15 August 2012

Thomas Szasz on "Varieties of Psychiatric Criticism"

In an article published in "History of Psychiatry", Thomas Szasz offers the following provocative comment:
The historical evidence compels us to conclude that, after more than 200 years of psychiatric criticism, we have made no progress in unshackling the psychiatric slave from his psychiatric master.So-called psychiatric critics are largely responsible for this situation: instead of focusing on the timeless task of enlarging the sphere of human liberty by seeking the abolition of psychiatric slavery, they choose to pursue fleeting popularity by the self-righteous denunciation of one or another psychiatric treatment of a non-disease, and/or converting inpatient insane asylum slavery into outpatient medical disability-dependency.

Let us not fool ourselves. Mental patients and mental health practitioners are more securely attached to the coercive apparatus of the therapeutic state than they have ever been. And let us not lose sight of the falsehoods psychiatric leaders tell politicians, the press and their fellow psychiatrists. Thomas Insel, MD, Director of the National Institute of Mental Health, explains:

"It’s time to fundamentally rethink mental illness. … Psychiatric research today promises to produce a true science of the brain … Mental disorders are brain disorders. … What is emerging today is a picture of mental illness as the result of a pathophysiological chain from genes to cells to distributive systems within the brain, based on a patient’s unique genetic variation. … With a true science of mental illness – from genes, to cells, to brain circuits, to behavior – psychiatrists will be able to better predict who is likely to develop a mental disorder and to intervene earlier. Once that happens, we will be in a different world. (Moran, 2011)"
As Szasz captures so eloquently, we need to strip such beliefs of their rhetorical power. There are very real reasons to worry about the status of neuroscience and neurology, especially as those fields become ever-more linked to a State and its putative therapeutic edifice. How should we understand these concerns?

We ought to move beyond simple paranoia about the action of an unintentionally malevolent State to endeavor to see the potential threats engendered by melding neuroscience to constitutional law, ethics, and policy.

Consider those who see the need for neuroscience and politics to be reconciled. There are many people (we've critique some of them here) who see in neuroscience and neurology the promise of further liberation. The common law system from these perspectives is often cast in the role of an especially antediluvian beast that has not yet recognized the hard truths of human neurobiology and its hard wiring. Policy and law informed by neuroscience, so these arguments go, can empower citizens, call into question the status of a crime, and revise legal and ethical understanding of intentionality.

Circumstances, however, are not so simple. True, many scholars (among them many historians of medicine) believe that critical questions or observations about the legal and therapeutic status of psychiatry have become passe, perhaps even irrelevant. These arguments are either construed as self-evident, impractical, or utopian. Such views are, of course, not really reflecting circumstances. Indeed, what seems to have most changed is the willingness of elites (self-fashioned, of course, because who can tell if they really represent an elite) to trust that they ought to have the authority to decide whether critical questions or provocative observations about the status of psychiatry or clinical psychology have legitimacy at all. The tin ear that has plagued one side of the DSM-5 controversies is just one example.

But where has this 'elite' confidence come from? Here speculation provides tentative suggestions: it seems likely that the fusion of neuro pharmacology with neuro imagining has aided and abetted their confidence. The phrases "we have data" and "we now know that" have become rhetorical strategies for communicating the new authority and license of practitioners of these fields. They no longer appear insecure, as they might have done in the 1960s and 1970s.

It is perhaps too late to say this, but neurobiologists and neurologists might wish to think carefully about the ways in which psychiatric authority and psychiatry therapeutic traditions may influence their attitudes about science and clinical practices.

1 comment:

  1. It is also disturbing that when a person reaches old age, most neuroscientists would expect the person to experience Alzheimer's disease just because they know for a fact that the neurons degenerate at this point in time. Scientists would like to call it disease, but with mild manageable symptoms, to some, it's just as simple as that - aging brain.