Sunday, January 29, 2012

Made of Paper: Szasz and Laing

In the early 1970s, when I was a college undergraduate, the “anti-psychiatry” movement flourished. The libertarian renegade psychiatrist Thomas Szasz was one of its most celebrated exponents. An heir to the classical liberal tradition, Szasz criticized the practice of involuntary mental hospitalization in the United States and other democracies, as well as the use of the concept of mental illness for ideological enforcement in the Communist regimes.  In The Myth of Mental Illness (1960) and other books, Szasz argued that there is a fundamental difference between the physical problems properly described as disease and supposed sicknesses of the mind. The latter were not defined by bodily malfunctions, but by non-conforming behavior and beliefs. Judgments on the kinds of behavior and beliefs considered “sick,” in Szasz’s view, are no more than attempts to impose one’s own system of beliefs on others.  A system of psychiatric diagnoses, according to this perspective, is a secularized religion, in which psychiatrists have taken the role of priests.  Since those who diagnose mental illnesses have the enforcement powers of the state behind them, Szasz argued, the diagnoses are means of policing thought.
One of the big differences between psychiatrically enforced systems of belief and action and religious systems, is that the former deny the moral agency of individuals. Szasz’s earliest criticisms of the mental illness profession were aimed at the insanity defense in law. If an individual is not responsible for criminal actions because of incompetence to make decisions, that individual has no moral agency. Essentially, then, the insanity defense in criminal trials and the insanity concept in general are strategies for denying free will to some individuals.
I found Szasz’s ideas appealing, but also troubling. It did seem to me like the continual invention of new mental disturbances took away both personal autonomy and moral responsibility from growing numbers of people. Diagnoses of mental incapacity seemed tautologies to me: “Why does he act the way he does? Because he’s crazy.  How do you know he’s crazy? Because of the way he acts.” But there are also situations in which individuals’ views of the world make it impossible for them to care for themselves, and we may be warranted in judging them mentally incompetent. One of the consequences of the decline of involuntary mental hospitalization through the deinstitutionalization trend that began in the 1960s was that the homeless population rose. My own preference would be for families or local communities to care for their own incompetents, whether the source of those individuals’ inability to care for themselves. Unfortunately, our immediate social institutions today are frequently not up to this job, 
Another writer associated with the anti-psychiatry movement who influenced my thinking was R.D. Laing, although Laing repudiated the “anti-psychiatry” label.  Laing’s most valuable contributions came fairly early in his career. After he achieved “guru” status, he became increasingly bizarre, although in the context of this writing it would probably not be appropriate to say that he went crazy.  Laing’s The Divided Self, published in the same year as The Myth of Mental Illness, described people as having a need for selfhood or identity, connected to the identities of other people. Psychological disturbances, for Laing, were ways that people coped with insecurities about their existence as selves. 
Laing was once asked if he believed that there was such a thing as madness. Yes, he answered, but it is not a sickness.  He presented mental problems as what one might call spiritual troubles, rather than clinical conditions. Like Szasz, he saw the medicalization of human behavior as objectification and as an unsupportable denial of free agency. If I say that people are controlled by causes outside their own wills, he once remarked, you will say that I am a good scientific thinker. If I say that I am controlled by causes outside my own will, you will say that I am mad and lock me up.

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