Thomas Szasz and The Myth of Mental Illness

Thomas Szasz was a psychiatrist who challenged some of the fundamental assumptions of modern psychiatry. In his controversial book The Myth of Mental Illness (1961), he argued that many of the problems we describe as mental illnesses are not actually illnesses at all. Instead, they are problems in living.

Szasz believed that psychiatry had adopted the language and methods of medicine to describe problems that are fundamentally different from physical diseases. A physical illness involves some sort of bodily dysfunction. But problems involving thoughts, emotions, relationships, values, and behavior are not necessarily diseases in the same sense.

As Szasz put it:

'Thought and mood, unlike bile or urine, are not material things.'

Psychiatrists cannot directly observe someone's thoughts or feelings in the same way that a physician can examine bodily tissues. Instead, they infer psychological problems from what people say and do.

Szasz was not denying that people suffer psychologically. His argument was that calling this suffering an illness can prevent us from understanding what is actually going on.

Mental Illness or Problems in Living?

One of Szasz's central arguments is that many psychological difficulties are better understood as strategies people develop to deal with problems in living.

A person struggling with anxiety, depression, anger, or difficulties in relationships may have developed certain ways of thinking and behaving that serve some purpose, even when those patterns cause considerable suffering.

These strategies may have developed over many years, perhaps beginning in childhood. They may have helped a person deal with difficult circumstances at one time but become destructive later in life.

Szasz also recognized that people are not necessarily aware of what they are doing. In his discussion of hysteria, he argued that a person may begin by adopting a particular role and eventually come to believe in that role so thoroughly that it becomes part of their identity.

He described how roles can become habits, and how patterns of behavior can become deeply ingrained over years or decades.

This raises an interesting question: To what extent are people aware of the strategies they are using?

Someone who struggles with anger, for example, may genuinely want to stop getting angry. But anger may have become a habitual way of dealing with frustration, disappointment, or feelings of helplessness. The person may have little understanding of why they continue to respond this way.

Something similar may happen with anxiety or depression. People may develop patterns of thinking and responding to life that they would very much like to change, but they do not know how.

Recognizing that these patterns may involve strategies does not mean that people are deliberately choosing to suffer. A strategy can become so deeply ingrained that a person has difficulty imagining another way of responding.

The Medicalization of Human Problems

Szasz was particularly concerned that the medical model of psychiatry could obscure the nature of psychological difficulties.

When we call something an illness, we generally mean that it is happening to a person rather than something the person is doing. The person may not be responsible for developing the illness and may have little ability to change it through personal decisions.

Szasz argued that this framework can be misleading when applied to problems involving thoughts, values, motivations, and behavior.

He believed that many of the things psychiatrists treat have more in common with philosophy, ethics, and human relationships than with medicine.

This was part of his broader criticism of psychiatry: by defining problems in living as illnesses, psychiatrists could claim the authority of medical professionals without necessarily identifying a medical disease.

Szasz took this argument much further than most contemporary mental health professionals would accept. He rejected the classification of conditions such as schizophrenia as mental illnesses, insisting on a distinction between demonstrable diseases of the brain and problems involving human behavior.

There are some important questions about this position, particularly when it comes to conditions like schizophrenia, where people can experience symptoms that seem to be largely outside their control. Biological factors may play a significant role in such conditions, though this does not rule out the importance of psychological and social factors. To what extent these difficulties can be understood as strategies, in Szasz's sense, is a difficult question.

But Szasz raises an important question about the extent to which the language of mental illness is applied to problems that are not necessarily medical diseases.

Why the Distinction Matters

I think there is considerable value in Szasz's emphasis on understanding psychological problems as patterns that have developed over time.

People develop ways of responding to difficult circumstances, and those ways of responding can become deeply ingrained. They may involve beliefs about themselves, assumptions about other people, fears, motivations, and patterns of behavior that they do not fully understand.

In counseling, it is important to get beneath the symptoms and understand these underlying patterns.

At the same time, recognizing that a psychological problem involves habitual responses or strategies does not mean that the person has consciously chosen those responses or can si