This mini-essay will discuss the section “MENTAL ILLNESS AS
A SIGN OF BRAIN DISEASE” only.
The paper can be found at http://psychclassics.yorku.ca/Szasz/myth.htm
(also at bottom of page)
(also at bottom of page)
I will argue that Szasz’s argument ignores that other
models exist that do not assume mental illness is necessarily brain disease,
that his arguments about differences between physical illness and mental
illness are not accurate and he does not
make the case that mental symptoms are epistemological errors.
Szasz begins the section by acknowledging that brain
diseases can cause “disorders of thinking and behaviour” and correctly states
that some believe that mental illnesses are all due to brain diseases. (This
somatic school of thought was epitomised by Griesinger for whom all mental
illnesses are brain diseases.) He then states “many” doctors (psychiatrists and
physicians – perhaps meaning general and family medicine doctors) and
scientists agree with this assertion. This is imprecise – does he mean almost
all doctors and scientists or a bare majority or substantial minority? And
which geographical grouping of doctors/ scientists – his colleagues, the US,
the World? If Szasz is trying to prove mental illness is a myth he needs to
establish this is the case for all conceptions of mental illness and if this
somatic school is not a belief held by a majority of doctors/ scientists he
cannot even argue he has proven mental illness is a myth spread by most doctors
and scientists. Szasz also omits to mention the influential Jaspers whose “General
Psychopathology” textbook was opposed to viewing all mental illness as brain
disease. Depending on how influential Jaspers and those with similar viewpoints
were depending on location and time, some doctors/ scientists may not hold the
view that all mental illness is
caused by brain disease. Since this model is ignored by Szasz he can only at
best assert that he has demonstrated that mental illness is always brain
disease is a myth as he has ignored other models.
Szasz states that the somatic school “implies” that “all
problems in living” as an alternative to term for mental illness must be caused
by changes in physical processes (amenable to scientific discovery) and not due
to intrapsychic or social conflicts. He does not make the case that a broad conception
of “problems in living” is believed by the somatic school is due to brain
illness. What is encompassed by this broad term? Is it restricted to mental
illness and what examples of mental illness is it restricted to? If it applies
to mental illness – however so defined – then Szasz could make this argument
for the somatic school - whilst ignoring mental illness models such as those of
Jaspers and the biopsychosocial model. Biomedical models do accept the
causative role of social factors via biological intermediaries. Szasz also does
not state how and why the somatic school separates problems caused by
intrapsychic/ social factors from mental illness. Finally, “problems in living” seems a deeply
inadequate descriptor for severe forms of mental illness for example someone
starving themselves close to death for fear of fatness.
Szasz states that mental illness is viewed as identical to
bodily disease but we know illness (of any type) does not correspond exactly to
disease. Many medical illnesses – such as functional medical conditions - do not have proven disease processes and some
clear biological abnormalities are not regarded as illnesses such as benign
glycosuria. Szasz then uses the term “mental and bodily diseases” so it is unclear
if he is referring to all mental illness or just mental illness with or without
proven brain disease.
Szasz next compares CNS symptoms to a rash or fracture but
this is a category error- a rash would be more clearly categorised as a sign
observed on examination and a fracture categorised as an investigation finding
or diagnosis. Szasz claims CNS symptoms could not be “emotion or
complex…behaviour” yet counter-examples exist – epilepsy or Alzheimer’s can
cause these symptoms. Szasz claims beliefs cannot be a product of disease despite
counter-examples including some he mentioned earlier associated with unusual
beliefs such as GPI syphilis and delirium – even if we do not understand the
mechanism of how these unusual beliefs are formed they seem likely as a product
of these diseases. Even if we exclude examples or proven brain disease as not
mental illness the precedent has been set and given our imperfect knowledge
especially of mind/brain and the possibility of discovery in the future of
disease processes the most that can be said is in “for mental illness in the
absence of proven brain disease there are no established disease processes
causing beliefs”.
Szasz asserts mental symptoms are an epistemological error
by claiming mental symptoms are different from physical symptoms specifically
pain but this is a category error – pain is at least in part a psychological
experience involving the mind so is at least partly also a mental symptom and
arguably since all symptoms are communications by patients, minds/brains are
always involved. That we lack the ability to measure adequately physical
counterparts of mental activity now does not mean we will not be able to in
future – in the past we could not measure many bodily activities that are
possible now.
Szasz asserts mental health symptoms are classified using
psychosocial comparisons/ judgements but physical symptoms and signs are also
compared to the doctor’s judgements e.g. of what heart sounds should sound
like. Psychosocial factors including culture also affect what are thought of
physical symptom expression e.g. pain. Given the importance of psychosocial
factors affecting expression of mental outputs of speech and behaviour it is a
strength, not a weakness, that these are
taken account of e.g. before a belief is classified as delusional it must be
outside the patient’s cultural norms.
Szasz only addresses one model of mental illness – the
somatic school – and by failing to address other models cannot prove mental
illness is a myth. His arguments against the somatic school are weakened by
counter-examples and category errors and false distinctions between physical and
mental illness.
http://psychclassics.yorku.ca/Szasz/myth.htm
