Mad, or bad? Attacking the Concept of Madness
2013-04-15 0:00

By Holly Case | AEON

In 1961, a young psychiatrist initiated a one-man insurgency against his own profession. ‘Psychiatry is conventionally defined as a medical specialty concerned with the diagnosis and treatment of mental diseases,’ he wrote. ‘I submit that this definition, which is still widely accepted, places psychiatry in the company of alchemy and astrology and commits it to the category of pseudoscience. The reason for this is that there is no such thing as “mental illness”.’

Fifty years after his book The Myth of Mental Illness: Foundations of a Theory of Personal Conduct first ventured this uncompromising view, its author Thomas Szasz visited Cornell University in upstate New York. He was there to speak to an audience of students, many of them coerced or bribed by their professors to attend, plus a few local lawyers and psychiatrists. His subject was ‘The Insanity Defence: The Case for Abolition’. The talk started late because a man in a wheelchair was being positioned near the front of the lecture hall. Szasz greeted him enthusiastically; the audience would later learn that he was Ronald Leifer, a psychiatrist who had been denied tenure at the Upstate Medical Center at Syracuse in 1966 for defending Szasz and his iconoclastic ideas against practically the whole of the psychiatric profession.

When it finally started, the lecture was heavily anecdotal and lasted barely half an hour. The 91-year-old psychiatrist spoke in a quiet voice and with a thick Hungarian accent. Students shifted in their seats. Then came the Q&A. Although the subject was the insanity defence, the audience was more interested in Szasz’s assertion that there was no such thing as mental illness. ‘What about schizophrenia?’ ‘How can you be a practising psychiatrist if you don’t believe in mental illness?’

One student asked him: ‘Are you trying to say we all have different brains?’ The lecturer seemed unsteady on his feet. ‘Yes,’ he replied, ‘we do.’ Another student put it to him that we might be determined by our neurological make-up. ‘I think you and I have different brains,’ Szasz replied. That got a laugh from the audience. It was clear that being the only one in the room with a brain like his was part of his persona; being contrarian was his way of being right. Throughout his career, even friendly co-optation irked him. When scholars started associating him with the anti-psychiatry movement, he wrote a book entitled Antipsychiatry: Quackery Squared (2009).

The psychiatrist inherited from the Inquisition the task of quarantining society’s dangerous elements

Szasz liked to present himself as a dissident. And yet, when he began dynamiting the foundations of psychiatry in the 1960s, rebellion was in vogue, and he seemed very much a man of his time. Along with so many other radicals of the decade of dissent who got half of what they wished for, he has largely been forgotten, his troubling declarations defused by decades over which he worked as an academic and a practising psychiatrist.

After the talk at Cornell, he confided over a stiff drink that he generally did not give talks anymore. ‘I’m too old,’ he told me. ‘Plus, not many people know I’m still alive.’ Indeed, not long after our conversation, Szasz died, last fall. But did his ideas die with him? On the contrary, it might be that the world has only recently come around to his way of thinking.

Near Szasz’s school in Budapest there stood a statue of Ignaz Semmelweis, a Hungarian obstetrician who found posthumous fame as a 19th-century martyr of science. To Szasz, the sickly and discontented young son of a Jewish businessman, Semmelweis became something of a hero. The late doctor’s claim to fame had been the discovery that it was possible to practically eliminate the often-fatal ‘childbed fever’ common among new mothers in hospitals if doctors simply washed their hands before assisting with childbirth — especially if they had just been performing autopsies. When his findings became more widely known in the 1840s, he expected a revolution in hospital hygiene. It didn’t come, and Semmelweis grew increasingly outspoken and hostile towards doctors who refused to acknowledge his discovery. Vitriolic academic exchanges ensued, and he was eventually lured to a mental hospital where his opponents had arranged for his incarceration. He was beaten severely and put in a straitjacket. He died within two weeks. Echoing Voltaire, Szasz recalled the doctor’s tragic life in an autobiographical sketch in 2004:
It taught me, at an early age, the lesson that it can be dangerous to be wrong, but, to be right, when society regards the majority’s falsehood as truth, could be fatal. This principle is especially true with respect to false truths that form an important part of an entire society’s belief system. In the past, such basic false truths were religious in nature. In the modern world, they are medical and political in nature.


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