Book Review: Psychiatry The Science of Lies

Reading this short book by Thomas Szasz is a real challenge. Each chapter contains half-a-dozen spring-loaded boxing gloves, which punch you on the nose as you read. That's what it felt like to have my assumptions and settled ideas about psychiatry and mental health challenged by Szasz. I had expected the attack on psychiatry, but was unprepared for his attack on patients as malingerers or the neo-liberalism that drives his approach to social reform.

The Szasz argument goes something like this: psychiatry is fake and has nothing to do with medicine. Mental illness does not exist, it is conjured into existence when a psychiatrist makes a diagnosis. So in psychiatry disease is the same thing as diagnosis. He suggests there is an unholy alliance between the state and psychiatry. The state has delegated to psychiatry the power to incarcerate individuals guilty of no crime. 

Here is Szasz in his introductory chapter, a passage that sums up his argument:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the "mental patient's' inability to prove his 'psychiatric innocence' makes psychiatry one of the dangers to liberty and responsibility in the modern world (3).

Later Szasz makes clear why psychiatric diagnoses are so damaging: 'Attributing a medical diagnosis to a healthy person does not transform him into a bodily-medically ill person, whereas attributing a psychiatric diagnosis to him does indeed transform him into a mentally-psychiatrically ill person' (15). 

If mental illness does not exist then Szasz must find a reason why so many individuals claim to be mentally ill. Szasz argues that individuals who claim to be mentally ill are in fact malingering. Szasz winds the clock back and shows us the Victorian consulting room. He says the patient arrives believing he or she is ill. The doctor must conclude that the patient is malingering or that he, the doctor, can find no disease. In the face of this unpalatable dilemma a third option emerges: the patient is mentally ill or, in the language of the time, suffering from hysteria: 'Thus arose the modern idea of mental illness, the product of the conflation of having a disease and occupying the sick role (voluntary or involuntary)' (23).

Szasz doesn't explore the 'role' of the patient much more than this. His book tends to get lost in the history of psychiatry and the wickedness of Sigmund Freud. It wages war on a number of unlikely subjects: Kay Redfield Jamison's bi-polar disorder is described as 'an alleged illness'; whilst the author, Lauren Slater, belongs on a 'list of "mad persons" using their madness to build successful careers as celebrity experts on madness' (100). Particular ire is reserved for the psychologist David Rosenhan who tricked the psychiatry establishment into admitting him and his colleagues into a dozen psychiatric hospitals despite having no symptoms of psychosis apart from a pretend 'auditory hallucination' - they told doctors that they repeatedly heard the word 'thud'. Szasz condemns Rosenhan's use of the word pseudo-patient arguing that Rosenhan was actually a real patient with a pseudo mental illness. Szazs thinks that Rosenhan had unwittingly supported the coercive system of mental health care rather than exposing it as prone to error..

If mental illness is a myth then I'm left wondering how Szasz understands the real fear and distress that people experience. There's no indication in this particular book. I see the feelings of distress that individuals experience as an understandable and legitimate reaction to stressful events.I don't see people experiencing psychosis as malingering, but as coping best they can with the circumstances of their lives. I imagine Szasz would say, 'fine' but let's not call it mental illness, and if an individual requires help let it be a be a private arrangement between the client and their chosen mental health professional, which has nothing to do with the state and it's coercive power.

This New American article, Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses, deploys the Szasz arguments against modern psychiatry and its revision of DSM-V. So Szasz is current and worth reading for his radical and alternative viewpoint, but I'm going to turn to his classic works rather than rely on this collection of essays.