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dealing with the criminally insane

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The Wrath

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That author (Thomas S. Szasz) has been mentioned in some earlier posts. From a brief scan of the articles linked (here and elsewhere) he seems to deny the existence of mental illness as such. He seems to go beyond arguing that most diagnoses of mental-illness are wrong, and seems to say that they are all wrong. If so, he's quite obviously mistaken. If not (i.e. if he agrees that mental illness is something real, in some cases) then the main question posed by this topic holds. In addition, one has the more complex question of what types of facts should be considered in judging a person to be legally insane and not in control of their actions.

Clearly, it is unjust to punish someone for things they had no control over. They may still be held liable (e.g. for recompense), but that does not arise from criminality. Mens rea (broadened to include negligence) is a vital part of criminality.

What are some of the facts that you are aware of that lead you to say that Dr. Szasz is "quite obviously mistaken" if he argues that mental illnesses are myths, as he does?

Basically, Dr. Szasz considers mental illnesses to be metaphorical illnesses in the same way that "spring fever" is a metaphorical illness. Organs can diseased, and that is the root of the medical idea of disease. But the mind, can the mind be diseased? The brain, yes, but one's views, one's thinking, can such things be diseased? Ill?

He doesn't deny the facts that give rise to what people call mental illnesses, only the interpretation, as it were. Although it's been some time, I've read a few of his books, so more than just the articles available on his site. They do offer some introduction to his views.

I know that Dr. Peikoff thinks that we're heading towards a theocracy. Interestingly, Dr. Szasz has his own version of a dystopian future that we're headed towards (and already are in) — a Therapeutic State wherein all of ethics has been medicalized.

As an aside, I don't know if I could find the source, but I remember Dr. Szasz mentioning that there was a psychiatrist here in the US who was an immigrant and unfamiliar with certain idioms. When one of his patients said that she had butterflies in her stomach, he thought that she was hallucinating.

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name='Trebor' date='Jul 29 2009, 07:46 PM' post='226113']

Basically, Dr. Szasz considers mental illnesses to be metaphorical illnesses in the same way that "spring fever" is a metaphorical illness. Organs can diseased, and that is the root of the medical idea of disease. But the mind, can the mind be diseased? The brain, yes, but one's views, one's thinking, can such things be diseased? Ill?

He's wrong. Many mental illnesses have known physiological causes within the brain. Some forms of schizophrenia, for instance, are caused by an inability of the left and right hemispheres of the brain to communicate with each other.

I know that Dr. Peikoff thinks that we're heading towards a theocracy. Interestingly, Dr. Szasz has his own version of a dystopian future that we're headed towards (and already are in) — a Therapeutic State wherein all of ethics has been medicalized.

Okay. And even if that were true, it would prove his theories about the validity of mental illness...how, exactly?

As an aside, I don't know if I could find the source, but I remember Dr. Szasz mentioning that there was a psychiatrist here in the US who was an immigrant and unfamiliar with certain idioms. When one of his patients said that she had butterflies in her stomach, he thought that she was hallucinating.

And this is supposed to prove that there's no such thing as hallucination?

Edited by The Wrath
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Would it be fair to say that you're in agreement with the DSM-IV?

When homosexuality was a mental illness, but stopped being a mental illness, what happened?

The cases are pretty well-documented. I don't care to look them up, because you'll just turn around and say "he could have been faking mental illness." Well, yeah, and God could have created the universe 6,000 years ago, but made it look billions of years old. Even so, the PTSD thing was just an example. I could come up with a thousand others, and you would probably just deny their validity as well. I trust the psychiatrists who study these things, for the same reason I trust my doctor to identify the warning signs of skin cancer.

You seem to be accepting the notion of the author of the article you just posted that the very concept of mental illness is erroneous. If you've already made up your mind that all claims of insanity are bullshit, then there's no evidence I can give you that you'll accept, because you can always just claim the person is faking it.

There's a church for people who deny the validity of psychiatry. It's called Scientology. I hear Tom Cruise and John Travolta are involved so, if you do in fact doubt the existence of mental illness, at least you're in good company.

Well, you asked for opinions, and I gave my own, in part.

I could simply quote your own comments right back at you, but why bother? Read it yourself.

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What are some of the facts that you are aware of that lead you to say that Dr. Szasz is "quite obviously mistaken" if he argues that mental illnesses are myths, as he does?
Certain manifestations of psychosis are as real as stomach aches, and can even be traced to physical causes. The wards of mental hospitals are full of such people. While the doctor in your example mistakenly thought his patient was hallucinating, the fact is that some people have hallucinations.

Aside: If you have not seen the movie "Changeling", it is a good one, and also relevant to this topic of false imprisonment, under a diagnosis of mental illness. (Nevertheless, the exceptions do not prove the rule.)

Organs can diseased, and that is the root of the medical idea of disease. But the mind, can the mind be diseased? The brain, yes, but one's views, one's thinking, can such things be diseased? Ill?
The mind is a manifestation of the "brain". So, I don't see the dichotomy here. One can cut off a piece of the brain and end up losing a part of one's mind. Even if another part of the brain can take over eventually, that does not change the fact that the two were linked at a point in time. Analogously, one could claim that the stomach can be diseased and ill, but the digestion cannot. I cannot derive any meaning from such a formulation: faults observed in digestion could be a manifestation of problems with the stomach. It is really uncontroversial.

Of course, there is a history of people labelling ideological errors (or ideological disagreements) as being mental illness, and I agree those are not. Professional doctors in the field need to be drawing the "razor" more sharply, to distinguish one from the other. Denying the reality of the real illnesses will hurt rather than help their case, because anyone who has had any experience with people who are really hallucinating and who have lost control of their thinking (as I have had) will write off such theorists as people who are ignoring reality, in order to push an ideological viewpoint.

Many libertarians -- including many that Objectivists find highly objectionable -- think the world is heading to some type of dystopian end. Even if they are all correct about this particular forecast, it does not imply that they're all on a similar page about all legal/political questions; and it is even less likely that they're on the same page on morality/philosophy... and even less on scientific issues like medicine.

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I think humans are capable of making objective, rational decision. The line between foreseeable and unforseeable can be drawn just fine.

In both your new scenarios, for instance, the owner of the property can establish safety guidelines, and obeying them would be the deciding factor in the accident becoming a crime or not.

And yes, commiting any crime is immoral. Not sure what you mean by an "immoral person" though. I would think an immoral person would have to be completely evil and depraved. One crime does not make someone a completely immoral person.

I think you are dodging the questions. Yes, we can make objective, rational decisions, and sure the property owner can establish safety guidelines. On the other hand we can also make errors of knowledge and judgement, and we certainly don't have safety guidlines for everything. So, what defines negligence and how far must an individual be able to foresee things?

No, an immoral person is not necessarily completely evil and depraved. There are degrees of immorality. In these scenarios however there are no immoral actions. Those are mistakes, accidents if you will, that could happen to aynone.

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Certain manifestations of psychosis are as real as stomach aches, and can even be traced to physical causes. The wards of mental hospitals are full of such people. While the doctor in your example mistakenly thought his patient was hallucinating, the fact is that some people have hallucinations.

I could not hope to do justice to Dr. Thomas Szasz's views, and arguments, here in snippets, no more so than I could hope to do Miss Rand's views justice in snippets. At best, a forum such as this is but an adjunct to learning, not a primary source. I generally recommend that people actually read Miss Rand, for example, as a primary, not go to Objectivism Online. I'd suggest the same for Dr. Szasz.

Aside: If you have not seen the movie "Changeling", it is a good one, and also relevant to this topic of false imprisonment, under a diagnosis of mental illness. (Nevertheless, the exceptions do not prove the rule.)

Interestingly, I had seen it at Blockbuster, but had never been interested in watching it, not until I read a recently posted article about Alan Turing, the mathematician, by Dr. Szasz in which he mentioned the movie, "The Shame of Medicine: The Case of Alan Turing." I have seen the movie; I'm not arguing that exceptions prove the rule.

The mind is a manifestation of the "brain". So, I don't see the dichotomy here. One can cut off a piece of the brain and end up losing a part of one's mind. Even if another part of the brain can take over eventually, that does not change the fact that the two were linked at a point in time. Analogously, one could claim that the stomach can be diseased and ill, but the digestion cannot. I cannot derive any meaning from such a formulation: faults observed in digestion could be a manifestation of problems with the stomach. It is really uncontroversial.

If the brain is diseased, one has a brain disease. I agree. If one has a digestive problem, one should take care of it. Doing so requires that one actually identify the nature of the problem including it's cause.

Of course, there is a history of people labelling ideological errors (or ideological disagreements) as being mental illness, and I agree those are not. Professional doctors in the field need to be drawing the "razor" more sharply, to distinguish one from the other. Denying the reality of the real illnesses will hurt rather than help their case, because anyone who has had any experience with people who are really hallucinating and who have lost control of their thinking (as I have had) will write off such theorists as people who are ignoring reality, in order to push an ideological viewpoint.

I agree; one should never deny the reality of the real.

"As I have shown elsewhere, the so-called voices some mentally ill people "hear" are their own inner voices or self conversations, whose authorship they disown.(10) This interpretation is supported by the fact that neuroimaging studies of hallucinating persons reveal activation of Broca's (speech) area, not activation of Wernicke's (auditory) area.(13)" Thomas Szasz: "Mental illness: psychiatry's phlogiston"

Many libertarians -- including many that Objectivists find highly objectionable -- think the world is heading to some type of dystopian end. Even if they are all correct about this particular forecast, it does not imply that they're all on a similar page about all legal/political questions; and it is even less likely that they're on the same page on morality/philosophy... and even less on scientific issues like medicine.

I wasn't making any such arguement. Dr. Peikoff thinks that we're headed towards a theocratic state; Dr. Szasz thinks we're headed for, and have been in, a therapeutic state with psychiatry as the Church of America. For example, see this recent thread here on this forum, "How should I handle this?"

Someone asked for views on dealing with the criminally insane. I offered a point of view that I basically agree with, expressed better than I would care to give the time to trying to do on this forum. If you and others do not want to read Dr. Szasz's works, by all means do not read them.

But for anyone else, perhaps Dr. Hurd's reviews on a couple of Dr. Szasz's books will stimulate their interest:

From Dr. Hurd's reviews:

On The Myth of Mental Illness:

"A classic work that has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. Szasz is a lone voice in the wilderness. He has the courage to state that the psychiatric profession routinely declares war on personal responsibility."

On Cruel Compassion: Psychiatric Control of Society's Unwanted:

"Not afraid of the truth, Thomas Szasz uncovers and refutes many of the myths surrounding the psychiatric and mental illness industry. He describes how our current society is being transformed from a constitutional republic into a Therapeutic State."

Myself, I'd recommend: The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement

Edited by Trebor
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Someone asked for views on dealing with the criminally insane. I offered a point of view that I basically agree with, expressed better than I would care to give the time to trying to do on this forum. If you and others do not want to read Dr. Szasz's works, by all means do not read them.

But for anyone else, perhaps Dr. Hurd's reviews on a couple of Dr. Szasz's books will stimulate their interest:

From Dr. Hurd's reviews:

Thanks for the link (this link goes directly to the expanded version).

I've granted that many things are labelled "mental illness", when they are not.

Nevertheless, from a legal perspective, we're still left with the question of how to deal with people who are genuinely mentally ill.

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Trebor, you and Dr. Szasz seem to be using similar arguments to the ones Creationists use to debunk evolution. Creationists are fond of pointing various hoaxes and false positives in an attempt to prove that the theory of evolution is wrong. But pointing out that the Piltdown Man was a hoax does not disprove evolution. It simply disproves that the Piltdown Man was real. Similarly, pointing out that mental illnesses can be faked and misdiagnosed does not prove that they do not exist.

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It also cannot be ignored that there is no "cure" for schizophrenia and no "cure" for mental disturbances that bring on psychotic breaks.

While there is no current cure for schizophrenia, the medication is very helpful, and regaining the proper functioning of the brain chemistry is crucial though what is equally beneficial is for the schizophrenic to discover or to apply reason while he is on medication.

Besides, what threw up a flag for me in this above comment is that you seem to be confusing schizophrenia with insanity -- and the two conditions are not interchangeable. A schizophrenic has a brain chemistry imbalance that can be treated with modern medications; and I'm not sure how the insane can be so medically treated. Some brain disorders lead to insanity, if not treated, but some people just seem to lose touch with reality altogether.

If a person can be shown to have lost touch with reality (he is insane), and he commits crimes (he's criminally insane), then he needs to be kept away from other people he is a threat to. Cutting off someone's head because the devil told you to do it or because one believed that person was the devil doesn't leave much room for letting this person (treated or untreated) to roam the streets, even if he is eventually cured. Unless it can be shown that the person was not responsible at all for having done that, but if he is so insane he doesn't know the difference between a random passenger on a bus and the devil, he is an objective threat to anyone he sits next to anywhere in society. Let's put it this way, a dog or a lion is not morally responsible for what he does either, but you can't let a rabid dog or a lion roam the streets.

I haven't read this whole thread and I am behind on my oo.net readings, so excuse me if I am repeating something already said.

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Besides, what threw up a flag for me in this above comment is that you seem to be confusing schizophrenia with insanity -- and the two conditions are not interchangeable. A schizophrenic has a brain chemistry imbalance that can be treated with modern medications; and I'm not sure how the insane can be so medically treated

Not confusing them, that is why I made the distinction in my post. It could be seen as unclear and for that I apologise.

The danger of many schizophrenics (my partner develops treatment plans for them and works generally with the homeless) is that it can be very difficult to control the taking of their meds (and taking them properly with no added alcohol or street drugs) in an outpatient scenario. Leading to psychotic breaks.

If it seemed I was lumping them together that was not my intention, but rather to list a couple instances of potentially dangerous hard to treat issues that need addressing for the "cure & release" system that was proposed earlier in the thread.

Edited by QuoVadis
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As someone who has lived for years very closely with someone who suffers from a severe case of bipolar disorder, I have to wonder what kind of idiot tries to refute the existence of mental illnesses, in particular those that are the manifestation of chemical or other biological imbalances in the physical brain. To quote the fictitious character of Dr. Lillith Sternin: "Why don't you just drill a hole in his head for the evil spirits to come out, then?"

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As someone who has lived for years very closely with someone who suffers from a severe case of bipolar disorder, I have to wonder what kind of idiot tries to refute the existence of mental illnesses, in particular those that are the manifestation of chemical or other biological imbalances in the physical brain. To quote the fictitious character of Dr. Lillith Sternin: "Why don't you just drill a hole in his head for the evil spirits to come out, then?"

Well then, let us hope that you and yours never have to suffer the indignity of being the beneficiary of such idiots.

Trebor the Idiot

Edited by Trebor
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What precisely are you suggesting, Trebor?

Also, answer this: do you or do you not accept that there are people who are genuinely mentally ill?

Precisely, I'm suggesting that those who might yet not accept the view that "we all know" that mental illnesses are real illnesses just like other illnesses, and that psychiatrists are medical doctors just like other doctors, read Dr. Thomas Szasz's book, The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement, which I mentioned previously. Here again is a link to the book on Amazon.

To understand psychiatry, insanity and mental illnesses, one needs to understand the history of psychiatry, insanity and mental illnesses. That is the reason I recommend that particular book by Dr. Szasz.

Beyond that, here are a couple of YouTube videos that may be of some interest to some, though doubtfully to yourself.

Dr. Jeffrey Schaler on Psychiatry as a Fraud

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Precisely, I'm suggesting that those who might yet not accept the view that "we all know" that mental illnesses are real illnesses just like other illnesses, and that psychiatrists are medical doctors just like other doctors, read Dr. Thomas Szasz's book, The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement, which I mentioned previously. Here again is a link to the book on Amazon.

To understand psychiatry, insanity and mental illnesses, one needs to understand the history of psychiatry, insanity and mental illnesses. That is the reason I recommend that particular book by Dr. Szasz.

Beyond that, here are a couple of YouTube videos that may be of some interest to some, though doubtfully to yourself.

Dr. Jeffrey Schaler on Psychiatry as a Fraud

You did not answer Wrath's question. Do you or do you not, personally, accept that there exists such a thing as mental illness and that there are in fact mentally ill people? If you do not believe that there is such a thing as mental illness than what would you say about people currently diagnosed as schizophrenic, bipolar, obsessive-compulsive, chronically depressed, etc?

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To understand psychiatry, insanity and mental illnesses, one needs to understand the history of psychiatry, insanity and mental illnesses. That is the reason I recommend that particular book by Dr. Szasz.

I don't think anyone here would deny that the treatment of mental illnesses in the past was horrific, just as treatments for other illnesses were horrific. But to say that psychiatry is a fraud when medication genuinely treats a wide variety of mental illnesses is to ignore the facts of reality. I will grant you that sometimes, maybe even often in certain cases, medications are prescribed when a person actually needs serious psychotherapy; or even in some cases medication is prescribed when there isn't anything wrong aside from the fact that so and so is being obnoxious. However, to say the whole field is a fraud is just ridiculous. The brain is an organ, and like any other organ, it can malfunction. Such malfunctions severely limit the cognition of the sufferer of a mental illness, and medication can bring tremendous relief from that malfunction.

As to the relationship between mind and brain, in other threads we discussed how sometimes a person has psychological problems and sometimes he can have neurological problems -- and the two are treated differently; psychotherapy versus medication. But even aside from that, there are people who have something wrong with their mind, which is why it is called a mental illness. You seem to be saying that because it is the mind, which is not physical, then one cannot call it an illness, when in fact it is very clear that their cognition is malfunctioning. As to why, that would probably require a specialist to diagnose it, but there certainly are people out there who either will not or cannot think straight because they have a mental disorder (brain or mind goes awry).

Misdiagnosis, either in the past or in the present, does not have any claim on the fact that certain people legitimately have a mental disorder.

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I personally do not accept that there exist mental illnesses, excepting as metaphorical illnesses.

What would I say about people currently diagnosed as having various mental illnesses?

In brief, that they have been diagnosed with having various mental illnesses, various metaphorical illnesses.

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I personally do not accept that there exist mental illnesses, excepting as metaphorical illnesses.

What would I say about people currently diagnosed as having various mental illnesses?

In brief, that they have been diagnosed with having various mental illnesses, various metaphorical illnesses.

Ok then, that makes sense. Then you and I are not in agreement, nor are you I suspect in agreement with Wrath or Tom or most of the other posters. I see nothing metaphorical about hallucinations or bipolar disorder.

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Then you and I are not in agreement, ... I see nothing metaphorical about hallucinations or bipolar disorder.
Just to make the picture complete, Trebor did grant (link) that the brain can be diseased. So, his disagreement may be more subtle than it first appears. Edited by softwareNerd
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Just to make the picture complete, Trebor did grant (link) that the brain can be diseased. So, his disagreement may be more subtle than it first appears.

I'm thinking he might have a mind / body dichotomy. If a mental illness (the way I use the term) effects cognition, unless medicated, then a badly operating brain does effect the mind. For something like schizophrenia, too much dopamine production leads to easy memory triggering -- the subconscious runs wild, so to speak -- and this can seriously effect one's ability to remain focused and to think rationally. Similarly, for something like bipolar disorder, as I understand it, the chemical imbalance leads to emotions swinging up and down quite easily. Now, I think it would take a competent psychotherapist / psychiatrist to come up with the correct treatment plan, but the two fields do not necessarily have to be in conflict with one another, as a treatment plan may include medication and psychotherapy.

Also, on a related topic, there is a disorder that is called synethesia, whereby different regions of the brain next to one another are not electrochemically isolated as well as they should be and the person experiences sounds when they see certain things or colors around number or words or even tastes when they hear certain words. The only cure would be to better isolate those regions of the brain, but obviously, such a condition would make even talking about what something looks like or sounds like is being interfered with by a brain malfunction. So, the mind / body dichotomy -- of saying the brain is not the mind and has no relation to it -- would lead to not making the correct diagnosis when it comes to assessing what the problem is.

These people with these problems are not imagining their ills -- that is, it is not "just in their minds" -- but are real experiences that occur when the brain malfunctions.

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I'm thinking he might have a mind / body dichotomy. If a mental illness (the way I use the term) effects cognition, unless medicated, then a badly operating brain does effect the mind. For something like schizophrenia, too much dopamine production leads to easy memory triggering -- the subconscious runs wild, so to speak -- and this can seriously effect one's ability to remain focused and to think rationally. Similarly, for something like bipolar disorder, as I understand it, the chemical imbalance leads to emotions swinging up and down quite easily. Now, I think it would take a competent psychotherapist / psychiatrist to come up with the correct treatment plan, but the two fields do not necessarily have to be in conflict with one another, as a treatment plan may include medication and psychotherapy.

Also, on a related topic, there is a disorder that is called synethesia, whereby different regions of the brain next to one another are not electrochemically isolated as well as they should be and the person experiences sounds when they see certain things or colors around number or words or even tastes when they hear certain words. The only cure would be to better isolate those regions of the brain, but obviously, such a condition would make even talking about what something looks like or sounds like is being interfered with by a brain malfunction. So, the mind / body dichotomy -- of saying the brain is not the mind and has no relation to it -- would lead to not making the correct diagnosis when it comes to assessing what the problem is.

These people with these problems are not imagining their ills -- that is, it is not "just in their minds" -- but are real experiences that occur when the brain malfunctions.

I think it is also worth noting that with cognitive therapy, changing your most basic and typical thought patterns will literally over time change your brain architecture and chemical composition. So what is going on in the "mind" has very real physical effects.

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I think it is also worth noting that with cognitive therapy, changing your most basic and typical thought patterns will literally over time change your brain architecture and chemical composition. So what is going on in the "mind" has very real physical effects.

Cognitive therapy is the best we have right now, and I think it may need some more work; that is, one would have to integrate the Objectivist understanding of emotions with psychotherapy. It's very controversial, but I don't know that bipolar disorder or schizophrenia can be handled with just cognitive therapy; some practitioners claim they can be so treated, that these disorders come about due to psychological problems not brain malfunctions. But I've seen people recover or at least become functional with medication, so my personal conclusion is that both may be necessary. Basically, check with your psychiatrist or your psychologist, and find something that works for you. Both fields are still somewhat in a pre-scientific state, which is one reason there is so much controversy over treatment plans.

In general, however, I have found that making a cognitive re-evaluation of something that is giving you trouble can solve the issue -- if it is a psychological problem. I'm not an expert, but that has a lot of potential. And I have heard claims this can work for more serious illnesses, but I'm not convinced.

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I personally do not accept that there exist mental illnesses, excepting as metaphorical illnesses.

What would I say about people currently diagnosed as having various mental illnesses?

In brief, that they have been diagnosed with having various mental illnesses, various metaphorical illnesses.

On the denial-of-modern-science ladder, this is one step up from Creationism which is, itself, one step up from flat earth theory.

Also, a quick scan of the Wikipedia article on Szasz shows that he is involved with Scientology...which, alone, is almost enough reason to discount everything that he says.

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It might be worth noting that I don't think a mental illness (psychological or neurological) in and of itself causes criminal or violent behavior. There was a study done in Australia of people with significant mental problems and their relation to crime and it was discovered that so long as the mentally ill do not get on illicit drugs they can retain enough self-control not to become violent offenders. In general, Miss Rand is right in "The Psychology of Psychologizing" that even with mental problems a person can retain self-control. However, some aspects of someone getting triggered on a trauma (i.e Vietnam) is experienced as if it is happening right now, and he may not realize for a few moments that it is a memory flash and not a real event in real time. I've know people who were in Vietnam and have had other such experiences with traumas and they all relate the same thing -- that while the flash-back is occurring, it seems like it is happening now. I wouldn't say these people are necessarily dangerous, but obviously some don't realize they are not actually in a traumatic situation right now. There are treatment methods for this type of problem, but due to the realism of experiencing that traumatic event in the here and now, it is often resisted by the patient. In other words, it may be necessary to get triggered on a trauma and have it dealt with fully by a specialist, say at a trauma treatment center, before one can move on from it and be whole again.

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