Whistling in the wind

There are reasons to be critical of Thomas Szasz’s views about mental illness. For example, few would want to go as far as him in recommending that society manage without a mental health act. His definition of illness as physical lesion also unnecessarily excludes psychological dysfunction as illness.

In his commentary, ¹ Edward Shorter focuses on criticising Szasz on an issue on which he is in fact correct, namely that no biological markers have been found for mental illness. Shorter seems to be using his skills as a historian to suggest that psychiatry has overlooked what he calls obvious evidence of organicity from past research in the role of panicogens in triggering panic disorder; the response of catatonia to barbiturates and benzodiazepines; and hypothalamic-pituitary-adrenal dysregulation in melancholic depression (see my Critical Psychiatry blog entry on 16 May, http://criticalpsychiatry.blogspot.com). The general conclusion from this research, unlike that of Shorter, is that no biological cause of mental illness has been found. Even the American Psychiatric Association admit that ‘brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group’. ²

Szasz has been dismissed as an anti-psychiatrist. Even 50 years later, the point of his ‘myth of mental illness’ has not been understood. Shorter’s unscientific attack on Szasz does not promote the interests of psychiatry.