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First, any model borrowed from an existing field of distinct activity cannot adequately serve to explain those activities which fall outside the original. That is the problem with virtually all game theory models, so it is not exclusive to Szasz's discussion. Then, games simply differ from behavior in general by virtue of the freedom we enjoy in making up the rules of a game, while we lack such freedom in devising a successful way of talking and dealing with, say, the circulatory system or the stratosphere. (So, as has been suggested, behavior might better be compared to fire-fighting than to games, the former being an activity that is varied and yet rule-bound.) Finally, this entire emphasis on the concept "game" is open to question because it relies on a philosophical heritage (Wittgenstein's discussion of "language" and "game") which is a problem area in its own right—so surely not to be taken for granted.
Szasz defines the game situation conventionally, as "characterized by a system of set roles and rules considered more or less binding for all of the players" (p. 7). But many human activities involve only one person. (Some, like Wittgenstein, have argued for single-party games. What they seem to be saying is that we can play the above, but not that by playing we automatically engage in a party game.) It is questionable even whether most interactions occur in the context of mutually understood, let alone binding, rules.
If game-playing is to explain all behavior, it is not enough either that we can see the behavior as directed toward a goal or as following some rules. Otherwise how can we distinguish between accidentally going through the motions of a particular game, and actually playing the game? Ordinarily we would have to ask the players; i.e., to be playing a game according to "rules considered binding" the players must know the rules and be aware that they are game-playing.
Then, even within an ordinary game there are actions which cannot be understood by reference to the rules alone. A chess player's moves but not his skill may be understood by rules; or the rules of tennis prescribe what actions are to be taken, but not what grip is best. There are also activities during a game which may be incidental or irrelevant, e.g., dropping a pawn or wiping one's forehead. If these are to be construed in the light of still other games (the rules of how best to hold one's racket or the rules for wiping) then this leads to an infinite regression. The same problem is encountered with one's reasons for playing the game and such things as the history of the game.
It is revealing to see some behavior as game-like and we commonly do this, e.g., "playing cat and mouse with each other." But this is a metaphor, meaningful only if there is some non-game-playing behavior to which we are comparing it. A metaphorical account loses significance when applied as a general theory.
This is just a broad outline of some objections to Szasz's theory. The assumption has been that an explanatory theory which seeks to relate phenomena to something already known must depend on the general understanding of at least the essentials of that thing. But the game-playing model ignores or distorts characteristic aspects of what is generally understood when we talk not only of games, but also of behavior. Perhaps one of the most crucial of these is the concept of intention.
Szasz, contrary to the traditional psychiatric view, maintains that hysteria is willful imitation of illness. This is dependent on his seeing the hysteric's symptoms as strategy, i.e., moves in a game. That there are results of the symptoms is undeniable (e.g., he may receive sympathy); that these are the intended aims and goals, that they are part of a game, where the players are aware of the rules and goals, is another matter. But note Szasz's prejudice toward this interpretation of all behavior: "If it appears that human beings are not so engaged [in purposeful, goal-directed activity], it is useful nevertheless to assume that they are and that we have been unable to comprehend the goals and rules of their games" (p. 14). Now there are difficulties with this, but most human behavior can be seen to achieve some goal, and, since Freud, it is plausible that many of these are not explicitly known to their holders.
The problem for Szasz lies in his failure to make the distinction between goal-directed and/or rule- following, and game-playing, i.e., strategic, behavior. He wants to extend the notion of the goal directed- ness of most behavior and say that to reach any end is to have made moves in a game-strategy. We are uneasy with this interpretation when we find the player(s), as in hysteria, unable to avow either the point of the "game" or the rules which are supposedly being followed.
Szasz attempts to get around this difficulty by imputing unconscious intention to the strategies of the mentally ill. But "feigning," "impersonating," "cheating," "lying," and even "strategy" depend for their meaning on the concept of conscious action. It becomes even more complicated when Szasz refuses to discuss the difference between "conscious" and "unconscious," insisting instead that it is more meaningful to talk about goal-directed and rule-following activity as opposed to making mistakes. This doesn't help because "goal-directed, rule-following" and "mistaken" are not descriptive of the same dichotomy as conscious-unconscious: since hysteria has been interpreted as game-playing "it is more accurate to regard hysteria as a lie than as a mistake" (pp. 142-43).
Szasz's ascription of "unconscious" to the intention of the mentally ill is thus of no practical significance other than to make his use of "strategy" more palatable. Whether or not the person is aware is then insignificant in determining whether strategy is involved. But recall that ordinarily, in difficult cases, we must ask the players if a game is in fact being played. In Szasz's treatment of "mental illness" the criteria becomes whether or not the behavior can be interpreted by the observer as achieving some goal, and if so, then it is to be assumed that rules are being followed, a game is being played, i.e., there is strategy intended, whether consciously or unconsciously.
This poses a difficulty because some actions have results which may appear to have been goals and involved strategy without this being the case. For example, good health can result from cycling without ever having been a consciously or unconsciously intended goal (I cycle because it is the cheapest transportation). And, crucial to Szasz's use of "unconscious intention," there are neither conscious nor unconscious strategies for improving health here. Another counterexample is the case where one accidentally performs a sequence of motions which could be interpreted as moves in a game by an observer; e.g., in the process of throwing out (discarding) a dart one may (accidentally) hit a perhaps unseen dart board. These exceptions make it questionable whether the idea that all behavior, even if goal-directed, is strategic (rule-following) and game-like has universal application, and Szasz's treatment of the concept of intention fails to help in making that point.
Szasz gets into this confusing position of calling the behavior of the mentally ill unconsciously willed in order to get away from the mental illness concept with its tendency to remove blame and responsibility for one's actions. However there is a paradox in his view of personal responsibility which is worth noting. On the one hand he criticizes Freud and the entire mental illness model for a deterministic view of human nature which "undermines the principle of personal responsibility . . , by assigning to an external source (i.e., the 'illness') the blame for anti-social behavior" (p. 297). On the other hand Szasz implicitly adopts a deterministic position himself. It is his belief that a game-playing theory can correct the defect of determinism in psychiatry: how this is to be accomplished is not made clear, except as noted at the outset—that determinism is avoided if causal explanations are avoided.
In some ways Szasz falls into an environmentalist position which implicitly entails a variety of determinism. Recall his description of man's "mind" as a product of his social environment. Then there is his view that whatever "language" one speaks, whatever game one plays, "each has its own 'raison d'etre' . . ., because of the particular circumstances of the communicants, each is as valid as any other" (p. 12, emphasis added). This turns out to be very similar to Skinner's view that no one can be praised or blamed for any action because that "action" is determined by environmental contingencies.
So there is this deterministic tendency and at the same time an indeterminism in Szasz's thinking, e.g., in that every game is equally valid. The latter tendency is based on the contention that ethics, i.e., the rules of behavior games, are arbitrarily devised (just as the rules of oridinary, e.g., chess, games), for they vary from one culture and era to the next, It has been argued often, but there are serious problems with the position that there is nothing more to ethics than arbitrarily agreed upon rules. If that were the case then there would be no way to identify, e.g., criminal "games" such as murder by objectively established criteria, and act accordingly, as even Szasz would advocate. (There are other explanations besides arbitrariness which account for variations between culture's ethics. Furthermore, the variations are more apparent than real.)
Szasz's attempt to explain even the hysteric's behavior with the game model, and then his assertion that every game is valid, begs a serious question, namely, whether there are objective criteria for evaluating any behavior. Then it becomes just as difficult to know what "personal responsibility" refers to in such an indeterminate scheme, as in a deterministic explanation of human behavior. The closest he comes to an objective standard of evaluation is to speak of maturity, i.e., "flexible integration of rules as behavior regulating agencies" (p.180). However an "operational meaning" can be given to maturity only on the basis of "certain preferential values of a given society" (p. 288).Again the indeterminism. And one wonders where the rules come from. Part of the problem is that he speaks in passing of following one's own rules (p. 175) but doesn't integratethis into his general theory.
So in Szasz there is not a resolution of the problem with "responsibility" encountered in speaking of mental illness and health. And in general his alternative explanation falls short of adequacy. The conclusion that we reach is that "mental illness" ought not be discarded either because it is a myth, because on the basis of Szasz's arguments it isn't, or because the alternative offered provides a better explanation.