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In 1960 Thomas Szaz wrote The Myth of Mental Illness.

He proposes that the term “mental illness”, unlike a physical illness is a phony term similar in explanatory power to the concept of witches that people use to explain conditions they don’t understand. He says this term is outmoded and he wants to retire this concept since he claims it describes two unrelated conditions, neurologic conditions or ordinary social conflicts inherent in life.

If he is proposing that attaching labels to things is not the same as understanding them of course he is right. Proposing taxonomy for things that are perplexing is a first step to understanding them. With new observations, theories, advances in pharmacology and neurosciences the classification of mental illness has expanded and changed. No one should assume that these classifications are anything but working diagnoses, anymore than the classification of bacteria. With the advent of DNA probes, PhD microbiologists routinely throw MDs into mass confusion by showing that the previous classification of bacteria was in error and renaming common microorganisms. Likewise, refuting old theories and practices of mental health does not refute the concept of mental health.

The question Szaz asks is “To what use is the concept of mental illness put?”

I have already said it is used in order to construct taxonomy, so as to develop a working understanding of the phenomenon. This is not the answer he wants to hear.
He compares it to witchcraft, for which there is no objective evidence.

As mentioned above he divides mental phenomenon into physical disease such as neurosyphilis or stroke where there is a loss of function and the trials and tribulations of daily life that affect some people and that are often labeled mental illness. Of course we now know that mental phenomenon act within the substrate of the physical brain. It is false that all brain pathology is composed of neurologic deficits. Mania and schizophrenia have positive symptoms that correlate with hyperactivity in areas of the brain. Some psycho-pharmacy relates to suppressing excessive function of neurotransmitters while other drugs boost the production of neurotransmitters, but mostly no one really understands how they work. There is also a borderland between neurology and psychiatry where you have conditions that can simulate mental illness such as psychomotor epilepsy. In other words, things aren’t so simple.

According to Szaz physical symptoms such as pain require no social interpretation in order to register in the diagnosticians mind as being a sign of disease. If a man says “ my abdomen hurts”, the MD thinks that the man has physical disease. Not true. The disease could be “functional”, psychosomatic, or otherwise non diagnosable as physical and hence possibly mental.

If a man reports that he is being persecuted by Communists, or that he is Napoleon, Szaz thinks the situation needs to be weighed against the possibility that he is telling the truth. Thus situational reality, he thinks, is based on the actual sociological fact that he is not Napoleon or those Communists are not really after him. Thus Szaz implies that what differentiates the mental state we call insanity from normal belief in reality is its veracity. But as they say, just because you are paranoid it doesn’t mean people are not after you. Insanity may cause a delusional state. It offers no protection from real Communists nor does really being Napoleon protect you from insanity. He is wrong that there is a simple dichotomy between physical and psychiatric illnesses.

He makes the same logical error when he posits that other psychiatrists claim“ people cannot have troubles -- expressed in what are now called "mental illnesses" -- because of differences in personal needs, opinions, social aspirations, values, and so on. All problems in living are attributed to physicochemical processes --”

No one claims this, or if they do they are wrong but this does not prove the reverse, that all problems experienced in their mind other than simple bodily misery or lack of function are due to personal or interpersonal dysfunction. Some people get elected to suffer serious psychic pain, depression schizophrenia, anxiety and what have you, that other persons in the identical situation would tolerate with less difficulty and it isn’t their fault.

Szaz then proceeds with the now familiar tactic of setting up straw men and making them commit logical errors. For example “the notion of mental illness is used to identify or describe some feature of an individual's so-called personality. Mental illness -- as a deformity of the personality, so to speak -- is then regarded as the cause of the human disharmony. It is implicit in this view that social intercourse between people is regarded as something inherently harmonious, its disturbance being due solely to the presence of "mental illness" in many people. This is obviously fallacious.”

If people say that all social dysfunction is due to mental health problems they are wrong. This does not prove the reverse statement that there are no mental illnesses besides those caused by known brain pathology.

He then goes on to criticize psychiatric ethics for participation in law, social control and other areas and to point out certain abuses. This section I don’t disagree with, except that physiatrists are needed in some forensic application but should not disguise themselves as therapists in this case. If he would confine himself to these points he would not be so controversial. In fact he would not be famous. He probably be like most shrinks sitting listening to boring patients and chain smoking and drinking coffee to stay awake.

The key point that may get lost in his thinking is that most psychiatric patients are hurting with a painful condition. If the psychiatrist remains an advocate for the patient who tries to use his powers, if any, to help the patient; he is no different from any other physician or ethical healer. If he deviates from this he is wrong but is no different from any other person who is guilty of a breach of trust. I have personally observed that there are usually a few quacks in every town and at least one of these is a psychiatrist.

This does not mean psychiatry or the concept of mental health is invalid.

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This section does need more content...

...and I'm glad you're willing to help out! I agree with the taxonomy bit: every well-established medical disease started out as a vague collection of signs and symptoms. They're a start. Further research helps establish pathophysiology.