I had heard of Thomas Szasz before in passing, but did not really know much about him at all. Just reading the Wikipedia entry about his views gives me many new things to think about in regards to society’s views on mental illness as a “disease.”
Szasz does not believe in mental “disease,” and he says it is a myth and a metaphor which has (and I presume still does) caused a lot of damage in the past. As I understand it, he says the disease concept developed at least partly because of a desire to control the behavior of others that some found to be undesirable or uncomfortable.
Two historical examples that helped me understand what he means are “hysteria” as a mental problem for women who were not behaving in the way men wanted them to and homosexuality, again as a mental disease for not behaving in the way some in society wanted people to behave.
I’m not sure how I feel about mental “illness’ and “disease” but I do wonder how our continuing efforts to learn about the brain will affect Szasz’ theories.
Szasz has written many books and articles so you can access plenty of information if you want dig deeper into his views but let’s discuss the purpose of this particular article. In this piece Szasz is proposing an idea intended to address the conflict that results from involuntary hospitalization and treatment due to a diagnosis of mental disease.
He wants to respect both the “psychiatric protectionists,” individuals who believe mental illness exists and fear consequences and problems as a result of psychosis and the “psychiatric voluntarists,” who don’t necessarily agree with current psychiatric premises and practices and do not want to see forced hospitalization and compulsory treatment.
Here’s how Szasz describes the two opposing viewpoints:
“Many people (and virtually all psychiatrists and other mental health experts) fear the danger of a "nervous breakdown or psychotic illness." These persons believe that mental illness exists, that it is like any other illness, " that it is amenable to modern psychiatric treatment, and that the effectiveness and legitimacy of such treatment are independent of the patient's consent to it. Accordingly, such persons seek protection from life-threatening mental illness and support the use of involuntary psychiatric interventions."
“On the other hand, some people (including a few psychiatrists and other mental health experts) fear the literal danger of psychiatry more than the metaphoric danger of psychosis. Some of these persons also believe that mental illness does not exist and that psychiatric coercions are tortures rather than treatments. Accordingly, such persons seek protection from the powers of psychiatry and advocate the abolition of involuntary psychiatric interventions.”
Szasz’ solution to this conflict is the creation of a Psychiatric Will, similar to traditional wills and living wills. So to protect the desires of the individual who wishes to prepare for a possible future inability to state his or her desires concerning the possibility of psychiatric problems, the competent individual can state their wishes and desires in writing, which would avoid conflict and indecision of those left to deal with the situation.
Szasz believes individuals have the right to determine their possible future treatment of “mental disease,” just as they do for physical disease and should not be coerced into any treatment.
Of course we can see that individuals wouldn’t necessarily even consider such a possibility. I certainly didn’t before reading this article. So Szasz takes this one step further by saying that society should accept that any individual who does not specifically say he or she WANTS psychiatric coercion in the case of mental problems, would automatically be assumed to prefer liberty over psychiatric coercion.
I really like how Szasz worked to develop an idea that respects everyone, no matter where they stand on the issue of mental illness:
“The use of psychiatric wills might thus put an end to the dispute about involuntary psychiatric interventions. Earnestly applied, such a policy should satisfy the demands of both psychiatric protectionists and psychiatric voluntarists. Surely, the psychiatric protectionist could not, in good faith, object to being frustrated in their therapeutic efforts by persons competent to make binding decisions about their future —specifically, decisions to prohibit personally authorized psychiatric assistance. Nor could the psychiatric abolitionists object, in good faith, to being frustrated in their libertarian efforts by persons competent to make binding decisions about their future—specifically, to authorize, under certain circumstances, their own temporary (or not-so-temporary) psychiatric enslavement.”
As usual, the article itself goes into much more depth that I do here, so if you are interested, read the entire piece.
I think it just might blow your mind, but in a good way.