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Government and the Mentally Ill

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It is proper for the government to commit and/or medicate people who are a danger to others because of their mental illness. It is just an issue of how much danger they really are: there are cases when the danger is very serious, and the use of force is then justified.

Another instance of a mentally ill person "losing" his rights is when a guardian (custodian perhaps?) is appointed, as the person is unable to make day to day decisions for himself. In this case this person gains a status similar to that of a child or teenager, and this is also a proper function of the government to decide.

I am basing my opinion on the principle of one fundamental right, a man's right to his own life. In the case of a person who is expected to be a danger to others or himself if left alone (because he is unable to exercise his rational faculty), no further rights can be derived from this fundamental right. If someone chooses to take care of him, they can. In the case of someone who is a danger, it is the government's job to take him into custody, if no one else will.

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I'd like to know what members of the Objectivist community think about the practice of involuntary psychiatric commitment. If you are in favor of it, does your support extend to forced medication, or merely to confinement in a mental institution?

I would suggest reading anything by Dr. Thomas Szasz ( http://www.szasz.com/ ). Not an Objectivist, but a professor of psychiatry, he has written several books and has a long history of challenging the very idea of mental illness. For an introduction to his basic ideas, you can read his various essays on his "Szasz Materials" link on his home page, or: http://www.szasz.com/szaszwri.html

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Dr. Szasz makes good points all around (at least they sound good to me, a layman), but after looking over some of the articles, I didn't find a good case made for completely abolishing involuntary commitment.

He appears to make a good point that the standards used today are bad, and that psychiatry is headed in the wrong direction etc., but I haven't seen a substantive challenge against the idea of "mental illness"/ inability to make rational choices. (in fact I haven' seen the concept of reason come into this at all in those articles.)

There's also no definition for the concept of rights, no philosophical basis for his demands that patients should not be coerced: as far as I have seen, his starting point is the statement that "freedom is good, government involvement is bad" no matter what. He is a typical Libertarian, as far as I can see.

I admit however that I can't possibly challenge anything he says within the field of psychiatry (in fact it sound like he's right to me), and I also haven't read all the stuff on the site. If you can, please point out/quote anything you think is a strong argument for the things I mentioned, or contradicts my criticism.

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Before much was known about the causes of mental illness, those suffering from such disorders were confined primarily because doctors didn't know what else to do with them. However, it has been discovered that recovery happens much more quickly if the mentally disturbed are given the proper medication (when appropriate), some guidance as to how to deal with their illness, and then released to deal with reality on a daily basis. It turns out that it is not good for anyone, let alone the mentally ill, to be locked up in a room and sedated, as this does not lead to recovery.

I think the only time the government ought to be involved is if the mentally disturbed is shown to have a record of being a danger to others, since the role of the government is to protect the individual rights of everyone in society. Otherwise, if the mentally disturbed is not a danger to his fellow man, then the government has no business getting involved.

There is a lot of controversy as to the root causes of mental malfunction -- i.e. is it biological, psychological, "environmental", or unclear thinking in stressful situations. As some others have pointed out on this board, sometimes being rational is certainly not easy if one actually has a biological (neurological) problem, and even on medication they have to learn to think things through. So I think the overall lack of a rational philosophy pervading the culture is one reason why they may either get a mental illness or cannot recover even on medication in some cases. The state of the field of psychology is rather primitive these days, leading some practitioners to think that giving medication is sufficient for recovery -- i.e. once the brain starts working correctly, then that is all there is to it. But it is only in some cases that this is true.

I also think there is a kind of superstition out there about the mentally disturbed -- i.e. that they will all become raving lunatics out to murder everyone. This isn't true, but the myth continues because every once in a while someone with schizophrenia will commit a murder. However, this does not mean that everyone with that illness is a danger to others. There are actually many tens of thousands of people out there (if not many more) with a mental illness that are not a danger to anyone, because once they get the treatment they need they can go on to live more or less normal lives.

Of course, having a mental illness is no excuse to go around hurting others or using violence against them, but these make the headlines, so most people have a fear of those who have that illness.

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Dr. Szasz makes good points all around (at least they sound good to me, a layman), but after looking over some of the articles, I didn't find a good case made for completely abolishing involuntary commitment.

He appears to make a good point that the standards used today are bad, and that psychiatry is headed in the wrong direction etc., but I haven't seen a substantive challenge against the idea of "mental illness"/ inability to make rational choices. (in fact I haven' seen the concept of reason come into this at all in those articles.)

There's also no definition for the concept of rights, no philosophical basis for his demands that patients should not be coerced: as far as I have seen, his starting point is the statement that "freedom is good, government involvement is bad" no matter what. He is a typical Libertarian, as far as I can see.

I admit however that I can't possibly challenge anything he says within the field of psychiatry (in fact it sound like he's right to me), and I also haven't read all the stuff on the site. If you can, please point out/quote anything you think is a strong argument for the things I mentioned, or contradicts my criticism.

As I said, since the 50s he's been arguing that there's no such thing as mental illness. I do not think he's a "typical Libertarian," nor that he holds, as you suggest, the view that "'freedom is good, government involvement is bad' no matter what."

I do not find the concept of "reason" missing at all from his discussions on the topic of "mental illness" or of the "mentally ill."

He has long argued that mental illnesses -- he does not deny or dismiss the problems that people have in living that are typically referred to as mental illnesses -- are metaphorical illnesses, not literal illnesses, but that the metaphor has been dropped and the phenomena that are referred to as mental illnesses are treated as though they are in fact illnesses. If there are no such things as mental illnesses, if they are only metaphorical illnesses, in the way that spring fever is a metaphorical illness, then that should be acknowledged. If there are no mental illnesses, that would be sufficient gounds, philosophically, to "demands that patients should not be coerced" because they are mentally ill.

If he is correct, if there are no mental illnesses, then, again, that itself is sufficient grounds, or argument, for the case for completely abolishing involuntary commitments for the "treatment" of "mental illnesses." (He is certainly not for the use of "mental illness" as relieving a person of his responsibility for his criminal actions, the "insanity defense." If a person commits a crime, he should be treated as a criminal.)

If he is correct, then metaphorical illnesses should not be held to be literal illnesses, nor "treated" by a medical specialty, no more than a "sick economy" should be held to be a literal illness to be treated by a medical specialty.

It is not that the standards used today are bad; if mental illnesses are only metaphorical illnesses, then there's no proper standard for their medical treatment because they're not medical conditions.

For my part, I find his arguments convincing. Still, I think the ideas of mental health and mental illness to be of worth, metaphorically.

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The problem is that if you are not going to call it a mental illness, then what are you going to call it? Obviously, there are people out there who have cognitive difficulties, and by that I mean they do not have the normal capacity to tell what is real and what isn't. And I do think reality and rationality as the standard were lacking in that claim that there are no mental illnesses. Now, there is a legitimate differentiation between a brain disorder making reasoning very difficult and a psychopathology making reasoning very difficult, but if his only complaint is that a mental illness is not caused by a bug one can catch, then what are you going to call these mental malfunctions?

Also, I think there is the differentiation between someone who has either a brain disorder or a psychopathology versus such an incorrect philosophical framework that he cannot tell what is real and what isn't. I've known some philosophy professors who have this problem, and I wouldn't attribute it to something going wrong in the subconscious or something going wrong with the neurology in their brains -- it came about from a conscious choice to disregard what was right before their eyes.

Generally speaking, a mental illness would have to be defined as someone having the difficulty of dealing with reality in a rational manner brought about by either a brain disorder or a psychopathology. Psychopathology means they have significant problems with their subconscious processing such that they have abnormal reactions to everyday things -- such as, say, being deathly afraid of germs to the point of cleaning all of the time. In some cases, an apparent psychopathology can be cured or rendered less disruptive by medication, so there are borderline cases. But to say there are no mental illnesses in the sense he was saying is just wrong, and I detected a lot of relativism in his semi-reasoning.

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For my part, I find his arguments convincing.
I have not read the original, but do you grant that some people are psychotic. Forget all the neurotics; that's a different category. Forget whether you want to call psychosis an illness or not. Will you grant that psychotics are in a different enough category to non-psychotics, at least during a psychotic episode.

For instance, a close family member of mine was perfectly sane and rational all his life. Then, he got a disease that began to eat away at his spinal column (at least that's my layman's understanding). He would have episodes of hallucinations. For instance, he would see spiders climbing up the wall. His reaction would then make sense, given this input. So, he would perhaps try to hit the spider with something, and so on.

Are you saying that these episodes are not significantly different from his perception and consciousness before he had the disease?

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Are you saying that these episodes are not significantly different from his perception and consciousness before he had the disease?

From reading "The Myth of Mental Illness" I think Dr. Szasz would say that your family member didn't have a mental illness, he had a spinal column disease that lead to his cognitive malfunctioning. But, obviously, from your description, your family member had some sort of cognitive problem that in his case can be traced back to his injury due to an illness. In some cases, according to some professionals, things like psychotic episodes, schizophrenia, bipolar disorder, depression, and things like are all caused by brain malfunctions, sometimes on the neuro-chemical level. But obviously, these types of brain disorders also creates an inability to reason well in all cases of cognition. In other words, there is definitely a connection between certain brain disorders and cognitive thinking. It is not as if someone can have a badly functioning brain and still be cognitive in the normal sense. There are even people out there who have such a badly functioning brain (or some areas) that they fully believe that their own body parts are not theirs -- and they go through an effort to cut off their hands or feet to get rid of the alien appendage. So, at what point does one call it a cognitive problem if cognition is effected by the brain malfunctioning?

I think part of Dr. Szasz' conclusions arise from the idea that the mind is something that cannot catch a disease or cannot malfunction -- i.e. the brain can go haywire, but this doesn't effect the mind. I don't think that is true. I actually think it can go either way, that bad brain functioning can lead to mental problems, and sever enough mental / mind problems can lead to brain malfunctioning. There is growing evidence that how one thinks or doesn't think can effect the operations of the brain. Even on that thread concerning lack of sense of self (i.e. spiritualism) and the functioning of the brain is reciprocal, in that one can induce the state of being "spiritual" by meditation, thus shutting down a part of the brain that gives one a sense of self, or one can get a brain disorder or injury that leads to a lack of self-awareness.

The thing for professionals to figure out, and there is growing debate on the issue, is diagnosing improper thinking in psychology versus improper brain functioning in psychiatry versus brain injury. Perhaps one day they will even be able to do some sort of partial brain transplants to help out those who had part of their brains injured.

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From reading "The Myth of Mental Illness" I think Dr. Szasz would say that your family member didn't have a mental illness, he had a spinal column disease that lead to his cognitive malfunctioning.
Interesting. So, he would agree that there was an illness in the sense of something wrong with a part of the body, but he would be debating whether to call it a "mental" illness, as opposed to a "brain" illness or a "spinal column" illness? If that's the essence, it seems to be much ado about nothing.
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Interesting. So, he would agree that there was an illness in the sense of something wrong with a part of the body, but he would be debating whether to call it a "mental" illness, as opposed to a "brain" illness or a "spinal column" illness? If that's the essence, it seems to be much ado about nothing.

I wish that I could do justice to all that Dr. Szasz has said in a brief post, but I know that I cannot.

I just found a bit of a biography on him by Jeffery Oliver entitled, "The Myth of Thomas Szasz": http://www.thenewatlantis.com/publications...of-thomas-szasz, if anyone is interested.

We are currently watching our government deal with our ailing economy. Given the prevalent views, we are watching them attempt to correct it by injecting "capital" in the hope of stimulating it. If one misidentifies the nature of, the cause of, a problem, one has no means of solving it; as long as the wrong views are held, we can expect more of the same in this drawnout march to totalitarianism. (By the way, I've read recently that Madoff, or his lawyers, are investigating or planning on using the "insanity" defense. http://www.presstv.ir/detail.aspx?id=79918...tionid=3510203)

The same applies to mental illnesses. If their nature is misidentified, then there is no means of addressing them.

There are many essays by Dr. Szasz on his web site under the "Szasz Materials" link, and they offer some introduction to his ideas. In a manner similar to Mises, I find fault with Szasz's philosophical views, but not with his criticisms of psychiatry and "mental illness."

I'm not sure if Mr. Movias has read Szasz's book, "The Myth of Mental Illness," or only an essay of that title on the Szasz site, but that was his first book challenging the idea of mental illness. It's certainly more robust in criticism than his essay(s).

It's been awhile since I've read any of his books, but the one that I found most relevant and memorable is "The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement" http://www.amazon.com/Manufacture-Madness-...5258&sr=8-7

He really is a fascinating thinker and prolific writer, and in spite of any faults I find relative to Objectivism, he's got a lot to say. Plus he's quite enjoyable to read. He shines a light on his subject that's very revealing and informative. Reading him just for a history of psychiatry is worthwhile and revealing.

I mentioned Dr. Szasz in response to cliveandrews question, "I'd like to know what members of the Objectivist community think about the practice of involuntary psychiatric commitment. If you are in favor of it, does your support extend to forced medication, or merely to confinement in a mental institution?"

Dr. Szasz has been fighting against involuntary psychiatric commitment his whole adult life. He has a lot to say on the subject, and I thought to suggest him to cliveandrews given his question.

"Because the mind is not an object like the body, it is a mistake to apply the predicate disease to it. Hence, as I asserted half a century ago, the "diseased mind" is a metaphor, a mistake, a myth.

Actually, this idea is not as novel as it might seem. Emil Kraepelin (1856-1927), the creator of the first modern psychiatric nosology, acknowledged the fundamental analytic truth that there are no mental illnesses. In his classic, Lectures on Clinical Psychiatry (1901), he stated: "The subject of the following course of lectures will be the Science of Psychiatry, which, as its name [seelenheilkunde] implies, is that of the treatment of mental disease. It is true that, in the strictest terms, we cannot speak of the mind as becoming diseased [Allerdings kann mann, streng genommen, nicht von Erkrankungen der Seele sprechen]." Half a century earlier, the Viennese psychiatrist Ernst von Feuchtersleben (1806-1848) explicitly emphasized the analogical-metaphorical character of mental illnesses: "The maladies of the spirit [die Leiden des Geistes) alone, in abstracto, that is, error and sin, can be called diseases of the mind only per analogiam. They come not within the jurisdiction of the physician, but that of the teacher or clergyman, who again are called physicians of the mind / soul (Seelenärzte) only per analogiam".

The transformation of religious explanations and controls into medical explanations and controls of behavior is one of the momentous consequences of the Enlightenment. The waning power of religion and the Church and the waxing power of science and the State is manifested, among other things, by the political control of medical practice and the drug laws that deny access to lay person to drugs (except those classified as over-the-counter). To legally obtain or possess a "prescription drug," the lay person must establish a professional relationship with a licensed physician and receive a diagnosis for an illness: that is, he must be a patient who suffers from a proven or putative illness. For example, to receive a sleeping pill, the person must "suffer from insomnia." This charade contributes mightily to the medicalization rampant in our society. In turn, medicalization is mindlessly equated, especially by the cognoscenti, with scientific, moral, and social progress, and contributes further to its popularity.

Although medicalization encompasses more than psychiatry, we must be clear about one thing: Psychiatry is medicalization, through and through. Whatever aspect of psychiatry psychiatrists claim is not medicalization, is not medicalization only if it deals with proven disease, in which case it belongs to neurology, neuroanatomy, neurophysiology, neurochemistry, neuropharmacology, or neurosurgery, not psychiatry.

Psychoanalysis is medicalization squared. It is important, in this connection, not to be fooled by lay analysis, clinical psychology, or social work. These and other non-medical mental health and counseling "professions" are medicalization cubed: as if to compensate for their lack of medical knowledge and qualifications, nonmedical mental health "professionals" are even more deeply committed than psychiatrists to their claim of special expertise in the diagnosis and treatment of mental illnesses."

***Szasz, T., "The medicalization of everyday life," The Freeman, 57: 18-19 (December), 2007. Reproduced from www.szasz.com by permission of J.A. Schaler.***

Link: The Medicalization of Everyday Life by Thomas Szasz, http://www.szasz.com/freeman23.html

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My apology to Mr. Miovas for misspelling his name (Movias). I also misspelled Jeffrey Oliver's name (Jeffery).

The Szasz article, "The Medicalization of Everyday Life," is brief, and there was more that I was tempted to quote, but I figured that it would be inappropriate.

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The Medicalization of Everyday Life by Thomas Szasz, http://www.szasz.com/freeman23.html

There are several issues that I agree with in this article; the mentally ill cannot be forced to take medication and the mentally ill cannot be forced out of society -- so long as they are not a danger to others. It is not the role of the State to medicate people or to incarcerate them who they see as mentally disturbed. The abuses of this type of power are legion, and one could be medicated or incarcerated if the State disagreed with your way of living or even for your ideas; so I am completely against this idea of State power.

However, it must be kept in mind that there is such a thing as reduced cognitive abilities that can come from either a brain problem or a psychological problem. If Dr. Szasz doesn't want to call these mental illnesses because they are not contagious or are not caught like a cold, then, OK, but it doesn't render the admission that certain people have reduced cognitive abilities because of mental problems. Also, some mental illnesses cannot be reduced with just counseling, some people do need medication and on a daily basis in order to function cognitively. I will agree, however, if he said that medication has taken the place of counseling, such as unruly kids in school being prescribed Ritalin instead of being counseled on how to behave. But these abuses do not account for the need of some to have medication.

So, in short, there is a need for both psychology and psychiatry -- the need for counseling and the need for medication, and professionals can even disagree when one or the other is needed. And I don't know what else to call these except mental illnesses. It's not a stigma as Dr. Szasz argues if people are educated about what they are -- that is, not all mental illnesses means that one is a lunatic. This is more of an educational problem than a problem as to what to call them.

The proper standards to use in assessing whether or not one has a mental illness are reason and reality -- if one cannot be rational (under certain circumstances) or cannot use their cognition due to brain disorders, then they have a problem, and I don't see why it shouldn't be called a mental illness. As I've said before, just because one has a mental illness it doesn't mean one is insane. One can have problems with their psychology or their brain functioning through no fault of their own, and they need some medical help, either medication or psychotherapy -- and he should not be ashamed if he needs these; just as he shouldn't be ashamed if he needs cancer treatment if he has cancer.

I can understand why someone would want to keep it private, as people with mental illnesses are often cruelly judged as being lunatics, but he shouldn't be ashamed if he needs professional help.

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However, it must be kept in mind that there is such a thing as reduced cognitive abilities that can come from either a brain problem or a psychological problem. If Dr. Szasz doesn't want to call these mental illnesses because they are not contagious or are not caught like a cold, then, OK, but it doesn't render the admission that certain people have reduced cognitive abilities because of mental problems.

When he says this though:

"Whatever aspect of psychiatry psychiatrists claim is not medicalization, is not medicalization only if it deals with proven disease, in which case it belongs to neurology, neuroanatomy, neurophysiology, neurochemistry, neuropharmacology, or neurosurgery, not psychiatry."

doesn't that cover it, at least as far as medication is concerned? He's not dismissing the concept of mental illness in the sense you're referring to, he's just saying that if it's being treated with a drug, i.e. with chemicals that are intended to interact with existing chemicals and processes in the brain or body, then what you're looking at is a physical problem, not a mental problem. I think he's saying that apparent psychological problems are either physical or philosophical: if physical then they should be treated by a physician and possibly medicated, and if philosophical then they're the sort of problems that once would have been dealt with by clergy or a similar sort of counsellor. If it's not a physical problem then it does seem obvious that drugs wouldn't be of any benefit, yet there's really no way to get help for a mental issue without being exposed through the system to chemicals that do have an effect on the brain and probably just confuse the issue. Seeing the distinction would be the first step to developing a non-medicalized way of dealing with a non-medical problem.

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I think he's saying that apparent psychological problems are either physical or philosophical: if physical then they should be treated by a physician and possibly medicated, and if philosophical then they're the sort of problems that once would have been dealt with by clergy or a similar sort of counselor. If it's not a physical problem then it does seem obvious that drugs wouldn't be of any benefit, yet there's really no way to get help for a mental issue without being exposed through the system to chemicals that do have an effect on the brain and probably just confuse the issue. Seeing the distinction would be the first step to developing a non-medicalized way of dealing with a non-medical problem.

But this is assuming that a psychological problem is a philosophical problem or a problem with one's philosophy. One can be perfectly rational and yet still have a psychological problem, and having a philosophy of reason does not prevent psychological problems. In other words, for something like a real psychological problem, it is most definitely a mental problem -- it is not something that has gone wrong with one's philosophy nor something that has gone wrong with biological functioning. Man has both a conscious mind and a subconscious mind, and things can go wrong with the subconscious mind -- i.e. one can have conflicts in the subconscious that are not the results of being illogical.

As an example, a very good friend of mine once developed psychological problems because his mother abandoned the family when he was a child -- and she blamed her children for that. He took the blame because he wasn't old enough to realize his mother was having problems, and began to repress his personality. After a while, he forgot why he was repressing his personality, because it became automated. Many years later, he was diagnosed with an abandonment psychological problem. This was not a malfunction of his conscious mind nor a malfunction of his brain, but rather a conclusion reached when he was too young to know better. In this sense, he had a mental illness -- a subconscious conclusion that he could not access and correct with his conscious mind. And for subconscious problems, one cannot just get down in their and do some re-programming, at least not without guidance, which is the proper role of psychotherapy.

So, no, it wasn't a disease in the sense that he could pass it on to acquaintances, but he was perfectly rational. I know because I knew him well. But this subconscious conclusion was like a time bomb ticking away, and when he fell in love with a woman, his subconscious shut down. It wouldn't let him fall completely in love with her because love brings the possibility of abandonment and his subconscious preventing him from knowing he was in love with her because of the repressed pain of his mother abandoning him. If one is not going to call this a mental problem, then what are you going to call it? And it couldn't be fixed with medication nor could it be fixed with Objectivism -- he was a very good Objectivist.

Basically, your subconscious is always processing information, that's it's job, and sometimes it can process to a conclusion that one is not aware of directly. This type of problem would require more than a good philosopher and medication would probably not help, so psychotherapy is the best option, though one needs to find a good one who will spot the automatized processes and help one to correct them. And in my own personal experience, one can think and think about resolving the conflict, but thinking doesn't always do the trick by itself. And sometime there can be a direct conflict between one's conscious mind and one's subconscious, which would be a mental malfunction that would not be the result of either bad philosophy nor bad brain functioning.

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As an example, a very good friend of mine once developed psychological problems because his mother abandoned the family when he was a child -- and she blamed her children for that. He took the blame because he wasn't old enough to realize his mother was having problems, and began to repress his personality. After a while, he forgot why he was repressing his personality, because it became automated. Many years later, he was diagnosed with an abandonment psychological problem. This was not a malfunction of his conscious mind nor a malfunction of his brain, but rather a conclusion reached when he was too young to know better. In this sense, he had a mental illness -- a subconscious conclusion that he could not access and correct with his conscious mind. And for subconscious problems, one cannot just get down in their and do some re-programming, at least not without guidance, which is the proper role of psychotherapy.

So, no, it wasn't a disease in the sense that he could pass it on to acquaintances, but he was perfectly rational.

Well, there are a lot of diseases and physical problems that aren't contagious, so I don't know how that's really relevant. You can't pass on a broken leg but you can't walk on it, either. If something happens in someone's past that results in them holding two conflicting beliefs about reality, even subconsciously, that's what I would call a philosophical problem. It's not some sort of spontaneous malfunction, true; it's more like a deformity like that which would result from, say, foot binding (to make a physical comparison). Being unable to walk because your feet are horribly deformed because you (or your repressive/dysfunctional family or culture) made it that way isn't an illness. The fact that he's perfectly rational but has this "philosophical deformity" makes sense just as it makes sense to say that a woman is perfectly healthy, has a strong immune system etc., but still can't walk because of this crazy thing someone did to her feet when she was too young to know better.

I'm not denying that problems like the one your friend has do happen and even that there could be certain inabilities or tendencies that they display as a result of that particular problem that are out of character, and of course there should be appropriate ways to get help for them; but I also agree with the doctor quoted earlier in that they aren't illnesses or any other sort of medical problem and treating them through a medical system, especially one that tends to treat all mental issues as though they were neurological issues that require chemical remedies, isn't necessarily appropriate. Because since there are also medical problems, i.e. problems with brain chemistry etc., that also result in destructive or uncharacteristic behaviour, having only one name or way of dealing with two really very different issues seems like an obvious problem, doesn't it?

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There are different schools of thought as to how to best treat a psychological problem; some professionals think that medication is all they need to function normally while other professionals think that all psychological problems can be traced to improper thinking. The second is known as cognitive therapy, and is closer to saying it is a conscious thinking problem (i.e. philosophy). However, I'm not convinced that proper thinking alone will resolve the issues in someone such as my friend. Introspectively, I know that I thought through some similar problems I was having, and that didn't help; I had to take appropriate action against the problem for it to be resolved. And I think this happens because the subconscious integrates all along by itself without it being a conscious integration. Your subconscious is what makes it possible for you to walk or to type because knowing how to move one's leg and how to put words together and hit the keys has been automatized. Learning a new keyboard layout would require conscious effort, just as learning to dance requires conscious effort, but it is the practicing that makes it automatized.

In certain situation, as a child or as an adult, certain situations become automatized and I don't think merely thinking about it will change the atomization. That is, one couldn't merely think about how to dance or read a book on how to dance, and learn how to dance, without taking the appropriate steps for the dance one is learning. Likewise, I don't think one could merely think about not walking the way one does and take on a different gait.

You kind of make a point about the broken leg, we don't refer to that as an illness, and we don't categorize it like we would gout or a bruised leg or an infection in the leg. But maybe professionals do. In other words, if you are a doctor and specialize in foot problems, one calls oneself a podiatrist; so it is possible that if one works on all aspects of problems with the mind / brain, then one can be called a mental health professional.

I don't want to get into a semantic issue here, because I think that is up to the professionals in that field; but certainly, there are mental health professionals, some prescribe medication, some prescribe psycho-therapy -- it all depends on what they think works best.

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I agree with various points made by Mr. Miovas and bluey; however, regarding the stigma of mental illnesses, I beg to differ with one thing you've said Mr. Miovas, "It's not a stigma as Dr. Szasz argues if people are educated about what they are -- that is, not all mental illnesses means that one is a lunatic. This is more of an educational problem than a problem as to what to call them."

That is in part an essential feature and purpose of psychiatry, to stigmatize.

"...psychiatrists have always used diagnostic terms to stigmatize and control people -- for example

* black slaves who ran away to freedom suffered from drapetomania;

* women who rebelled against being controlled by men suffered from hysteria;

* until only a few years ago, men and women who engaged in sexual acts with members of their own sex suffered from the dread disease of homosexuality."

Szasz http://www.szasz.com/cchr.html

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That is in part an essential feature and purpose of psychiatry, to stigmatize.

"...psychiatrists have always used diagnostic terms to stigmatize and control people -- for example

I'm not denying that it is possible to misdiagnose something as being a mental illness when it is not -- i.e. those slaves who wanted to escape from slavery were probably among the healthiest of their plantation; and those woman who wanted independence back in the Victorian era were probably healthy though smothered; as to homosexuality, yes, until recently it was thought of as a mental illness, but the view of them is changing since we don't know why some people are homosexuals and why some aren't.

But note that all of these examples are from the past -- even more than a hundred years ago. These days, if you are told that you have bipolar disorder or schizophrenia, it's like being told you have cancer, only the medication is very helpful and can lead to an effective treatment. Certainly no professional today would claim someone has a mental illness in a morally condemning way -- these are illnesses, not moral wrongs. Likewise for actual psychological ills. Unless one went through the effort to give oneself a mental illness, one is not morally responsible for having the illness and any good mental health professional knows this. If, on the other hand, one deliberately tries to screw up his own mind or over uses mind altering drugs (LSD, Cocaine, Heroine, etc.), then he can be held morally liable for his condition, though a professional would probably not chew him out because it isn't his place to make moral condemnations.

The real stigmatization is in people not understanding that a mental illness is not a moral wrong. It is possible for someone with a mental illness to commit a moral wrong, but having the illness is not an indication of a moral wrong. Having a mental illness, either a brain disorder or a psychological problem, is like having cancer -- and it might take a long time to eradicate it, just like cancer -- it is something that has gone wrong with you; and if you need professional help, then seek it, just as you would if you had cancer.

Denying that you have the problem will only make it worse -- it's kinda like AA, you have to admit you have the problem before you can work on the solution.

However, I will add that even these days, psychotherapy and psychiatry are not perfected sciences like physics. There is still a lot to be learned about mental problems and how to resolve them. In the early days of the science, anyone who acted differently from the cultural norm was considered to have a mental illness; fortunately, we have come a long ways -- aside from a few ignoramuses who think that anyone who acts differently is a lunatic.

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Stigmatization is a social phenomenom, in no way is it an essential feature or purpose of the doctor-patient relationship in psychiatry.

But of course. And the Internal Revenue Service exists to provide tax services to the citizens, depends upon voluntary compliance, and collects the revenue the government needs in order to protect individual rights in our free, capitalist, country.

I'm not denying that it is possible to misdiagnose something as being a mental illness when it is not -- i.e. those slaves who wanted to escape from slavery were probably among the healthiest of their plantation; and those woman who wanted independence back in the Victorian era were probably healthy though smothered; as to homosexuality, yes, until recently it was thought of as a mental illness, but the view of them is changing since we don't know why some people are homosexuals and why some aren't.

A misdiagnoses assumes that the "condition(s)" -- in these cases, the slave fleeing slavery, the woman rebelling against being controlled, a person engaging in sexual acts with members of their own sex -- is or are properly within the domain of a medical specialty to begin with. A doctor who misdiagnoses an illness is focused on illnesses, not on social control. Well, excepting for psychiatry.

It is revealing that psychiatry considered those "conditions" (drapetomania, hysteria, homosexuality) to be mental illnesses, and the use of force was held to be justified and appropriate in the process of "treating" such "diseases." Was it an honest mistake on the part of a fledgling medical profession? Or does it reveal something important about the nature of psychiatry and the "diseases" it "treats"?

You say that homosexuality was, until recently, thought to be a mental illness, but that "the view of them is changing since we don't know why some people are homosexuals and why some aren't." What? "We" previously knew why people were homosexuals and therefore thought homosexuality to be a mental illness, but we've forgotten what we knew?

If the history of psychiatry is irrelevant ("...all of these examples are from the past -- even more than a hundred years ago."), then modern psychiatry and what it professes to "treat" cannot be understood. But then, of course, we now know that being "...told that you have bipolar disorder or schizophrenia, it's like being told you have cancer..." Well, all of us excepting for the few such as Thomas Szasz who is "just wrong." ("But to say there are no mental illnesses in the sense he was saying is just wrong...")

"An ounce of clear thinking is worth a pound of research into the mysteries of the obvious." - Thomas Szasz

Edited by Trebor
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It is revealing that psychiatry considered those "conditions" (drapetomania, hysteria, homosexuality) to be mental illnesses, and the use of force was held to be justified and appropriate in the process of "treating" such "diseases." Was it an honest mistake on the part of a fledgling medical profession? Or does it reveal something important about the nature of psychiatry and the "diseases" it "treats"?

I think that psychology is not an exact science even today, and I think part of the reason why is that they do not have a proper standard by which to judge cognitive malfunctioning. In the examples given -- slave behavior, women behavior, homosexuals -- the standard was basically the social norm; and if one acted against the social norm then one was thought to have had a mental illness. One can see that this was especially true of systems like Communist Soviet Union and Communist China, where psychology was definitely used to control the inmates; and if one did not accept communism then one must be mentally ill.

A proper standard would have to take into account a rational understanding of cognition so as to be in a position to judge if someone's cognition is off due to an illness, but it would also have to take into account free will and the fact that people can rightfully choose to act differently from the social norm -- that is, a slave can choose not to accept slavery, and a Victorian woman can choose not to accept domination over her person, and a homosexual can choose to have sex with another of his sex. The social norm standard doesn't take into account that the social norm was also chosen, and in this case by a majority in that society. It is basically social metaphysics, and yes I think it is improper and especially evil to say that someone not living by the social norm is mentally ill.

However, that does not mean that there cannot be a proper standard by which to judge whether or not someone has a mental illness -- i.e. their cognitive abilities are diminished due to something going wrong in their minds or in their brains. Dr. Szasz seems to want to say that no such standard can exist; that one can never tell rationally if someone else's cognitive abilities have become diminished because there is no proper standard.

It is one thing to point out that the standard was wrong in the past, and is not fully identified in the present, and yet another thing to say that no such standard can ever be identified. Clearly, there are cases where one's cognitive abilities are diminished due to either a psychological problem or a brain disorder, based on the standard of reason and reality -- that is, it is clear that they are not being cognitive about reality and cannot reason properly due to some malfunction.

Now, should these people be controlled? It is my position that the State has no authority to control these malfunctions unless the person having them is a danger to others; and further that it is up to the individual having these problems to decide if they want treatment for their malfunctions or not. There are all kinds of horror stories out there of someone being locked up in a psych ward against his will due to having problems, but this should only happen if they are a danger to others -- in these cases, it is either jail or a psych ward. Unfortunately, for many cases, the person having the problem may not even be aware that he is having the problem, but he cannot be locked up against his will unless he is a danger to others. In other words, having a mental illness in and of itself is no grounds for locking them up.

I think the lack of a proper standard has led to all sorts of misdiagnosis, and these cases are definitely tragic, but that doesn't mean that all of psychology needs to be thrown out -- it means that they need better standards, one that takes into account man's actual nature and that cognition can properly be identified.

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But of course. And the Internal Revenue Service exists to provide tax services to the citizens, depends upon voluntary compliance, and collects the revenue the government needs in order to protect individual rights in our free, capitalist, country.

Obtuse non sequitor (or is that redundant?)

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I think that psychology is not an exact science even today, and I think part of the reason why is that they do not have a proper standard by which to judge cognitive malfunctioning.

You've made many good point with which I agree; however, I'm confused about some things you've said as well.

The central question is: Are there mental illnesses? Szasz says no. You say yes.

Szasz holds that a "mental disease" (mental dysfunction) that is caused by a brain disorder is not a mental disease. I think that is obvious. Whatever the mental dysfunctions, if they are caused by brain disorders, or any other bodily dysfunctions, the cause is the disease, the mental dysfunction is not. To call such dysfunctions "mental illnesses" is to confuse cause and effect.

You've excluded "incorrect philosophical frameworks" from mental diseases, but I'm not sure why. You did say that someone can be rational and yet have psychological problems (mental illnesses?), and I agree with that. But such problems result from, excluding brain or physical disorders, ideas held subconsciously, incorrect ideas. I would think that any bad or wrong idea held subconsciously will or will likely cause psychological problems, conflicts between consciousness and reality.

In my view, if there are mental illnesses, then they are not caused by brain disorders or anything else bodily, but are distinctly diseases of the mind. I don't know what such mind diseases would be other than fundamentally errors in thinking, such as your example of your friend with "abandonment" problems.

If, as you say, "mental illnesses" include both "psychopathologies" and mental dysfunctions caused by brain (or other bodily or physical) disorders, that introduces a profound confusion into the issue, a confustion of cause and effect and therefore of what to do about them.

I agree that "social norm" is an inappropriate standard for mental health or bodily health, or much anything else. A proper standard would have to be objective.

You say that "It is my position that the State has no authority to control these malfunctions unless the person having them is a danger to others; and further that it is up to the individual having these problems to decide if they want treatment for their malfunctions or not. There are all kinds of horror stories out there of someone being locked up in a psych ward against his will due to having problems, but this should only happen if they are a danger to others -- in these cases, it is either jail or a psych ward. Unfortunately, for many cases, the person having the problem may not even be aware that he is having the problem, but he cannot be locked up against his will unless he is a danger to others. In other words, having a mental illness in and of itself is no grounds for locking them up."

I agree mostly, but with one serious concern.

The only "dangerous to others" that I think should be considered as criminal, and potentially warrant confinement, is the initiation of the use of force.

If I understand your view, you hold that there are "mental illnesses" (even including mental dysfunctions caused by brain or other physical disorders) which cause an individual to be a "danger to others" and warrant being locked up. In other words, you hold that there are "mental illnesses" which cause crime. Correct?

Further, you hold that an individual can have such crime causing "mental illness" yet not know that they have them?

"The problem is that whenever a person factually guilty of committing a serious crime pleads insanity, the jury is asked to answer an intrinsically nonsensical question, namely, what "caused" the defendant to commit his wrongful act: his self or his mental illness? If the former, then he is a guilty victimizer. If the latter, then he is an innocent victim (of insanity). I say the question is nonsensical because, regardless of whether a person is (deemed to be) sane or insane, he has reasons, not causes, for his action. If we regard the actor's reasons as absurd or "crazy," we call him insane or mentally ill. However, that does not prove that an alleged condition ("insanity" or "mental illness") caused him to commit the forbidden act. In short, the insanity defense combines and conflates two problematic elements about "insanity": 1) what is "it" (as a phenomenon or disease)?; 2) does it cause and excuse bad behavior?"

"Does Insanity Cause Crime?" - Thomas Szasz

http://www.szasz.com/iol9.html

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Stigmatization is a social phenomenom, in no way is it an essential feature or purpose of the doctor-patient relationship in psychiatry.

Obtuse non sequitor (or is that redundant?)

I know, they treat "mental illnesses."

"Not by coincidence the history of psychiatric interventions forcibly imposed on patients is long and depressing. In a letter he wrote to me in 1988 Karl Menninger summarised the history of psychiatry with these sad words: "Added to the beatings and chainings and baths and massages came treatments that were even more ferocious: gouging out parts of the brain, producing convulsions with electric shocks, starving, surgical removal of teeth, tonsils, uteri, etc."3 To this list Menninger might have added the use of straitjackets, tranquillising chairs, confining chairs, cold baths, emetics, purgatives, Metrazol shock, inhalations of carbon dioxide, and neuroleptic drugs."

Thomas Szasz

At least they don't stigmatize.

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Szasz holds that a "mental disease" (mental dysfunction) that is caused by a brain disorder is not a mental disease. I think that is obvious. Whatever the mental dysfunctions, if they are caused by brain disorders, or any other bodily dysfunctions, the cause is the disease, the mental dysfunction is not. To call such dysfunctions "mental illnesses" is to confuse cause and effect.

I kind of see the point he is making here, but the simple point of the matter is that psychology is not advanced enough yet to be able to clearly tell what the cause is of a mental dysfunction. Sometimes it is caused by a brain disorder, sometimes caused by problems in the subconscious. It's like the stage we were at when someone had a fever, but there was no recognition of the germ theory of illnesses. I'm not trying to say that all mental illnesses are caused by germs, because they are not (and few are in this context). Brain disorders are being more and more recognized due to real-time scans of the brain, but before that, how could anyone know what was going wrong? And I think at least some of the early treatments were an attempt to identify the cause and to reduce the effects. I think it actually shows the advancement of the science that we can now consider many of those attempts as barbaric.

You've excluded "incorrect philosophical frameworks" from mental diseases, but I'm not sure why. You did say that someone can be rational and yet have psychological problems (mental illnesses?), and I agree with that. But such problems result from, excluding brain or physical disorders, ideas held subconsciously, incorrect ideas. I would think that any bad or wrong idea held subconsciously will or will likely cause psychological problems, conflicts between consciousness and reality.

This is still debatable. In the cognitive therapy theory of mental illness, yes, all psychological problems are the result of improper subconsciously held ideas. The problem is that this isn't always the case, and there is a lot of debate about things like bipolar disorder, schizophrenia, and depression, as to whether it is something wrong with the subconscious (improper ideas held subconsciously) or something wrong with the brain.

Also, it is possible to have a psychological association without having an explicit idea behind it. Animals are subject to this, which is why training your pets works. And we have a mascot dog at work that ran into a car while playing out back, and now he won't go out back to go to the bathroom because he is terrified that he will be hit by a car. I mention this because dogs and pets don't have explicit ideas, let alone ideas in their subconscious. In other words, the jury is still out about cognitive therapy, at least the way it is normally presented.

If, as you say, "mental illnesses" include both "psychopathologies" and mental dysfunctions caused by brain (or other bodily or physical) disorders, that introduces a profound confusion into the issue, a confusion of cause and effect and therefore of what to do about them.

But if one has not clearly identified the cause, then one cannot call the illness or the malfunction by the causal root. I mean, it would be great if they could do this, but right now they cannot. It's still an early science.

If I understand your view, you hold that there are "mental illnesses" (even including mental dysfunctions caused by brain or other physical disorders) which cause an individual to be a "danger to others" and warrant being locked up. In other words, you hold that there are "mental illnesses" which cause crime. Correct?

No, I'm not saying the mental illness caused the crime, what I'm saying is that with certain mental illnesses a person might be more prone to act erratically than he otherwise would. In other words, his mind is not working all that well, and something might set him off more easily. I hold, as does Objectivism (see "The Psychology of Psychologizing") that a man is responsible for his actions, even if he has a mental illness, so long as he is not psychotic. In a certain sense, it might be compared to acting while intoxicated -- yes you are still responsible, but you might be less likely to control yourself, though it is up to the individual to learn how to control himself. So, no, there is actually not much evidence that mental illnesses cause crime. I certainly wouldn't say that anyone having psychological problems is a danger to society; and according to statistics, for what they are worth, even the more serious ailments -- i.e. schizophrenia -- doesn't lead to a higher crime rate.

What I am saying is that if you have a mental illness and commit a crime, then you might be given the option of jail or treatment at a mental facility; and if you turn down treatment, then you go to jail.

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