Greetings:
This post might be of interest to those of you who followed the
"schizophrenia" thread.
Jim Mancuso
--
James C. Mancuso Dept. of Psychology
15 Oakwood Place University at Albany
Delmar, NY 12054 1400 Washington Ave.
Tel: (518)439-4416 Albany, NY 12222
Mailto:mancusoj@capital.net
http://www.crisny.org/not-for-profit/soi
A website dedicated to information on Italian-
American history and heritage.
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Date: Thu, 17 Dec 1998 23:11:23 -0500
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Date: Thu, 17 Dec 1998 16:43:15 -0800
To: HWLIPA@aol.com
From: tgreening@igc.org (Tom Greening)
Subject: Szasz
Cc: daherman@suffolk.lib.ny.us
Psychohistory might have something to do with medicine if it traced the
psychological history of various medical theories, practices, fads, etc.
Medicine is much more than a science or an applied science. It includes
anthropology, folklore, myths, economics, politics, etc.
To acquaint you with Szasz, here is some stuff--
Introduction of Thomas Szasz
Presented at the 1998 American Psychological Convention, San Francisco.
Sometimes I wish I had never heard of Thomas Szasz, or could get rid of
him. He has disrupted my life and career, caused me to alienate friends
and colleagues, tarnished my reputation, and in general driven me crazy.
I've been trying to get his ideas out of my mind for decades. They have
become intrusive thoughts, and sometimes lead to compulsive behaviors. I
wonder if there is a psychoactive drug that can cure me of this Szasz
illness.
For example, I remember once being at a conference at Esalen Institute
on the political psychology of Soviet-American relations. Esalen is a
place very hospitable to innovative and radical thinkers seeking more
humane ways to live individual lives and run the world. One of the
conference participants was a psychiatrist whose work I have greatly
admired for years. He brings brilliant psychoanalytic insights to
international relations, and works creatively on conflict resolution. As
we were walking to lunch one day I brought up my interest in Szasz's
critique of the myth of mental illness and his ideas about responsibility
and autonomy. The psychiatrist scoffed at the mere mention of Szasz,
saying he wasn't worth serious consideration. I felt like Szasz and I had
just been nudged off the Big Sur cliff.
In my craven and desperate attempts to re-enter the mainstream of
American psychology I read whatever I can find that disputes Szasz's
critique of the ideology and treatment of "mental illness." I try to follow
his opponents' reasoning, the research reports, the case histories, the
drug company promotional literature, the heartfelt appeals from the
National Alliance for the Mentally Ill, the glowing announcements from the
National Institute of Health about new breakthroughs in the biomedical
account of human woe.
But all my efforts have been in vain, and I fear I am a hopeless cult
convert. That may be why I have been asked to appear here today to accept
this award on behalf of Thomas Szasz, who had a previous commitment. Those
of you who are interested in the sad story of my deranged attempts to
consider intelligently the attacks on Szasz's theories and the rebuttals to
these attacks may wish to pick up a copy of a handout I have brought.
Having declared myself mentally incompetent to speak further, I will
now present some remarks Dr. Szasz wrote for me to deliver to you.
============================================
August 1, 1998
Ladies and Gentlemen,
I wish to express my gratitude to the American Psychological Association, and
in particular to the Committee on the Distinguished Humanistic Psychologists
Awards, for the honor of bestowing upon me the Rollo May Award for 1998. I
sincerely regret that, because of a long-planned family commitment, I am
unable to accept the award in person. I thank Dr. Thomas Greening for his
willingness to do so in my stead.
Inasmuch as Dr. Greening has generously agreed to represent me here today and
will offer comments of his own, I will be brief and simply restate what I see
as the gist of my efforts as a "humanistic psychologist."
Surely, treating persons as human beings ranks high among the core meanings
of the adjective "humanistic." To me this has meant, among other things, a
moral obligation to reject treating persons as the carriers of stigmatizing
diagnoses and a willingness to take a stand for the many practical
implications of that position. The most important of these implications is
opposing -- mainly on moral and legal grounds -- the twin pillars of
psychiatry and clinical psychology as institutions of social control: 1) Civil
commitment, which I regard as a base rhetorical device (euphemism) for
depriving innocent persons of liberty -- in the name of mental health; 2) the
insanity defense (and similar defenses, such as diminished capacity), which I
regard as a base rhetorical device (euphemism) for diverting persons guilty of
crimes from the criminal justice system to the mental health system -- in the
name of mental illness.
I consider these propositions as self-evidently true and as morally valid as
the proposition that black-skinned persons are human beings. It took a long
and bloody struggle to abolish slavery. It will take a long -- I hope
bloodless -- struggle to abolish psychiatric slavery.
Thank you very much.
Thomas Szasz
======================================================
THOMAS GREENING, Ph.D.
Diplomate in Clinical Psychology
PSY 1178
1314 Westwood Boulevard, Suite 205
Los Angeles, California 90024
Phone: 310-474-0064. Fax: 818-784-8715.
Email: tgreening@igc.org
Myths about the "Myth of Mental Illness" Revised 8/3/98
Critiques of Szasz's arguments, followed by rebuttals.
Comments welcome.
1. These theories minimize the complexity and severity of mental
illnesses. Calling them merely "disorders" or "problems in living" does
not do justice to the enormity of these illnesses.
Rebuttal: Not necessarily. Suffering is suffering, disorder is disorder.
"Problems" can be devastating, deadly.
2. People like Szasz and his proponents don't care about the mentally ill,
their families, or the citizens they sometimes victimize, and would just
turn them loose to fend for themselves, even if that means suffering as
homeless vagrants. These radical, libertarian ideas about "freedom" and
"rights" produce chaos, suffering, and an abdication of responsibility for
our fellow beings.
Rebuttal: We can (and, I urge, should) act compassionately and caringly
toward troubled, homeless people without resorting to the medical model.
If someone is very upset, sad, poor, cold, hungry or homeless, I have a
choice of models to use in viewing them and a choice of behaviors in
response to their suffering. Do I need to label them "ill" before I can
feel enough compassion to intervene? If so, are they or I more "ill"?
Labeling people "ill" or "diseased" may produce a fatalistic attitude in
them and others, and create a self-fulfilling prophesy.
3. Some "mentally ill" people are dangerous and commit murders. They
should be identified, diagnosed, and involuntarily confined and treated to
protect innocent citizens and the social order.
Rebuttal: Society should enact laws to define and control illegal
behavior. This is a legal and police issue, not a psychological or
psychiatric issue. In the process, the Constitution and civil rights must
be respected. Using statistical prediction to identify potential violent
offenders would lead to imprisoning
more young, poor black men than persons labeled "schizophrenic."
.
4. These theories ignore the compelling scientific evidence from PET scans
etc. that schizophrenic patients have something distinctly dysfunctional in
their CNS. These patients really have something wrong with their brains.
Rebuttal: The evidence is not scientifically compelling. And if it were,
then these patients should be described as having brain diseases, not
"mental illnesses," and should be treated accordingly. Neurologists don't
accept the "mental illness" model, so psychiatrists try to invent
"neuropsychiatry." Most of the brain correlates of psychopathology are
descriptive, not explanatory, and give no evidence of causation. There is
also much inconsistency entailing false positives and false negatives.
Critics have found serious flaws in the CNS, PET scan, MRI, SPECT, twin
studies research: It is impossible to sift out how much brain pathology is
a result of some psychological disorder or medication mis-management, and
how much is a cause. Even if it were proven that organic brain pathology
is causative in certain cases, to what extent can it be overcome by
psychological interventions and social support? Is as much thought, effort
and money being directed in studying those factors? Here is just one among
many relevant references: "Childhood-Onset Schizophrenia: Brain MRI
Rescan After Two Years of Clozapine Maintenance Treatment." American
Journal of Psychiatry, 153:4, April, 1996 p. 564 - 566. A line from the
abstract: "Caudate enlargement in patients with childhood-onset
schizophrenia who are taking typical neuroleptics appears to be secondary
to medication exposure."
5. In contrast to Szasz's orientation, an advantage of the illness model
is that it destigmatizes the mentally ill. Szasz, Laing and others who
hold theories that involve psychodynamic and family dynamic causation
stigmatize the patients and their families, putting counter-productive
guilt and blame on them. Such theories stigmatize these patients as being
"crazy" or "anti-social" or "deviant" and their families as
"schizophrenogenic" or "dysfunctional."
Rebuttal: We don't have to blame and stigmatize people with problems, or
their families. Everyone will benefit most if we can learn more about the
true causes of these disorders, not invent comforting theories. I suspect
NAMI and some schizophrenia researchers of being driven by (unconscious?)
needs to find genetic and biological causes and to deny other
possibilities. Why might they be doing that? Do they have a need to
direct our attention away from familial, psychodynamic or ontological
factors? Or is it just that in 20th century America the medical model,
biological "science," and the search for the magic bullet are powerfully
and seductively appealing, and rewarding in terms of grant money, career
advancement, etc? See Margaret Brown's discussion of Torrey in her
Saybrook Graduate School dissertation.
6. Other theories that claim mental illnesses are caused by social,
political, economic, or other forms of oppression, stress and hardship
merely shift the blame to vague, intangible, abstract forces that cannot be
dealt with medically and scientifically. Many people endure such stresses
without becoming mentally ill, and many people from comfortable
circumstances do become mentally ill.
Rebuttal: There are studies showing the effects of social, political, and
economic oppression on rates of mental disorders.
7. Another contrasting advantage of the mental illness, medical,
biogenetic, model is that it provides a legitimate basis for attracting
treatment and research funding.
Rebuttal: Diverts money and effort from other research. Mean-end
fallacy--a dishonest or erroneous theory won't produce valid results.
8. The mental illness model, even if it is just a "myth," is a harmless
and useful metaphor for describing and attracting help for these patients.
Rebuttal: No--it leads to chemical and electrical interventions and
damage, to involuntary hospitalization and loss of civil rights and
responsibilities, and to neglect of other more humane approaches. It also
leads to broadening and diluting the definition of "illness" until it
becomes meaningless and ridiculous. For example, the brochure of the
Sierra Tucson rehabilitation center states: "The Sierra Model defines
disease as a dysfunctional state with characteristic form, whether that
form is a mental health disorder, an addiction or a physical problem.
Tuberculosis is a disease. So is depression." Under this definition the
following would be diagnosable and treatable as "diseases:" Reckless
driving; poor hand-writing; bad grammar; batting slumps; inadequate
record-keeping and late filing of income tax returns; inability to believe
in, understand and use the DSM-IV. Especially when backed by coercive and
invasive interventions by the state, the "mental illness" model is
dangerous. It also may provide a self-fulfilling, passive fatalistic
resignation to the ""diagnosis" and undermine patients' and caregivers'
motivation to test creatively the limits of constructive change
===================================================
At 10:45 AM 12/17/98, David Herman wrote:
>From: HWLIPA@aol.com
>To: daherman@suffolk.lib.ny.us
>12/16
>Psychohistory has nothing to do with medicine
>I am not real familar with the thinking of Thomas Szasz but on the basis of
>what I do know, I am not convinced he knows what he is talking about.
>Of course you are quite free to feel differently, but I doubt that Szasz ever
>had any conception of what psychohistory is about
>Henry Lawton
Thomas Greening, Ph.D.
Suite 205
1314 Westwood Blvd.
Los Angeles, CA 90024
Phone (weekdays): 310-474-0064
Phone (home office): 818-784-2895
818-784-8715
email: tgreening@igc.org
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