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Szasz's "The Myth of Mental Illness" is one of those works which is completely and utterly misinterpreted simply because of the title. I don't have the book av
by elbasti 8y ago
Szasz's "The Myth of Mental Illness" is one of those works which is completely and utterly misinterpreted simply because of the title.
I don't have the book available at the moment, but in the introduction he says something to the effect of "I don't regret writing this book, but I regret calling it what I did, because people judge it without reading it."
The gut-reaction to such a title is to think the writer is saying "depression doesn't exist" or "schizophrenia doesn't exist" or "manic depressives are lying."
This isn't what he says in the book at all. Rather, his argument is more along the lines of:
1. The word "illness" should be used to represent a cause-- and resolving the cause should cure the illness. Cancer, the flu, hyperparathyroidism--all map to causes.
2. The conditions which we call mental illness don't have a knowable cause. They are symptoms which we pattern match against.
3. Corollary: Illnesses should be hypothetically curable. There may be a cure for cancer. But there cannot be a "cure" for most "mental illnesses" because there is no shared, physical cause that underlies say, all cases of "bipolar disorder".
3. So we shouldn't call them "illnesses". We should call them something else.
Unfortunately that's about as much as I remember of his argument, but it's very different than the common accusation... And it also strikes me as accurate.
The problem with naming things is that it makes them real. I think often the hacker news crowd forgets how ill-informed most of the world is, and the degree to which people crave certainty.
When a person is told by a psychiatrists "Your 8 year has depression so we'll put her on X pill" or "You have bipolar type 2, so I recommend Y medicine", it has a certain finality.
Most people don't think "The doctor is telling me that my behavior matches some patterns. That is it. She does not know why, and we may never know why, there may not even be a reason why. So we should think about what we can do to mitigate this."
No. The we think "I've been diagnosed with a disease. (Sorry I'm being an a-hole|I won't go to your party|didn't get out of bed), I suffer from bipolar and there's no cure".
- dragonwriter 8y ago> The gut-reaction to such a title is to think the writer is saying "depression doesn't exist" or "schizophrenia doesn't exist" or "manic depressives are lying." Even at the more generous level of “mental illness is different from physical illness” it is wrong, and dangerously so. > The word "illness" should be used to represent a cause-- and resolving the cause should cure the illness. This has never been what “illness” means; illness (both in general and in specific named instances) is often recognized and identified long before causes. > The conditions which we call mental illness don't have a knowable cause. They don't usually have a known cause. That they don't have knowable cause is an unwarranted conclusion. Plenty of physical illness don't have known mechanisms, and most of those that do were noticed and given names as illnesses before (sometimes centuries before) the mechanism was identified. This doesn't mean they don't generally have knowable causes, as is evident from the ones whose causes were later learned. > Illnesses should be hypothetically curable. That doesn't even remotely follow. Having a know cause doesn't imply curability because causes are not necessarily reversible. > I think often the hacker news crowd forgets how ill-informed most of the world is True. It's easy to forget that many people do not even realize that pattern matching on symptoms is how much diagnosis of physical illness is done, and that even where causes are known it's often not worthwhile (and sometimes not practical) to actually test for them directly.
- elbasti 8y agoBut mental illness _is_ different from physical illness. That's the whole point. The dangerous thing is to presume that's not true. Or even worse: to lie about it. The phrase "chemical imbalance" comes to mind. Complete and utter fabrication of a physical cause. It may be that a physical cause is discovered for some conditions which today are considered "mental illnesses"... say, schizophrenia. Well, when that happens it will stop being known as a mental illness and just a physical illness.
- dragonwriter 8y ago> But mental illness _is_ different from physical illness. No, it's not, it's a subset of physical illness. It's not even possible for it to be otherwise without magic.
- drdeca 8y agoI think you might not be interpreting that in the way that it was meant. Perhaps consider: what things would someone who calls some things “mental illnesses” and not call them “physical illnesses”, contrasted with the things they would call “physical illnesses” and would not call “mental illnesses”. What name would you give to these two categories? I am reminded of a conversation I had with my dad, perhaps 5 years ago, where he referred to something as a plant, and I was confused because he meant that in a way that excluded trees, while I hadn’t interpreted it that way. Now, of course, in the technical sense, trees are plants, being members of the kingdom Plantae. But at the same time, if one is in an area with 5 trees, and a plant which is not a tree, and someone tells you “look at the plant”, the pragmatic way to interpret what they mean, is that they want you to look at the plant (i.e. the plant which is not a tree). Scott Alexander said (as a paraphrase/snowclone of Christ’s “The Sabbath was made for man, not man for the Sabbath.”) “The categories were made for man, not man for the categories.”. Edit: small formatting fix
- umvi 8y ago> No, it's not, it's a subset of physical illness. It's not even possible for it to be otherwise without magic. I think GP's point is that you can't determine a mental illness with physical characteristics/measurements. Can you diagnose schizophrenia with a blood test? X-Rays? Nope. Perhaps an MRI? Maybe, though AFAIK this still isn't really possible. With physical illnesses it's easy. Broken bone. Cancer. Viral infection. All of these can be diagnosed without communicating to the patient at all, simply by making physical observations using chemistry and physics. Not so with mental illness. With mental illness you basically have to just talk to the patient, take their word at face value, and then deduce based on symptom pattern matching. A determined fraudster could fake a mental illness, and it would be impossible for doctors to be able to tell AFAIK (correct me if I'm wrong), the same which cannot be said for tumors.
- km3k 8y agoI haven't read the book, but from your summary it sounds like the argument is that for illnesses that we don't yet understand well enough to cure or even have a potential cure, we should use a different word. That sounds pedantic. There's many non-mental diseases that we don't yet understand fully enough to know how to cure completely. There are many diseases where there are varied causes of the disease, where we are still learning these causes, and still learning what could be a cure. Should all these not be called an illness too? The disease like this that I'm most familiar with is Cystic Fibrosis. 35 years ago, doctors had no idea what caused it. Now we know it is genetic. However, the disease is caused by many different possible combinations of gene mutations and we're still discovering more that can cause it. There's currently over a thousand gene mutations that cause Cystic Fibrosis. While a lot of progress in slowing disease progression has been made, there is no cure. We're not even certain about what would be needed for a full cure as science is still learning about the full extent of the disease. Cystic Fibrosis does not meet your criteria for an illness either. Should we not call it as such? I think that would be absurd. It is clearly an illness. Just because we don't fully understand a disease yet doesn't mean it can't be called an illness. If you want to come up with a new word that can clarify the fact that we don't fully understand it yet, I guess that's fine, but I don't like confusing people by trying to deny the common understanding of a word.
- elbasti 8y ago> but I don't like confusing people by trying to deny the common understanding of a word. I think that's actually the crux of the argument. The phrase "mental illness" IS the perversion of a common understanding of a word. When people hear "illness" they think "thing that is broken". Is a runny nose an illness? No, the flu is an illness. I don't think it's about whether we fully understand the cause or not; I think it's about whether or not we think there probably is a single, physical cause. So we absolutely should call Cystic Fibrosis an illness even if we don't know the cause, because we think there probably IS one. And heck, there may be two causes! And then... well, then it would be TWO illnesses with similar symptoms, not one. At this point I'm straying from the book because I don't remember it too well, so this is editorializing: I don't think that holds for many mental illnesses. "Depression"--do we think there's one, or few, underlying physical causes of it? Highly doubtful. And we know it's highly doubtful because the treatments that make the symptoms go away are so varied in their mechanisms of action and effectiveness. Exercise. Sunlight. Changing jobs. Medication. Time. Talk therapy. All these things "work", to some degree or another, but the odds that they are targeting the same underlying, malfunctioning, physical mechanism are very slim. So one would say "depression is not an illness, the same way a runny nose is not an illness. It's a pattern."
- 50656E6973 8y agoIn The Manufacture of Madness: A Comparative Study and of the Inquisition and the Mental Health Movement, Szasz goes into the history of Psychiatry and how it evolved out of and is the modern day equivalent of the Inquisition. After the Enlightenment, Church was separated from State, but the need for the subjugation of thought criminals remained. In fact, the first psychiatrists asserted that the witches of the Inquisition were in fact just insane people. The Soul was rebranded as the Mind, and heretics were rebranded as insane while the truth about the mind remained a mystery.
- _bxg1 8y agoAs someone who has depression and anxiety, I can definitely testify that there's a certain fatalism that one experiences once they've been "diagnosed" with mental illness. However. There's a dangerous perspective held by a conservatively-minded minority of more people who say mental illness "isn't real" and you just need to "suck it up" and "have stronger character", and it amounts to victim-blaming. Arguing to eliminate the insanity plea sounds very much along those lines, regardless of what the book said. Whether the doctor in question falls into that camp or not, it's a dangerous line to walk. Personally I think of mental illness as analogous to obesity: it is simply a current state of being, and a spectrum at that. But it's important not to let it slide outside the realm of medicine and of having factors outside of the victim's control. People have fought long and hard for that ground and it's understandable they would feel threatened when someone (even just seemingly) tries to undercut it.
- empath75 8y ago> There's a dangerous perspective held by a conservatively-minded minority of more people who say mental illness "isn't real" and you just need to "suck it up" and "have stronger character" I don't think most cases of depression are an illness for the same reason that I don't think that hunger is an illness. It's the body and mind's natural response to a life which it wasn't evolved to cope with. Which isn't at all the same thing as telling people to suck it up. If everyone is forced to take drugs in order to thrive in what civilization has become, it's not the depressed person who is sick.
- _bxg1 8y agoRight, so you're not in that group. But there are people who literally write off every possible thing that's wrong with someone's mind as a character flaw and therefore that person's fault and something they don't need any professional assistance to deal with.
- empath75 8y agoI wish we thought of depression as a disease of systems instead of of people -- and that our first response to rising numbers of depression diagnoses wasn't only to treat people, but also to reform society. Like if a building is on fire, you don't just do first aid on people that get burned. You evacuate the building and put the fire out.
- phkahler 8y agoSometimes there is a specific physical cause: https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2014/celebrating-science.shtml https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2... The situations with those two patients is revealing - the same genetic condition underlying two different diagnoses. The same treatment. The fact that not everyone with those conditions has the same defect or can benefit from that treatment. The field really is in its infancy. But sometimes there really is a physical cause and treatment.
- jhbadger 8y agoBut it is equally true that there can be no "cure for cancer" in the sense of a cure for all cancers. Just like with bipolar disorder, "cancer" is just a broad description of symptoms. There is no shared physical cause that underlies all cancers. That's why some cancers are treatable and others are still basically a death sentence. That being said, while "bipolar disorder" is clearly a disease, or like cancer, a set of diseases, it is true that the mental health profession has an unfortunate long history of making non-majority personality traits "mental illnesses" -- homosexuality was considered a mental illness until the mid 1970s, for example.
- yellowstuff 8y agoThe book "The Emperor of all Maladies" doesn't put it in those exact terms, but makes it clear that essentially the same is true of cancer. Cancer is a symptom of many kinds of health problems, not a single disease that responds to a single treatment. If we understood bleeding as poorly as we understood cancer, then everything from R&D for better bandages to public campaigns to reduce gun violence would be lumped together as "treatment for bleeding."
- astazangasta 8y agoThere is a difference, that cancer has a biological cause (a genetic lesion). "Mental illness", e.g. schizophrenia, has no such origin in a bodily abnormality.
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- amanaplanacanal 8y agoWhat? How do you know that? That doesn't seem like something you can say is known.
- astazangasta 8y agoHow about, "after decades of searching using all of the best available tools, none has been found".
- amanaplanacanal 8y agoWe know that some mental illnesses have a genetic component. How would that happen if there were not something physical? Just because we don't know now, doesn't mean we will never know. That's how science works.
- astazangasta 8y agoI'm obviously not rejecting materialism, I'm merely attempting to distinguish between "mental" and "physical", i.e., the cause of your 'mental illness' is "nutrient deficiency" vs. "your wife left you". If, on balance, people experience mental distress when they experience extreme emotional turmoil without any significant accompanying physical event, we can't posit a physical cause and therefore shouldn't seek a purely physical solution (drugs). People have 'mental illness' because of mental problems, not physical problems. Also: everything has some genetic component, this is trivially true. Genetics are what separates humans from dogs and plants. It doesn't necessarily help us to explain the phenomenon adequately. Also also: another way science works is its inability to prove negatives. Therefore, saying, "someday we might discover this" can be said for pretty much anything that remains unproven.
- alain94040 8y agoCorrect, also known as the taxonomy mistake: just because you give something (here: symptoms) a name, doesn't mean you know what it is.
- AchieveLife 8y ago> No. The we think "I've been diagnosed with a disease. (Sorry I'm being an a-hole|I won't go to your party|didn't get out of bed, I suffer from bipolar and there's no cure". Straw man argument and incredibly insensitive. The proposed causation between diagnosis and excuse making behavior is ridiculous. People will make excuses regardless of their knowledge of a diagnosis. It's about what they _want_ to do and their level of comfort with confrontation. Medicine will continue categorization because it assists with treatment. IMO, it's stigma like your pov that needs to be re-educated.
- elbasti 8y agoAgree it sounded (and probably is) insensitive. I think a different comment expressed this more clearly, by saying "that there's a certain fatalism that one experiences once they've been "diagnosed" with mental illness."
- AchieveLife 8y agoRight. I argue that the right education about mental health applied to the mass population would greatly mitigate the occurrences of many if not all of the arguments here.