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From International Socialism, No.72, October 1974, p.30.
Transcribed & marked up by Einde O’Callaghan for ETOL.
Ideology and Insanity: Essays in the Psychiatric Dehumanisation of Man
Thomas S. Szasz
Calder and Boyar: Open Forum, £3.15
WHAT SHOULD ONE DO if a friend or relative loses all his energy, spends most of his time sitting staring into space, cries a large part of the day, is frightened to go out of doors, feels that he is responsible for certain crimes and that everyone is consequently out to get him, and claims he would be better off dead? Is he ill? According to Thomas Szasz it is important to see his problem as a moral not a medical problem: he is not ill. He should therefore not seek treatment in the ordinary sense of tablets or hospitals, but should go for voluntary private consultations with a therapist like Szasz himself (to whom incidentally he pays a not inconsiderable fee).
This is the modest fare which remains when disentangled from the yards of argumentation Szasz uses to prove that mental illness is not ‘illness’. But because he talks so much of individual freedom with a quasi-Marxist analysis of ideology many socialists think he has given them the right answer. In fact he has been considered among the ranks of the left anti-psychiatrists Laing, Cooper and Goffman, although his radicalism never goes beyond a criticism of existing psychiatric institutions to a criticism of the society in which they operate.
His main contention is that different sorts of language must be used about mental illness and physical illness: the symptoms of mental illness concern hopes, wishes and fears, whereas a sprained ankle can be discussed as if the body were a machine. To use the language of the machine about human fears by labelling them a ‘sickness’ is to be guilty of a philosophical error: it is also a confidence trick by which the labellers are able to control the ‘sick’ people. By creating an ideology of an ‘objective mental health’ the state is able to tuck people away in mental hospitals for a much longer period than it would be able to keep them in prison. Szasz sees psychiatrists as policemen controlling individuals: talk of mental health serves to blind ordinary people to the existence of a genuine conflict of interests, and this seems like the argument of Marxists who see the ‘national interest’ obscuring class conflict.
There is some truth in all this. There are cases where hostile relatives or the Establishment have been able to get their way by getting someone labelled ‘psychopathic’ or ‘senile psychosis’. But the reason that these are abuses is just that there is a viable concept of mental illness as ‘illness’ in other cases, and not, as Szasz claims, that the labelling of deviant behaviour as ‘illness’ is a logical error in all cases.
Szasz is himself a victim of the approach he attacks. For he does not see that the concept of physical illness is also defined by society. It is not just about bacilli. What we call ‘illness’ varies both with the standards we expect (e.g. in terms of energy output) and with the treatment available. For example certain gastric disorders are considered a normal part of life in certain societies as they were formerly in Europe. Physical illness is largely detected by people telling others how they feel – the distress of the ‘patient’ (or sufferer) is a crucial part of the meaning of illness.
Szasz hardly pays any attention to this. The sorts of cases he mentions are almost always those which would be given the official diagnosis ‘psychopath’ or ‘personality disorder’, where the distress of the ‘patient’ is usually small; but these make up only a fraction of the cases of ‘mental illness’, which is the generality about which he writes all the time instead of distinguishing the different types, depression, schizophrenia, obsessions, phobias and so on. This issue of distress is very important because physical treatments such as ECT and drugs can often prove a welcome relief to anguish even if not a long-term cure. Many radicals with the best intentions advise friends to refuse these treatments because they feel that to accept them is to sell out – believing that by admitting that physical treatments can assuage the anguish of the soul they are somehow betraying, or de-humanising, the person.
But this is to be as confused as those ‘positivists’ whom they believe are de-humanising people by talking about them as if they were machines; humanism means recognising the unity of the physical and mental sides of a person, and talking about whole ranges of different types of ‘illness’ which may be neither particularly physical nor mental, for example exhaustion, obesity and dysmenorrhea. Marxists need to approach the topic of illness as a whole in society, rather than dividing it along the traditional line between body and soul. This approach would reveal how the ideology of both mental and physical health stems less from psychiatrists and bureaucrats and more from the economic demands of the system of production as a whole. If Szasz had done this he would have found a more substantial target for his criticism than socialised medicine in the mental health services.
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