The Myth of Mental Illness: Foundations of a Theory of Personal Conduct Paperback – February 23, 2010

I will start by saying I have Bipolar Disorder, and have struggled with it for many years.I've had some time off recently, so I wanted to really investigate the science behind my disorder. I started with two books on mental health policy over the past 50 years ( "American Psychosis" for a negative take, and "Better but Not Well" for a more positive, mainstream take), then I read the latest psychiatric information about the disorder- the suspected genetic causes , the brain chemistry approach, the neurological evidence from the official peer-reviewed literature. I altogether found it unsatisfying. Everywhere I turned, it was always "While the specific mechanism is unknown, it is believed..." or "While specific genes cannot be found, it does seem to run in families..." Even the neurological explanation didn't seem able to distinguish cause from effect, or come up with any predictive mechanism. I began to really question the mainstream, so I read "Anatomy of an Epidemic", which was an excellent summary of all the research showing that the brain-chemistry model is ineffective. I even investigated my own medication, and found that Lamictal, the primary drug of choice for bipolar treatment, was found to be ineffective in 7 out of 9 clinical trials ( Of course GSK only published the positive two).All Thomas Szasz really says here is that we can't view mental illness, that is to say, the major mood disorders and psychoses, as normal diseases. We can't pretend that mental illness is some exogenous force that is totally irrelevant of the victim's life experiences, the victims traumas and tragedies, and the victim's behaviors. In fact, new research into the pscychosocial explanation finds very strong evidence for the importance of these things in predicting the incidence of mental illness. And if its true, as Szasz argues, that there is this very strong psychosocial element, then therapy to understand these issues and perceptions and to allow the patient to change behavior is the best option for treatment. Again, research shows the efficacy of Psychotherapy in general as well as CBT specifically.Finally, I can say he is 100% correct in his assertion that much of psychiatry is inhumane. Involuntary treatment, and even the attitude that certain ways of life are "right" and other ways "bad," are means of controlling people. They are a way for society to get rid of undesirables and call it compassion, and on the other side, an escape valve for the oppressed. A key piece of evidence for this is that "homosexuality" was a mental illness for a long time, something we would scoff at now; that was a means of social control, not a means of helping the patient. Healing can only occur in an atmosphere of respect and dignity, where the doctor respects the patient's rights and autonomy, and where the patient takes responsibility.The book is quite plodding at points, but if you skip his abstract explanations and jump straight to the examples he gives, it is very clear. While I'm not convinced that all mental illness is purely a construction, I think Szasz hits the nail on the head for the general direction Psychiatry has moved.

A good book that both exposes and questions the current narrative regarding mental health.

Now, well into my seventh decade of close, (obviously nonprofessional) dealings with a variety of persons with diagnosed/diagnosable "/mental illness/;" and eleven years after my first reading of Myth...; and reading and taking value from 40 relevant books by the following, I take further instruction from Szasz's knowledge, authority and sensibility: Anon(OCD), Amador,X, BacklarP, Breggin,P, "RoyC"(OCD), Davis,L, Engel,B, Feingold,B, Flach,F, Forward,S, Fumento,M, Glasser,W, Glenmullen,J, Gorman,J, Gottesman,I, Grossman,F, Harvey,P, Hedaya,R, Keefe,R, Landau,E, McKee,W, Miller,A, Moskovitz,R, Papalos, Paris,J, Perlmutter,A, Pfeiffer,C, Podvoll,E, Richette,L, Rosen,L, Sacks,O, Salzman,L, Torrey,EF, Walker,S, Wyden,P&B.Some quotes:"I wish...to reintroduce freedom, choice and responsibility into the conceptual framework and vocabulary of psychiatry.""Mental illness is not something a person has, but is something he does or is.""...little doubt...that both Freud and Sullivan were correct in identifying painful memories, their repression, and their persistent operation, as significant antecedents in the personal and social behavior of hysterically disabled individuals.""An integral part of this scientific ethic is the principle that knowledge...must not...be kept a secret by a small group and used as a source of power to mystify and control, stupefy and dominate, other individuals or groups.""It is important to understand clearly that modern psychiatry - and the identification of new psychiatric diseases - began not by identifying such diseases by means of established methods of pathology, but by creating a new criterion of what constitutes disease.""The reclassification of non-illnesses as illnesses has, of course, been of special value to physicians and to psychiatry as a profession and social institution. The prestige and power of psychiatrists have been inflated by defining ever more phenomena as falling within the purview of their discipline.""The phenomenology of body illness is indeed independent of the socioeconomic and political character of the society in which it occurs. But this is emphatically not true for the phenomenology of so-called mental illness, whose manifestations depend upon and vary with the educational, economic, religious, social, and political character of the individual and society in which it occurs.""...To exhibit, by means of bodily signs - say, by paralyses or convulsions - the idea and message that one is sick is at once more impressive and more informative than simply saying: `I am sick.'""(Some) religious teachings...reward sickness and stupidity, poverty and timidity - in short, disabilities of all sorts..." "...the sick person is entitled to help simply because he is sick...""...the obligatory nature of the care required generates a feeling of helplessness in the person from whom help is sought. If a person cannot, in good conscience, refuse to provide help - and cannot even stipulate the terms on which he will supply it - then truly he becomes the help-seeker's slave.""...the hysteric plays at being sick because he is afraid that, if he tried to participate competently in certain real-life activities, he would fail.""The hysteric's seeming ignorance of what he is doing may also be interpreted as his not being able to afford to know it...""...It is precisely those who play these games (of hysteria and mental illness) most skillfully whose performances are likely to prove successful and whose identities will therefore be authenticated as sick...""The principal alternative to this dilemma lies...in abolishing the categories of ill and healthy behavior...""...even if one could brush aside the pathogenic or pathologic mechanisms, one would have persons who are not at all well-suited to a complex interpersonal environment...""...(The) Ganser syndrome... is the strategic impersonation of madness by a prisoner...the patient, being under charges from which he would be exonerated were he irresponsible, begins, without being aware of the fact, to appear irresponsible.""In the case of malingering, hysteria, and the Ganser syndrome - and, indeed, in all cases of so-called mental illness - psychiatrists actually confirm the patient's self-definition as ill and so help to shape his illness.""...let me emphasize only that investing hope in religious faith is perhaps one of the best psychological investments a person can make...""In the individualistic, autonomous "psychotherapy" which I prefer, the patient himself defines what is good or bad, sick or healthy.""...our goal should be to enlarge his (the patient's) choices by enhancing his knowledge of himself, others, and the world about him, and his skills in dealing with persons and things."Comments:One can take inspiration from the prescient application of Szasz' theory in Helen Keller's story, wherein her live-in teacher, who never heard of Szasz, challenged family opposition and transformed, Helen, who had neither vision, nor hearing, nor speech, nor discipline, into an educated individual superbly valuable to herself and to her society. Surely today's professionals would find her superbly diagnosable.I believe that the case workers, nurses, social workers, ward assistants, housekeepers etc. have been, to varying degrees using Szasz' principles all along. And Glasser seems to have capitalized on this as expressed in his 1965 book, Reality Therapy. All personnel who had any contact with his confined patients were required to attend the meetings. Teamworking, they realized remarkable success.My sister, before her passing with cancer in 1991, had been a housekeeper at Maryland's Springfield State Mental Hospital for about 20 years. Fed-up with mopping up one patient's urine she decided to teach this, no doubt "exquisitely diagnosed," individual how to use a urinal. It was easy, and that solved the problem. And, she conducted a spiritual group for the patients, and she counseled them individually, and, in some cases, she had more success than the professionals with enabling them to return home.Hopefully Szasz' and others' illustrations of psychiatrists' huge cost to our society, combined with the present declines in mental health care funding, will eventually lead us to no longer simple-mindedly admire or gloat about our young who obediently strive to become doctors (perhaps psychiatrists).There should someday exist a book version for the cognitively-disabled, the less educated and the less-English-language-competent.It was painful chopping 5000 words out of my booknotes to write this 1000-word review. A wealth of critical information not here is in the book.Bill Norwood