Thomas Szasz: Does mental illness exist?

Thomas Szasz: Does mental illness exist?

Question 1 My name’s Terry Simpson and at the moment
I’m Chair of an organisation called The UK Advocacy Network, which is a network of
survivor groups in England and personally I’m a survivor of coercive psychiatric treatment
which changed my life quite a lot, so I find your ideas very moving and I’m very pleased
that you speak out so articulately against coercive treatment. But when I’ve tried
to explain to people that I don’t believe there is such a thing as mental illness, people
quite often get very angry with me and say ‘you’re denying that people suffer’,
which quite clearly people do. Now, I just wondered if you think there is anything that
can be done about the suffering – spiritual suffering, emotional suffering – whatever
way we use to describe that. It almost seems as if you’re saying ‘well, that’s life
really and we can’t do anything’, but I wondered, do you think there is anything,
any activity that can be reasonably undertaken to help people? Thank you very much. Well, if I didn’t think
there was anything to be done, I would have changed my life course very early. Many, many
things can be done. The field is wide open but it requires a repudiation of the medical
approach. I’m speaking very candidly. We can’t have it every which way. It requires
– and this really connects to, and I appreciate again, thank you again for your invitation
– but what kind of – because my conception is that you sort of want to know something
about mental health policy. I mean what should we do? Not just throw up our hands. Now what
we should do cannot be answered in a generic form because we are dealing with individual
human beings. We are not dealing with types. We are not dealing with what to do if you
have a melanoma or if you have malaria, where we know. There are a certain number of things
that will help and there’s lots of other things which will not help. Now here what will help depends entirely on
that individual, on their – his or her – social network, the person’s intellectual and other
assets and viabilities, money, social standing, who they are, what kind of people they are
surrounded by, their own spirit, what they want to do about it, the society in which
they live. And, some kind of – I don’t know what to call this person because he’s
not an expert, because he’s not an expert in any particular skill – some kind of helper
– minister, priest, doctor, teacher. You know, doctor used to mean teacher – some
third party who really wants to help this person and wants to adhere to the old medical
hypocritic saying, ‘first do no harm’. If you use any kind of coercion, you are out
of the picture. Force, you cannot help people with force. This is a totally quakerish, pacifistic
premise and this is of course totally alien to psychiatry, because psychiatry, if you
abolished all psychiatric force there would be no psychiatry because you see people resent
what you say. Well you can imagine how much they resent what I say. Because there are
two answers, two things you come up with. The person says ‘you don’t think people
suffer’, which of course they do. They just don’t want to call that the same kind of
suffering as suffering from backache or toothache. It’s a different kind of suffering. And
secondly then they say ‘ah ha, you want 15 year old children to take heroin and you
want people to commit suicide’. I don’t want any of those things, I just don’t want
doctors to lock up people and drug them forcibly because they say they are going to prevent
this – suicide – which of course is over-predictive; they are talking about the future. I mean
they don’t know if somebody’s going to commit suicide until the person is dead, because
the person could change his mind at the last minute. Question 2 Hi, my name is Hugh Ricards. I’m a Quaker
and a psychiatrist and someone who suffers from mental illness too. Just to kind of put
you in the picture, I developed some mental illness or mental disorder or whatever you
want to call it. I was given a diagnosis and as a result of that I was able to make contact
with other people who had symptoms that were very similar to me, so I felt that I belonged
in a group of people who were sharing my experience quite specifically, which I found incredibly
supportive. I then underwent treatment which involved doctors and a psychologist and .. And what did it consist of? Well, that’s not particularly relevant I
don’t think, but what happened is what as a result of that intervention, where we also
had a diagnosis and treatment that was appropriate and based on evidence, I got considerably
better. And so I take a slightly different view from you in that I think mental distress
can sometimes be categorised. I don’t think that stops you from treating the person who’s
an individual in any way, but actually that I found that was, from a personal point of
view, incredibly liberating and very useful and improved – turned me from someone who
found it difficult to function, into someone who found it a lot easier to function. Do
you think I was completely wrong? No. No. You have not mentioned something and
I assume that that was important, especially after the first remark of this gentleman’s
questions. You implied that all this was done with your consent. You implied that in your
entire narrative. Now if so then I am entirely applauding your approach to it. So you think that it’s only the coercive
mental – I’m saying I had a diagnosis of mental illness which I was very happy with,
so I feel that you’ve changed your position because on the one hand you’re saying that
– one of your positions if you like is that mental illness is a completely useless concept
and then your other position is that it’s just coercive treatment and I think they’re
two very different… Not if you read my books. Those are not two
different concepts because characteristically, historically, psychiatric diagnoses were made
against people’s will. People didn’t say, go to a doctor and say like they now go and
say, you know, ‘I think I have gall bladder disease’ or ‘I read up about this’.
They don’t say ‘I have paranoid schizophrenia, do something for me’. And you still haven’t
said anything about whether any of what was done to you was done to you against your will
at the time at which it was done, because you see to my mind, these are not two different
things, these are two different approaches to the same phenomenon. One is whether or
not mental illness is an illness, is a categorical logical medical analysis, and the other one
is a political analysis, the use of force. The use of force is nothing to do with my
argument because in medicine the use of force is forbidden. No? Can you treat someone with
diabetes against his will? Absolutely you can. If you call in a psychiatrist. You can do it under common law or under the
Mental Health Act. But the patient goes home and doesn’t take
his insulin, I don’t follow you. Sorry, say again. Well, you are the doctor. I mean let’s be
practical about this. I’m the patient and I come to you and you say ‘yes, you have
diabetes. Take so much insulin every day’ and I go home and I say ‘thank you, doctor’
and I go home and don’t take insulin and die, or take an overdose and kill myself.
What is your role in this situation? You’re an endocrinologist or internist. All I’m saying is that there are certain
situations when you can treat what’s called so-called medical illnesses coercively, so
it’s not just the field of psychiatry. For instance, if a person has a delirium, you
may feel it’s your duty of care to provide care for someone in order to preserve their
life and it might be absolutely the right thing for you to do, and indeed the mental
health allows you to do that. Question 3 I’m Christine McPherson. I’m an approved
social worker which means that if I work with psychiatrists, people are at risk maybe or
harm themselves and they also have mental illness, then we actually can assess for compulsory
admission to hospital. So that’s part of my role. I was wondering, what you were saying,
if people are maybe really distressed and maybe we feel they have harmed themselves
and maybe could kill themselves, I mean that sort of situation, use the Mental Health Act
to actually protect the person. I’m sorry? We use the Mental Health Act to actually protect
the person from the risk to themselves or the risk to other people. Yes. I mean that is compulsion. Yes. So what you’re saying is if we don’t use
that compulsion then we will let them kill themselves. I mean is that going to be the
logical conclusion of not using compulsion? I just wondered what your response to that
would be? Well I take it – forgive me for beginning
my answer this way – I take it that you have not read much of my writings. Well, a long time ago. I apologise, I haven’t
read it recently! Because this is what I’ve seen with the
previous question. This is a primarily political and, if you like, humanistic, historical position
which I have which is not unique to me, and that is that compulsion is a bad thing. Now,
let me use a religious analogy. What is the separation of church and state about, in America?
Traditionally, priests used to be able to coerce people because they had the wrong ideas,
and after all, you don’t want to let somebody die without being able to go to heaven and
be damned. So they had their own rationalisations and this is the history of coercive religion,
OK, both in Islam and Christianity, less so in Judaism too in some ways, in early enough
days. Now there came a time at the beginning of modernity when people, especially in America,
decided that religion is a very important thing but they should have no power at all
to bother people against their will. Now we all accept that. If you are a Catholic, you
can go to confession and tell the priest ‘I’m going home and kill my wife. I’m going home
and kill myself’ and that’s called the confessional. It cannot be violated. It is
not violated as far as I know. Thousand, two thousand year history of this virtually. Now,
why isn’t it the priest’s duty to stop people from suicide? Why isn’t it the teacher’s
duty? What’s the connection between suicide and medicine? Now there is a historical answer
to that, that medicine has become an arm of the state. They’re licensed, and this is
what is the ‘it’ that we are talking about. The ‘it’ is called ‘social control’,
which is what you are describing. You are not willing to commit yourself to whether
or not there was coercion used. Now I have written, you know, the Mental Health
Act is the latest of a long series of health legislations. This is how the whole history
of psychiatry begins. Before there was modern psychiatry, mad doctors locked up people.
There were locked mental institutions before the term ‘psychiatry’ is only mid-19th
century. 1847 that the word ‘psychiatry’ was coined. Go to the [0:14:08]. It was coined
by a Viennese doctor named [0:14:12] in 1847 but the mad houses go back much earlier and
what were they? Prisons. Exactly what this gentleman complains about. Bedlam. Obviously
modern society needs it, so this idea is entirely against the stream, except for some people.
There are some new mental patient liberation movements, some sociologist – I mean Irvin
Golfman comes to mind – this is not really within psychiatry. [0:14:50] about this. He
was not really against locking people up. He pretended that he was but he didn’t come
out [0:14:55] about this. So I think I’ve answered your question. Yes, it’s not a
question of letting people suicide, I’ve already answered that. It is not your business
to assume this power. Should you let people to kill each other in Iraq? I mean this becomes
an endless rationalisation for meddling in other people’s lives. Well, what’s imperialism
based on? You know, we want to bring English law to the Indians. Some of this sounds really
quite good and the consequences may be quite good. I mean British influence in India – you
know, I’m not an Indian so who am I to say this? – it seems to me on the whole it was
very beneficial in that area. But that doesn’t justify coercion. That doesn’t justify their
going there with arms. And some of it was quite interesting because as you know, the
opium war was for free trade in opium, not to prevent opium use. I mean history is so
ironic about this. It was the Chinese who didn’t let the British from India export
opium to China. That’s how they got Hong Kong. You have to know history to appreciate the
absurdity of what is called the ‘medical model’, because it’s simply absurd. But
of course, as long as enough people believe in it, this power, it works. Imperialism works
very well until it didn’t. Question 4 Hello, my name is Bernadette Lynch and I’m
a Mental Health Awareness Trainer and a former sufferer of depression. I wanted to ask, if
we think about the ‘it’ as being human suffering, do you think that human suffering
can however have an impact on our biochemistry and physiology and our bodily function, so
that there is actually more of a connection between the two than perhaps we’ve talked
about so far. Without a doubt. It seems to me common sensical
that how our life goes, how we feel, influences our physiology. And is it the doctor’s job to attempt to
correct that if there’s become a problem with the biochemistry or the physiology? Is
it the doctor’s role to do something about that? Your questions are wonderful because what
a doctor’s job is, is defined by essentially two power sources: the doctor and the state
in which he works and the profession in which he works which limits it. Now what is a doctor’s
job? What is an ophthalmologist’s job? Is it his job to address your marital problem
or just to give you a refraction, just to give you glasses? Is it a neuro-radiologist’s
job to worry about your bunions or your ingrowing toenails, or your diabetes for that matter?
He’s only taking pictures and possibly only administering [0:14:55] therapy. This is what
modern medicine since the 19th century – how did psychiatry, how did psychoanalysis come
into being? So Viennese doctors had a lot of patients who [0:18:35], meaning that they
went to doctors and there was nothing wrong with them. The doctor knew it and the patient
often knew it but wouldn’t admit it. So in order to say ‘Mrs Jones, I don’t want
to see your face again. I think you should see Dr X’, [0:18:52], you or somebody else.
In America – again, forgive me for being very down to earth – psychiatry and psychiatrists
have often been called the ‘sewers of society’. That expresses this idea. It deals with a
subject and with people that most doctors don’t want to deal with because they want
to deal with dermatology, with urology, gynaecology and all these specialties, cardiology and
so on, pulmonary diseases, asthma – I mean there are so many diseases and the whole thing
is, you know, the more science advances, the more complicated these things get. So we are
really living in an age of double-talk and double-think because doctors become more and
more specialised. I mean some ophthalmologists, basically all they do for four or five hours
in the morning, is cataract surgery and at 1 o’clock they go and play golf and they
get $1,000. They don’t do refractions, somebody else does that. They only do this. There are
now surgical groups – surgeons, because this is a very complicated operation – only
do complete prostatectomies for men who have cancer of the prostate and who are young enough
and who are very worried about complications, impotence, having nerves cut, impotence and
loss of bladder control. Now this can be a very, very complicated operation because this
requires very complicated anatomical dissection of this very complicated area, the pelvic
area. So this is all they do. They’re not only surgery specialists, but this is the
only operation they do. Just like neurosurgeons only do neurosurgery. So it’s a long-winded
answer is it the doctor’s job? Which doctors? It is certainly not the general practitioner’s
job because he cannot do it properly. Now this would be a job for mental health but
in my opinion that won’t work either because the ‘it’ is too varied. The clientele
is too varied. So you have to – I look upon psychiatric help, psychotherapy as a tennis
game. Now if you play tennis very well then your game will depend very much on what kind
of a player you are playing with. You will play a much better game against a stronger
player than against an amateur. Now the same thing happens in a conversation. I mean this
is after all a very sophisticated conversation we’re having already. This is not an average
conversation about mental illness. But then it depends on your input and on my answers
and who is sitting here we would have a different conversation. So you see, this is very complicated,
very simple.

19 thoughts on “Thomas Szasz: Does mental illness exist?

  1. My only question would be is why does "mental illness" appear to be hereditary, i get that you cannot see it in cytology or on an autopsy table. I look at things like Ernest Hemingway and his family why did 80% of his family all seemingly have some sort of strange disposition to killing themselves? I feel as though Thomas Szasz is the charlatan who references his books many times in this lecture. Really makes one feel like he is just trying to sell books.

  2. Good man. He is talking about physical treatments (ie medical drugs, electrical & substance shocks & operating on brains). There is no route there to assist with "mental maladies". Why? The issue is not with the brain. The issue is with the soul/psyche/spirit. He instinctively knows that but does not fully articulate it.

  3. Psychiatry is a mess and a weapon used by many supposed to be "advanced states" to silence people whose opinions or experiences "represent a threat" (if so "they" decide it) to those who are in positions of power … That is when they will use force in psychiatry, or psychiatry in itself. I wonder how many people have been committed against their will because of reporting abuse with directed energy weapons, same thing that happened to US diplomats while in their embassies of Cuba and China. WHAT A SHAME.

    More info on the following websites: (EN) (EN) (ES)

  4. As long as there are people who lie, there will be mental illness. Doctors need to face this first. Some people can see through the stupidity and the facade around psychiatry . Most shrinks need to be seeing someone themselves, before they ever think of charging for their ‘services’ .

  5. it's not possible for a rational man to discuss logic with one who is not logical or rational…..what Dr. Szasz says in his books is that there is nothing about a mentally ill diagnosed patient that can be empiracally seen in a microscope materially…like one can see a germ or virus under a microscope…Mental illness is a behavioral malady; an erroneously way of thinking that ultimately becomes so skewed as to render the person unable to cope with existence….Even this great man has difficulty trying to respond to totally irrational concepts put to him…

  6. Värsta mördare på mänskliga värden det är psykiatri. Skam att det tillåts i 21-talet, hur dom trakasserar människor, riktiga mördare utan kunskap.

  7. Mental ill-health. Exists. The way it is treated is open for debate. Denying mental illness exists is not a good start to helping people get better.

  8. One of the great minds of the past century. Hopefully society will listen and then completely change their approach.9:00 the point about other medical care not being coercive is incorrect though, which others here debate. People are often coerced to have treatments, operations, etc which often are worse than the disease. That why I believe in holistic all natural across the board.

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