Is mental illness a myth?

• Author: Vatz, Richard E.

Psychiatrists, physicians, and lawyers are among those arguing over whether deviant, dangerous, or self-destructive behavior has a biological basis.

There has been a running debate over the validity of "mental illness" and its status in the marketplace of ideas. This is to some extent the culmination of many years of criticism of the view that mental illnesses are real illnesses - termed the "medical model" - and more than a decade of efforts in biological psychiatry aimed at demonstrating that they do indeed have a biological basis. The best evidence is that most of the behaviors called mental illnesses are not illnesses and that the skepticism regarding psychiatric claims is increasing, not decreasing.

Psychiatrist Thomas Szasz, whom columnist and former psychiatrist Charles Krauthammer calls "the premier critic of his own profession," has contended for more than 30 years that mental illness is a myth, a point requiring careful explanation. Szasz does not deny that the behaviors labeled mental illness exist. Yet, this remains the most frequent misunderstanding - or purposeful distortion - of his views. As one typical example, Harvard University law professor Alan Dershowitz said of Szasz's position in an interview, "If you've seen somebody who is ... [severely] troubled, you can't believe Tom Szaszs argument that theres no such thing as mental illness."

What Szasz maintains, however, is that calling deviant, dangerous, and/or self-destructive behavior mental illness distracts from an understanding of such acts. Moreover, this type of invidious labeling leads to depriving of the freedoms of some innocent people, such as in involuntary psychiatric interventions. In other situations, it allows the unjustified relieving of individuals of responsibility for their actions, even to the point of exculpation of heinous crimes, such as in the case of would-be presidential assassin John Hinckley.

Szasz believes that the great preponderance of what is called mental illness constitutes problems in living and/or deviant behavior. Illness, he argues, is exclusively "a condition of the body... I define illness as the pathologist defines it - as a structural or functional abnormality of cells, tissues, organs, or bodies."

Psychiatrists employ a number of rhetorical devices to promote mental illness as illness, despite there being no such medical evidence for any but a few of the so-called mental disorders. One is to hitch the general term to a few specific mental illnesses neuropsychiatrists...