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Mental Illness: No Longer a Myth
| Article
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13158 |
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Section : |
MODERN THOUGHT
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| Issue
Date : |
11 / 1987 |
3,919 Words |
| Author
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Paul S. Appelbaum
Paul S. Appelbaum, M.D., is A.F. Zeleznik Professor of
Psychiatry and director of the Law and Psychiatry Program at
the University of Massachusetts Medical School. For the 1988-
89 academic year, he is Visiting Interdisciplinary Professor
at Georgetown University Law Center. |
"The myth of mental illness": No phrase has had as profound an impact on public attitudes toward the mentally ill as this provocative title of a 1960 book by maverick psychiatrist Thomas Szasz. If efforts to understand the origins and effects of mental illness that have long perplexed the public, Szasz has offered an easy way out: What we call mental illness is just behavior of people who have learned to use unusual means of communication. True, they sometimes act bizarrely and appear disturbed. "Real" illnesses, however, always result from changes in body organs that can be seen under the microscope or from physiologic process that have gone awry. Mental illness lacks these manifestations. Thus, he concluded, to call these people ill serves no function other than to discount the messages--often challenges to the status quo--they are trying so desperately to get across.
Szasz's views were greeted with enormous enthusiasm in the sixties. At a time when suspicion of all established authority was on the rise, people were more than willing to believe that the idea of mental illness was being foisted on them by a psychiatric establishment primarily interested in retaining its power and prestige. When new victims of oppression were discovered monthly, the notion that those called mentally ill were so labeled only because they scorned middle-class values and conformist behavior seemed almost irrefutable. And as the college and graduate students who read Szasz--and came to believe that illness was entirely in the eye of the beholder--moved into the positions of power, Szasz's theories began to affect policy toward the mentally ill.
If there were no such thing as mental illness, why should states spend huge sums of money (in some jurisdictions the largest single expenditure in the budget) to maintain state hospitals for hundreds of thousands of patients? The residents of these facilities should be sent back to their communities and the hospitals themselves closed. If psychiatrists were lying--for the sake of maintaining their own power--or at best were simply deluded when they said that someone was mentally ill, why should they have the power to ask courts to commit the innocently deviant to psychiatric facilities? Involuntary hospitalization should be restricted to those who threaten harm to others, or who are suicidal. Suffering should not be grounds for deprivation of liberty. And even if there might still be some basis for hospitalizing people, why should psychiatrists be allowed to treat the unfortunates with potent medications? Those who are not really ill need no treatment at all; they should have the right to refuse drugs.
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