Thomas Szasz was a physician who later became a psychologist. The Myth of Mental Illness is a controversial book, and it is famous for having changed the way people have viewed psychiatry for decades. For some, the arguments give them more confidence in accepting themselves as they are, by seeing the social stigmatization does not always point to anything “real.” For others, it is an insult to what they experience as real and debilitating.

The Changing Nature of Mental Illness

The first point Szasz makes is that psychological diseases keep changing over time. Szasz recalled that not long ago, there were less than 20 psychological illnesses – then , during his lifetime there were hundreds. It isn’t that change itself is indicative of foul play – without change, there is no evolution or advancement, but the point is that we haven’t really discovered new illnesses, as much as we have re-categorized old behaviors.

In other words, it isn’t that people are becoming more mentally ill over time, it is that more “fake” categories of illnesses have been systematically created. What was considered normal before is now considered a mental illness, and what was considered a mental illness before, is now no longer so. Since, over time, our definitions keep changing, the mental illnesses that have been categorized are arbitrary, and are indicative of nothing more than a briefly agreed upon taxonomy.

Psychiatrists depended on the creation of new categories to be able to justify their usefulness. If there are so many diseases, and hence, so many problems, we’re going to need a lot of smart people to solve them. And if a government cares about the mental health of its people, it should subsidize these efforts.

And there is a more insidious motive, that the creation of mental illnesses was a way for the bourgeois to keep the lower classes in line, by describing unpleasant or offensive or unproductive behavior as “insane.”

But the psychopathologies that have been identified over time do not point to real problems. In fact, every psychological disease can be classified into two categories, “non-disease” or neurological disease. For example, homosexuality was considered a mental illness – now it has become a non-disease. Neurosyphilis and beriberi are forms of “madness” that were later classified as brain disorders.

Problems of Living

Szasz focuses on the dichotomy between mental disorders and problems of living. By “problems of living” – he means the inability to carry out one’s own life tasks – in the absence of a brain disease. Someone who is experiencing problems of living has a physically normal mind, but has the wrong software (or philosophy).

Szasz does not accept that a mental disorder can be separate from a neurological disorder, and then not simply be “a problem of living.” It is a linguistic argument. In other words, if there is nothing physically wrong with your brain, and you are having difficulties in your life, you are not “sick” – you need to read more philosophy, or something.

Then Szasz contrasts the nature of psychology with the hard sciences. In the hard sciences such as physics and chemistry, there is no dispute between different schools about what discoveries are considered valid or correct. If there are disagreements, they are not major disagreements. But with psychiatry this is not the case.

To be clear, that is not to say that there is unanimity about everything in the hard sciences – this is obviously not the case. But there is at least a certain level of agreement upon the basics. In contrast, psychology has no such agreement – some schools are so different in their analysis of the human mind, that they appear to be exact opposites.

The fact that there are many competing schools of psychoanalysis, that there is no unanimity of how to treat non-physical “mental illnesses”, suggests psychoanalysis more closely resembles religions and the Greek schools of philosophy, rather than the hard sciences. It becomes clear to Szasz that psychiatry is not interested in objective facts about the human mind, but about the most appropriate modes of living, which are highly subjective.

In a sense, psychology can be quite useful. If the psychologist is able to free the patient from constricted ways of seeing the world, if he is able to open new experiences for their patient that will improve their lives, then psychology can function as a kind of software update.

But if the psychiatrists insist on explaining away the problems of the patient by referring to childhood events that will determine the future of the patient’s life, then they are being harmful since they constrict the power of the patient to act freely.

The Difference Between Categories and Things

There is a difference between categories and the things they describe. Freud, for example, knew this but he worked around it and acted as if the two were equal anyway. In other words, neuroticism is not a real thing, it is a category that loosely describes how some people behave under a common understanding of neuroticism, but there is no such thing as a neurotic. There may be people that exhibit neurotic tendencies, but we cannot label them as neurotics.

The DSM is a common standard that psychiatrists have agreed upon, but when it comes to the real world, where the stakes are high, some mental illnesses are immediately rejected.

Legally, there are moral and practical questions that ought to be considered. The idea of free will is especially important. Pleading insanity is a way for criminals to avoid accepting responsibility for their actions. In the 1990’s the US congress refused to classify pyromaniacs or problem gamblers as psychologically ill, for example.

Szasz argues that psychology, like religion, is a form of social control. That at one point, when the ruling class didn’t know what to do with odd balls or people who didn’t follow the rules, the label of “mental illness” was a convenient way of keeping them in line. Ultimately, a mental illness is whatever deviates from the social norm.

Freud may have claimed to be a hardheaded atheist, but what he started was basically a religious movement. He demanded his students to accept his ideas as eternal truths, not to be questioned. There were secretive methods of psychoanalysis that were not made available to the public. His school eventually conflicted with other schools, sometimes extremely so.

Another religious parallel was drawn to Freud – namely, the idea of regression, not wanting to grow up, desiring to remain in a permanent state of childhood. Szasz remarks that in the Biblical story of the Fall and in Paradise Lost, this idea is dramatized and overrated.

Humans are not, in fact, so attached to childhood. All you need to do is observe a child’s behavior, and how they desperately ache to become an adult. There are powerful drives towards symbolization, as observed by Susanne Langer, and strong drives towards maturation, cooperation, and relationships.

Psychoanalysis as a Drug

The goal of psychology should be to give individuals a higher degree of freedom, to allow them to escape the mental traps they have set for themselves. That is, to function as a form of guiding moral philosophy that can be grounded in the real world.

Christianity resolves the problem of anxiety, for example, by suggesting that this life does not matter so much. That it is merely a test for an afterlife. So, everything that men are after, whether money or power or lust, are all illusions and false gods. It is the meek and the humble and the poor that will inherit the kingdom of heaven. In that way, Christianity relieves the individual of the weight of responsibility of life.

It should be the goal of psychology to do the same, but not to claim to be a science, but rather to function as a substitute for religion. It should deal with the problem of living.

To give people who have not found a way of relieving their basic anxiety a way to do so. But this is not by psychoanalyzing them, it is not through historicism (a position that states that everything is deterministic). Indeed, the psychoanalytic interpretation of Freud, instead of freeing the individual to act, has trapped him in the past. The idea is that the events of the past will inevitably shape the future, try as you might to resist the forces of fate, they are too powerful. It is this ideology that makes psychoanalysis a drug, since the rationalization of behavior is too easy, too addictive, and too convenient.

I found the writing to be quite dry and boring, but some ideas were interesting to consider. If psychiatry has indeed become the new religion, it is at least useful to understand the ways in which it may fail – if nothing else, the book is a reminder to never take subjective interpretations of behavior too seriously.