Insanity The Idea And Its Consequences By Szasz Essay, Research Paper

Insanity the Idea and its Consequences by SzaszWell, I highly recommend Szasz’s book _Insanity: the Idea and itsConsequences_. I can’t say for sure on this, but apparently thereis an overwhelming tendency among “real” doctors to define diseasein terms of objectively verifiable cell damage (perhaps parallel toTV-repairmen’s definition of “broken” in terms of not turning on?). I’ve had the chance to ask one or two doctors about this, and theysaid that that is true, for whatever it’s worth. Apparently,pathologists have no interesting controversies about what is a”disease,”and they have clear criterion for establishing them as such. But perhaps the real problem is that people are taking philosophicalstances under the pretense of science. For our intuition (mineat least) is that there are two very different kinds of things:_inabilities_ and _unwillingnesses_. A person has a disease ifthey are _unable_ to do something they otherwise could; a personhas a pseudo-disease, dubbed a mental illness, if they are _unwilling_to do something that psychiatrists think they ought to do. Thephilosophical difficulty underlying is probably that most doctorsare determinists who believe that free will is illusory; henceapparent unwillingness is merely another form of inability. Of course, the problem is then that _all_ undesirable (undesiredby shrinks?) behavior is a fortiori a disease. Not a plausibleconclusion, though of course many embrace it. Now perhaps it will be argued that I am setting up a straw man. Forcould we not take an intermediate position, according to whichmost apparently unwillingness is voluntary, but the extreme tails areactually inabilities? I don’t claim that this view is incoherent. But here are my reasons for taking the “extreme” view that allbehavior not traceable to brain damage and the like is fully voluntary. I begin with a wonderful line from the Roman poet Terence:Homo sum, humani a me nihil alienum puto. I am a man, and nothing human is alien to me. What am I getting at here? Simply, that there is no “insane”behavior that is so foreign to me that I cannot see it as oneof the countless manifestations of the depths of the human soul. Adolf Hitler orders the death of millions of Jews. I cannotempathize with his decision; but I _understand it_; for I understandthat hatred and cruelty are one facet of the human personality. As I child, I was a little bundle of passions; and I rememberfeeling hatred that could have led me to take life were I not apowerless child. Jeffrey Dahmer raped and tortured boys, thenmurdered them and ate them. Again, we may view his action asunthinkable, but is it? Isn’t sexual obsession yet another facetof the human personality? One needn’t feel the same impulses tounderstand that a different person may have different impulses,and that they may choose to act on them. Think of any great character from literature. Wouldn’t the wholelot of them be labelled “mentally ill”? Literature, with itsdepictions of the depth of the human personality, with its depictionsof the reaction of ordinary people to extreme circumstances. Butisn’t it the essential characteristic of great literature that itmakes us see the world through the eyes of another person, makestheir behavior and choices seem natural to us, makes us see ourselvesin another? When we read _the Brothers Karamazov_, for example,we experience Dmitri’s desire to kill his father as natural;and we experience his choice _as a choice_. Similarly,Smerdyakov’s choice to murder his father solely in order to proveto himself that moral law does not bind him: we experience his choiceas a choice, because we recognize his action as a manifestation ofa desire to rebel that all of us understand. And finally, whenSmerdyakov hangs himself from guilt — is that any less understandableto us? Is action followed by intense remorse so hard to understandas part of the human experience? Surely anyone who has deliberatelyhurt one he loves has felt the urge to suicide; or at least _we canunderstand_ such an urge. These examples are merely meant to jolt your intuitions. Beforeus we have two hypotheses: the determinist one that at leastextreme behavior is really a kind of inability, even though it appearsto be merely an unwillingness. And the hypothesis of radical freewill, which claims that there is no human behavior so bizarre andwicked that we cannot readily understand it as a free choice oncewe try. But — what about studies showing that schizophrenics have 50%more of some chemical in their brains? When I see claims like these,I can only intone “reverse causation” again and again. Perhapsmaking unusual choices _causes_ the presence of unusual chemicals,rather than the other way around. Certainly if we accept introspectionas a form of observation — and why shouldn’t we? — we have lotsof support for this idea. I suppose a reductio ad absurdum of myview here would be that you could even claim reverse causation forbrain tumors. True enough; I would distinguish this case in virtueof the fact that no one has been shown to be able to produce a braintumor into existence on demand, whereas surely they could do sowith some brain chemicals. I have something related to say about the ability of drugs to changebehavior, which is usually supposed to show that somehow the originalcondition was a “treatable disease.” I just think that this ideais (if you pardon the expression) crazy. Suppose we give a happyperson a drug that makes him miserable: does this show that happinessis a disease? Similarly, why should a drug that makes a sad personhappy show that sadness is a disease? Or suppose we give aso-called “hyperactive” kid Ritalin, and he calms down. How doesthat show that “hyperactivity” is a disease? Would calmness beshown to be a disease if a drug could turn calm kids hyperactive?–But what should we make of these claims that “what is a disease” isculturally determined? Well, there are two interpretations of thisstatement. The first one is anthropological: people acquire theirviews of disease from other people in their culture. The second isepistemological: the _justification_ of a statement like “X has adisease” is cultural. Now the first view might be coherent; butthe second surely is not. For how could the mere agreement ofa bunch of people that “X has a disease” make the proposition true?Only, to be sure, if “diseased” is just a disguised way of saying”to be pitied” or “lacking valued abilities.” But if this were thecase, why not get rid of of the word and say what we really mean?But I submit that this option is rather counter-intuitive. Forsuppose I proposed the following bare-bones definition of disease:a person has a disease if his body contains bacteria or viruseswhich will kill him within 24 hours. Of course this definition doesnot exhaust our common-sense concept; but surely it is not “culturallydetermined” whether a person has a disease in this sense. NowI suggest further that the above is _sufficient_ for”having a disease” in the _common-sense_ meaning of the term;hence there are at least some cases where the presence of disease

is not culturally determined. Or to reverse the perspective: surely a witch doctor or Sovietpsychiatrist’s view that “Bill has a disease” is just plain wrong. They may have the backing of their culture, but nevertheless they err. Don’t they?–You make an interesting use of Rawls’ concept of the original positionto justify involuntary commitment, drugging, etc. I assume you getthis out of section 39, where he tells us that: The problem of paternalism deserves some discussion here, since it has been mentioned in the argument for equal liberty, and concerns a lesser freedom. In the original position the parties assume that in society they are rational and able to manage their own affairs…But once the ideal conception is chosen, they will want to insure themselves against the possibility that their powers are undeveloped and they cannot rationally advanced their interests…[Mention of children and the mentally disturbed as prime examples, but continues as follows] It is also rational for them to protect themselves against their own irrational inclinations by consenting to a scheme of penalties that may give them a sufficient motive to avoid foolish actions and by accepting certain impositions designed to undo the unfortunate consequences of their imprudent behavior. (section 39, pp.248-249)Now the case of the mentally ill should be particularly problematicfor Rawls, because he explicitly states that the choice of principlesof justice must be neutral between different “conceptions of the good.”But why shouldn’t the values and choices of the putatively mentallyill be interpreted as a different conception of the good? Thisis especially clear when the so-called mentally ill are perfectlylucid but behave “strangely.” For example, supposedly mentallyill people who are voluntarily homeless; why should their “conceptionof the good” be weighted differently than the similar desire ofthe Franciscan monk to take a vow of poverty?You do touch on the interesting issue of childrens’ rights. Sufficeto say that there is a big difference between practicing paternalismon people whose intelligence and knowledge are drastically limited,and practicing it on another adult who has normal abilities butbehaves strangely. I think that hypothetical consent may make senseas a standard for young children and the retarded, but extending itfurther seems laden with grave difficulties. –I conclude this rather long comment with my normative views. To begin with, I believe that medical care should be basedupon the consent of the patient; and moreover, so should pseudo-medical care. Just because I don’t consider “mental illnesses”to be real diseases doesn’t mean that people shouldn’t be ableto buy drugs to try to change their behavior. But as least asimportant: just because someone doesn’t like your behavior, andpossesses a drug that can change you, doesn’t mean they have a rightto involuntarily drug you. Now of course “mental illness” does exist in one sense: there isvery strange behavior, some of it harmful to oneself, some harmfulto others. If harmful to others, then I favor appropriate criminalpenalties, much as I support the rights of devil-worshippers untilthey start sacrificing children, at which point I favor standardpunishments. If harmful to themselves, then of course I favor nopenalty at all. The sorrow that self-destructive people bring to otherssimply has to be accepted and dealt with by voluntary persuasionand the like. (As Szasz says: “The truth is, the mentally ill arenot disturbed; they are _disturbing_. They are not sick, they are_sickening_”)Probably the two obvious policy implications that drop out here are(1) I oppose involuntary commitment and (2) I oppose the insanitydefense. Now of course the difficult case arises with children. To beginwith, I believe that we should stop trying to make ourselves feelbetter by labelling the drugging of problem children as “treatment.”Once we face that harsh fact, we will have to judge whether itis a good idea to change bad behavior using drugs, taking intoaccount that the child’s lack of recourse raises the burden ofscrutiny which we must impose upon ourselves. –To conclude, I believe that one of the greatest errors of modernthought is the medical metaphor. The medical metaphor addsnothing to our knowledge of human choice and behavior; indeed,it takes away the deep and penetrating knowledge that we once hadwhen we looked at every human being as another free-willed being. Calling wild mood swings “multiple personality disorder” doesn’tteach us anything; but it is not without purpose. Its purposeis to de-humanize the person, to strip him of his dignity,and to justify coercion. ————————-I would think that mathematical _potential_ is determined byyour brain. There is a little to how good I could get at math,no matter how hard I tried. “Being a genius” is rather different;you have to take advantage of some of your mathematical abilityby applying some effort before you could be considered a “genius.”Maybe I should map out my argumentative flow chart a little better. 1. Mental illness by definition cannot be a condition chosen at themoment at which it is occurring. (A physical illness could bechosen at some time in the past, such as when I inject smallpox intomy veins. But it isn’t choosable at the moment at which I amsuffering from it. I think imposing the same restriction on ourconcept of mental illness makes sense.)2. Some conditions considered to be mental illness are straightforwardlybrain diseases. E.g. Alzheimer’s disease, and some effects ofsyphillis. I accept these without a problem. 3. So the interesting class are mental illnesses which don’t appearto be brain diseases. 4. Now to begin with, it isn’t clear that this idea is even coherent. Is the idea of free-floating mental damage, independent of braindamage but not chosen by the mind, a coherent idea?5. Let’s suppose that it is coherent. Nevertheless, should we evenconsider it? E.g., the idea that some people appear to have mindsbut don’t is perfectly coherent; but nevertheless I think it to beabsurd, just based on my own study of my own mind. Similarly, mightwe rule out as absurd the existence of a subset of the populace withoutfree will?6. Let’s suppose we don’t. Now we are at my final argument, whichI perhaps find most persuasive. Terence summed it up: “I am a man,and nothing human is alien to me.” Put a little more formally,when we observe a person, we can apply one of two hypotheses. Thefirst is that they are compelled to act as they do; they don’texperiencetheir actions as choices; they are mentally ill. The second isthat they do experience their actions as choices; and however unusualtheir choices, we can nevertheless _understand_ their choices. Thisis where I draw upon the power of literature: for it depicts theextremes of human action is a manner that makes the actorsunderstandable. And my argument here is that I have never found a case where Ithought that the second hypothesis wasn’t better than the first. I might add a final point: could many of the things called mentalillnesses be so adjuged without making implicit _value judgments_about what kind of life you ought to live? A pathologists can tellyou you have a tumor without judging whether it is good to have atumor (if you are Hitler, it is probably good, right?). Buta psychologist couldn’t tell you that you are hyperactive unlesshe made a value judgment that you should be less energetic andflighty.