I was hooked in by the book’s title, Ideology and Insanity, by psychiatrist Thomas Szasz; ideology can verge on insanity. But Szasz’s focus is instead on the “ideology” of the mental health industry. He says there is no such thing as mental illness. Szasz acknowledges the behaviors we label mental illness, but deems it a mislabeling – actually a metaphor, we apply to behaviors outside ethical and social norms. That’s very different from a true illness like, say, chicken pox, with a clear physiological etiology. (But Szasz’s brush is too broad. Some mental illness is physiological: depression, for example, is often a brain chemistry problem.)
Szasz’s argument has a political dimension. The basic political divide is between individualism and collectivism – and perhaps wisdom would steer a middling course, because we all crave autonomy but also social connectedness. However, Szasz importantly notes that the dichotomy isn’t symmetrical, because while in an individualistic society, people would be perfectly free to also satisfy their communitarian social instincts, a collectivist society would not correspondingly allow free pursuit of their individualistic proclivities. Indeed, that can be punishable, an element of coercion that makes all the difference.
The point isn’t merely theoretical. Szasz cites Joseph Brodsky, a poet in the Soviet Union who was sent to a labor camp for, literally, the crime of being a poet. The state judged that poetry was not socially useful and did not fulfill Brodsky’s obligations to the collective. So in the “worker’s paradise” you had to be a worker, with no choice about it.
Szasz’s main argument is that the whole enterprise of modern American mind doctoring aims at making us a more collectivist society. That’s the import of his saying “mental illness” labeling is a guise for enforcing social conformism. Szasz maintains that for most people in mental institutions, being “treated” for “their own good” is basically a fiction for what is really imprisonment. Moreover, since Szasz wrote in 1970, there’s been a huge shift from putting mentally ill people in asylums to literally jailing them. (See this recent article in The Economist.)
While reading all this, I kept thinking, Okay, but schizos really do have something gone wrong, and whether it has a physical cause like chicken pox or not is kind of beside the point. But on the other hand, the problem of stigmatization and the nexus of mental diagnosis with politics is a very real concern. I’ve written before about the plague of “analyses” by those who actually do think the views of people they disagree with – whether on matters of religion, science, or even economic policy – reflect mental disorders. Szasz describes one egregious example: in 1964 a magazine devoted an entire issue to printing psychiatrists’ diagnoses of presidential candidate Goldwater, mostly calling him a paranoid schizophrenic. None had ever even met the man. (Incredibly, the magazine’s name was Fact! Goldwater was one of the sanest politicians I’ve seen.)
While the mental health industry strives mightily to cloak itself as science, especially with its sciency-seeming DSM encyclopedia of diagnosable “mental disorders,” the trouble is that none can be tested for objectively. It’s all just subjective evaluation of a person’s behavior. And if a doctor disapproves of how a person chooses to live and act — or his politics! — it’s all too easy to label him with some “disorder.”
That slipperiness is illustrated by own diagnosis. To get insurance coverage when a girlfriend and I went for counseling, the therapist said, “I’ll just put down ‘anxiety.’”
And don’t forget that, until quite recently, homosexuality was in the DSM, formally labeled a mental disorder, with gays stigmatized as diseased and defective (rather than just different) vis-à-vis the norms which, via that diagnosis, the mind doctors were indeed seeking to impose societally. And of course homosexuality was furthermore duly criminalized. (Szasz actually doesn’t even mention this because, when he was writing, few people thought twice about it.)
The term “mental illness” itself has no clear boundaries. Indeed, a lot of the “disorders” in the DSM, truth be told, fall within the spectrum of what common sense tells us is normal behavioral variation. I’ve written, for example, about “Attention Deficit Hyperactivity Disorder.” With respect to that personality feature, normality encompasses a range. Maybe extreme outliers merit the word “disorder.” But most people diagnosed with ADHD (a substantial percentage of the population!) are actually within what should be considered a normal range.
Society used to be more rigid about how people had to be. Today we’ve grown more open, tolerant, and accepting of diversity, more willing to allow people the freedom to be the way they are, or want to be. That’s all good. And yet, contradictorily, ever more people are diagnosed (and stigmatized) with “disorders” that really amount to non-conformance with the dictates of the normality police. Thus, while the goal of improving mental health in the abstract is hard to argue with, too much of the mental health industry is geared toward the suppression of individuality. That’s so Twentieth Century. (Or, really, Nineteenth.)
There are of course some true whackos. But, as Szasz argues, most “mentally ill” people don’t actually have minds on the fritz at all but, rather, face what might better be called problems of living. How to live is the salient question in philosophy, and for many people, enmeshed in their webs of trying circumstances, its solution is far from clear. True, counseling may be helpful to them. But their problems are not all in their minds.