Tuesday, November 6, 2012

The Tragedy of Thomas Szasz

Thomas Szasz

The following is a mini-obituary for Thomas Szasz, M.D. from the National Review on October 15, 2012. He died at the age of 92 on September 8, 2012.  He was the author of a book called The Myth of Mental Illness in 1961, in which he argued that there is no such thing as schizophrenia or any other severe mental illness, and that all people mislabeled in this manner should be free to wander the streets, no matter how mentally impaired they may seem to be.

He later undermined any credibility he might have had, which was precious little to begin with, by throwing in his lot with Scientology by serving as spokesman for their Citizen’s Commission on Human Rights.

The obit expresses my sentiments exactly.

"Like most people whose writings do great harm, Thomas Szasz started with a plausible-sounding principle, but instead of using it to clarify his thoughts, he made it the center of his worldview, bending everything else to fit while he ratcheted up the overstatement. Szasz’s governing notion was that psychiatry is not just an inexact branch of medicine, not just a discipline subject to misuse, but nothing less than a gigantic fraud, useful only for keeping inconvenient people under control.

“Mental illness did not exist. It was merely a myth, on par with witchcraft, exploited by those in power to control the masses. By denying the existence of what everyone could see with his own eyes, Szasz threw out the baby with the bathwater, and included the tub and plumbing fixtures for good measure. The 1960s spirit of “only the mad are sane” romanticism, and the 1970s post-civil-rights hangover, gave his pernicious doctrine a long shelf life.

“With his sharp mind, Szasz could have helped curb psychiatry’s abuses and excesses; instead, his charismatic nihilism led to the usual overreaction (most notably the draconian policy of deinstitutionalization, unfortunately still very much with us) and ensuing counterreaction (nowadays he is widely and correctly considered a crank). Dead at 92. R.I.P."


  1. I share your assessment on Szasz. But one of the reason that Szasz ideas have some influence, is that psychiatry still has some serious shortcomings, and is as much a set of competing fiefdoms than an unified science with different branches (making it an easy target for criticism).

    The saddest thing about Szasz is that his views have often overshadowed (in the media or the general public) the constructive, science-based criticism from people as diverse as Daniel Carlat, Allen Frances, Ben Goldacre, Jerome Wakefield, Marcia Angell, and many others.

  2. I am astonished at this ignorant piece of writing. I suspect you have never even read one of Szasz's books or probably do not have the intellect to understand. Your blog heading is also totally in line with Szasz's views, so I have no comprehension on why you can be in agreement with such a puerile obituary. For those who may prefer a more intelligent account of Szasz's work I suggest people read

    1. I, for one, can tell the difference between schizophrenia and personality disorders.

      (I heard Szasz speak in person spouting his nonsense, and it was quite easy to understand how full of crap he was).

    2. You might want to explain why you think what he says is crap rather than use an argumentum ad hominem. Where for example has Szasz said that there is no difference between schizophrenia and a personality disorder? Or do you just want to set up a straw man argument?) Why not blog about this in detail rather than use some biased obituary that you have cut and pasted?

    3. The comment I made about the difference between schizophrenia and personality disorders is not a reference to Szasz, but to your comment about the alleged "inconsistency" of my blog heading.

      I cut and pasted the obituary because it sums up my views pretty well.

      I've already posted extensively about the issue of brain diseases versus behavioral problems, and have been quite critical about when the two are clearly being conflated by my colleagues.

      The anti-psychiatry groups, on the other hand, assert that NO psychiatric disorder is an actual disease, and demand a level of proof that any psychiatric problem is a brain disease that is clearly nonsensical. I've already said why in many previous posts.

    4. Sorry but I do not see any reference to schizophrenia and personality disorders in your blog heading (which can be read as a pure Szaszian viewpoint). 'Anti-psychiatry' groups (which does not include Szasz who was anti anti-psychiatry!) just require the scientific proof that schizophrenia is a brain disease. This is not a nonsensical requirement. Most scientists require some empirical evidence. They are still waiting.... And please do not misquote Szasz to justify your ideology. Thanks.

    5. Sorry I didn't spell everything out for you. The point of the obituary AND my comment about schizophrenia/personality disorders was that Szasz applied the family dysfunction/mental health issue far too broadly.

      I did not say that scientific proof is not required to show that schizophrenia is a brain disease. What I said was that, no matter how much proof is offered, it's never enough for many people who are stuck in a false belief, whereas they'll take much weaker evidence as proof for many of their other beliefs.

      Feel free to have the last word.

  3. Appears as if you may have a great deal of resentment towards a man who is now dead.

  4. Yeah, Szasz's life was tragic, as is the life of all geniuses who find themselves the focus of the derisory attention of a confederacy of dunces.

    You indict yourself as something of a twit in making puerile remarks such as "clearly nonsensical", in lieu of any definitive evidence showing that an abstract concept can be susceptible to literal pathology. It was Montaigne who once said, to paraphrase, that there is nothing so firmly believed as that which is least known.

    I would have some respect for whoever authored this paltry vomiting if, preparatory to writing this piece, the author had actually done some research. I mean, is there anything in this piece that can be said to be an accurate reflection of Szasz's tenets and contentions?

    Mr Allen, if you extract the actual research findings from all the self-serving propaganda, it does not, as you imply, lead us inescapably to the conclusion that the referent of the term "schizophrenia" is a brain disease.

    It is just that psychiatrists, who work in an environment where their careers are contingent upon the espousal of psychiatric dogmas, see what they want to see.

    Believing is seeing for the psychiatric researchers, their ignorance reinforced by their positivist delusions which estrange them from awareness of the essentially eisegetic character of what are actually their own interpretations, formed in the light of their own prejudices.

    1. Ok, Anonymous. Why don't you correct me and the obit writer as to exactly what Szasz's tenets and contentions actually were?

  5. "The 1960s spirit of “only the mad are sane” romanticism, and the 1970s post-civil-rights hangover, gave his pernicious doctrine a long shelf life."

    Szasz, as shown by his book 'Anti-psychiatry -Quackery Squared' was very much against the Laingian view 'only the mad are sane'. His book 'The Manufacture of Madness' published in 1970 shows he was one of the first psychiatrists to speak out against the view that homosexuality was a mental disease and that black people in America were persecuted - a pernicious doctrine eh?

    "most notably the draconian policy of deinstitutionalization, unfortunately still very much with us"

    Anyone with a little knowledge of Szasz would know that he was totally against de-institutionalisation. As was he against locking up people against their will where no crime had been committed.

    He was also against the nonsense that ADHD is a brain disease. The person who wrote this obit and worse the person who cuts and pastes it are totally ignorant of Szasz's work. Disgraceful.

  6. Mr. Stuart,

    Thanks for writing.

    If you read my blog you'll know I don't disagree with Szasz on everything - ADHD being one incident of common ground.

    If you re-read the sentence you took from the obit, it does not say that Szasz agreed with the "only the mad are sane" Laingian view, only that that the spirit of the times gave Szasz's conceptualization of schizophrenia a longer shelf life.

    I disagree with Szasz that schizophrenia and other psychoses are not real diseases. I also think that psychotic people can be every bit as mentally impaired as someone with alzheimer's disease, and NOT holding them against their will is as immoral as letting demented individuals wander the streets unimpeded.

    And, if untreated, people with schizophrenia DO end up committing petty crimes and ending up in prison, as evidenced by the large number of mentally ill inmates present in today's jails. Better they be locked up temporarily on mental wards and treated. Ditto for their ending up living in cardboard boxes on the street.

  7. "NOT holding them against their will is as immoral as letting demented individuals wander the streets unimpeded."

    You are the judge and jury? By what right do you have to do so? You may think schizophrenia is a 'disease' but the science does not support your view. The reason why they end up in prison or homeless is because of their economic situation not because of an illness. Correllation is not causality.

    " Better they be locked up temporarily on mental wards and treated."

    Treated with what? Brain damaging chemicals? Is a prison worse than a mental hospital? I do not think so. At least in prison you may not get a forced lobotomy or ECT.

    My beliefs do not just come from Szasz, but psychologists such as Richard Bentnall and neurologists such as Oliver Sachs. As a 'diagnosed' schizophrenic I know more about this than you. Want to discuss?

    1. Not much to discuss really. The government gives mental health professionals and the police the right to commit mentally ill individuals who are dangers to themselves or others, and any committed patient who wants to can go in front of an impartial judge and challenge it.

      There haven't been any forced lobotomies for many many decades, and these days it's difficult in many states to get ECT even if you want it, let alone if you don't.

      Everything else you say is just plain incorrect. Sorry. I have nothing else to add.

    2. The governments (and their police) have imprisoned and killed 'mentally ill' persons for many years. Think Nazi Germany, Russia and China. Forced lobotomies - forced injections of risperdal - as well as ECT are widespread. As are forced drugging of children 'deemed' to have a brain disease of ADHD. What have I said that is incorrect? Please specify.

    3. Everything you just now said is absolutely true.

    4. Except the part about forced lobotomies and ECT if you mean here in the US. We all agree tryranical governments can use all sorts of things for nefarious purposes.

  8. The tragedy of Thomas Szasz is the fact that such an intellectual giant is no longer able to provide his sane views because of his suicide. I also think that this blog piece is incredibly insensitive and in fact 'bitter'. I wonder why? It does totally misrepresent everything that Szasz spoke of.

  9. The fact is that immigrants of all countries (i.e it is not a specific racial issue) are 5 times more likely to be diagnosed as schizophrenic. This one fact shows that schizophrenia is a cultural phenomenon and is therefore not a medical disease. Unless you want to define the word disease in such a way to change the meaning of the word. Szasz is correct in his views about ADHD, Schizophrenia and of psychiatry.

    1. I don't know where you got the "5X more likely" stat, but yes, immigrants (and you left out African Americans BTW) are significantly more likely to be diagnosed as schizophrenia than native-born white people.

      The reason for this, however, is not that the neurobiological syndrome of hallucinations, delusions, and disordered thought does not exist, but has to do with another major theme of this blog:

      Unfortunately, a high percentage of my colleagues do not take the time to take a careful history, or they use a "checklist" style, leading to a large number of misdiagnoses. Misdiagnosis of schizophrenia in particular is especially likely to occur when the doctor does not take the time to understand the language and culture of the patient.

  10. Ok I made a mistake. I can only find evidence of 4X more likely from the British Medical Journal. And I left out the fact of African Americans because I am from Europe and can only talk about European issues. From reading your site blogs I can see little difference between you and Szasz. Only that you have a belief (as yet unsupported by science) that a proportion of those diagnosed as schizophrenics (how many?) have a biological disease. I really would like you to debate this topic in future blogs.

  11. Dear Dr Allen,

    While you reject Dr Szasz's core argument that so-called mental illnesses are not literal brain diseases, in your header you refer to "twisted science”, "parents who want to believe that their children have a brain disease (presumably when their children to not have one) to avoid an overwhelming sense of guilt.”, and you say that "issues have been denigrated in psychiatry in favor of a disease model”.

    Which is it? Do the "mentally I'll" you refer to have bonafide brain diseases, or do they have guilt-ridden parents to whom it is useful to twist science and narrate their child's behavior as neurological pathology? You cannot have your cake and eat it too. You cannot without contradiction berate Szasz for stating that so-called mental illnesses are not brain diseases, and then complain that psychiatric issues are denigrated by the disease model.

  12. You say that Szasz's ideas have done great harm. In a sense, you are correct. His clear thinking and precise honest language have devastated the lies and errors that comprise the immoral pseudoscientific racket of coercive psychiatry.

    But to say that Szasz was a nihilist is to strip yourself of credibility regarding his work. A nihilist, according to the New Oxford American Dictionary, believes that life is meaningless, and rejects moral principles; but Szasz denounced coercive psychiatry precisely for its immorality and found it meaningful enough to pen 36 books about. He examined the moral principles and the meanings of behaviors, and denouncing psychiatry for willfully misconstruing both.

  13. Your assertion that Dr Szasz proposed that people who behave in deplorable ways which you label as "mentally ill" be free to wander the streets is nonsense. There are many actions that society does not condone and that are not often prosecuted as crimes, and Szasz wrote about this in detail in many of his publications.

    Your implicit premise, that jailing the breakers of society’s rules under medical pretenses is how to best deal with such people, is a slap in the face of judicial process and of liberty itself.

    1. Hi Steph,

      I'm talking about completely different psychiatric conditions when I speak of those that are obvious brain diseases and those that are the product of guilt ridden parents desires to be left off the hook.

      Thinking that if one disorder in the DSm is a crock, then they ALL must be is a very good example of "black and white thinking," which is amazingly simplistic and a logical fallacy to boot.

      So I assume you think patients with severe Alzheimer's disease should not be treated "coercively," and should be allowed to wander aimlessly in the street, because Alzheimer's is just an "alternate way of remembering things."

    2. Dr Allen,
      Thank you for your kind reply.

      You open quite a path by saying that there are two different types of psychiatric conditions: brain diseases, and products of desires of guilt-ridden parents.

      The latter, arising from feelings of guilt and desire, are, as you allude, not literal brain diseases. This was Szasz’s observation also; in this, you and Szasz agree.

      But with regards to the former, the "psychiatric conditions...that are obvious brain diseases”, here you conflate two distinct categories, psychiatry and neurology, the study and treatment of the abstraction we call the mind, and the study of and treatment of the organ that is the brain. Your notion that brain diseases are diseases of the mind, and vice-versa, is false, but revealing.

      Psychiatry -increasingly expanded and called ‘neuropsychiatry’ for reasons that become clear below- strives to maintain legitimacy as a real medical speciality that treats real diseases, by claiming that figurative mind diseases are literal brain diseases.

      This proposition is doubly fatal to psychiatry existentially. Firstly, it demonstrably false; so-called mind diseases are not seen in the brain and can have none of the objective defining characteristics of brain diseases -if they did, they would be brain diseases, and not mental diseases. And secondly, if mental illnesses were brain diseases, all of psychiatry logically should be absorbed by neurology. This of course shows no sign of occurring, and in fact cannot legally occur, since psychiatrists engage in activities that neurologists reject, namely, coercing as “patients” people who want nothing to do with them.

    3. I made no mention of the DSM that you correctly refer to as a crock. If I had, I would have leveled an argument against its errors, and supported my case with reason and evidence. This is what you should do also, state an argument.

      Something either is a disease or it is not. When one knows the literal definition of the term disease he can determine if that thing does or does not pertain to the category we call diseases.

      You say that my logic is fallacious in this regard, but you make no argument. Don’t just say that my black-and-white thinking amazes you with its simplicity; show that it is incorrect, if it is.

      If, as you say, either-or reasoning is false in this case, and it is untrue that so-called mental illnesses either are or are not brain diseases, then state your case, demonstrate how I am wrong. It would be cruel for you, with your greater experience and expertise, to leave me foundering in ignorance and error.

    4. And finally, Alzheimer’s is not an illness of the mind, it’s a disease of the brain; it is observable upon autopsy, has an objective differential diagnosis, and a progressively degenerative course -as do other brain diseases, from GBM, to CJD, to multi-infarct cerebral atrophy -and as the so-called mental diseases notably do not.

      But about coercion, that central issue that psychiatry tries to mask, you should remove your quotes around the word and own up to the fact that you condone coercion in some cases; you are immoral if you do not support the right to defense against aggressors.

      The reason for such aggression, from premeditated malevolence to unwitting brain-damaged hazard, does not negate the legitimacy of the use of force in self-defense in certain circumstances. This is accepted legally, and psychiatry is not needed to legitimize the moral use of force.

      Weasel-quotes, however, that turn coercion into “coercion”, are an attempt to soften clearly-defined concepts and to distance us from clear thinking, and it is with such use of language that vile rhetoricians attempt to hide the illegitimate and immoral coercion that psychiatry perpetrates and serves to justify.

      (My heartfelt thanks, Tom Szasz.)

    5. Hi Steph,

      Sorry, but the evidence that schizophrenia, true bipolar disorder (not for what often passes for that today) and melancholic depression are every bit as much brain diseases as Alzheimer's disease is overwhelming. If you saw someone with these disorders every day for a whole month or two and spoke with them for hours over an extended period of time like we used to be able to do, you'd agree with me even if you didn't review the extensive literature.

      Those disorders are pervasive and persistent and do not react very much to changes in the social environment - unlike, say, personality disorders.

      The brain is literally the most complicated object in the known universe, with a trillion constantly changing connections. The idea that if we can't find one specific exact "cause" for a given disorder, so therefore there are no diseases of the young brain (unlike every other organ in the body), is a bit like saying we didn't know the bubonic plague was a real disease until after bacteria were discovered.

      There is no demonstrable pathology at the level specificity you seem to be asking for in parkinson's disease, migraine headaches, and a host of other neurological conditions. But I think you'd agree that those are in fact diseases.

    6. I said SOME of the disorders in the DSM are crocks, not the whole book. The criteria for those disorders seen in the chronically and persistently mentally ill are pretty damn good.

    7. "Alzheimer’s observable upon autopsy." Parkinson's disease is not observable on autopsy, but I notice you didn't say whether or not you think it's a real brain disease.

      Sorry, but your knowledge of the neuroscienctific literature on schizophrenia is also completely inadequate for you to be making the statements you're making. Have you made literature searchs for the last 20 years and kept up with all of the studies, and then critically evaluated them? I doubt it.

      Do that (it would take you months because there's so much of it) and then spend some time in a mental hospital interacting with people with the disease. Only then will we have something to discuss.

      Yes, I do believe coercion is necessary in some cases, although obviously it can and has been misused. Then again, it's also been misused by the criminal justice system, so maybe we should get rid of all the jails?

  14. You have dedicated your life to the critique of psychiatry and psychotherapy with an emphasis on the role of the family in what is often referred to as mental health. That in this you have not found an ally of inestimable value and valor in Thomas Szasz is a astounding and a shame.

  15. Dr Allen, re your Jan 28, 2017 3:16pm post:

    Your comment brings up another of Szasz's observations that reveals contradiction in your belief re mental illness and brain disease.

    Namely, should schizophrenia -or any so-called mental illness- be proved to be a brain disease, as you claim it has, then we would know that it is not and never was a mental illness. In this you actually agree with the man whose observations you have yet to understand and whom you disparage based on your misunderstanding.

    Szasz wrote repeatedly that there were most probably many brain diseases of yet unknown aetiology, but that a brain disease of unknown aetiology is a CNS pathology of unknown origin, and not a illness of the mind. If the behaviours that some call schizophrenia turn out to be symptoms of brain disease -say, of cerebral infection or a toxic accumulation in prefrontal cortex- then what today is called schizophrenia will be recognised as symptoms of an infectious disease or poisoning, and will be treated by ID specialists or toxicologists, not psychiatrists.

    Surely you know the historical example of the evolution of epilepsy from so-called mental illness treated by psychiatrists to brain disease treated by neurologists. No one classifies epilepsy as a mental illness anymore; and no one today says that it ever really was one, despite its being classified as such for decades by psychiatry.

  16. Continued, re your Jan 28, 2017 3:16pm post:

    You reject the literal, classical, Virchowian, definition of disease, but offer no alternative definition or reason for this. Seeing someone every day for a month or two and speaking with them for hours over an extended period is neither objective nor proof of disease, though it may reveal signs or symptoms of disease.

    But here we must take care not to conflate symptoms of a disease with the definition of the disease -another error useful to psychiatry that Szasz wrote about.

    Is migraine per se a disease, or a possible symptom of an underlying disease? To distinguish and answer, one must know the literal definition of disease. Pain is not a disease, but it may point to one. If migraine turns out to be caused by faulty release of neuropeptides by the trigeminal nerve, then the disease is neurological; if it turns out to be caused by vasoconstriction, then the root problem is vascular, and so on. (As a note, “Pain and Pleasure, a study of bodily sensations” the book that Szasz wrote in 1957, directly before "The Myth of Mental Illness”, was a work of art and a tour de force when it comes to understanding pain and meaning, and it set the groundwork for what later unfolded as his life’s work first articulated in "The Myth...” The book is brilliant and cuttingly relevant also today.)

    Furthermore, real diseases can have, at least in theory, asymptomatic forms -such as, say, an asymptomatic tumor, or asymptomatic infection. But asymptomatic kleptomania, asymptomatic schizhophrenia, asymptomatic gambling addiction, or asymptomatic depression? Nonsensical, all of them. There is no such thing as a symptom of mental illness, because so-called mental illnesses are defined by behaviour, by their so-called symptoms. ...And, and this is basic, no behaviour, not even deplorable misbehaviour, is a disease, that is simply not what diseases are, literally, by definition.

    Finally, your statement that I claimed that if we cannot identify the exact “‘cause'” [sic] for a “disorder” [sic] then it is not a disease is a flat misrepresentation of my words. I have never stated that all diseases and causes are known and that there is no disease of unknown aetilogy; what a foolish view that would be.

    And although you mentioned it to try to refute my argument, some people in fact did not know that the bubonic plague was a real disease until after bacteria were discovered; we know this because they tried to treat the black death with prayer and lucky charms, as they lacked understanding of disease and lacked means to differentiate real (ie, biological) disease from metaphorical (ie, spiritual) disease -just as today you sometimes do not apply the understanding of disease that permits us to differentiate real (ie, bodily) disease from metaphorical (ie, mental) disease.

    Thank you again for debating these ideas upon which so much turns. While I do my best to show that your ideas are wrong, I also appreciate and respect that you are one of the few psychiatrists willing put himself on the line in a public forum for the sake of the better argument.

  17. Hi Steph,

    I too appreciate that you are formulating thought-out arguments instead of just making wild assertions as some "anti-psychiatry" types do.

    I don't get your distinction that brain diseases can not cause purely mental illnesses. Of course they can.

    Also, you are defining disease in terms of gross psychoanatomical pathology only, when diseases of the brain can be due to defective wiring patterns at the synaptic level in neural tracts.

  18. Dr Allen, re your Jan 28, 2017 4:28PM posting:

    You say that my knowledge of the literature is inadequate to make the statements that I have.
    That, is not an argument.

    You cite your years of study -not knowing my own- as if anyone who disagrees with you is simply not up-to-date.

    You know -no, actually, I’m certain you don’t-, Szasz wrote about this too:

    Just as we do not need to examine all bachelors to prove that there is not one who is married, and just as we do not need to examine all dolphins to determine for certain that not one is a fish, we do not need to examine all the so-called mentally ill and all the literature on so-called mental illness to know that the abstraction called a mind cannot have a literal physical disease.

    It’s in the definition of the terms.

    1. By your definition, Alzheimer's disease can not affect the mind, only the brain. Really?

      I didn't know the mind and the brain could be separated so clearly. People also claim we understand what consciousness really is - we don't, although a brain does seem to be required. Next thing you know, someone will claim that we've discovered the independent existence of the soul from the body. (Actually, that'd be nice if we did).

    2. Dr Allen, re your 29/Jan/17 10:06PM posting:

      You do know that mind and brain can be separated clearly, because you do not clearly and precisely define your terms. The brain is an organ, mind is an abstraction -as well as a verb.

      Interestingly, you say that next thing we know someone will be talking about the soul. But reality has been the other way around. In psychiatry, soul has proceeded mind by centuries, and the origins of today's mind-doctoring, as the Greek etymology of the term psychiatry reveals, was in the soul and dates to the first psychiatrists in Germany.

      In fact, Szasz noted that "in German, there is no word congruent with “mind”; there is Geist = spirit, and Seele = soul". This, Szasz said, "was one of the reasons why German psychiatry has been closer to philosophy, to religion, to the spiritual aspects of man, than has Anglo-American psychiatry, which has aspired to be materialistic, scientific, medical in the technical sense.” ...I can see why you say it would be nice -and I add useful- to talk about the soul.

      You should read Szazs’z, “The Meaning of Mind”, he devoted an entire book to the separation/conflation that you cite.

      Furthermore, it is one thing to say that a physical entity such as Alzheimer’s and its amyloid plaques affect the mind; it is quite another to say that the mind is a physical entity.

      A bullet or a drug in the brain can affect ones mind (ie, emotions and behaviours), but from that it does not follow that mind is a physical, and therefore directly or indirectly observable, entity.

    3. I made a typo in my posting above, it should read:

      "You do NOT know that mind and brain can be separated clearly, because you do not clearly and precisely define your terms. The brain is an organ, mind is an abstraction -as well as a verb."

  19. Thank you, Dr Allen, for your kind words and willingness to pit idea against idea.

    Your stating that of course brain disease can cause purely mental illness is neither an argument nor proof.

    And your phrase entails more than you might realise, because now you have broached the CAUSE of a condition also. Cause vs existence of disease is another topic that Szasz explored cogently with respect to the inflation in the number os so-called mental illnesses over his lifetime.

    Overeating did not used to “be” a disease, though it could cause disease; the same was true of smoking or drug abuse, they were not diseases per se, but could cause diseases. Today, cause has been conflated and concatenated with disease, and overeating “is" a disease, and drug addiction “is" a disease. Actually, unwisely using food or drugs is still not a disease, though such narration serves certain purposes that I will not get into here.

    Additionally, when you refer to “purely mental illness”, I believe that you to mean entirely non-physical illness or disease. To unpack this idea and use of terms, we must have clear definitions of disease and illness, both in literal and metaphorical use.

    Specifically with respect to your question re brain disease and so-called mind illnesses, you do not get the distinction, because you do not avail yourself of precise, limited, and literal vs metaphorical definitions of brain disease and so-called mental illness, that would enable you to separate and distinguish the two.

    Would you agree that in order to determine if a brain disease is or can cause a mental illness, we must first be able to define brain, disease, mind, and illness?

    Since you do not clearly differentiate brain from mind, and do not distinuish the metaphorical use of the term sick or diseased (ie, bad, reprehensible, as in a sick joke or diseased economy) from the literal (ie, Virchovian) definition pathology or disease -microscopic or macroscopic, it does not matter- you are lost in a quagmire of imprecise language and imprecise thought.

    When I first began studying TS Szasz’s work, I read how he considered the correct and precise use of language to be the most important and valuable inheritance that we can bequeath to posterity (my paraphrasing). At the time I reckoned he wrote in hyperbole. Now, decades later, I realise that he did not.

    It is difficult for me to do justice to Tom Szasz’s work in such a brief space. The premisses in your single phrase, "brain disease can cause purely mental illness”, was dismantled and examined in “The Meaning of Mind”, “Schizophrenia, the Sacred Symbol”, “The Myth of Mental Illness”, “The Medicalization of Everyday Life”, “Ceremonial Chemistry”, “Cruel Compassion”, and in innumerous articles, at minimum.

    1. It sounds to me like you are the one whose definitions are far too vague an,d imprecise to be useful. If you want to say mental illness can't exist by definition, that may be a cute debate strategy, but logical it is not. Feel free to have the last word!

    2. Dear Dr Allen,

      Thank you for your reply, but again you make no argument.

      Proclaiming that ‘my’ definitions -which come from the Oxford American Dictionary, and to which you offer no alternative- are illogical, too vague, and part of cute debate strategy, is not an argument. Scientists do not call competing ideas “cute strategies”, they prove them false. And this I will do with your central premise, that mental illnesses is brain disease, one final time:

      By definition, ‘mind’ is an abstraction that refers to thoughts, feelings, and behaviours, it is also a verb that means to pay attention; mind is thus not a physical entity. But the literal, Virshovian, definition of ‘disease', is pathology of the body, and is hence physical. It therefore necessarily follows that speaking of a physical brain disease of the non-physical mind is nonsensical, a category error.

      Facing this proof, you protest that my -really Szasz’s- “overly” simple black-and-white thinking amazes you, and imply, but fail to demonstrate, that the logic is incorrect.

      When you reject black-and-white reasoning regarding what is, and what is not, a brain disease, the onus is on you to prove your claim. You must show that mental illness neither is, nor is not, a brain disease.

      With that, I wish you the best.

      Although you have misunderstood and misrepresented Tom Szasz’s good observations, I give you credit and thanks for publicly posting our conversation of contesting ideas.

      Stephen Kourakis

  20. Dear Dr Allen,

    You invited me to have a last word, but did not post my reply when I offered one a few days ago.

    It took me considerable time and thought to write what I did. I would like you to please post it, or to please explain to me why you will not -perhaps you will show me that I should retract or rethink my statements, which I will gladly do if so persuaded.

    Although I do my best to dismantle your arguments and assertions, I do so out of respect for TS Szasz's ideas -which I cannot knock down- and out of concern that people might be led astray by the mischaracterization of the man and his ideas in the obituary you posted and in comments you made.

    I cannot accept your statements regarding Szasz and his observations without putting myself into self-contradiction; in this regard, I do not have the choice of believing otherwise; I must accept what reason and evidence show. But my writing style was, at times, cutting; I own that. It was, I believe, directed at your ideas and never at you ad hominem, and seems to me to be legitimate defense of a third-party (ie, Szasz) in just proportion to your posthumously pronouncing him a “tragedy”, with "precious little credibility”, "widely and correctly considered a crank”.

    Thoughts? I continue open to dialogue and to hearing your views and interests.

    Best regards,
    Steph’ Kourakis

    1. Steph,

      Oops, sorry. I thought I had published that last one.