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.
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.