Thomas Szasz Radio Interview

This week’s All in the Mind (mp3 here) from Australia’s ABC looks very good [Update:  Part 2 (mp3)]:

In 1961 maverick psychiatrist and libertarian Professor Thomas Szasz published his controversial and influential epic, The Myth of Mental Illness. In it he argued that mental illness is a fiction and a medical metaphor. Half a century later he maintains we live in a therapeutic state—a ‘pharmacracy’ where psychiatry is synonymous with coercion. On the eve of his 89th birthday he joins Natasha Mitchell in conversation over two weeks about his contentious legacy.

Bryan Caplan has an excellent paper (ungated draft here) analysing Szasz’s ideas from an economic perspective. The abstract:

Even confirmed economic imperialists typically acknowledge that economic theory does not apply to the seriously mentally ill. Building on psychiatrist Thomas Szasz’s philosophy of mind, this article argues that most mental illnesses are best modeled as extreme preferences, not constraining diseases. This perspective sheds light not only on relatively easy cases like personality disorders, but also on the more extreme cases of delusions and hallucinations. Contrary to Szasz’s critics, empirical advances in brain science and behavioral genetics are largely orthogonal to his position. While involuntary psychiatric treatment might still be rationalized as a way to correct intra-family externalities, it is misleading to think about it as a benefit for the patient.

I’m utterly convinced that the extreme preference view is right for many supposed mental illnesses. What the hell makes Narcissistic Personality Disorder anything other than being a selfish, arrogant bastard, for example? I think there are other things like Schizophrenia which can’t easily be described as extreme preferences, but I’m not sure they should be considered diseases either. Depression is the most obvious example here. Being inordinately sad without good reason is clearly not a good thing and can be quite debilitating, but why are we inclined to call it a disease? It’s surely just one end of a spectrum of human psychology, not a discrete condition like a virus or genetic abnormality such as Down’s Syndrome. Being really physically weak or really ugly can be debilitating, but we don’t call those conditions diseases. Not yet, at least.

One Response

  1. Just a quick comment on your post:

    Schizophrenia may not be able to be described as a choice but I can’t think of any case in which a condition is not the result of a choice or series of choices….. for which, if we are to opt for freedom, the individual should be held accountable. As Szasz has said, freedom and responsibility are two sides of the same coin. Promoting or attacking one side means you do the same to the other. When someone’s motive requires that freedom be attacked, the side least likely to expose him to detection is the side selected as the target – responsibility. Without wishing to start a witch-hunt, it is where and how this is being implemented in the world today which then becomes the question of seniority.

    Jim Clayson

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