My aim in this essay is to raise the question “Is there such a thing as mental illness?” and to argue that there is not. Since the notion of mental illness is extremely widely used nowadays, inquiry into the ways in which this term is employed would seem to be especially indicated. Mental illness, of course, is not literally a “thing” — or physical object — and hence it can “exist” only in the same sort of way in which other theoretical concepts exist.
Yet, familiar theories are in the habit of posing, sooner or later — at least to those who come to believe in them — as “objective truths” (or “facts”). During certain historical periods, explanatory conceptions such as deities, witches, and microorganisms appeared not only as theories but as self-evident causes of a vast number of events. I submit that today mental illness is widely regarded in a somewhat similar fashion, that is, as the cause of innumerable diverse happenings.
As an antidote to the complacent use of the notion of mental illness — whether as a self-evident phenomenon, theory, or cause–let us ask this question: What is meant when it is asserted that someone is mentally ill?
In what follows I shall describe briefly the main uses to which the concept of mental illness has been put. I shall argue that this notion has outlived whatever usefulness it might have had and that it now functions merely as a convenient myth.
MENTAL ILLNESS AS A SIGN OF BRAIN DISEASE
The notion of mental illness derives it main sup- port from such phenomena as syphilis of the brain or delirious conditions-intoxications, for instance — in which persons are known to manifest various peculiarities or disorders of thinking and behavior. Correctly speaking, however, these are diseases of the brain, not of the mind. According to one school of thought, all so-called mental illness is of this type.
The assumption is made that some neurological defect, perhaps a very subtle one, will ultimately be found for all the disorders of thinking and behavior. Many contemporary psychiatrists, physicians, and other scientists hold this view. This position implies that people cannot have troubles — expressed in what are now called “mental illnesses” — because of differences in personal needs, opinions, social aspirations, values, and so on. All problems in living are attributed to physicochemical processes which in due time will be discovered by medical research.
“Mental illnesses” are thus regarded as basically no different than all other diseases (that is, of the body). The only difference, in this view, between mental and bodily diseases is that the former, affecting the brain, manifest themselves by means of mental symptoms; whereas the latter, affecting other organ systems (for example, the skin, liver, etc.), manifest themselves by means of symptoms referable to those parts of the body. This view rests on and expresses what are, in my opinion, two fundamental errors.
In the first place, what central nervous system symptoms would correspond to a skin eruption or a fracture? It would not be some emotion or complex bit of behavior. Rather, it would be blindness or a paralysis of some part of the body. The crux of the matter is that a disease of the brain, analogous to a disease of the skin or bone, is a neurological defect, and not a problem in living.
For example, a defect in a person’s visual field may be satisfactorily explained by correlating it with certain definite lesions in the nervous system. On the other hand, a person’s belief — whether this be a belief in Christianity, in Communism, or in the idea that his internal organs are “rotting” and that his body is, in fact, already “dead” — cannot be explained by a defect or disease of the nervous system.
Explanations of this sort of occurrence — assuming that one is interested in the belief itself and does not regard it simply as a “symptom” or expression of something else that is more interesting — must be sought along different lines.
The second error in regarding complex psycho-social behavior, consisting of communications about ourselves and the world about us, as mere symptoms [p. 114] of neurological functioning is epistemological. In other words, it is an error pertaining not to any mistakes in observation or reasoning, as such, but rather to the way in which we organize and express our knowledge.
In the present case, the error lies in making a symmetrical dualism between mental and physical (or bodily) symptoms, a dualism which is merely a habit of speech and to which no known observations can be found to correspond. Let us see if this is so. In medical practice, when we speak of physical disturbances, we mean either signs (for example, a fever) or symptoms (for example, pain).
We speak of mental symptoms, on the other hand, when we refer to a patient’s communications about himself, others, and the world about him. He might state that he is Napoleon or that he is being persecuted by the Communists.
These would be considered mental symptoms only if the observer believed that the patient was not Napoleon or that he was not being persecuted[sic] by the Communists. This makes it apparent that the statement that “X is a mental symptom” involves rendering a judgment. The judgment entails, moreover, a covert comparison or matching of the patient’s ideas, concepts, or beliefs with those of the observer and the society in which they live. The notion of mental symptom is therefore inextricably tied to the social (including ethical) context in which it is made in much the same way as the notion of bodily symptom is tied to an anatomical and genetic context (Szasz, 1957a, 1957b).
To sum up what has been said thus far: I have tried to show that for those who regard mental symptoms as signs of brain disease, the concept of mental illness is unnecessary and misleading. For what they mean is that people so labeled suffer from diseases of the brain; and, if that is what they mean, it would seem better for the sake of clarity to say that and not something else.