’s the argument of Thomas Szasz, professor emeritus of psychiatry at the State University of New York in Syracuse. He has been repeating and elaborating that message since publication of his iconoclastic book in 1961.

A fiftieth anniversary reissue has a new preface and two essays published in 1997 and 2006. The essays, “Mental Illness is Still a Myth,” and “Defining Disease,” restate his thesis, referencing some of the two dozen books he has written in the intervening years. The new preface is a succinct yet lively summary of his position, and could serve as a standalone introduction to his ideas, attitudes, and bombastic style.

Szasz asserts that “The claim that ‘mental illnesses are diagnosable disorders of the brain’ is not based on scientific research; it is a lie, an error, or a naive revival of the somatic premise of the long-discredited humoral theory of disease” (p. xii). Szaszian rhetoric does not countenance qualification, accommodation, or counterargument: those who disagree are naïve, mistaken, or liars.

A pugnacious style can be entertaining, but Szasz makes numerous serious errors of argumentation. For example, he argues that mental illness cannot be caused by brain disorder because if brain pathology is found (as happened with syphilis and epilepsy), then the patient was misdiagnosed: it never was a mental illness; it was a brain disorder all along (p. xiii). But surely that is a circular argument.

Szasz rejects all behavioral evidence of illness. If there is no demonstrated physical pathology, there is no illness, period. That’s why the idea of a purely mental illness is a myth. For example, since there is no clear biological determinant of schizophrenia, it is merely an unusual belief system, not a mental illness (p. 279).

Szasz admits that people can have serious problems living with themselves and others because of their strange beliefs and odd behavior. Such people can benefit from psychotherapy, and even from psychoactive drugs, but such a person is not a “patient,” does not have an “illness,” and the therapist is not providing a “treatment.”

Is Szasz just pedantic? Not at all. It matters what words are used because language shapes understanding, and that becomes public policy, which ultimately leads to laws regulating social life. If you have a “mental illness,” it’s not your fault. It is just bad luck, like getting diabetes or cancer. The disease has nothing to do with who you are as a person.

Therefore you may have to be restrained, stigmatized, sent to prison or a psychiatric institution, forced to take medication you don’t want, required to submit to a medical procedure you have declined, have your parental rights terminated, have your will overturned. It's nothing personal, you understand. It may be necessary to deny insurance coverage or disability payments, remove you from school, report you to the police. You may be denied a job, separated from your family, forbidden to own a gun, denied parole, divorced, or be subjected to involuntary brain surgery or electroconvulsive shock, all “for your own good” and “for the safety of others.”

That’s what was wrong with the psychiatric, medical definition of “mental illness” fifty years ago, and is still wrong today. Psychiatry has become an instrument of the state, according to Szasz. The state has a monopoly on legitimate violence, the legal right to control its citizens by coercion and force. It has delegated some of that responsibility to psychiatry. That’s why the medical definition of “mental illness” is legally and morally wrong.

What’s the alternative? Szasz does not deny that some people have serious psychological problems. But there are so many difficulties with the term, the concept, and the psychiatric approach to “mental illness” that he wants no part of it. He has restricted his own practice to “psychiatric relations with consenting adults—that is, confidential conversations conventionally called ‘psychotherapy’” (p. xix). People with mental problems, he says, are trying to communicate, but doing it badly because they are playing the social game by different rules than the rest of us.

Fifty years after first publication, the idea that mental illness is a myth is still highly controversial, in part, I submit, because of Szasz’s polemical and hyperbolic rhetoric. Nevertheless, if a reader can get past style to the author’s core ideas, it becomes apparent that Szasz’s legacy includes at least four important contributions.

1. In speaking against “mental illness,” Szasz warned of dehumanization and negative consequences of labeling people. Today, creeping medicalization and pathologizing of everyday life are recognized as problems.

2. Szasz spoke strongly against psychiatry's use of coercive force against people. Today there are much stricter legal safeguards around involuntary psychiatric commitment, and better-defined criteria for the legal “insanity” defense.

3. Szasz was one of the first psychiatrists to challenge the diagnosis of homosexuality as a form of mental illness. His unrelenting attacks on the assumptions of psychiatric diagnoses have led to greater awareness of the distinction between scientific categories and social prejudice.

4. Szasz has been a champion for individual rights in psychiatry. People should be free to choose or decline psychiatric care at any time, he argued. Psychiatry and psychology are now more aware of this.

Szasz is a self-described libertarian and also believes that individuals should have free access to all psychiatric and psychoactive drugs, and should be able to choose electroconvulsive shock or lobotomy, if that is what they want. Each person has the right to choose his or her psychological destiny. Whether mainstream attitudes will catch up to that agenda remains to be seen.

[Kasane · Rating 2 out of 5]

A libertarian account of mental illness guided by wishy-washy values and unnecessary reliance on linguistics. The merits of this book need to be carefully cherry-picked.

[Blake Ashley · Rating 4 out of 5]

should be required reading for all students of psychology/anyone interested in the mental health field. The medical model of mental illness has gone too far!!

+Great takedown of the medical/biological model of mental illness and of the psychiatric institutions, ‘diagnoses’ etc.
+A framing of mental illness and psychological ‘treatment’ that avoids deterministic fatalism, respects autonomy, and doesn’t hide behind obscurantist jargon
+Interesting critique of the history of psychiatry, with a lot of attention devoted to my boy Freud. I like Freud generally, but I did learn a lot about he contributed to some of the problems that plague psychology today (this isn’t to say he didn’t do A LOT for psychology, don’t get it twisted)

-Some of the writing was quite dry and I felt some sections didn’t need to be included or could have been far shorter (chapter 7 in particular)
-I don’t know how well his explanation of mental illness applies to more ‘serious’ problems such as schizophrenia, and there wasn’t really any attempt address this. I think this book applies a lot more to things like depression, anxiety, BPD, potentially EDs

[Dovilė Stonė · Rating 5 out of 5]

Sunki psichinės ligos kaip objektyvaus reiškinio ir kaip medicininio koncepto dekonstrukcija. Bandoma pademonstruoti, kaip "psichikos liga" dėl savo semantinių šuolių ir neobjektyvių matų iškrenta iš objektyvaus fizinio mokslo, vadinasi, ir medicinos rėmų.

"I noted before, a serious discrepancy between what psychotherapists and psychoanalysts do and what they say they do. What they do, quite simply, is to communicate with other persons (often called “patients”) by means of language, nonverbal signs, and rules; they analyze—that is, discuss, explain, and speculate about—the communicative interactions which they observe and in which they themselves engage; and they often recommend engaging in some types of conduct and avoiding others. I believe that these phrases correctly describe the actual operations of psychoanalysts and psychosocially oriented psychiatrists. But what do these experts tell themselves and others concerning their work? They talk as if they were physicians, physiologists, biologists, or even physicists. We hear about “sick patients” and “treatments,” “diagnoses” and “hospitals,” “instincts” and “endocrine functions,” and, of course, “libido” and “psychic energies,” both “free” and “bound.” All this is fakery and pretense whose purpose is to “medicalize” certain aspects of the study and control of human behavior."

Mintis tokia, kad psichikos "ligas" gydyti užsimojusi psichiatrija/psichologija nevykusiai imituoja medicinos šaką. Kas reiškia akligatvį "pacientams" ir psichologijai kaip savitam mokslui. Čia noris prisimint Jonathan Shedler esė "It’s Time for Psychology to Lead, Not Follow"*:

"It is an intellectual, scientific, and clinical dead-end when psychology seeks to be “like” medicine or like any other discipline. Psychology should not be more like medicine. Psychology should be like psychology. Psychologists contribute most to understanding and treating mental suffering by being first-rate psychologists, not aspiring to be second-rate medical doctors.
Can psychology define for itself what we treat and how we treat it, instead of forcing ourselves into misshapen slots defined for us by medical researchers, healthcare systems, and health insurance companies?
Can we contribute to the world as psychologists using psychological concepts and methods? Can we be proud to be psychologists again?"

Grįžtant prie knygos, ji sena, bet klasi(š)ka. Atidžiai ją skaitant, kyla daug sunkių minčių ir abejonių. Kaip tik dėl to ji galėtų būti vienas iš būtinų skaitinių būsimiems psichikos sveikatos specialistams - šalia Scott. O. Lilienfield "Science and Pseudoscience in Clinical Psychology"**. Kokybiškai šios knygos labai skirtingos, kone viena kitai prieštaraujančios: jei "The Science and Pseudoscience" nagrinėja įvairių metodų efektyvumą besiremdama evidence-based medicinos modeliu, šioje gi psichikos liga kvestionuojama kaip medicininis/objektyvus konceptas, t. y. ar išvis moksliškai sąžininga psichikos ligas reprezentuoti toje pačioje kategorijoje su somatinėmis ligomis.

Skaitant abi, gaunasi labai sveika, bet skausminga proto mankšta. Man, į pasaulį žiūrinčiai iš evidence-based perspektyvos, noris ginti(s), bet suprantu T. Szasz argumentus ir laikau juos labai svarbiais. Įtariu, kad įmanoma bent dalinai suderinti abu šiuos požiūrius, paleidus psichikos "ligos" metaforą ir nustojus apsimetinėti, kad psichikos reiškiniai gali būti objektyviai pažinūs. To niekad nebus dėl kalbinių ir psichometrinių metodų ribotumų.

Dar kartą prisiminus J. Shedler:

"Psychologists contribute most to understanding and treating mental suffering by being first-rate psychologists, not aspiring to be second-rate medical doctors."

* https://www.psychologytoday.com/us/bl...
** https://www.goodreads.com/review/show...

[Grace · Rating 1 out of 5]

Yikes. Not at all what I expected. Extremely abstract, esoteric, and philosophical. It was likely a much more relevant and ground-breaking criticism of psychiatry at the time it was written, but (luckily) now much of the information seems quite obvious (e.g., psychiatrists should not have paternalistic attitudes toward patients but should treat them as equals, with dignity and respect, and work collaboratively with them on their “problems with living”). But the points were definitely not persuasively argued, and overall the boom was painfully boring to read. If there are some good points, there are more ten times as many holes... okay, so hysteria is a “language” and a “role” that patients adopt... fine. What about schizophrenia? Bipolar? The nature of severe mental illnesses such as these is not even addressed.

[Mark Desrosiers · Rating 5 out of 5]

Bane of emotional cop-outs, ammunition for stoics. In any case, he's right.

[Karla Drozd · Rating 4 out of 5]

interesting perspective especially in todays world, when the word mental illness is thrown around like it’s nothing

[Aaron Davis · Rating 2 out of 5]

Mostly tangential nonsense. The over-explaining of every single facet of his argument is wrapped up in such a sprawling mess of metaphors I've forgotten what the point was by the time I finish the sentence.

Honestly a slog. Get fucked, Thomas

[Donna · Rating 5 out of 5]

Szasz presents an interesting idea, the extension of which I embrace - that mental illness is not merely a biological phenomenon.

[Nguyễn · Rating 5 out of 5]

Wow I'm not the only one who thinks that this mental illness thing is total bullshit and an actual method of oppression, sign of an overly consuming society.

[Kyle Glover · Rating 5 out of 5]

Szasz's most enduring and controversial work, his fellow psychiatrists attempted to ruin his career for writing this book and when they could not, simply ignored him until his death in 2012. However, the force of his argument remains. One may read the title and think that Szasz is stating that peoples' suffering is not real, that it is a myth. This is not the case. Szasz understands human suffering, what he thinks has been erroneously labelled as mental illnesses, as largely attributable to "problems in living." People do not suffer from mental illnesses but are struggling with life and all of its difficulties. For Szasz saying that a mind is sick is metaphorical, like saying a joke is sick. The joke doesn't have a cold, it was just made in poor taste (another metaphor). He goes to great lengths to point out the difference between these metaphorical illnesses and actual physical illnesses like diabetes or paresis. However, the metaphor is not merely a linguistic barbarism, but has individual, social, and political consequences. Szasz spent much of the rest of his long life writing about how disastrous for society and individual liberty the idea of mental illness has been. This book was the start of his long battle for human freedom and dignity. An important book for therapists and laymen alike.