The Myth of Mental Illness

I just finished reading The Myth of Mental Illness by Thomas Szasz, and I don’t have my Shelfari account anymore, so I might as well post a review here.

In six words: Szasz is a mighty dull writer. I will slog through almost anything, but it took vigor to make it to the end of this one. Style takes a back seat to incoherence. Szasz loves to be obscure, and he hates it when people get the point of what he trying to say. Nevertheless, I will be brave and try to piece together his argument.

It goes something like this:

The discipline of psychiatry is committed to the self-image of being a serious scientific/medical profession. As a result, the behaviors and life problems which psychiatrists study must (by definition) be viewed as true medical diseases with organic causes. Any contrary view would take psychiatry out of the realm of medicine. It would mean that drugs and other medical interventions in a hospital setting are not the correct treatments. This can never be acknowledged by the dons of psychiatry.

Szasz argues, at tedious length, that instead of being diseased, people with mental ‘illnesses’ are just living a different sort of life from the rest of humanity. They have problems adjusting to the demands of society, but they are not ill in some easily treatable way. Indeed, the very ‘illnesses’ they appear to have are actually a primitive sort of body/mind language that communicates to others (and perhaps to themselves) the pains and sufferings they can’t articulate using ordinary language in social settings.

The bottom line, according to Szasz, is that people who are mentally ‘ill’ should take responsibility for their own return to normalcy. Psychiatrists and psychologists can only aid a person’s self-initiated recovery, and it is beyond their power (and always will be) to provide a simple ‘cure’ in the form of a drug, for example.

In the interest of full disclosure: I have a psychiatrist and I take medication for a serious mental illness (if you want to call it that). I’m not ready to drop either, but I think there may be something to Szasz’s argument.

It’s all the rage now to say that mental illnesses are caused by chemical imbalances in the brain (serotonin and dopamine mainly), which can be corrected by the proper prescription of drugs that affect those chemicals. There are a couple of problems with this theory:

1) There does not seem to be any real difference in the levels of serotonin and dopamine (or any other neurochemical) between ‘healthy’ individuals and ‘mentally ill’ ones. If there were a pattern, they could devise a test to screen people for these diseases. Alas, they cannot.

2) Although the drugs they use to treat major depression, bipolar, etc. do affect the levels of these chemicals, it does not seem to matter in which direction you push them, up or down. Selective Serotonin Uptake Inhibitors (SSRIs) like Prozac, Zoloft and Paxil are massively popular in America for treating anxiety and major depression, but in Europe an important drug for the same conditions is the Selective Serotonin Uptake Enhancer (SSRE), tianeptine.

What is really going on here? Do they really understand how these “chemical imbalances” are supposed to work in the brain? Do depressives need both more and less serotonin in their synapses? As I learn more about the subject, I grow more skeptical. Even the drug company literature is not reassuring (invariably, they state outright that the mechanism of action of the drug is unknown). I know I can’t do this alone, but I’m not sure the drugs are helping much, maybe there is a reason for that.

~ by Yuri Guri on July 10, 2008.