Controversial Psychiatrist Argues a Case Against His Own Profession : Doctor Analyzes ‘Myth’ of Mental Illness

When she was 2 years old, her father was involuntarily committed to a mental institution. “I got to know him better than anybody because I saw him every week,” said the Newport Beach woman in recalling the childhood visits of 40 years ago.

Once at 3 in the morning when she was 16, she remembers her mother dragging her to the mental hospital that housed her father. Her mother demanded that she be committed because she had broken curfew.

“I was terrified,” she recalled. “Fortunately, the doctor on duty refused to do what my mother wanted. He said I didn’t need to be institutionalized. He said the problem was a conflict between my mother and me, not that I was mentally ill.”

In 1979 her father was released from the mental institution. “He was just ‘dumped’ after 30 years in the hospital. Within four years he was dead.”

‘Bloody Hands’

Upon hearing this account at a recent UC Irvine Extension workshop, Dr. Thomas Szasz, 65, a psychiatrist and the featured speaker, replied: “Mine is a profession filled with bloody hands. Who else except a psychiatrist has the power to serve as both judge and jury as to whether you will be incarcerated or go free?”

Szasz, a professor of psychiatry at the State University of New York’s Upstate Medical Center at Syracuse who has developed a nationwide reputation for his criticism of his profession, spoke to an audience of about 25, mostly psychologists but also a sprinkling of individuals seeking to increase their understanding of how psychiatry works.

They paid $75 to hear him discuss such subjects as what he called the “myth of mental illness,” involuntary mental hospital admissions and the need for people to be held totally responsible for their acts regardless of whether they are considered “sane” or “insane.”

At the outset, Szasz told the audience he did not agree with the accepted definition of who is a psychiatrist. He argued that a psychiatrist is any mental health professional, including licensed psychiatrists, psychologists, social workers, or marriage, family and child counselors.

Major Objections

Szasz frequently elaborated on ideas originally presented in the 18 books he has written, of which the most famous is probably “The Myth of Mental Illness.” Published in 1960, it spells out his major objections to modern psychiatry.

Szasz’s other books include “Schizophrenia: The Sacred Symbol of Psychiatry,” “The Therapeutic State: Psychiatry in the Mirror of Current Events,” “Sex by Prescription” and “The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric and Repression.”

Szasz freely accepted questions from the audience during his wide-ranging lecture and, as the daylong session progressed, expounded in greater detail on his central theme that mental illness is a myth.

“Mental illness does not exist,” Szasz said. “These things called mental illnesses are not diseases at all, but part of the vicissitudes of life.

“Look through a pathology textbook, and you will find diseases of the eye, brain and organs. Mental illness is not listed among them. It is not listed because it is not an illness of the organs, tissue, cells or metabolism.

‘The Fiction, the Lie’

“Illness must have a biological cause, but mental illness does not. So by definition , mental illness is not an illness. Yet, psychiatrists continue with the fiction--the lie --that mental illness is like any other illness.”

Dr. Martin Brenner, president of the 250-member Orange County Psychiatric Society--which represents two-thirds of the county’s psychiatrists--in a telephone interview took strong exception to Szasz’s contention that mental illness is a myth.

“Mental illness is a disease,” countered Brenner, medical director of the Care Psych Center at Western Medical Center in Anaheim, a 103-bed psychiatric unit. Brenner also is an assistant clinical professor at UC Irvine Medical School.

“There is ample scientific evidence that mental illness is a disease. Mental illness is recognized as such not only by the American Psychiatric Assn. but also by the public. Yet, the mentally ill continue to be stigmatized--thereby preventing them from seeking treatment--precisely because people like Dr. Szasz make statements that the mentally ill are suffering from some mythical ailment.

Opposing Opinion

“Dr. Szasz believes that if he can convince people that mental illness is not real, and that there is no effective treatment for it, then it will be pointless for people to be treated by psychiatrists,” Brenner said.

“Instead, Dr. Szasz believes that people will get over whatever is bothering them--he refuses to call it mental illness--if only they worked harder at organizing their lives, if they were ‘better people,’ or had greater will power,” Brenner said. He added that he knows of no psychiatrist in Orange County who shares Szasz’s views.

“But these recommendations by Dr. Szasz for the treatment of mental illness are doomed to failure because medical evidence clearly shows that this regimen of greater mental discipline proposed by Dr. Szasz is a fruitless approach in attacking mental illness, whether it’s a relatively minor problem like mental depression to a more severe problem like schizophrenia. Medical evidence clearly shows that people have no control over combating these illnesses because of genetically determined factors over which they have no power.”

Life Compared to Game

Szasz remains unconvinced by arguments from members of the psychiatric establishment. “The reason there is no mental illness is because life is like a game, which some master less well than others,” Szasz told his audience. “It’s like chess. A few people excel at it; others play it passably; some of them give up the struggle of trying to master the game at all.

“By the same token, some people fail to learn how to live competently because they cannot, or will not, learn to do so. But why do we have this expectation that all people can do so?

“We have this expectation because every educated person knows that people who do not live competently, or normally , are sick. These people are said to be suffering from the most severe form of mental illness known to psychiatric science: ‘schizophrenia.’

“This idea of mental illness is supposed to be helpful--for science, for society and, above all, for the ‘patients’ suffering from this alleged malady. But it is not. In fact, it is deadly. Why? Because ideas have consequences, and this particular idea has deadly consequences.”

Negative Effects

Among the negative effects that Szasz said flow from someone’s being diagnosed with a mental illness such as schizophrenia were incarceration in mental hospitals and repeated medication with debilitating drugs.

Finally, there is de-institutionalization--when previously hospitalized patients, Szasz said, are released and left to fend for themselves in an inhospitable environment. Many are bag ladies and other homeless persons who find shelter in doorways or boxes on the street, Szasz said.

These former mental patients are unprepared to cope with their surroundings because, Szasz argued, they often have spent years, and sometimes decades, in involuntary confinement. During this time, in the name of “therapy,” they have become even more de-socialized than they were prior to commitment, Szasz contended.

Szasz’s second major criticism of established psychiatry is that people should be held totally responsible for their acts, regardless of whether they are considered “sane” or “insane.”

Hold People Responsible

“Particularly for violent crimes,” Szasz said. “I believe that people who have broken the law should be incarcerated to preserve the social system--the rules of the game. I do not advocate this out of a desire for retribution or punishment.

“As I have noted, life is like a game--a chess game if you will--and if people cheat they will destroy the game. So, the purpose of incarcerating people who steal TV sets or try to shoot the president, like John Hinckley, is not to punish them, but to maintain the integrity of the game of life.”

Responding to the claim made by some critics that these views make him a “heartless” libertarian, Szasz said: “I do not want to punish the ‘mentally ill,’ or more precisely people who are unable to live competent lives. I want to punish criminals.

“My solution, though I can’t completely reconcile it intellectually with my libertarian values, is to provide free room and board to law-abiding people who don’t fit into the social fabric of everyday life.

Alternative to Institutions

“It would be run something like the Salvation Army (shelters), and the only requirement you would have to meet would be to obey the law. There would be no psychiatrists, social workers or the like.

“You wouldn’t be locked up against your will, and you would be free to come and go as you pleased. It’d probably cost about $15 to $20 a day. But that beats the $300 to $400 a day it costs to keep someone in a New York state mental hospital.”

Brenner said he agrees to some degree with Szasz’s contention that people should be held totally responsible for their acts regardless of whether they are mentally ill.

“There’s something positive to be said about self-responsibility,” Brenner said. “If individuals are not responsible, you cannot maintain social order, and you cannot expect the individual to get anything done.

“But telling a mentally ill person that you expect him to behave responsibly is not going to cause him to automatically act responsibly, especially if he’s violent.

‘Only a Hope’

“When I’m treating a schizophrenic patient in a hospital I tell him that I expect him to behave like a normal person by doing such things as dressing himself and refraining from hitting or cursing.

“But even as I utter these words, I know that this is only a hope or expectation. I recognize that this person is psychotic, out of touch with reality, and that it is beyond his power to follow my instructions and behave in a completely responsible manner.”

Szasz acknowledged that despite his criticism of psychiatry, he sees private patients, like other psychiatrists. “I have no objection to psychiatry between consenting adults,” he said.

“I do this because I believe that psychotherapy can help people make choices about how they are going to live their lives,” Szasz said.

“But I’m talking about psychotherapy in the old-fashioned, common-sense term; people talking seriously about their life’s problems.”