When is a ‘critique’ not a critique?
Anthony Stadlen
Copyright © Anthony Stadlen 2014, 2020
[Existential Analysis, 25.2 (July 2014).]
[Existential Analysis, 25.2 (July 2014).]
Abstract
This paper shows that Szasz (1) opposed the presumption
of illness; (2) duelled with dualism; (3) researched the history of ‘hysteria’;
(4) perceived its profound paradigmatic potential; (5) confirmed the compassion
of the confused; (6) denounced ‘mental health’ and ‘anti-psychiatry’; (7) rejected
the role of ‘physician’ to the ‘mentally ill’.
Keywords
Szasz, paradigm,
hysteria, illness, dualism, Cartesian, scientistic, communication
Introduction
For more than half a century people have deplored what
Thomas Szasz said. The trouble is, he usually didn’t say it.
Szasz was on the editorial board of Existential
Analysis from 1994 until his death in 2012. But most existential therapists
disapproved of him just as everybody else did. This Journal published various
criticisms of him (Cohn, 1992; Sabbadini, 1992; Hetherington, 2002; Wolf, 2002)
and two members of the board circulated emails denouncing me for inviting Szasz
to conduct an Inner Circle Seminar.
I argued (Stadlen, 2003) that the
criticisms were ill-informed and illogical. I called for serious
criticism of Szasz in this Journal.
Szasz conducted three Inner Circle London
Last year the Journal published my obituary
of Szasz.
In my paper (2003) and my obituary (2013) I
tried to show, inter alia, that the accusation
that Szasz is a ‘Cartesian dualist’ is wrong.
Now, in the last issue of this Journal, Christina
Richards (2014) offers what she calls a ‘critique’ of Szasz’s The Myth of
Mental Illness (1961). She says she seeks to ‘honour’ Szasz’s memory
‘through robust engagement with his thoughts and ideas’ (Richards, 2014: 76).
She repeats the claim of Szasz’s ‘Cartesian dualism’ (67, 70).
How ‘robust’ is her ‘critique’?
Is it a critique?
A critique must understand what it
criticises. Has Richards delivered a critique? Only then can the question whether
it is ‘robust’ arise.
1. ‘Cocaine and scaffold poles’
Richards’s title is: ‘Of cocaine and scaffold poles’. These,
for her, indicate ‘mental illnesses’ with a biological cause, her counter-examples
to Szasz’s thesis. ‘Cocaine’ refers to ‘cocaine use disorder’ (69); ‘scaffold
poles’ to ‘a scaffold pole fall[ing] through [someone’s] head’ and causing a
frontal lobe injury (71, 73, 75). Hence the ‘coked up, disinhibited person with
a frontal lobe injury’ (76).
But these examples in no way contradict
Szasz’s thesis. He agreed that brain illness or injury, or drugs, may cause psychological
confusion. He insisted that, if someone proves to have a brain illness or
injury, or a ‘toxic psychosis’, then that is what they have – a matter
for neurologists. But he objected to the assumption that they have it.
He wrote (Szasz, 1978a, quoted in Vatz and
Weinberg, 1983: 92-3):
It is of course possible that some persons now
identified as schizophrenic suffer from a biological brain abnormality; that
such an abnormality affects their behavior, making them the victims of an
‘organic psychosis’; and that although such a specific biological defect is at
present not yet demonstrable, it may, with the development of more
sophisticated biomedical technology, become demonstrable in the future …
We are already familiar with a score of
such diseases –Parkinsonism, epilepsy, pheochromocytoma, Cushing’s syndrome
(endogenous and exogenous), as well as diabetes. All of these diseases ‘cause’
mental symptoms.
Richards notes (69) that DSM–5 includes
‘physical illnesses that affect the mind’. She argues that these are,
therefore, ‘mental illnesses’. Szasz accepted such illnesses, but not as
‘mental illnesses’. She declares that ‘social illness
is, in a very real sense, brain illness and vice versa’ (70). Szasz rejected the
concept of ‘social illness’ as a vague metaphor. But he accepted as obvious
that social, interpersonal and psychological problems can have physical,
biological and medical consequences, and vice versa.
Szasz’s first papers were in ‘psychosomatic
medicine’, including ‘The psychosomatic
approach in medicine’ (Alexander and Szasz, 1952)
written with his teacher Franz Alexander. In The Myth of Mental Illness,
Szasz criticised philosophical confusion in this field, including Alexander’s ‘image
of mind and body as two aspects of the same coin’ (Szasz, 1961: 103). But he
assured me, at the end of his life, that he stood by his early papers and saw
this as a field wide open for research.
Richards’s deployment of
‘cocaine and scaffold poles’ repeats an often repeated misunderstanding of Szasz, that he denies the
influence of ‘mind’ on ‘body’ and ‘body’ on ‘mind’. He did not deny what is so
described, but he objected to this dualistic way of describing it. But Richards
does not see this, and accuses Szasz himself of dualism.
2. ‘Cartesian
dualism’
Richards’s throwaway remark ‘Of course, this is
Cartesian dualism’ (67) and her casual reference to ‘Szasz’s notion of a Cartesian
dualistic split’ (70) are not ill-argued. They are not argued at all. Richards ignores
Szasz’s criticism of, and attempt to transcend, so-called ‘Cartesian dualism’
in The Myth of Mental Illness and elsewhere. She ignores half a
century’s debate about whether Szasz was a ‘dualist’, and my evidence in this
Journal (Stadlen, 2003; 2013) that he was not.
Szasz wrote to me (2002):
The dualism accusation is a
red herring. Suppose, for the sake of argument, I am a dualist, bad man, Jew,
Nazi, etc. What has this to do with whether it is justified to lock up someone
who talks of suicide or to claim that homosexuals are diseased?
It matters, though, whether the ‘dualism’
accusation is right or wrong. In another paper I shall develop my argument that
it is wrong. Here, I shall merely point to the abundant evidence that Szasz was
trying to transcend so-called ‘Cartesian dualism’.
Such an attempt is difficult. Many
have failed, as Szasz says (1961: 103) of Alexander; as Heidegger (2001 [1987]:
120, 143) and Boss (1971: 321-329; 1979 [1971]: 127-131) say of Husserl, Binswanger,
Marcel, Sartre and Merleau-Ponty; and as Merleau-Ponty in a 1959 note (1964: 253)
says of his own Phenomenology of
Perception, which Richards (67) commends for its ‘intertwining’ of
‘mind’ and ‘body’.
But the point is that Szasz tried. Richards
could have learned this from the sources she mentions, let alone those she does
not mention.
She mentions, but does not examine, Szasz’s
1960 paper ‘The myth of mental illness’. She confines herself, without
explaining why, to the 1974 edition of the 1961 book The Myth of Mental
Illness. There are four editions, which differ in important ways: the first
(1961), the Paladin (1972), the ‘second’ (1974), and the 50th-anniversary
(2010).
She does not mention, let alone examine,
any other of Szasz’s thirty-five books or hundreds of papers.
She selects from this vast oeuvre only the simplified
1974 edition of The Myth of Mental Illness to compare with what she calls the ‘great strides … in
neuroscience’ from 1960 to 2014. She ignores the ‘great strides’ Szasz made during this time.
In the first (1961) edition of The Myth of Mental Illness Szasz mentions
‘Cartesian dualism’ four times. He writes (78):
The concept of ‘mental pain’, like ‘moral disgust’,
codifies the Cartesian dualism, according to which the world consists of two
sets of realities, one physical and one mental.
He criticises Felix Deutsch and Leon Saul
for ‘adhering to the simple Cartesian view of twin realities’ (101), and his
former co-author Franz Alexander for continuing ‘to adhere to the traditional
Cartesian mind-body dichotomy, no matter how hard he strained to overcome it’
(103). He wrote (104):
The challenge of the Cartesian dichotomy was not met.
It was side-stepped.
In each of the three later editions, Szasz
mentions ‘Cartesian dualism’ (by name) once only.
In the Paladin edition (1972: 89), he repeats
only the first of the above four references. In the 1974 and 2010 editions, he omits
all four but adds a new one (78):
In effect, then, Freud’s theory of conversion was an
answer to the question, How and why does a psychological problem manifest
itself in a physical form? This question rearticulated the classic Cartesian
dualism of mind and body and generated the new psychoanalytic riddle of the
so-called ‘jump from the psychic into the organic’ – which psychoanalysis, and
especially the theory of conversion, then allegedly sought to clarify.
Thus, although Richards could have found four
times as many references to ‘Cartesian dualism’ in the first edition (1961),
she could still have found this one reference, whose importance we shall see in
section 3, in the one edition (1974) she does discuss.
She could have found more in Szasz’s other
writings. The first part of his first book, Pain
and Pleasure: A Study of Bodily Feelings (1957), has the title ‘The Mind-Body Problem in the Light of the
Philosophy of Science’. Szasz cuts to the chase (14):
instead of first running into
the mind-body problem and then trying to deal with it, I have chosen to tackle
this problem first …
And (21):
Freud himself apparently
never could shake off the shackles of the classical Cartesian dualism … He
accepted the everyday distinction between mental and physical pain and tried to
account for it along psychological lines. The following excerpts illustrate his
adherence to the Cartesian view of mind and body …
Szasz writes (22)
of ‘the common dualistic causal approach to so-called mental
disorders’ (my emphasis). One would expect this ‘so-called’ from Szasz, who had
never believed in ‘mental illness’ (Schaler, 2004: 28). But he also writes
of ‘the difficulties which the so-called Cartesian dualism brings
in its wake’ (my emphasis). Thus
he realised, in 1957, that so-called ‘Cartesian dualism’ is
not Descartes’s dualism. This
was only shown in detail four decades later by the philosophers Gordon Baker
and Katherine J. Morris in their book Descartes’ Dualism (1996).
This explains, I
suggest, why he reduced the references to ‘Cartesian dualism’ in all editions
of The Myth of Mental Illness after the first. He opposed psychiatric
and ‘psychosomatic’ dualism even more fiercely, but in honesty must have hesitated
to call it ‘Cartesian’.
The philosophers whom Szasz cites in Pain
and Pleasure and The Myth of Mental Illness all tried to transcend
‘mind-body dualism’: Moritz Schlick (1935), Alfred North Whitehead (1938),
Susanne Langer (1942), Bertrand Russell (1948), Gilbert Ryle (1949).
The psychiatrist Ronald Leifer, Szasz’s
student in the 1960s, reports (Leifer, 2013) that the first books Szasz set his
class were Susanne Langer’s Philosophy in a New Key (1942) and Gilbert
Ryle’s The Concept of Mind (1949), remarkable attempts to transcend dualism.
Szasz adopts Langer’s
term ‘non-discursive language’ and Ryle’s terms ‘myth’ and ‘category-mistake’ and
his proposal that ‘mind’ and ‘body’ are like team spirit and team rather than two
sides of a coin. Ryle’s first chapter is ‘Descartes’ Myth’.
In Philosophical
Sketches (1962: 2) Langer herself acknowledges Szasz’s Pain and Pleasure (1957) as
a recent attempt to resolve ‘the mind-and-body problem’.
The philosopher Antony
I’ve always had
the idea that [Szasz] (like Descartes and other great thinkers) was a much
deeper, more complex and more defensible thinker than many of the popular
accounts would allow.
In The
Meaning of Mind: Language, Morality, and Neuroscience (1996), Szasz
argues that ‘mind’ is a verb, wrongly reified as a noun. This alone shows the
absurdity of attributing to Szasz the dualistic view that ‘mind’ and ‘body’ are
separate substances.
I shall sketch
some of Szasz’s ideas in this late book, not because all are correct (some are
not), but to show that he was still exploring radical ways to transcend dualism.
He claims ‘mind’
was used only as a verb before the sixteenth century. This is wrong. Chaucer (1957
[1933]) uses it ca. 1386 as a noun, rhyming it five times in The
Man of Law’s Tale alone.
But Szasz is surely
right that ‘mind’ has been increasingly reified and substantialised over the
centuries to culminate in today’s alienated and dehumanised psychiatric concept
of ‘mind’.
He wrongly says that
(106) ‘when Descartes wrote in French he always used the word l'âme [the soul]’. Descartes also used the Latin
mens and the French esprit, which both mean ‘mind’.
Szasz concludes
(107):
If I interpret Descartes’
thesis correctly, it is a mistake to blame him for the division of the human
being into body and mind and to name this dichotomy ‘Cartesian’.
This is not
quite right. But it shows again that Szasz had independently realised what
Baker and Morris (1996) demonstrated that very year: that Descartes’s dualism
was not ‘Cartesian dualism’.
Szasz says (107)
that Descartes was
a pioneer neuromythologist,
the first to claim to have discovered evidence for locating the soul inside the
cranium.
But Descartes
was born in 1596. Shakespeare (1957: 443), writing ca. 1594-6,
already has Prince Henry, in King
John (act 5, scene 7), speak of
his dying father’s
… pure brain
Which some suppose the soul’s
frail dwelling-house …
Richards does not mention Thomas Szasz:
Primary Values and Major Contentions (Vatz and Weinberg, 1983), which
contains long extracts from Szasz’s works, criticisms by other writers, and
responses by Vatz and Weinberg. Nor does she mention Szasz Under Fire: The
Psychiatric Abolitionist Faces His Critics (Schaler, 2004), which contains
twelve critical essays by world authorities each answered by Szasz at such length
that this is in effect his thirty-sixth book.
In Szasz Under Fire (Schaler, 2004:
122), Ray Scott Percival tries to interest Szasz in Popper’s dualism which, Percival
claims, would be
a stronger argument for the myth of mental illnesses …
Popper’s argument for dualism is the strongest case against the reductionist
view. Popper argues that there are at least three radically different classes
of thing … there are three worlds …
Szasz responds (Schaler, 2004: 131):
Ray Percival agrees with my argument and seeks to
perfect it. He does so, moreover, by using the ideas of Karl Popper, a
philosopher whose work I also admire.
But he declines Percival’s
invitation (134):
Creating the categories of Worlds 1, 2, and 3 was
decidedly not one of Popper’s good ideas. I recognise only one world, the world
of everyday life (which includes all of Popper’s three ‘worlds’).
Thomas Engelhardt acknowledges in his
critique of Szasz in Szasz Under Fire (Schaler, 2004: 367) that Szasz’s
position ‘should not be read as a Cartesian dualism of substances’. Szasz responds
(380-1):
I agree that … my position ‘should not be read as a
Cartesian dualism of substances’.
It is regrettable that Richards did not
take account of this rich and civilised tradition of dialogue between Szasz and
his serious critics.
But, even without it, might she not have
questioned the cliché of Szasz’s supposed ‘Cartesian dualism’? He didn’t even believe
in ‘the mind’, let alone in ‘mind’ and ‘body’ as separate ‘substances’. And his
opponents say there are two kinds of illness, ‘physical’ and ‘mental’ –
but he said there is
only one. A singular ‘dualist’.
3. ‘Hysteria’
Richards (68) writes that ‘hysteria’ is an ‘outdated’,
‘misogynist’ term. She implicitly reproaches Szasz for not using the term ‘conversion disorder’ already
adopted by DSM–1 (1952).
But Freud invented the terms ‘conversion’ and
‘conversion hysteria’ back in 1894 in his paper ‘The defence neuropsychoses’ and
his abstract for that paper respectively (GW1:
63, 481; SE3: 49, 249). The terms
purport to describe what Freud later called ‘that puzzling leap from the mind
to the body’ (‘jener rätselhafte Sprung
aus dem Seelischen ins Körperliche’) (GW11: 265; SE16: 258). The current DSM–5 (2013) still uses the term
‘conversion disorder’.
The concepts of ‘conversion’ and the
‘puzzling leap from the mind to the body’ are the quintessence of so-called
‘Cartesian dualism’, as pointed out by Boss (1963: 133-146) and by Szasz (1974:
78) in the one reference to ‘Cartesian dualism’ (which I quoted above) in the one
edition of The Myth of Mental Illness
that Richards does refer to.
As it happens, for decades after Szasz’s
1961 book, ‘hysteria’ remained a common diagnosis (Laing: 1961: 32; Walshe, 1963; Slater, 1965; Veith,
1965; Cooper, 1967: 28, n. 1;
Henderson and Gillespie, 1969; Krohn, 1978; Slavney, 1990: 3; Micale, 1995).
But that is not the point. Szasz says he is
(1974: 10)
using conversion hysteria as the historical
paradigm of the sorts of phenomena to which the term ‘mental illness’ refers.
Szasz’s is an historical study. He does
not believe in ‘hysteria’ or ‘conversion’. He is analysing the use of these terms, from
the 1880s on. He is not interested in finding a politically correct term for
the DSM.
Why does Richards not criticise DSM–5 for its outdated ‘Cartesian dualism’?
4. ‘Perhaps somewhat disingenuous’
Richards writes (68):
Szasz’ use of hysteria throughout The Myth of Mental Illness
is perhaps somewhat disingenuous. It is trivial to assert that a person with a
conversion disorder has nothing physically wrong with them, and that (if we
accept Szasz’ assertion regarding the term ‘mental illness’ above) they
therefore do not have a mental illness – it is a diagnostic criterion that
they have nothing physically wrong with them. Szasz therefore must be correct
when he suggests that the symptomatology therefore fulfils a communicative
purpose only …
Richards’s charge that Szasz was ‘perhaps
somewhat disingenuous’ is a grave one. In plain English, she is accusing him of
lying. She is not the first to do so in this Journal (see Stadlen, 2003).
A writer making such a serious allegation might
be expected to present her evidence as clearly and unequivocally as possible. But
the syntax of the above passage is confused. The word ‘therefore’ occurs three
times, giving an appearance of logical argument, but it is unclear what are the
premisses of the purported conclusions.
She adds the charge (70) that Szasz
conflates ‘hysteria with mental illness’ and ‘psychoanalysis with psychiatry’.
However, if I have understood her
correctly, it is Richards’s reasoning, not Szasz’s, that is logically and
empirically circular.
Traditional psychiatry, just like
psychoanalysis, has regarded, and still regards, ‘hysteria’ or ‘conversion
disorder’ both as a disease like any
other and as having minimal
‘communicative purpose’ (‘secondary gain’). It was Szasz who proposed that ‘hysteria’ was not a disease and that it was primarily
a communication.
A glance at DSM–5 shows that Freud’s
position on ‘hysteria’ remains the position of psychiatry today on ‘conversion
disorder’.
Freud praised Charcot for restoring to the
‘hysteric’ the dignity of being ill. As Szasz (1961) explains, and as I explain
in ‘Was Dora “ill”?’ (Stadlen, 1985; 1989 [1985]), Freud claims that ‘hysteria’
is a real illness, which ‘mimics’ other real illnesses. Not the person, as Freud
sees it, but the illness ‘mimics’ illness. He does not suppose that the illness, let alone the person, is, in general, imitating illness as a communication
to other persons. In his view, ‘hysteria’ is a ‘mental illness’, but he insists
that it has an ‘organic basis’, not yet discovered. In this sense it is a typical ‘mental illness’. This is why Szasz
takes it as a paradigm for ‘mental illness’ (and also for the confusions
of ‘psychosomatic medicine’), and why he is justified in doing so.
Szasz had already (1959: xxiii), in his
introduction to Ernst Mach’s The Analysis of Sensations (1959 [1875]),
quoted from Freud’s 1905 ‘Dora’ case, ‘Fragment of a hysteria-analysis’ (GW5:
276; SE7: 113):
It is the therapeutic technique alone that
is purely psychological; the theory does not by any means fail to point out that
neuroses have an organic basis …
Freud is insisting that, though there is apparently, in Richards’s words, ‘nothing
physically wrong with’ the ‘hysteric’, nevertheless there is something ‘physically
wrong with’ him or her. This is crucial.
In 1895 (GW1: 227; SE2: 160) he
wrote that his case studies ‘read like novellas’, but that this was the right
way to bring out ‘the relation between Leidensgeschichte (deep existential
suffering-history or passion narrative) and Leiden
(surface complaint or
‘symptoms’)’ (GW1: 200; SE2: 138). However, Freud still took for
granted the natural-scientistic view, as Szasz points out (1961: 75):
Problems of human living – or of existence [my emphasis –AS] as we might say today
– were thus treated as though they were manifestations of physical illness.
Towards the end of his life, Freud (GW14:
293; SE20: 255) called psychoanalysis ‘weltliche Seelsorge’ (‘secular
cure of souls’). But he stood by his natural-scientific (more correctly,
natural-scientistic) vision of man. The existential psychiatrist Ludwig
Binswanger in his 1936 lecture for Freud’s eightieth birthday called it ‘homo
natura’, man as object for natural science. Binswanger warned (1947a
[1936]: 184; 1963a [1936]: 174; my
translation; Needleman’s is defective):
the natural-scientific idea of ‘homo natura’
must destroy the human being as a being living in manifold directions of
meaning and only to be understood from them … until … precisely everything
which makes a human being into a human being and not a brutish creature is
annihilated …
And (1947a [1936]: 188; 1963a [1936]: 178):
Thus Freud stands before us as the
paradigmatic man of the twentieth century [seines Säkulums].
This devastating critique by a good friend
of Freud’s is exactly the point Szasz is making in choosing Freud’s theory of
‘hysteria’ as paradigmatic of the natural-scientific medical-psychiatric theory
of ‘mental illness’ in the twentieth century.
To recapitulate: Charcot redefined men and women
who had been called ‘malingerers’ as ‘patients’ whose ‘mental illness’,
‘hysteria’, allegedly had an ‘organic basis’. Freud saw his own patients, such
as Dora, as suffering from this ‘illness’. If they appeared to be imitating
illness, this was an illusion. They were not persons but what Freud
called, in his 1936 letter of thanks to Binswanger, ‘culture-specimens of homo
natura’ (Freud/Binswanger, 1992: 237; 2003 [1992]: 212). Their illness,
not they, imitated other illnesses. All this would, he assured his readers,
eventually be explained by natural science.
Szasz (1961: 48) shows that Freud was not
alone in this approach. On the contrary, it was paradigmatic of how psychiatry
works. Although Freud was not a psychiatrist, he aspired to be accepted by
psychiatrists. To see human action as mere happening, and imitating illness as
itself illness, is not exceptional but typical of what psychiatrists did
then and still do.
Thus, in mid-twentieth century, the eminent
psychiatrist and psychoanalyst Kurt Eissler wrote (1951: 252-253):
…malingering is always the sign of a
disease often more severe than a neurotic disorder … It is a disease which to
diagnose requires particularly keen diagnostic acumen. The diagnosis should
never be made but by the psychiatrist.
In his book Insanity: The Idea and its Consequences, Szasz (1987:
205-206) discussed so-called ‘factitious
post-traumatic stress disorder’, whose ‘victims’ reported ‘symptoms’ due to
their ‘combat in Vietnam Vietnam
And the just published DSM–5 Clinical
Cases (2014: 189) counsels:
It is incumbent on all providers to remember that
patients with factitious disorder are quite ill, but not in the way they pretend.
As for ‘hysterical symptoms’ as communications,
Szasz notes (1961: 150-1) that, while Freud was ‘a master at elucidating the
psychological function of indirect communications’, he did little such
elucidating with ‘hysteria’. I presume this was precisely because he saw it as
an ‘illness’. But even with dreams, slips and jokes, his primary focus
was their ‘intrapsychic’ function, not their interpersonal intentionality.
His patient Frau Cäcilie
M. had an ‘hysterical symptom’ resembling trigeminal neuralgia. Freud writes (GW1:
247; SE2: 178):
When I began to call up the traumatic
scene, the patient saw herself back in a period of great mental irritability
toward her husband. She described a conversation which she had had with him and
a remark of his which she had felt as a bitter insult. Suddenly she put her
hand to her cheek, gave a loud cry of pain and said: ‘It was like a slap in the
face.’ With this her pain and her attack were both at an end.
Szasz suggests (1961: 159) a number of
possible communicative meanings of this ‘symptom’. But Freud does not
say that Frau Cäcilie produced this ‘symptom’,
or relived this ‘scene’, in the presence of her husband or Freud, in order
to communicate that the remark felt like a slap in the face. This was
Szasz’s fundamentally innovative suggestion. Esterson (1982) took it a step
further when he suggested to me that her husband may have intended it as
a slap in the face.
When the ‘young man’ forgets the word aliquis
in a line of Virgil he was quoting to Freud, Freud interprets (GW4: 13-20; SE6: 8-14) that the ‘young man’ did so because he was anxious that
he might have made his mistress pregnant. Freud does not say that he
forgot the word in order to communicate his anxiety to Freud.
Freud reports (GW5: 235-236; SE7:
73-74) that Dora dreams of a fire and smells smoke. He ‘interprets’ to the reader,
but does not say whether he ‘interpreted’ to her, that, as he is a ‘passionate
smoker’, she would probably like a smoke-smelling kiss from him. But he does not
say that she dreamed of the fire, or told him her dream, in order to communicate
this supposed desire to him.
In all Freud’s writings on ‘hysteria’ –
from his 1886 report on his time with Charcot, through the 1893 paper on
‘hysterical paralyses’, the 1895 Studies on Hysteria, the 1896
‘seduction theory’, the 1905 ‘Dora’ case and the 1906 retraction of the
‘seduction theory’, to the 1908 papers on ‘hysterical phantasies’ and
‘hysterical attacks’ – he regards ‘hysteria’ as a typical ‘mental illness’, a
real disease that has an ‘organic basis’ yet to be discovered. And he assigns ‘communication’
a nearly negligible role, as so-called ‘secondary gain’. This has been the
position of mainstream psychiatry from the nineteenth century to the present DSM–5.
Freud’s rhetorical claim (GW1: 427; SE3: 192) about ‘hysterical symptoms’ was ‘Saxa loquuntur!’
(‘The stones speak!’). He, Freud, could decode that they spoke of sexual abuse
in childhood. He must have known the inscription above the entrance to the Siegmundstor
tunnel in Salzburg
Freud writes in the ‘Dora’ case (GW5: 240; SE7: 77-78):
He
that has eyes to see and ears to hear may convince himself that no mortal can
keep a secret. If his lips are silent, he chatters with his finger-tips;
betrayal oozes out of him at every pore.
But Freud gives no indication that he
supposes the ‘mortal’ is ‘chattering’ to anyone but himself.
He does write of ‘motives for being ill’ (GW5: 205; SE7: 46):
In
Dora’s case that aim was clearly to touch her father’s heart and to detach him
from Frau K.
It is on such occasional discussion by
Freud of ‘secondary gain’ that Szasz built his communicational theory.
Thus there is not even a prima facie
case for Richards’s allegation that Szasz’s use of ‘hysteria’ in The Myth of
Mental Illness is ‘perhaps somewhat disingenuous’.
5. ‘Compassionate
practice’
Richards suggests (66):
… there can indeed be ‘mental
illness’ but … this may nonetheless lead to compassionate practice.
And (75):
… we might imagine a mental
illness which allows for the provision of services, including the deprivation
of liberty where necessary, but which is founded on dignity and respect …
People may show compassion whether ‘mental
illness’ exists or not, and whether they believe it exists or not. They may show
compassion while obeying orders to keep their jobs, whether or not they believe
it is justified to deprive innocent people of liberty.
6. ‘Mental
health and anti-psychiatry’
Richards praises The Myth of Mental Illness as
‘a seminal work in the field of critical mental health and anti-psychiatry’
(66).
Szasz’s work was not ‘in the field
of critical mental health and anti-psychiatry’.
He denounced the concept of ‘mental
health’, ‘critical’ or uncritical, exactly as he denounced the concept of
‘mental illness’. He regarded both concepts as inseparable aspects of a single
myth, metaphor and mystification.
He denounced so-called
‘anti-psychiatry’ (Szasz, 1976a; 1978b). His penultimate book was Antipsychiatry:
Quackery Squared (2009).
In the 50th-anniversary edition
of The Myth of Mental Illness, not mentioned by Richards, he wrote
(2010: xxix):
Subsuming my work under the rubric of antipsychiatry
betrays and negates it just as effectively and surely as subsuming it under the
rubric of psychiatry. My writings form no part of either psychiatry or
antipsychiatry and belong to neither. They belong to conceptual analysis,
socio-political criticism, civil liberties, and common sense. That is why I
rejected, and continue to reject, psychiatry and antipsychiatry with equal
vigor.
7.
‘Compassionate physician’
Richards (76) claims that Szasz has ‘proved an
inspiration in the development of many aspects of my thinking and practice’.
She praises him as a ‘compassionate physician’. He was, but how does she know?
He was also highly knowledgeable about medicine. He diagnosed his daughter’s
lupus, which the specialists had missed (Szasz, S., 1991: 35). But he wrote
(Schaler, 2004: 381):
I have long ago embraced the risk of impairing my
credibility by rejecting the role of the correct psychiatrist qua physician who ‘believes in mental
illness’. I did so because I love medicine, not because I hate it; and because
I feel secure enough in my medical identity, which I earned by hard work and
maintained by vigilant interest in the subject, without feeling the need to
bask in the glory (or shame) it reflects on me when what I do is not done in
my role as a physician. In short, I have not looked to my medical
credentials as a means for validating my work.
Richards is praising Szasz as a ‘physician’
to the ‘mentally ill’ – the opposite of what he
said his life’s work meant. She claims to ‘mean no disrespect to his memory’ (76),
and I believe her. To disrespect one must understand.
Anthony Stadlen is an
existential-phenomenological analyst, family analyst, supervisor and teacher in
London ; convenor of Inner Circle Seminars;
historical researcher on paradigm case studies of psychotherapy; former
Research Fellow, Freud Museum , London
Address: ‘Oakleigh’, 2A Alexandra
Avenue , London N22 7XE
Email: stadlen@aol.com
Inner Circle Seminars: http://anthonystadlen.blogspot.co.uk/
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1 comment:
Excellent! Thank you for posting this. Would you be interested in doing a podcast with me about Szasz?
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