THE MYTH OF MENTAL ILLNESS - University of Washington

1 Szasz, Thomas S. (1960). The myth of MENTAL ILLNESS . American Psychologist, 15, 113-118. doi: THE MYTH OF MENTAL ILLNESS . THOMAS S. SZASZ. State University of New York, Upstate Medical Center, Syracuse M. Y aim in this essay is to raise the ques- trists, physicians, and other scientists hold this tion "Is there such a thing as MENTAL view. This position implies that people cannot ILLNESS ?" and to argue that there is not. have troubles expressed in what are now called Since the notion of MENTAL ILLNESS is extremely " MENTAL illnesses" because of differences in per- widely used nowadays, inquiry into the ways in sonal needs, opinions, social aspirations, values, and which this term is employed would seem to be es- so on. All problems in living are attributed to pecially indicated. MENTAL ILLNESS , of course, is not physicochemical processes which in due time will literally a "thing" or physical object and hence be discovered by medical research.

2 It can "exist" only in the same sort of way in which " MENTAL illnesses" are thus regarded as basically other theoretical concepts exist. Yet, familiar no different than all other diseases (that is, of the theories are in the habit of posing, sooner or later body). The only difference, in this view, between at least to those who come to believe in them MENTAL and bodily diseases is that the former, af- as "objective truths" (or "facts"). During cer- fecting the brain, manifest themselves by means tain historical periods, explanatory conceptions such of MENTAL symptoms; whereas the latter, affecting as deities, witches, and microorganisms appeared other organ systems (for example, the skin, liver, not only as theories but as self-evident causes of etc.), manifest themselves by means of symptoms a vast number of events. I submit that today referable to those parts of the body.

3 This view MENTAL ILLNESS is widely regarded in a somewhat rests on and expresses what are, in my opinion, similar fashion, that is, as the cause of innumerable two fundamental errors. diverse happenings. As an antidote to the com- In the first place, what central nervous system placent use of the notion of MENTAL ILLNESS symptoms would correspond to a skin eruption or whether as a self-evident phenomenon, theory, or a fracture? It would not be some emotion or cause -let us ask this question: What is meant complex bit of behavior. Rather, it would be blind- when it is asserted that someone is mentally ill? ness or a paralysis of some part of the body. The In what follows I shall describe briefly the main crux of the matter is that a disease of the brain, uses to which the concept of MENTAL ILLNESS has been analogous to a disease of the skin or bone, is a put.

4 I shall argue that this notion has outlived neurological defect, and not a problem in living. whatever usefulness it might have had and that it For example, a deject in a person's visual field may now functions merely as a convenient myth, be satisfactorily explained by correlating it with certain definite lesions in the nervous system. On MENTAL ILLNESS AS A SIGN OF BRAIN DISEASE the other hand, a person's belie} whether this be a The notion of MENTAL ILLNESS derives it main sup- belief in Christianity, in Communism, or in the port from such phenomena as syphilis of the brain idea that his internal organs are "rotting" and or delirious conditions intoxications, for instance that his body is, in fact, already "dead" cannot in which persons are known to manifest various be explained by a defect or disease of the nervous peculiarities or disorders of thinking and behavior.

5 System. Explanations of this sort of occurrence . Correctly speaking, however, these are diseases of assuming that one is interested in the belief itself the brain, not of the mind. According to one and does not regard it simply as a "symptom" or school of thought, all so-called MENTAL ILLNESS is of expression of something else that is more interesting this type. The assumption is made that some must be sought along different lines. neurological defect, perhaps a very subtle one, will The second error in regarding complex psycho- ultimately be found for all the disorders of think- social behavior, consisting of communications about ing and behavior. Many contemporary psychia- ourselves and the world about us, as mere symptoms 113. 114 THE AMERICAN PSYCHOLOGIST. of neurological functioning is epistemological. In identify or describe some feature of an individual's other words, it is an error pertaining not to any so-called personality.

6 MENTAL ILLNESS as a de- mistakes in observation or reasoning, as such, but formity of the personality, so to speak is then rather to the way in which we organize and express regarded as the cause of the human disharmony. our knowledge. In the present case, the error lies It is implicit in this view that social intercourse in making a symmetrical dualism between MENTAL between people is regarded as something inherently and physical (or bodily) symptoms, a dualism harmonious, its disturbance being due solely to which is merely a habit of speech and to which no the presence of " MENTAL ILLNESS " in many people. known observations can be found to correspond. This is obviously fallacious reasoning, for it makes Let us see if this is so. In medical practice, when the abstraction " MENTAL ILLNESS " into a cause, even we speak of physical disturbances, we mean either though this abstraction was created in the first place signs (for example, a fever) or symptoms (for ex- to serve only as a shorthand expression for certain ample, pain).

7 We speak of MENTAL symptoms, on types of human behavior. It now becomes neces- the other hand, when we refer to a patient's com- sary to ask: "What kinds of behavior are regarded munications about himself, others, and the world as indicative of MENTAL ILLNESS , and by whom?". about him. He might state that he is Napoleon The concept of ILLNESS , whether bodily or MENTAL , or that he is being persecuted by the Communists. implies deviation from some clearly defined norm. These would be considered MENTAL symptoms only In the case of physical ILLNESS , the norm is the if the observer believed that the patient was not structural and functional integrity of the human Napoleon or that he was not being perseucted by body. Thus, although the desirability of physical the Communists. This makes it apparent that the health, as such, is an ethical value, what health is statement that "X is a MENTAL symptom" involves can be stated in anatomical and physiological terms.

8 Rendering a judgment. The judgment entails, more- What is the norm deviation from which is regarded over, a covert comparison or matching of the pa- as MENTAL ILLNESS ? This question cannot be easily tient's ideas, concepts, or beliefs with those of the answered. But whatever this norm might be, we observer and the society in which they live. The can be certain of only one thing: namely, that it notion of MENTAL symptom is therefore inextricably is a norm that must be stated in terms of psycho- tied to the social (including ethical] context in social, ethical, and legal concepts. For example, which it is made in much the same way as the notions such as "excessive repression" or "acting notion of bodily symptom is tied to an anatomical out an unconscious impulse" illustrate the use of and genetic context (Szasz, 19S7a, 1957b). psychological concepts for judging (so-called).)

9 To sum up what has been said thus far: I have MENTAL health and ILLNESS . The idea that chronic tried to show that for those who regard MENTAL hostility, vengefulness, or divorce are indicative of symptoms as signs of brain disease, the concept of MENTAL ILLNESS would be illustrations of the use of MENTAL ILLNESS is unnecessary and misleading. For ethical norms (that is, the desirability of love, what they mean is that people so labeled suffer kindness, and a stable marriage relationship). Fi- from diseases of the brain; and, if that is what they nally, the widespread psychiatric opinion that only mean, it would seem better for the sake of clarity a mentally ill person would commit homicide illus- to say that and not something else. trates the use of a legal concept as a norm of MENTAL health. The norm from which deviation is measured MENTAL ILLNESS AS A NAME FOR PROBLEMS whenever one speaks of a MENTAL ILLNESS is a psycho- IN LIVING social and ethical one.

10 Yet, the remedy is sought The term " MENTAL ILLNESS " is widely used to de- in terms of medical measures which it is hoped scribe something which is very different than a and assumed are free from wide differences of disease of the brain. Many people today take it ethical value. The definition of the disorder and for granted that living is an arduous process. Its the terms in which its remedy are sought are there- hardship for modern man, moreover, derives not fore at serious odds with one another. The practi- so much from a struggle for biological survival as cal significance of this covert conflict between the from the stresses and strains inherent in the social alleged nature of the defect and the remedy can intercourse of complex human personalities. In hardly be exaggerated. this context, the notion of MENTAL ILLNESS is used to Having identified the norms used to measure THE MYTH OF MENTAL ILLNESS 115.