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This essay is based pretty much completely on my experience in dealing with mental illness denialists here and also on a forum that had a depressing number of them
There are basically 11 arguments that Mental Illness Denialists use, and each one is bullshit.
- Conflationary Argument: If psychiatric conditions are problems in the chemistry of the brain, then the idea that talk therapy will do anything is a load of bullshit.
- True and false. Mental Illness is defined in a specific way, and it generally requires symptoms to have no specific cause. For example, with depression, a person could be "depressed" in the sense of mourning the loss of a loved one, or feel overburdened from work. Treating a "depressed" person in either of these situations with medicine is unlikely to happen, and unethical because it is unnecessary. The first would be treated with talk therapy to try to help the person out, and the second would as well, but probably with some suggestions about changing the work situation. Mental illness and general mental distress can be caused by environment (ie, home/work situation), life situation (ie, recent death), or a brain abnormality. Psychiatry (in the sense of the treatment of mental disorders with various biological treatments, but primarily drugs) would only treat that last one. The times when mental health professionals deal with the first two, it's essentially just them being someone to talk to, and is not a medical treatment.
- It is true however that mental health professionals frequently use a combination of biological and talk therapies in treating patients. This is because mental illnesses often have multiple causes, a combination of environmental, lifestyle, and biological. Drugs treat the biological cause, while the talk therapy suppliments the drugs by helping with the non-biological causes
- The DSM Panel Argument: The inclusion or removal of illnesses in the DSM is based on the vote of a panel, not science.
- Yes and no. Yes, they are included as a result of the vote of a panel, but the panel is voting based on years or decades of research including hundreds or sometimes thousands of studies on the matter. And even then, the vote isn't strictly whether or not to list the mental illness, but to list it separately as a mental illness. Take, for example, Body Dismorphic Disorder. As of yet, it is listed in the DSM IV TR as a specific form of a general somatoform disorder. Any voting on whether or not to include it in the DSM V is about whether or not there is sufficient evidence and need to list it separately.
- The First Szasz Argument: In the past the mental health field was used to oppress people, such as African-Americans (drapetomania), women (hysteria), and homosexuals (once listed in the DSM), and the use of psychiatry in the USSR, Nazi Germany, etc., as well as comments about the abuse of ECT and lobotomy.
- This is nothing more than an association fallacy and emotional appeal. What psychiatry has been used for in the past and in different places is totally irrelevant to its mainstream medical use. You might as well say that because chemistry was used to kill Jews in the Holocaust, political dissidents in the USSR, and is used today to create date rape drugs, chemistry must be evil as well.
- The Second Szasz Argument: Psychiatry fails the Popperist definition of science, and it therefor pseudoscience
- The Third Szasz Argument: There is no scientific evidence for the existence of mental illnesses.
- This is true. If we're in the 1950s before the advent of neuroimaging. Last time I checked, it was 2012. In fact, neuroimaging is so common in the various fields that deal with mental illness that you would see comparative MRIs of a schizophrenic and a non-schizophrenic brain in pretty much the first day of an abnormal psychology course at any accredited college. The first two arguments Szasz uses all the time can be chaulked up to being emotional and holding on to outdated ideas on Phil of S, but this one simply smacks of self-chosen ignorance, and that Szasz kept making it after the 1970s was a pretty clear demonstration that Szasz was not at all interested in science, medicine, or helping those with mental disorders.
- Additionally, vaccinations were discovered in 1721 and became widespread before the 1840s, but the germ theory of disease wasn't formulized until the late 19th century. It has long been held in medicine that just because we don't know how something works doesn't mean it doesn't work, and that we shouldn't use it. So, even if there was no evidence for the existence of mental illness, the fact that we can remove symptoms from patients says something about how effective treatment is.
- The Fourth Szasz Argument: The mind is not a physical thing, therefore the idea that it can be diseased is nonsense, and mental illness is a metaphor, not a real thing.
- Sure, the mind is not a physical thing, it's just a metaphor. A metaphor for the brain structure and chemistry we know exists. If the entire complaint that the anti-psychiatric community has is that the word "mental" in "mental illness" comes from "mind" (which it actually does not, but never mind), then I'm sure the entire field will be quite happy to change the word.
- The Fifth Szasz Argument: Psychiatry is fine, as long the patients seek treatment of their own free will.
- The only time (at least in the US where Szasz lived and worked) a person can be involuntarily committed to psychiatric treatment is if they have presented a clear and present danger to themselves or others, usually requiring an attempted suicide or the committing of a violent crime, or if the person has been deemed unfit to stand trial (unable to aid in their own defense) they will also be committed to psychiatric treatment. Both of these cases are actually extremely rare. The final condition where a person can be committed to psychiatric treatment against their will is if they are diagnosed as being psychotic (usually but not exclusively schizophrenic) or mentally retarded, and then they, like a child, are left with their next of kin having legal responsibility for them. In this case, saying that they are being treated against their will is rather like saying that a person found unconscious on the side of a street with their guts hanging out is treated "against their will". No, they are unable to give informed consent, so consent is either implied (in the case of the unconscious person) or given by their legal guardian (as in the case of the psychotic/mentally retarded person).
- In the United States pleading not guilty by reason of insanity (the 'insanity defense') is used in less then 1% of cases, and is successful in about 25% of the cases where it is used, even when the patient has been previously diagnosed with a mental disorder such as schizophrenia, and while the person may be released months later, they are often confined in a mental institution longer then if they were in prison. This is changing however, as effective drug treatment is reducing the need for such prolonged treatment.
- The Sixth Szasz Argument: There are no cures in psychiatry, only treatments.
- This is also true with cancer, AIDS, and countless diseases and conditions which no one doubts the existence of. Also, recently, a group of researches have cured schizophrenia symptoms in mice by altering the genes of the mice in question.. Given funding and 20-30 years, and we could reasonably have a cure for schizophrenia, making this argument all the most irrelevant.
- Anything that includes mention of Freud or the Behaviorist school of psychology.
- Freud was once the leading figure in the mental health field, but is today only mentioned in a historic sense. He is appreciated for helping to divert the study of mental illness away from only what is observed in the patient's behavior, but is otherwise completely ignored and sometimes hated, because his opinions were frequently completely unfounded. Rather like Aristotle in physics, he is both appreciated and hated, and to reference him in modern literature outside of the historic is a demonstration of the author's stupidity and a sure way to get yourself laughed out of the scientific establishment.
- Occasionally, the Behaviorist school will be mentioned. This was the original school of thought in the mental health field, and they only treated the patients based on the abnormal behaviors the patient demonstrated. There are some modern mental illness denialists who seem to think that this amounts to a tacit agreement with their position: this is not true. They treated mental illness in the way that they did simply out of a lack of any better way to treat/define mental illness, since they were working the 1840s until the early 20th century when they were overshadowed by the Cognitive school and the Freudians. The Behaviorists later merged with the Cognitive school (which focuses on talk therapy to treatment of poor thinking skills) and remains a vital component of modern mental healthcare.
- The Tom Insel Argument: Tom Insel is the head of the National Institute of Mental Health and once said “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”
- This is being taken wildly out of context. Dr. Insel is lamenting the lack of use of neuroimaging techniques in the diagnosis and treatment of mental illness and nothing else. Some Anti-Psychs like to claim this is Dr. Insel admitting that there is no evidence for the existence of mental illness, and this is simply lying.-- Token Conservative Feminist Thought Police 17:58, 9 September 2013 (UTC)
- The Scientology Argument: Psychology/Psychiatry is not a medical field, but an evil mind control cult.
- The irony should be palpable. But if not, lets say they're right. If it is a mind control cult, it must not be a very good one, since there are fields with the respect of basically the entire medical and scientific community, and support from the vast majority of the public with the funding that these fields have, but there are still a large number of idiots who think it is some evil conspiracy.
Additionally, people in the anti-psychiatric community will sometimes complain about things like stigmatization of those with mental disorders, over use of medication, lack of use of brain imagining techniques, etc. These are often legitimate complaints, and the mental health field is largely working on them, but are often stymied by insurance companies who seem to feel that the costs outweigh the benefits.