Back in the mid-80’s, I was one of a few, fortunate psychiatrists in Massachusetts in charge of administering the just-released atypical antipsychotic medication clozapine. In our clinic, its use was still limited to a small number of carefully-selected patients with schizophrenia who had not responded to any of the conventional antipsychotic agents.
Harry was one of my first clozapine patients. He had been an inpatient for much of his adult life, and was widely thought to be a “lost cause.” For many years, Harry had been tormented by threatening “voices” urging him to harm either himself or others. He had become a shrunken wreck of a man, pacing the halls with a haunted look on his face, and confined to the inpatient unit with little hope of a normal life.
Clozapine changed all that for Harry. After a few months of treatment, the voices quieted down, and we were able to discharge Harry from the hospital and arrange for placement in a neighborhood residence. As I described in an earlier essay, Harry actually went on to earn his driver’s license.1
But, in the world of mental illness deniers, I was the deluded one. There is no such thing as schizophrenia, these critics claim. Mental illness itself is a “myth”, as famously (or infamously) argued by the late psychiatrist, Thomas Szasz. (Disclosure: Dr. Szasz was one of my teachers during residency). At most, the deniers claim, what psychiatrists call “mental illness” is nothing more than a socially-constructed label, or a misguided metaphor. According to mental illness deniers, the term “schizophrenia” does not identify a “real disease”, like cancer or coronary artery disease; rather, it is a term grounded in a mistaken theory of disease, based on an agenda of social control and coercion. Szasz argued, to his dying day, that only bodily disease is “real”. For him, a “diseased mind” was a contradiction in terms. Szasz argued that classifying thoughts, feelings, and behaviors as diseases was a category mistake, like classifying the whale as a fish.2
Szasz was a genial man, and a brilliant polemicist who still has many admirers among antipsychiatry groups and bloggers. But Szasz was flat out wrong regarding what should count as “disease.”3 When someone is suffering and incapacitated by a condition that destroys the ability to separate delusion from reality, that is real disease. When this person winds up lying dirty and disheveled in an alley way, hearing the Devil’s voice saying, “You don’t deserve to live,” that is real disease. When someone’s thoughts are tangled up in knots; when their emotions are blunted; when they think constantly of suicide, this is not the result of a metaphor or a myth. This is the reality of serious psychiatric illness, like schizophrenia.
To be sure, not all critics of psychiatry are “antipsychiatry.” Some are prominent psychiatrists themselves who rightly point to specific problems within the profession, such as over-prescription of some medications in certain settings, or the use of imprecise diagnostic criteria. In contrast, dyed-in-the wool antipsychiatry groups dismiss psychiatry as a fraud. They write off psychiatric diagnosis as nothing more than pathologizing “disapproved of behaviors” or “problems in living.” (Try telling that to someone like Harry, or to his anxious and beleaguered family). In a sense, mental illness deniers represent the flip-side of mental illness alarmists — people who, for example, see mass shootings, gun violence, and other violent acts as the product of mental illness, despite the fact that when psychiatric illness is adequately treated, it is very rarely associated with violence. Left untreated, however, serious psychiatric illness can increase the risk of violence; and, unfortunately, many people with untreated psychiatric illness wind up in the largest “mental health system” in the U.S. — our jails and prisons.
Both the deniers and the alarmists misconstrue the nature of psychiatric illness, and both do harm to people like Harry. The mental illness deniers erect barriers to the effective treatment of serious diseases like schizophrenia and bipolar disorder, and make it harder to persuade Congress to provide adequate funding for psychiatric research — after all, why should we fund research on a “myth”? The mental illness alarmists fuel social prejudice and job discrimination against those, like Harry, who suffer from severe psychiatric impairments. In my view, the mental illness deniers pose as much risk to the health of this country as climate change deniers.
To be sure, some people who post angry comments on antipsychiatry websites have had bad experiences with their own psychiatric care. Whether their accounts are entirely accurate or not, these people are understandably aggrieved by perceived mistreatment. Having worked in a variety of psychiatric settings over several decades — hospitals, nursing homes, outpatient clinics, and private practice — I have seen both excellent and poor psychiatric care, and everything in between. Certainly, there are legitimate reasons to confront psychiatry on its shortcomings. But this is a far cry from the outright denial of the reality of mental illness, and the blanket condemnation of psychiatry as a medical specialty. Like climate change deniers, mental illness deniers are doing a grave disservice to the health and wellbeing of their fellow citizens.
I have seen hundreds of people like Harry, suffering with psychiatric diseases as real as lung cancer or heart disease. And, with proper care and treatment, I have seen many of them recover their sanity, their lives, and their dignity.
Acknowledgment: Thanks to Dr. John Grohol for commenting on an earlier draft of this essay
For further Reading:
Insane Consequences: How the Mental Health Industry Fails the Mentally Ill by DJ Jaffe (Author), E. Fuller Torrey MD (Foreword)
- Pies, R. (2009, May 4). A Guy, a Car: Beyond Schizophrenia. The New York Times. Retrieved from: https://www.nytimes.com/2009/05/05/health/05case.html [↩]
- Szasz, T.S. (1998). “Thomas Szasz’s Summary Statement and Manifesto.” Retrieved from: https://selfdefinition.org/psychology/articles/thomas-szasz-summary-statement-and-manifesto.htm [↩]
- Earley, P. (2018). Psychology Today Article Debunks Claims By Antipsychiatrists: “Easily refuted by scientific evidence.” Retrieved from http://www.peteearley.com/2018/09/07/psychology-today-article-debunks-claims-by-antipsychiatrists-easily-refuted-by-scientific-evidence/ [↩]