Medicine

On a Doctor's Moral Duty To Cut Off Limbs, or, It's a Szasz, Szasz, Szasz, Szasz World

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Interesting report from Australia that triggered a big "Paging Dr. Szasz":

TO most people, the thought of amputating a perfectly healthy limb is unimaginable.

But for at least three Australians, possibly dozens more, cutting off their leg has felt perfectly normal.

These so-called "amputee wannabes" have a very rare condition in which they feel one of their limbs is not truly their own, and they become obsessed with cutting it off.

And people suffering from the bizarre body image disorder should be able to opt for amputation, a Sydney psychiatrist says.

Christopher Ryan, a psychiatrist at the University of Sydney, says there is a good argument for allowing patients with body integrity identity disorder (BIID) to have their unwanted limb removed.

"I am not saying we should unthinkingly cut off people's legs," Dr Ryan said.

"I realise that the idea strikes almost everyone as lunatic when they first hear it. However, there are a small number of people who see themselves, and have always seen themselves, as amputees," he said.

……..

Dr Ryan has examined the ethics of the issue in the international philosophy journal Neuroethics and says doctors have a moral duty to amputate for the health and safety of the patient.

He said one 30-year-old patient of his lived his whole life feeling he was truly an amputee, but was so ashamed of how he felt he did not tell anyone.

"Eventually he took the only step he thought he had open to him and placed his leg in a bucket of dry ice until it died and had to be removed," Dr Ryan said.

"Now, a year later, he is living happily as an amputee and getting on with his life."

The paper said the operations should be likened to plastic surgery, with elective amputation offered to BIID sufferers only.

That last sentence is my favorite–make sure you are only cutting off the limbs of those who are "BIID sufferers." How can you tell? Well, you know, they are the ones who keep asking you to cut off their limbs.

Thomas Szasz, a reason contributing editor, is famous, and infamous, for arguing that most of what is called "mental illness" in our culture is not in fact the result of an actually diseased organ, but merely an artifact of bizarre, difficult, or even stupid choices. (Some favorite Szaszian epigrams: "A berserk lunatic may claim to be Jesus or kill his wife. The point of such a person's behavior, I dare say, is to be revered like Jesus or be rid of his wife." "The patient's delusion is a problem to the patient's family, employer, and friends; to the patient it is a solution to the problem of the meaning(lessness) of his life.")

Szasz would point out that it gains us nothing to refer to people who express the desire to have healthy limbs cut off as suffering from a "condition" and medicalizing it and giving it a pseudo-scientific name–except for the cultural ratification of the desire, and the cultural and legal ratification of those professionals who want to help gratify it. (***And, as R.C. Dean points out in comment thread, it also gains the potential for private and public insurers to cough up for the procedure.***)

He'd say–and I say–if someone can find someone willing to help them cut off their limb as a commercial service, God bless 'em, I guess (the joke in a student skit at his old school had it that the only two categories in the "Szasz Diagnostic Manual" were "Crook" and "Bum," and I think the doctor would slot so-called BIID sufferers in the latter category, largely)–but that doesn't mean the rest of us have any duty to be supportive, understanding, or claim that weird desire should be dignified by being called a "medical condition."

As Szasz once wrote: "Without informed and uncoerced consent by the patient, no medical or psychiatric intervention is justified, while with consent every such intervention is justified, even if there is no illness and even if the intervention is considered to be harmful by its critics."

With that libertarian wisdom under his belt, Dr. Ryan could feel justified in cutting off (willing) people's limbs without the unnecessary multiplication of entities like the bogus "condition" of BIID.

Jacob Sullum interviewed Szasz in our July 2000 issue.

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  1. But, you see, if elective amputation is considered essentially plastic surgery, the patient has to pay for it himself, but once it is classified as a treatment for a condition, then it can be paid for by the taxpayers.

  2. I thought Szasz was the knife-wielding Batman villain. Whatever, he’d probably come to the same conclusion

  3. Wouldn’t doping these people up with drugs be much simpler?

  4. My main concern here is how the patient feels after you cut off their limb. My armature hypothesis, is that they’ll feel exactly as before and demand you cut off another. Much like Michael Jackson.

  5. Damn, RC, you nailed it first post. Screw you.

    Can’t a case also be made that since these people so badly want the limb gone, they will engage in dangerous techniques to remove it themselves? So refusing the surgery is actually placing them in danger?

    I thought I had heard of one or more of these people doing some very bad shit to their limb so it would be removed, like shooting it with a 12-gauge. Extreme blood loss is bad, mm’kay?

  6. Remember that Bradbury story, in which a guy thought his own bones were rebelling against him? Awesome.

  7. Pay for it yourself. Disqualify yourself from all disability claims. Go for it. If a healthy poor person desires to sell an arm to a weathy accident victim for transplant, I’ve no problem with that either.

    You could probably charge an arm and a leg for an arm and a leg.

  8. I once saw a news story about healthy women who had (some successfully) asked doctors to lop off their breasts, because they were afraid they might some day get breast cancer. I would call that hysterical self-mutilation.

    I find it hard to believe any doctor would do anything but chase such a person out of his office with the nearest blunt object at hand. But I’m not a doctor.

  9. There are actually people who have an uncontrolable desire to eat their own limbs, too.

  10. Also at issue here is the ethical code of doctors to “Do no harm.” Surgery which is not just cosmetic, but actually handicaps a person, violates the hippocratic oath. Any doc who chops a leg off a BIID could lose his license to print money/practice medicine. Some fear this same logic will be applied to transgender surgeries.

    BIID is getting more attention now because it’s uncomfortably close to Gender Identity Disorder, the uncontrollable desire to surigically manipulate one’s sex organs in order to become another gender. Transgenderism has a lot of political support because it seems related to homosexuality.

  11. Thomas Szasz, a reason contributing editor, is famous, and infamous, for arguing that most of what is called “mental illness” in our culture is not in fact the result of an actually diseased organ, but merely an artifact of bizarre, difficult, or even stupid choices.

    As I understand it, one of the current theories about BIID is that there is a defect in the portion of the brain responsible for mapping the body, which causes the brain to see a limb as a foreign body. If that’s the case, then there is a diseased organ.

  12. This is just like when Ash cut off his demon-possessed hand in Evil Dead 2. or not.

  13. the joke in a student skit at his old school had it that the only two categories in the “Szasz Diagnostic Manual” were “Crook” and “Bum,”

    What about “hypochondriac”?

  14. This is just like when Ash cut off his demon-possessed hand in Evil Dead 2. or not.

    Having a chainsaw instead of a hand is pretty damn cool, dude. GROOVY.

  15. doctors have a moral duty to amputate for the health and safety of the patient.

    No they don’t. Doctors have an ethical duty not to perform the amputation. As Abdul points out the surgery is mutilation and violates the doctor’s Hippocratic oath.As a libertarian I have no issue with someone contracting with another to mutilate his body.Another good reason to have no State licensure of medical providers.One not bound by the ethics and oath of our current doctors could do the job.

  16. I wonder, though, whether doctors should cooperate with such people. Szasz does not think doctors should help people take their own lives. Of course he would repeal all the laws that make it tough for people to do this themselves.

  17. it gains us nothing to refer to people who express the desire to have healthy limbs cut off as suffering from a “condition” and medicalizing it and giving it a pseudo-scientific name–except for the cultural ratification of the desire, and the cultural and legal ratification of those professionals who want to help gratify it.

    There is an unneeded conflation here between the concept that this condition (whatever it is) can be meaningfully classified and given a label so that it can be recognized, studied, discussed, and/or treated, and the idea that those activities answer the ethical dimensions of the choices that surround the condition.

    For the condition at hand there are a few important points.

    1)There is a consistent behavioral profile that is highly unusual.
    2) The behavioral profile leads to increased risk of harm to self (if not others).

    Arguing over whether the “harm” is “real harm” or not is the pointless activity. Arguing over whether the behavioral profile is a medical condition or just a choice is also pointless.

    Once you have classified an individual as having the condition, you can weigh the actions that flow from that. It you cut off their limb, that is as much a treatment for the condition as it would be to give them a pill which suppresses or removes the desire. Evidence-based practice would look at the outcome of the two treatments to see which results in better outcomes for the patients, on average, over-time, based on reasonable outcome measures.

  18. For any one not very familiar with Doctor Szasz he is no half-ass wishy-washy libertarian.I highly recommend all of his works.He offers a lot more than just his views on mental illness.

  19. Anyone seriously interested in the ethical questions that this issue raises and going beyond a knee-jerk ill-thought response, may be interested in reading and commenting upon the original article that sparked the media release above. It is free available and written in non-technical language. Go to http://www.springerlink.com/content/120989/?Content+Status=Accepted .

  20. Doctor Szasz he is no half-ass wishy-washy libertarian.

    True, but he is a half-ass theoretician of mental processes who can’t put together a valid argument to save his ass.

  21. I saw an hour-long TV show about these people. And yes, they do some *really* disturbing things to their limbs. Like binding them and mutilating them.

    Transgenderism has a lot of political support because it seems related to homosexuality.

    That does seem to be the case, though I don’t see it that way. And they don’t either. They typically claim to be straight. What’s really going on is that the condition just gets lumped together with everything else that’s not “normal”.

  22. Neu,

    That only works if the would-be limb loser considers taking a pill to remove the desire for amputation an equal outcome.They seem to desire amputation not the removal of desire for amputation.If they prefer the latter then give it to them.If “make me happy with keeping my limbs” pills were OTC doctors would not necessarily need to be involved.

  23. If that’s the case, then there is a diseased organ.

    Szasz would argue that this is just poppy-cock.

    The mind is not the activity of the brain…it is a ghost/soul that inhabits the body, or something.

  24. SIV,

    They don’t desire to have the desire removed?

    Man that is a loaded comment.
    If I had more time I would respond in more detail.

    Let me just say that demonstrating which outcome is better would involve the patient’s own satisfaction with the outcome…not their prediction about how satisfied they would be with the outcome.

  25. Also at issue here is the ethical code of doctors to “Do no harm.” Surgery which is not just cosmetic, but actually handicaps a person, violates the hippocratic oath.

    That obviously includes vasectomies and Tubal ligation. Perhaps you think being sterile is not a handicap. In that case, visit fertility clinics and talk to the patrons for a while to dissuade your ignorance.

    Or perhaps you believe that you are somehow uniquely qualified to decide what others should be able to do with their own bodies. In that case you are just an arrogant asshole.

  26. As long as a doctor agrees to do it and insurance and/or public money is not involved in the procedure, recovery, or long-term employment prospects of a voluntary amputee, let them cut off whatever they feel like.

  27. As I understand it, one of the current theories about BIID is that there is a defect in the portion of the brain responsible for mapping the body, which causes the brain to see a limb as a foreign body. If that’s the case, then there is a diseased organ.

    Do we treat any other diseased organs by removing another, perfectly healthy body part?

  28. Do we treat any other diseased organs by removing another, perfectly healthy body part?

    Abortion?
    That removes all the body parts.

  29. Szasz is a great libertarian, and his views on consent and treatment (both to not involuntarily treat people with a problem and to allow the treatment of people who “don’t” have a problem) is to be admired, and completely applicable here.

    But his understanding of diseased organs is behind current research and unimpressive at best.

  30. that should be:

    But his understanding of diseased organs is at best behind current research and unimpressive.

  31. The mind is not the activity of the brain…it is a ghost/soul that inhabits the body, or something.

    The mind can only operate with machinery that is running it. If the brain is broke, the mind will suffer.

  32. J sub D,

    I may be an arrogant asshole, but at least I see the difference between a tubal ligation and chopping someone’s frigging arm off, you ignorant slut.

  33. Personally, I’d rather page Dr. Saaz. Now where’s my bottle opener?

  34. Szasz would argue that this is just poppy-cock.

    The mind is not the activity of the brain…it is a ghost/soul that inhabits the body, or something.

    My point was that this is not all in the mind; there is an actual physical defect in the brain.

  35. Do we treat any other diseased organs by removing another, perfectly healthy body part?

    Not that I’m aware of, but it’s the best we can do at the moment. It’s preferential to unending mental torment which usually leads to self-mutilation, culminating in the need for amputation anyway.

  36. Szasz doesn’t think there is such a thing as mental illness *at all*. It’s a libertarian position, but I don’t think it’s scientifically valid. It was a lot easier to make that argument in the 60’s, when he first published “The Myth of Mental Illness”.

  37. At what point do we classify everyone’s neuroses? How many people are there in the world that have this problem? 10000? 100? 10? It reaches a point when there simply aren’t enough “sufferers” to deal with this on any sort of level other than personal. I think I’ll leave this one up to the individuals, doctors and insurance companies involved and not worry about the far reaching effects this might have on our legal system. Personally, I don’t care what these people end up doing. There are simply not enough of them to warrant my attention.

  38. It’s a libertarian position

    I’d say “it’s a position some libertarians share”. I don’t think you have to turn in your decoder ring if you think he’s full of it.

  39. Let me just say that demonstrating which outcome is better would involve the patient’s own satisfaction with the outcome…not their prediction about how satisfied they would be with the outcome.

    I have read about people like this in the past, and most of the people who have managed to get the limb amputated were quite content afterwards. If I remember correctly, they were relieved and finally felt normal. Many of them had done things to force the amputation of the limb.

    Do we treat any other diseased organs by removing another, perfectly healthy body part?

    Many women who have a genetic predisposition to breast cancer and have a family history of it have chosen to have pre-emptive mastectomies. It isn’t the same thing exactly since the healthy breasts are being removed lieu of another diseased organ, but in because of the potential that they might some day be diseased.

    Personally I think if someone wants to have a limb removed, for whatever reason, that should be their choice.

    I don’t believe that see living a life on psychotic meds in order to feel normal is inherently superior to feeling normal by having a limb removed voluntarily.

    I don’t think it is my or anyone else place to judge what is appropriate or a preferred protocol for the patient assuming the patient is informed of all options and potential risks.

  40. I may be an arrogant asshole, but at least I see the difference between a tubal ligation and chopping someone’s frigging arm off, you ignorant slut.

    What major life functions can you still perform with one arm? Oh that’s simple, all of them.

    What major life fuctions can you still perform after a tubal ligation? Oh that’s kinda easy too, all of them except reproduction.

    Your inabilty to reason does reflect well upon your education.

  41. From the article – bear in mind, this is a guy who wants doctors to go ahead with the procedure:

    “There is very little known about BIID and the literature surrounding it is scant. Our knowledge of the condition derives from only three sources-case reports, reports in the media and one methodologically weak survey.”

    As to the arguments against doctors doing the will of BIID sufferers, the author purports to rebut all such arguments.

    You can’t call these patients psychotic because psychotic people have lots of delusions, and BIID sufferers only have one delusion – that their leg isn’t their true leg. You can’t call them delusional, because who can’t judge the validity of a patient’s *feeling* that their leg doesn’t belong to them.

    As to the possibility that, if the BIID diagnosis is officially recognized, more people will call themselves BIID sufferers and seek surgery – well, the author acknowledges that possibility, but says it’s not a problem, because these people will probably be genuinely BIID sufferers who hadn’t come forward previously because doctors wouldn’t take their problems seriously. In other words, the author is quite willing to stipulate that there may be able-bodied people out there who have intact limbs because they are afraid of being dismissed if they come to a doctor and ask one of their healthy limbs to be amputated. If BIID became a diagnostic category, these patients would finally have the courage to exercise their autonomy and get their legs cut off! In other words, the present repressive regime, where the condition is not officially recognized, may have actually preserved the healthy limbs of many adults intact. That sounds like a feature, not a bug.

    Yes, if it’s officially listed in the DSM-VI or DSM-XXXIII or whatever the latest edition is, that means patients will be able to reach into the taxpayer’s pocket to pay for the procedure. But it won’t just be taxpayers who will have their autonomy infringed in the name of some would-be amputee’s autonomy – doctors would lose autonomy, too, if the author has his way:

    “Despite all argument above, many doctors will still find themselves unable to agree that the amputation of a healthy limb is ethically sound, even if all the caveats outlined are met. As is the case in termination of pregnancy [that is, abortion], dissenting doctors should be under no obligation to proceed with an amputation in these circumstances, but are under an obligation to refer the patient to another doctor whom they believe might proceed with the amputation if all the caveats are met.” So, infringe the autonomy of doctors with respect to a condition as to which, as the author admits, “very little is known.” That’s evidence-based policymaking for you!

    So other than trampling on the rights of taxpayers and “dissenting doctors,” this would be a great leap forward for freedom!

    As far as requiring would-be amputees to sign a form rejecting welfare, how would that be enforced in practice? If an amputee comes into an emergency room after being hit by a car, or beaten by some robber who preys on the handicapped, will the admitting nurse say, “I see from your record that you renounced welfare, so go away!” If he applies for Social Security disability on the grounds that he suffers from both mental and physical disabilities – not only am I crazy, but look, I’m so crazy I crippled myself! – would the Social Security Administration reject the claim, especially if he has a doctor’s letter saying he suffers from a bone fide mental illness?

    Yes, there are strange parallels with “gender identity disorder.” Pius XI in the encyclical Casti Connubii, discussed bodily mutilation in the context of sexual mutilation, but in language which would apply to BIID as well:

    “71. Furthermore, Christian doctrine establishes, and the light of human reason makes it most clear, that private individuals have no other power over the members of their bodies than that which pertains to their natural ends; and they are not free to destroy or mutilate their members, or in any other way render themselves unfit for their natural functions, except when no other provision can be made for the good of the whole body.”

  42. It would seem cheaper and more effective as a treatment to their condition simply to euthanize them. I mean, if you’re that self-destructive as to want perfectly healthy limbs amputated, you’re pretty far gone – whether you call it an official medical disorder or not. Their crazy foolishness solved, put out of our misery, and for almost no money. I suppose that might be considered a violation of their rights though.

  43. What major life functions can you still perform with one arm? Oh that’s simple, all of them.

    Try clapping, fuckwit.

  44. Try clapping, fuckwit.

    *Slapping one palm against thigh*

    Hardly a major life function, but not too difficult for someone with an IQ in the triple digits of 75 or above.

    Try again genius.

  45. Al,

    I mean, if you’re that self-destructive as to want perfectly healthy limbs amputated, you’re pretty far gone – whether you call it an official medical disorder or not.

    But it’s not self destruction to them, only to you. And you should not have the power to determine what these people should do with their own bodies.

  46. There is also publicly-funded support of actual crippled people to consider–ramps, elevators, and such. I’m not sure these people have a right to impose those costs on me.

  47. So someone thinks his arm doesn’t feel like a real arm. But a metal and contraption with pulleys and joints that sets off airport metal detectors, smells like the inside of a locker, weighs a couple of pounds more than a human arm, gets caught on the stuff leavig him immobilized in inconvenient places like train exits, shreads shirts, is useless for smashing mosquitoes, can’t be used to hold crutches or push a wheelchair …

    That’s gonna feel just right? And he’s got a doctor to take him seriously?

  48. So if someone feels like he doesn’t want to live anymore, is his suicide or even assisted suicide okay? Just taking this to the next level.

  49. Frankly, I would rather have an “alien” leg or arm or whatever, than have to deal with the inconveniences of not having the body part in question, not to mention enduring the physical pain of having the body part removed. I’ve heard that alot of amputees experience “ghost” pain from missing extremities. Sounds like they need psychiatric help a lot more than surgery. I agree with the Michael Jackson analogy, I wonder how many of them would then want more surgery . . . I don’t think agreeing to such bizarre requests would mean that the cure rate was 100%, or even close, upon amputation.

  50. Simply because Szasz is right about involuntary commitment, doesn’t make him less of an overall crackpot. I don’t think using him as a source helps the cause at all. (And I think he’s a willfully ignorant hack).

    Also, if I were a surgeon, I would refuse to do this surgery. One could argue that it is the quickest route to a somewhat normal life for the person seeking it. Maybe. Years of psychotherapy might not help, I guess. Whereas surgery and adjusting to life with one leg might be the end of it. Same thing with gender reassignment surgery. I’d want no part of it though.

  51. So if someone feels like he doesn’t want to live anymore, is his suicide or even assisted suicide okay?

    Yes.

  52. So if someone feels like he doesn’t want to live anymore, is his suicide or even assisted suicide okay? Just taking this to the next level.

    It depends what you mean by “okay.” I think it’s OK in the sense that they are entitled to end their life. And, it’s most certainly OK if they’re terminally ill and suffering or looking forward to suffering. However, if it were someone I loved and they weren’t in chronic physical pain or terminally ill, I wouldn’t simply assent because it was their right. I’d do everything in my power to get them psychiatric help–including involuntary commitment (I know. I’m against it on principle, but I’ll admit I’d do it to save someone I loved.)

  53. So if someone feels like he doesn’t want to live anymore, is his suicide or even assisted suicide okay? Just taking this to the next level.

    Yes. Dr. Death Jack Kevorkian is one creepy dude. But he is right on this.

  54. Slapping one palm against thigh is not clapping. It’s slapping your palm against your thigh.

    Now try wanking while typing–truly a major life function if there ever was one for people of all IQ levels.

  55. Now try wanking while typing–truly a major life function if there ever was one for people of all IQ levels.

    Easy. Use voice recognition software and go back later to edit out the moans and grunts.

  56. I just love people. They’re so fucked up.

  57. This is just one small step from people believing that they are women in men’s bodies. We’ve already almost entirely accepted the idea of someone being “transgendered” so there’s no reason not to accept this.

    Once society starts coddling every potential insanity by saying “it’s okay, you were born that way” there’s no clear line where it should ever stop. And the very first breach in the wall of sanity was with respect to what we call “gay rights”.

    That some men are not very interested in fucking women is fine, we’ve long known about the differences in people’s libidos. That some men should so love some other man that he wants to spend his life with him is fine as well – and also not uncommon throughout history (though there likely was rarely actual fucking going on, but that’s irrelevant). And finally, that some men have strong desires under varying conditions to fuck other men has been as long known as the day is long – and all should be perfectly legal, no one’s business and not subject to mockery or discrimination of any sort.

    But in the course of applying for this societal acceptance and (more recently) for “constitutionally protected rights”, advocates of these various behaviors and inclinations made the morally repugnant decision to claim that people who practice these activities were irrevocably “born that way”.

    Bull shit. Fifty years ago everyone knew it (and even if they did only have black and white TVs, they were no dumber than we are today – a point we generally miss in our “we’re alive today and you’re not!” prejudice) and it’s still true today.

    Once you allow insanities of any form to be considered “normal” you open the door for insanities of every form to assert themselves in the fucked up psyches of human beings everywhere.

  58. As an FYI, Dr. Oliver Sacks covered this phenomenon in The Man Who Mistook His Wife for a Hat. Fascinating stuff, and very readable.

  59. “Also, if I were a surgeon, I would refuse to do this surgery.”

    Would you refer the “patient” to another doctor willing to do the “surgery”? Because that’s what the author of this paper wants to force you do to, in the event you don’t want to do the surgery yourself. Unless you at least cooperate with the patient’s whim’s to the extent of sending him/her to a less scrupulous doctor, your medical license would be endangered, according to the proposal.

    That makes logical sense, once you accept that removing a healthy limb based on the weirdness of a patient is a legitimate medical procedure. It would be unprofessional for doctors to refuse to cooperate in a legitimate medical procedure! I can hear it now – “what if a doctor had some scruple about open-heart surgery – well, chopping off healthy people’s limbs is just as legitimate as a procedure – the medical protocols say so!”

    We’ve experienced this with abortion, as the author alludes to. The American College of Obstetricians and Gynecologists wants to force such a rule on doctors – either abort a woman’s kid if she wants it, or refer her to a doctor willing to do it.

    I know that Dr. Ron Paul (just to take one example) would rather risk his license than comply with a wicked rule like that.

  60. My point was that this is not all in the mind; there is an actual physical defect in the brain.

    Szasz would reject your claim because he rejects the idea that mental diseases are brain diseases.

    Of course the validity of the disorder as a medical diagnosis does not require there to be a structural deficit that we can identify (even if there is certainly, at some level, a structural difference that results in the difference in function).

    The only reason it matters that there is a physical difference in their brain is the effect it is having on the mind (i.e., the activity of their brain). Without the mental consequences, it make no sense to label the particular difference in brain structure as a “defect.” It is a “defect” because it results in a mental difference that is seen as a negative outcome. Structural differences that do not result in a functional deficit are not defects, they are just structural differences.

    Following this logic, there is no reason to have the validity of the mental illness diagnosis to rest on the structural difference since it is the functional deficit that defines the disorder, in a sense.

  61. mnuez | November 14, 2008, 5:27pm | #

    mnuez’s post reminds me of the real question that challenges psychology/psychiatry:

    How do you differentially diagnosis whether someone is mentally ill, or just an asshole?

  62. It was a lot easier to make that argument in the 60’s, when he first published “The Myth of Mental Illness”.

    It was no more valid in the 60’s.

    Szasz’s problem is that he sets up a comparison between diagnosis of mental illness (which he considers invalid) and diagnosis of “real disease” (which he considers valid) without having a clear understanding of how “real diseases” have always been diagnosed, what a diagnosis is, the difference between diagnosis and impairment/disease, or where the validity of a diagnosis comes from.

    In addition he calls categories used to discuss mental illnesses invalid because they are “metaphorical”. But, of course, metaphorical extension is at the heart of all human categorization, so the argument lacks any force. If metaphorically categories are invalid, then all categories are invalid.

    We could go on and on, but suffice it to say that Szasz makes a poor poster child. You might as well hitch your wagon to L.Ron Hubbard.

  63. What I want to know — is there anyone who is OK with allowing abortion or suicide, but opposed to allowing this (so long as it is done with their own funds)?

  64. Not sure if mnuez is trolling or really believes that gays are mentally ill.

    If trolling, well done sir. Fine work.

  65. Prolefeed,

    Re: suicide – context matters…

    If there suicidal ideation results from clinical depression it is virtually equivalent to BIID.

    If the person is avoiding the pain of, say, the end stages of cancer, then we are having a very different discussion.

    Not sure how abortion gets tied up in this issue. It seems unrelated to me.

  66. if there = if the

  67. “Try clapping, fuckwit.”

    What is the sound of one limb clapping? Sorry, I couldn’t help it.

  68. thump thump thump


  69. How do you differentially diagnosis whether someone is mentally ill, or just an asshole?

    This question vexes all of medicine not just the scientific sub-discipline of Psychiatry.
    How do we know if someone is suffering from a fever,or just an asshole?
    Cancer patient? Or just an asshole?
    Pneumonia? Or just an asshole?
    Diabetes? Or just an asshole?
    Broken leg?

    Thankfully, most of these ailments have pathologies so we can weed out the “just an asshole”s.
    Psychiatry is different as the diseases have no pathology and are subject to definition by committee.

  70. Procto,

    Psychiatry is different as the diseases have no pathology

    Incorrect.
    Fail.

  71. “Szasz would reject your claim because he rejects the idea that mental diseases are brain diseases.”

    Not true. There are many cases of “mental illness” that have been later confirmed to be a real (physical/cellular) illness. He doesn’t dispute that. He is merely skeptical of the practice of declaring all strange behavior to some yet undiscovered physical pathology.
    As am I.

  72. Dogzilla,

    There are many cases of “mental illness” that have been later confirmed to be a real (physical/cellular) illness. He doesn’t dispute that.

    Not exactly true.
    He rejects most evidence related to the physiology underlying mental illnesses that involve altered mood, behavior, or perception. He has only been willing to acknowledge illnesses which involve cognitive decline (memory loss, etc.).

    In one of his most recent articles (2008) he reiterated his claim that because the mind is not material matter it can not be diseased. He sees behaviors as choices of the mind, which can not be diseased because it is not material.

  73. Dogzilla,

    He is merely skeptical of the practice of declaring all strange behavior to some yet undiscovered physical pathology. [emphasis added]

    You give him too much credit.
    He is not merely skeptical.

    And this argument is a strawman.
    No one is declaring “all strange behavior” to be the result of undiscovered pathology.

    The APA is taking more than decade to conduct research and collect evidence as part of the process to revise their diagnostic criteria for the DSM-V.

    http://www.medscape.com/viewarticle/436403

  74. I think the best discussion of Szasz is this one…

    The Myth of Mental Illness
    RE KENDELL

    From Szasz Under Fire
    By Jeffrey A. Schaler

  75. Dogzilla,

    BTW, regarding: He is merely skeptical of the practice of declaring all strange behavior to some yet undiscovered physical pathology.

    RE Kendell points out that if this were what Szasz were about, he would have lots of support in the psychiatric community.

    In his response to Kendell in Szasz Under Fire, Szasz himself emphasizes that this is not what he is talking about. He is attacking the concept of mental illness at a more basic level. His attack is weak and poorly formulated, but it is not merely a skepticism related to the boundaries of diagnostic categories.

  76. In the 1960s I worked in a state mental hospital as an aide. This was before deinstitutionalization. There were many patients on my ward that I thought were just as normal as I was. However, from time to time, one of them would be released and would immediately do something incredibly dangerous and crazy and be back on the ward in no time. What I learned from that is that there are some people who need to be locked up and humanely cared for. We did a better job of this 50 years ago. Deinstitutionalization of mental patients-for which Dr. Szasz is partially responsible-is one of the worse things that I have seen in my lifetime. It has lowered the level of civilization in America.

  77. But in the course of applying for this societal acceptance and (more recently) for “constitutionally protected rights”, advocates of these various behaviors and inclinations made the morally repugnant decision to claim that people who practice these activities were irrevocably “born that way”.

    Hmmm, evidence that they are not born that way?

  78. Also, I’m not sure if anyone is “irrevocably” born heterosexual, homosexual or whatever is in between. But that’s just my two cents.

  79. With many new announcement about the wizard of oz movies in the news, you might want to consider starting to obtain Wizard of Oz book series either as collectible or investment at RareOzBooks.com.

  80. This is a scary condition that is real.

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