The Myth of Mental Illness Part 4: CHOICE, RESPONSIBILITY, AND PSYCHIATRY

CHOICE, RESPONSIBILITY, AND PSYCHIATRY

While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist.  Like the personal and social troubles which people had in the Middle Ages, they are real enough.  It is the labels we give them that concerns us and, having labelled them, what we do about them.  While I cannot go into the ramified implications of this problem here, it is worth noting that a demonologic conception of problems in living gave rise to therapy along theological lines. Today, a belief in mental illness implies — nay, requires–therapy along medical or psychotherapeutic lines.

What is implied in the line of thought set forth here is something quite different.  I do not intend to offer a new conception of “psychiatric illness” nor a new form of “therapy.”  My aim is more modest and yet also more ambitious. It is to suggest that the phenomena now called mental illnesses be looked at afresh and more simple, that they be removed from the category of illness, and that they be regarded as the expressions of man’s struggle with the problem of how he should live. The last mentioned problem is obviously a vast one, its enormity reflecting not only man’s inability to cope with his environment, but even more his increasing self-reflectiveness.

By problems in living, then, I refer to that truly explosive chain reaction which began with man’s fall from divine grace by partaking of the fruit of the tree of knowledge.  Man’s awareness of himself and of the world about him seems to be a steadily expanding one, bringing in its wake an ever large; burden of understanding (an expression borrowed from Susanne Langer, 1953). This burden, then, is to be expected and must not be misinterpreted. Our only rational means for lightening it is more understanding, and appropriate action based on such understanding. The main alternative lies in acting as though the burden were not what in fact we perceive it to be and taking refuge in an outmoded theological view of man. In the latter view, man does not fashion his life and much of his world about him, but merely lives out his fate in a world created by superior beings. This may logically lead to pleading nonresponsibility in the face of seemingly unfathomable problems and difficulties.  Yet, if man fails to take increasing responsibility for his [p. 118] actions, individually as well as collectively, it seems unlikely that some higher power or being would assume this task and carry this burden for him. Moreover, this seems hardly the proper time in human history for obscuring the issue of man’s responsibility for his actions by hiding it behind the skirt of an all-explaining conception of mental illness.



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References

HOLLINGSHEAD, A. B., & REDLICB, F. C. Social class and mental illness.  New York: Wiley, 1958.

JONES, E. The life and work of Sigmund Freud. Vol. III. New York: Basic Books, 1957.

LANCER, S. R.  Philosophy in a new hey.  New York: Mentor Books, 1953.

PETERS, R. S. The concept of motivation. London: Routledge & Kegan Paul, 1958.

SZASZ, T. S. Malingering: “Diagnosis” or social condemnation?  AMA Arch Neurol. Psychiat., 1956, 76, 432-443.

SZASZ, T. S. Pain and pleasure: A study of bodily-feelings. New York: Basic Books, 1957. (a)

SZASZ, T. S.  The problem of psychiatric nosology: A contribution to a situational analysis of psychiatric operations.  Amer. J. Psychiat, 1957, 114, 405-413. (b)

SZASZ, T. S.  On the theory of psychoanalytic treatment. Int. J. Psycho-Anal., 1957, 38, 166-182. (c)

SZASZ, T. S.   Psychiatry, ethics  and the  criminal law. Columbia law Rev., 1958, 58, 183-198.

SZASZ, T. S.  Moral conflict and psychiatry,  Yale Rev., 1959, in press.

 

Footnote

[1] Freud went so far as to say that: “I consider ethics to be taken for granted.  Actually I have never done a mean thing” (Jones, 1957, p. 247).  This surely is a strange thing to say for someone who has studied man as a social being as closely as did Freud.  I mention it here to show how the notion of “illness” (in the case of psychoanalysis, “psychopathology,” or “mental illness”) was used by Freud — and by most of his followers — as a means for classifying certain forms of human behavior as falling within the scope of medicine, and hence· (by fiat) outside that of ethics!

[*] Classics Editor’s note: In the original American Psychologist text the word “not” appears at this point. Dr. Szasz has informed me, however, that it “was a typo, which [he] corrected when [he] reprinted the piece, e.g., in Ideology and Insanity” (personal communication, 2002).

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