"The Myth of Thomas Szasz"

[reason.on]

Interesting article on a very interesting man, from "The New Atlantis" journal...

http://www.thenewatlantis.com/archive/13/oliver.htm

By the 1960s, American institutional psychiatry was a very large elephant caught in a seemingly inexhaustible growth spurt. “Nothing of human concern is really outside psychiatry,” proclaimed Dr. Karl Menninger, the profession’s unofficial dean. “So in one sense I have no hobbies. They are all part of my work.” This was to be the beginning of a golden age in psychiatry’s relationship with the American public. Psychoanalysis was busily remaking psychiatry after its own image—a new medicine born equally of natural and spiritual sciences. Practitioners were more than mere medics, they were soul doctors. The profession, as one practitioner predicted, would become “the integrator that unifies, clarifies and resolves all available medical knowledge ... into one great force of healing power.” The number of psychiatrists in the U.S. was increasing at roughly twice the rate of the population. In turn, practitioners were christening some five new mental illnesses every year.

Well, overconfidence will inevitably curdle, and in this case fairly quickly. In November 1982, a New York Times article was already describing “Psychiatry’s Anxious Years.” Some time in the early 1970s, the number of incoming practitioners as a percentage of all medical students had fallen by half. “Some psychiatrists conclude that the decade-long plunge ... reflects a disillusionment on the part of medical students over the scientific validity and practical effectiveness of the discipline,” the Times reported. The article went on to cite “the withering criticism” of one “outspoken” Dr. Thomas Szasz, “who has argued for years that ‘these things called mental illnesses are not diseases at all but part of the vicissitudes of life,’ dismissing psychiatry as a specialty without a medical cause.”

RCR

[Chris Grieb]

A quick reading of the article suggests some of the problems with Szasz's work. I have had two encounters with Dr. Szasz and I must say he is an extremly inpressive individual. I must also say that I think some of his views are wrong.

[reason.on]

A quick reading of the article suggests some of the problems with Szasz's work. I have had two encounters with Dr. Szasz and I must say he is an extremly inpressive individual. I must also say that I think some of his views are wrong.

I haven't spent too much time studying Szasz's work, but know enough to say I agree on some points, and not on others. As George H. Smith pointed out not too long ago on A2, there is a South Park episoide where some of the points I do agree with are portrayed aptly, and hysterically.

http://www.tv.com/south-park/bloody-mary/e...08/summary.html

Stan: Uh look, my dad was here yesterday and you all kinda messed him up by telling him he had a disease.

AA Member: Alcoholism is a disease.

Stan: No it, it's not... and you can't just go around saying stuff like that to people like my dad. He's kinda like a hypochondriac.

RCR

[Michael Stuart Kelly]

Christian,

That's funny. I had an exchange once with Jeff Riggenbach about addiction where he mentioned Szasz to me. (I am a recovered alcoholic and drug addict.)

I find Szasz's views on this subject (the ones I have read, especially about leaving the playing field) apply to some cases of addiction, but not all. I have a real problem with the experts in this field. They either want to claim that addiction is a disease or claim that it is not.

I say neither - or both to be more precise. I see differing degrees of elements of both over a huge spectrum of types of addiction. Having been there myself, I have personal experience to draw on for proper induction in addition to a large amount of contact with other addicts, recovering and otherwise. (Not so much, these days, though.)

My basic problem with Szasz is his oversimplification. I admit that there are a few basic common principles that define addiction. But the disease/not a disease issue is not one of them and the rest is highly varied.

Michael

[Dragonfly]

I think Szasz has thrown away a lot of dirty bathwater, but he didn't see the babies in it.

[reason.on]

That's funny. I had an exchange once with Jeff Riggenbach about addiction where he mentioned Szasz to me. (I am a recovered alcoholic and drug addict.)

I find Szasz's views on this subject (the ones I have read, especially about leaving the playing field) apply to some cases of addiction, but not all. I have a real problem with the experts in this field. They either want to claim that addiction is a disease or claim that it is not.

I say neither - or both to be more precise. I see differing degrees of elements of both over a huge spectrum of types of addiction. Having been there myself, I have personal experience to draw on for proper induction in addition to a large amount of contact with other addicts, recovering and otherwise. (Not so much, these days, though.)

My basic problem with Szasz is his oversimplification. I admit that there are a few basic common principles that define addiction. But the disease/not a disease issue is not one of them and the rest is highly varied.

I am aware of JR's view of addiction (which, I believe is basically that it doesn't exist), and like you, I probably fall somewhere in between the two extremes. I don't think there are any "addictions" that I would properly call diseases, and yet I'm not willing to completely throw away a biologically based concept of chemical/biological dependency and addiction (nor, entirely "mental illness").

RCR

[Michael Stuart Kelly]

Christian,

Some of the stuff you have to see in order to believe it.

With alcoholism, there are people I have known (I am thinking of one person in particular in Brazil) who have a very different response to the biochemical processing of the substance than I do. The moment they take one drink, the reaction is so powerful in their body that before too long they are "blacked out" and they go on a bender that could last days. They simply have no memory of what went on. I'll never forget the looks of perplexity of these people on talking about this and trying to understand what was wrong with them.

My own problem developed much slower, but it was just as devastating in the end.

There are parts of the alcoholism I call disease - the craving, the blackouts, the DT's, etc. I do not hold the AA view that alcoholism (as some mysterious state as a whole) is an incurable disease - sort of like a birth defect. Each of the parts can be worked on and cured. If they are not treated, just like any disease, they get worse and spread to include other symptoms. Also, some people simply will never be able to ingest alcohol just like some have an allergy to pineapple.

Of course, there is the moral component also. This needs to be grasped and held with all your worth when you are trying to overcome a substance addiction.

I wrote an article on all this a while ago on the old SoloHQ that I reposted here on OL, Understanding Addiction—One Objectivist's View. My basic thesis is that the volitional faculty is organic, just like any other living part of the human being, thus it is subject to disease, decay and death just like all living things are. The vehemence with which this concept was opposed by some of the posters was so great, I can only conclude that the idea of biological constraints on their own minds terrified them.

Even with a couple of more intelligent people, I couldn't get the idea across that the mind was part of a living entity. I think the issue underneath with these people is control. They get very afraid when they are not in control. Not to be able to control of their minds is the unthinkable. The unmentionable! Horrible idea! Preposterous! Defeatist! Victimization! Moral cowardice!

When someone induces them to do some serious thinking about all this, they end up losing control. You should see what some of them post.

Michael

[Michael Stuart Kelly]

I just reread my article on addiction. I have not read it since December of last year.

Wow.

I am very proud of it (except for the style). There are some very important ideas in it I need to develop further that I had forgotten about. Sense of identity is one of them.

Michael

[Robert Campbell]

Michael et al.,

I have a lot of respect for Thomas Szasz, but at times I think his point of view degenerates into old-fashioned mind-body dualism.

Not being a clinical psychologist, I've had virtually no occasion to write about Szasz's ideas. But having recently returned to the Liberty and Power blog, all I need to do is get involved in an extended dialogue with Sheldon Richman, who is a rather doctrinaire Szaszian.

Robert

[reason.on]

Michael,

Thought provoking post; I'll have to take some time to fully read your article, as well as the responses.

In the interim, I have one question for you: would you consider a lack of, or deficiency in "self-esteem" (using the Branden definition) to be a disease?

RCR

[Michael Stuart Kelly]

Christian,

In the interim, I have one question for you: would you consider a lack of, or deficiency in "self-esteem" (using the Branden definition) to be a disease?

I'm not a trained psychologist, but my gut reaction would be to say that some self-esteem issues are a disease and others involve applying chosen values and actions (morality).

Obviously if you can alter a person's self-esteem with a drug, there is a biochemical component that can become affected.

I find the idea I coined, "sense of identity," to be intimately wedded to self-esteem, except self-esteem involves normative considerations, whereas I was speaking of the cognitive in my article, of a person viewing an intoxicating substance as being an integral part of himself.

Steven Shmurak sent me a video CD of a lecture showing how infant affects are innate and are the initial building blocks of normative abstractions (I wrote about this in another thread in this section on OL). As this set of affects is an innate capacity that merge with the faculty of volition as it develops, I see no reason why it cannot become diseased like any living organ. Normative abstractions will obviously include self-esteem.

Still, like addiction, unless there are drugs involved, there is a part that involves free will, not disease. Responsible treatment will deal with this also.

That is my unlearned opinion for the moment. I plan to do more work in this area later.

Michael

[reason.on]

In the interim, I have one question for you: would you consider a lack of, or deficiency in "self-esteem" (using the Branden definition) to be a disease?

Obviously if you can alter a person's self-esteem with a drug, there is a biochemical component that can become affected.

Ah, but can you?

Self-esteem is not the euphoria or buoyancy that may be temporarily induced by a drug, a compliment, or a love affair. It is not an illusion or hallucination. If it is not grounded in reality, if it is not built over time through the appropriate operation of mind, it is not self-esteem.

RCR

Edited August 25, 2006 by R. Christian Ross

[Michael Stuart Kelly]

Christian,

The drug I was referring to was something like Prozak - a drug that affects the biochemistry of depression. There are people who exist with chemical imbalances in their brain that result in depression, i.e., their self-esteem is impacted. There are scientific studies that back this up - and, of course, the drugs work.

This does not mean that these drugs are not being abused, though. I sincerely believe that many people who could and should use volition solely (with or without therapy) instead are taking the drugs.

Thus, on one level, biochemistry does impact self-esteem. If you have the best self-esteem in the world, but if the right chemical imbalance occurs in your brain, you will get depressed.

I have personal experience with something similar, but with an illegal substance. I rarely feel fear in life. This is an emotion that simply is not part of my day-to-day living and never has been, except when I was a child. But, when I used crack cocaine, you should have seen the paranoia. It is comical now, but back then, I really did think that the police would come booming through underneath the crack at the bottom of the door and stuff like that. Eyes big, heart pounding and cold sweat. The whole deal.

The emotion I felt under the influence was very real. So I reason, if a chemical can temporarily trigger an emotion like that, a more permanent chemical imbalance will have a long-term effect and will need to be treated chemically. A depressed person will do depressing things, which will start the spiral on another level, not just chemical.

True causes always need to be identified. (Szasz was correct in noting that chemical prognoses have been abused by the psychiatry industry.) I hold that some problems require therapy and others require drugs because the causes are different.

btw - What did NB ever do to Szasz to get him so wound up?

Michael

[reason.on]

Michael,

There is much to reply to in your last couple of posts, and I haven't been able to really focus in on the discussion to engage properly...I just want you to know it isn't out of lack-of interest...I'll try to respond in more detail this weekend, and I have a feeling a new thread on the nature of "self-esteem" is imminent :-)

RCR

[Barbara Branden]

Michael, you wrote: "With alcoholism, there are people I have known (I am thinking of one person in particular in Brazil) who have a very different response to the biochemical processing of the substance than I do. The moment they take one drink, the reaction is so powerful in their body that before too long they are 'blacked out' and they go on a bender that could last days."

This interests me because a scientist I knew many years ago -- he did research at UCLA Hospital -- spent years investigating the effects of alcohol on the American indian, and discovered the following: that Indians do not process alcohol the way other races do. If a white man, for instance, gets drunk one evening, by the next morning or so the effects of the alcohol will have dissipated, and he will essentially be back to normal. But if an Indian gets drunk, the effects can last, unchanged from that first evening, for up to a week; his body does not process the alcohol with nearly the speed and efficiency of a white man's body. The scientist said that this is why liquor is potentially so dangerous to Indians and why alcoholism is rampant among them.

I wish I could tell you more about the scientist's research, and where you might find it. Unfortunately, the above is the total of my knowledge of the subject.

Barbara

[Michael Stuart Kelly]

Barbara,

The problem isn't the alcohol. It is what the alcohol turns into in the body: acetaldehyde. This is the nasty stuff that gives you a hangover and causes all the craving. It basically works like this: if you can handle the acetaldehyde, you drink more and thus increase the craving from the processed chemical. If you can't handle acetaldehyde well, you get sick quickly from drinking and get horrible hangovers.

The research you cite is correct. American Indians have an extremely high processing rate for acetaldehyde. East Asians have a very low capacity. Thus you find a vastly higher percentage of Indians who are alcoholics than certain types of Orientals (Japanese and Chinese mostly).

Here is a Wikipedia article on acetaldehyde for more information.

Also, here is a link to an article called Genetic Influences on Alcohol Drinking and Alcoholism. Dr. Ting-Kai Li is doing wonderful work in this area. Scientists have isolated a gene that deals with acetaldehyde processing and found that it is mutated in Orientals, not allowing them to process this chemical well.

The amusing part is that studies have been conducted on rats with selective breeding according to drinking habits. Now there are strains of rats, bred from ones who liked to get plastered, who drink alcohol by choice (they like it) and become alcoholics, and other strains, bred from rats rats who wouldn't touch the stuff, who do not. I wonder if the first category of rats would control their drinking better if they became Objectivists and more individually responsible...

This research has led to many advances in genetic isolation for studying and finding solutions for alcoholism. This, however, does not invalidate the importance of factors like environment. It is only one facet.

Michael

[Ross Barlow]

A news item just popped up on ScienceDaily.Com about a huge genetic study program concerning substance abuse and the inheritability of addiction vulnerabilities. Michael, when I read this news item I had just read your mention of Dr. Ting-Kai Li, director of the National Institute on Alcohol Abuse and Alcoholism, and he is quoted prominently in this article although this particular study was not his.

Here is the article’s link, shortened to a TinyURL:

http://tinyurl.com/rdr7y

I agree that abuse and addiction can be complex mixes of genetic inheritance, environmental influences and volition, and that there are considerable variations of the mix of these causal factors from individual to individual.

I have some war stories of my own about personal abuse of a wide variety of chemicals off-and-on over four decades, but I will spare you the gory details. Suffice it to say that the scars left upon my life are still part of my baggage.

-Ross Barlow.

[studiodekadent]

I have some problems with Szasz. He is somewhat Freudian. However, I believe his conclusion that psychiatry should be totally voluntary is correct except possibly in some extremely exceptional circumstances. He attacks the reductive physicalism that is currently poisoning psychiatry and he points out that a lot of psychiatry is based on values rather than actual objective science. He is also a great writer and speaker.