Psychiatry's Sacred Cow
Thomas Szasz and the mythology of mental illness
The most controversial psychiatrist writing today is the psychoanalyst Thomas Szasz, a professor at the Upstate Medical Center in Syracuse, New York. A very prolific author, he has devoted 15 books and almost 300 articles to arguing, with acute logic and devastating wit, that both mental illness and psychotherapy are myths.
Over a decade ago, New York State's commissioner of mental hygiene tried to get Szasz fired for espousing and developing these radical ideas. The attempt was unsuccessful, and his case became a classic illustration of the principles of academic freedom. As the American Association of University Professors demonstrated, a faculty member holding tenure—as Dr. Szasz did—could not be dismissed simply because his ideas are heretical.
Why was there such a furor over Szasz's scholarly investigations? The answer lies in a fundamental distinction between two kinds of myths: empty myths and loaded myths.
MYTHS DEAD AND ALIVE An "empty" myth is one that was originally believed in implicitly but one that, as the slow centuries roll past, loses its literal import, retaining only its shell. We derive empty myths from cultures distant from our own, either anthropologically or through the lapse of time. Myths transplanted from such remote origins die: Adam and Eve and the serpent in the Garden of Eden, King Arthur and his Knights of the Round Table, American Indian legends, the gods and heroes of the Norse Eddas, the legendary Doctor Faustus, and the witches of 17th-century Salem.
But good myths, when they die, go to heaven, and periodically their restless spirits revisit the earth, often calling on poets and musicians. By an effort of imagination, these artists imbue the ghostly shells of their visitors with a fantasy life, as Christopher Marlowe, John Milton, Goethe, Richard Wagner, Arthur Miller, and many others have done.
Mythological meanings, however, are always symbolic, and symbols can mean different things to different people. Are we to follow George Bernard Shaw—and apparently Patrice Chereau—in interpreting Wagner's Ring of the Nibelungen as a study of 19th-century industrialism? The novel interpretations of the young French director who recently mounted a new production of Wagner's opera at Bayreuth antagonized large segments of his audience, including many critics. They were irate because they cherished their own familiar meanings in Wagner's music drama.
Since most of us, when we think about mythology, probably have in mind empty myths, the reason for this digression is to emphasize that another kind of myth exists. It can be called the loaded myth, for it is anything but empty and anything but metaphorical. It cannot be treated symbolically because everyone believes it to be literally true. It is accepted unthinkingly as part of the value system by which we live, and we do not even recognize its mythic quality.
Loaded myths are very much alive; they are not spirits roaming the earth looking for a meaning. They are only incidentally the stuff of which art is made, for they constitute the warp and woof of the entire fabric of a society—its laws, its government, its education, its mores, even its religion and its ethical system. Nobody wonders how to interpret a loaded, living myth; its meaning is self-evident. And only someone who has enormous courage dares to raise the question of the genesis, significance, and consequences of a living myth and to grapple with the difficult answers.
MYTHS FOR PERSECUTION The reason it is so dangerous to tackle a living myth is that its validity is tied up with the professional livelihood of large numbers of influential people. Loaded myths serve a social function, often the sinister one of furnishing scapegoats: sacrificial beasts on whom the rest of us can load the onerous burden of our sins, driving these unfortunate animals forth into the wilderness.
But this itself is an empty, dead myth, since for centuries "scapegoats" have not been animals at all. They have been human beings whom we want to punish for our own problems by exiling them to a metaphorical wilderness. In order to do that, we must strip them of all their rights and privileges as people like us. They must be authenticated as somehow "different"—like George Ill's German mercenaries during the American Revolution—so that we can excuse ourselves for treating them as less than human.
Every society authenticates its scapegoats through the activities of a professional class that is richly rewarded and given enormous power and influence. The myths it employs, since they are believed in as literally true, are as loaded as any gun. When someone who has the power to use them aims at a human target and pulls the trigger, the person hit is destroyed as surely as if he had been shot. We need look no further than Verdi's Il Trovatore for a dramatic illustration of how the belief in a loaded myth like witchcraft destroyed not only the poor gypsy who was burned alive but also, with grim irony, the family of her persecutor.
This, then, is the kind of myth that Thomas Szasz has been attacking. He argues that "mental illness" is a secular myth. Just as witchcraft was created by a priestly class in a culture that valued religion, so mental illness is created by a psychiatric class in a culture that values science. Both myths were developed and supported by professional classes in order to justify society's persecution of the weak and powerless.
The hypocrisy of this persecution is indicated by the fact that it is disguised as benevolence. The inquisitor who tortured his victim to death claimed that he was saving her soul. The psychiatrist who tortures his victim in a living death claims that he is saving her mental health. In both cases, the myth is cloaked in the mantle of a culture whose values are unquestioned.
LOADED SCIENCE How, in 17th-century Salem, could one doubt the validity of religion? How, in the 20th century, can one doubt the values of science? But in neither instance does the myth have anything to do with the values under which it masquerades. Witchcraft was a perversion of religion; pinning psychiatric labels on those we want to degrade, a perversion of science. Szasz maintains that the myth of mental illness, in welfare bureaucracies no less than in totalitarian states, is used to control behavior perceived not only as dangerous but even as merely aberrant or eccentric. More fundamentally, the redefinition of evil as mental illness has not caused its disappearance; it has merely altered its mythology and replaced the clergy as its controlling profession with psychiatrists.
For Szasz, the mythology of mental illness is, in the terminology of Francis Bacon, today's most potent Idol of the Market-Place. "Mental illness" is a metaphor—or, as Bacon would say, a phantom or false appearance—that has become mistaken for reality and that supports the false "science" of psychiatry. It is a myth created by psychiatrists to lend medical respectability and an aura of objectivity to their work.
Although Szasz readily admits that the brain can suffer impairment, the "mind," he believes, since it is incorporeal, cannot have a disease as an organ of the body can.
Nevertheless, problems in living or difficulties of communication do indeed exist, as Szasz also readily admits. But treating them by physiological tinkering is analogous to calling for the television repairman when we do not like the programs relayed to our home screens. Consequently psychiatry, although it presents itself as science and follows a medical model, is really scientism. This phenomenon, which a growing number of modern thinkers, both scientists and humanists, are increasingly concerned about, is the misuse of scientific methods in disciplines where they are not really applicable.
In order to strip away the mask of scientism, revealing psychiatry's true features, Szasz discriminates between being sick—an abnormal physiological condition—and being a patient—a status. Although the two are often confused, they are not the. same, and they need not even coincide. An ailing Christian Scientist may refuse to play the role of a patient. Conversely, an erring delinquent may not be physiologically ill, but he may be forced to play the social role of "mental patient."
GAINING CONTROL By blurring the distinction between being sick and being a patient, the mental health ideology, Szasz believes, furnishes an excuse for controlling deviants, troublemakers, or simply burdensome individuals. A society that does not want to confront its moral, social, and political problems can evade them by creating a set of scapegoats, characterizing those whose behavior is a nuisance as "mentally ill" and locking them up.
So pervasive has this scapegoating become that it has even infiltrated our courts. Since loaded myths are clearly perceived as valuable tools of authority, the State's legal machinery grinds more easily when professional myth-makers are cogs in its wheels. Thus, just as clergymen played a vital role in the inquisition of witches, so forensic psychiatrists today play a vital role in our system of criminal justice.
Accordingly, accused lawbreakers frequently lose their legal rights under Anglo-American law. Without ever having been found guilty, they can be, and often are, incarcerated for indeterminate periods because psychiatrists, acting in collusion with lawyers and judges, have pronounced them incompetent to stand trial. Even more appalling, if they are tried, they may be saddled with an "insanity defense" resulting in "acquittal"—a hypocritical verdict leading, not to freedom, but to punitive incarceration, often for life, in a mental hospital. This is what happened in both of the famous medico-legal cases on which the insanity defense is based—M'Naghten, in England, and Durham, in the United States.
In his discussion of psychiatric nosologies, Szasz points out that all classification aims to control the objects classified. Psychiatric nosology has included such classifications as homosexuality, masturbation, drug addiction, and suicide. Such labels imposed on involuntary clients warrant their treatment as objects or things rather than as autonomous individuals. Hence, these classifications are used to stigmatize and control the persons to whom they are applied. When we realize that medical diagnoses classify diseases but that psychiatric diagnoses classify behavior, we can understand the point of Szasz's demonstration that "mental illness" is not physiological impairment but a way of living. The medical physician diagnoses diseases in order to control them; the psychiatrist diagnoses behavior in order to control it.
SHAKESPEARE AND SZASZ Just as mental illness, in Szasz's view, is a myth, so is psychotherapy a myth. As a metaphor, it is fine. But if we think for a minute about the etymology of the word—one which we have all come to accept unquestioningly—we can see how ridiculous the concept is when we take it literally. Therapy for the psyche? Curing the soul?
Shakespeare knew better than this, at the very beginning of the 17th century—that ideological hinge of time when Western civilization was turning away from a religious culture toward a scientific one. Watching wicked Lady Macbeth walking in her sleep, tortured by an anguish of remorse, the doctor who has been called to the castle says: "This disease is beyond my practice.…More needs she the divine than the physician."
Later, Macbeth himself asks the doctor about his queen. His query is an early illustration of the human desire to transform questions of good and evil into questions of health and disease. Macbeth, who knows very well what his wife has been up to, says, "Canst thou not minister to a mind diseas'd, / Pluck from the memory a rooted sorrow, / Raze out the written troubles of the brain, / And with some sweet oblivious antidote / Cleanse the stuffd bosom of that perilous stuff / Which weighs upon the heart?"
The doctor, however, unlike his psychiatric successors, recognizes that what ails his patient has nothing to do with disease and cannot be cured by pills. He answers, "Therein the patient / Must minister to himself." Lady Macbeth is not sick; she is a murderess. Her husband is trying, unsuccessfully, to do what today we are able to do with only too much ease. Thieves, muggers, rapists, and murderers—particularly when it would be awkward or inconvenient to investigate their crimes publicly in a court trial—are treated as if they were "sick" rather than immoral.
Szasz wants us to confront questions of good and evil, not to sweep them under the rug by invoking the myth of mental illness. He wants psychiatrists today to act like Lady Macbeth's doctor. The physician Shakespeare had created did not know what his patient had done, but he was acute enough to recognize that what she suffered from was no disease, but the gnawing of conscience for some terrible deed. In the last analysis, she herself would have to face the consequences of her own acts. And finally, when she did so, she chose to commit suicide. But even that decision, according to the psychiatric mythology of our modern Western societies, is a "mental illness."
SELF-HELP VS. TYRANNY Szasz recognizes that psychiatrists do act on their patients in various ways. He thinks that listening with sympathy and understanding to someone who has troubles may well help him. But this is not "therapy," in the medical sense, and it has nothing to do with being a physician. Many a person with no medical background performs this role. Most teachers have found that their students often seek them out for what purports to be intellectual guidance or academic advisement, when what they are really looking for is sympathetic understanding of their personal problems. The taxi-driver and the bartender proverbially render the same service.
Szasz is not anti-psychiatry. So long as an individual seeks out a psychiatrist of his own accord, so long as the psychiatrist does not betray his client's confidences, and so long as the psychiatrist never acts against his client at the instigation of a third party, he may well help his patient to understand his own character better and to change the goals of his life and the ways in which he is trying to reach them. But whenever the psychiatrist breaks faith with his client, whenever he controls him on behalf of someone else or on behalf of society—in short, whenever the so-called patient is a victim of psychiatric interventions that are imposed on him against his will—then he is a scapegoat.
Szasz's analysis of mental illness as mythology has far-reaching consequences leading to a distinction between two kinds of psychiatry. The first recognizes moral and social problems for what they are; the second disguises them under misleading medical labels. The first rests on personal responsibility and uncoerced choices involving self-discipline as well as self-direction; the individual's own freedom interacts with the freedom of others. The second, on the other hand, embraces moral failure and entails State control through bureaucratic technologizing at personal, social, and political levels. It fingers its scapegoats by calling them "mentally ill," their prognosis being implicit in a degrading diagnosis culled from the psychiatric nosology. It disguises its tyranny by applying the term treatment to coercion, involuntary commitment, and unwanted interventions visited on its hapless victims in the name of "therapy."
The questions that the erudite and courageous Professor Szasz has been posing for over two decades have no simple solutions. Rather, he is asking us to undertake a critical and often painful examination of our own thinking, to explore assumptions so fundamental that we have taken them for granted, not only in our individual lives but in our society. He is forcing us to decide what values are important to us, to arrange them in a hierarchical order, and then to establish our priorities, both as moral beings and as citizens, according to the conclusions we have reached.
M.E. Grenander is director of the Institute for Humanistic Studies, State University of New York at Albany. This article is adapted from a paper read at a Conference on the History of Myths and Legends, Dakota State College, Madison, South Dakota.