The Myth of Mental Illness Revised Edition

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Harper Collins, 1974 - Psychology - 297 pages
A classic work that has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. "Bold and often brilliant."--Science

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This book wasn't just a critique of the very concept of mental illness and institutional psychiatry but also a rousing defence of the notion of freedom and responsibility as central aspects in understanding human life activity.
Thomas Szasz argues cogently that for a disease category to be recognised it must be demonstrable with actual physical lesions or other physical signs of deviation from known physiological norms. This is not the case in psychiatric disorders like hysteria which rely on behavioural and verbal signs in order to be recognised, in short a communication disorder or deviance.
Thomas Szasz became the bete noir of psychiatry for writing this book because of its central challenge to the claim that so called psychiatric diseases are real diseases, and if not real then how can psychiatry claim to be a branch of medicine.
He has also been wrongly understood to be claiming that people who suffer from the symptoms that result in a psychiatric diagnosis like hysteria are malingering because they're not really ill and are faking illness. This is not the case, Szasz is claiming that the hysteric whilst explicitly playing the game of interpersonal reciprocity is in fact tacitly and unknowingly playing the game of submission and dominance.The psychiatric patient is claiming to relate to the demands of adult life overtly in an adult manner whilst covertly doing so in the manner of that is based on emotional control and the psychiatrist is likewise relating to the patient as a caring doctor when in fact practising a form of power and control. Both according to Szasz are equally dishonest, although they are being dishonest not just with each other but with themselves. The hysteria patient really believes that they are sick and the psychiatrist really believes he is a doctor.
Szasz didn't mention Sartre in this work although Szasz was fond of quoting Sartre regarding hysteria as being a lie without a liar. Sarte claiming that the level of awareness that the symptomatic communications are coming from is not understood (is pre reflective in Sartrean terminology) but is with intent, intent to be distinguished from deliberation which can only come from a level of awareness characterised by reflection and understanding. In this sense a hysteric is someone who believes his own lies according to Szasz.
Having read more of Szasz's works throughout the the last thirty years I have come to view his work as not being that different from the work of a number of others including Alfred Adler, Gregory Bateson, Jay Haley and Paul Watlawick who put forward similar ideas as did Jean Paul Sartre. However Thomas Szasz was the only one to actually have the courage to say that psychiatric illnesses including schizophrenia were not illnesses but problems in living given expression in a non discursive form of communication and that psychiatry was not a proper branch of medicine and shouldn't be practised with the use of involuntary treatment and the powers of the state.
Modern psychiatry is now dominated by neuroscience and the paradigm is that of biochemical determinism. The centrality of freedom and the escape from it into what Szasz terms problems in living is no longer a viable view point as psychiatry argues that they have proven the efficacy of neurological determinism with the marriage of neuroscience and psychiatry. Mind has become equated with brain and the wisdom of past philosophers of mind like George Herbert Mead and Gilbert Ryle is quietly forgot.But the truth of the human condition doesn't sit easy with modern psychiatry and its brave new reductionist concepts (many of which are quite old but repackaged) and the ideas of the late Thomas Szasz are just as revolutionary today as they were in 1960.


Illness and Counterfeit Illness
The Social Context of Medical Practice
an example of the myth
Hysteria and Psychosomatic Medicine
Contemporary Views of Hysteria and Mental Illness
The Ethics of Helplessness and Helpfulness
Theology Witchcraft and Hysteria
Hysteria as a Game
Impersonation and Illness
The Ethics of Psychiatry

8 Hysteria as Communication

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About the author (1974)

Thomas S. Szasz, M.D., is professor emeritus of psychiatry at the State University of New York in Syracuse, where he has taught since 1956.

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