Academic Taxonomy

Today, I read an excellent review of Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics, edited by Jeffrey A. Schaler. (Unfortunately, the link is not yet available; see below for a bibliographic reference to the paper copy.) In short, Thomas Szasz is a maverick psychiatrist, who has spent the past four decades denouncing the psychological concept of "mental illness," arguing that it is a myth and a method of social control. He does acknowledge that diseases of the brain (neurological pathologies) exist and that one can ascertain such diseases by brain scans and other diagnostic methods. However, as with other physical illnesses, Szasz argues that the state should not coerce anyone into receiving treatment; thus, whether a patient is diagnosed with heart disease or schizophrenia, that patient should have final say regarding whether to receive treatment.

Szasz's critique of "mental illness" as a meaningless term that opens the door for state tyranny forces us to examine the taxonomies we use to describe (on a material level) human behavior.

1. On one level, we can describe human behavior biologically. For example, depression stems partially from a neurological pathology, which can be diagnosed and tested. A simple remedy for the biological side of depression is medication.



2. On another level, we can use sociology, since humans are social, as well as biological, creatures. In the case of depression, environmental factors certainly can and do play a role; for example, one who is physically isolated from others may feel lonely and may, in turn, develop depressive symptoms.



3. On yet another level, we can examine human behavior psychologically. How do we think? Do our thought patterns shape our "reality," causing us to make false assumptions or to see things that "aren't there"? Proponents of cognitive behavior therapy, for example, argue that how we think (notably, our tendency to follow "irrational" ideas) can affect us adversely.

Some of you reading this will find this extremely pedestrian. "Of course we can analyze humans using these three disciplines! This isn't new or interesting!" However, I have observed a tendency both in academia and among the general public to favor one approach at the expense of the others, ignoring the fact that humans are complicated and affected by biology, culture, and thought patterns. While lip service may be granted to human complexity, we often tend to prefer a simplistic "nature vs. nuture" dichotomy.

What ultimately surrounds biological, sociological, and psychological analyses, of course, are philosophical and theological discussions. All academic fields make assumptions about what we know and what we can know (ultimately epistemelogical questions), and all academic fields contribute data/cases/examples that can be used in philosophical and theological debates (often, debates of a moral nature). It is very important to remind ourselves constantly that not only are humans complex but that science (whether natural or social) does not answer moral questions. Scientists can and do contribute indispensible data, but they ultimately cannot tell us what is "good" or "bad," at least from within the strictures of their fields. Scientists certainly should have every right to make normative claims, but when they do, we should realize that they are speaking philosophically/theologically, and not scientifically.

Thus, I am grateful for Szasz and his followers for the following reasons:

1. They help us to clarify our understanding of neurological pathologies. An "illness" is something physical, something that one can see represented on a brain scan or in a lab result. The psychological term "mental illness" is not medical at all, but behavioral.



2. We certainly can analyze behavior through other lenses (i.e., social conditions, thought patterns), but at that point, we should not say that we are diagnosing an illness. Someone may be able to overcome depressive symptoms through cognitive behavior therapy, but that is not medicine. (One should note that conventional psychiatry today usually recommends a combination of medication and psychotherapy.)



3. While Szasz helps to clarify our thinking regarding neurological pathologies, he doesn't shy away from making philosophical (specifically, moral and ideological) statements. For example, in opposing the insanity defense, Szasz forces us to return to fundamental questions: At what point do we hold a person accountable for his/her actions? What is an appropriate punishment for a given crime? Does that punishment serve the cause of justice? These are not medical questions but philosophical/theological ones, and we would do well to know the difference.

Reference:

Sullum, Jacob. "Thomas Szasz Takes on His Critics" [Book Review]. Reason May 2005:57+.