Mental Illness as a Social Construct:
Analysis of Thomas Szasz’s The Myth of Mental Illness
The social construction of reality entails the creation of social facts. Social facts refer to the shared and collective products of cognition by a social group (Collin, 1997, p.3). The creation of social facts thereby entails a society’s agreement of the meanings ascribed to different concepts. Thomas Szasz (1974) in The Myth of Mental Illness argues that an example of the social construction of facts is evident in the creation and development of the concept ‘mental illness’ (p.2). Szasz challenges the epistemological foundations of the concept ‘mental illness’ along with the moral basis of involuntary mental hospitalization. He does so through a linguistic, moral, and political critique of the concept along with the institution and discipline which enabled its creation.
In line with this, the task of this paper is two-fold. First, it aims to outline Szasz’s argument against the current use of the concept ‘mental illness’ and second, it aims to present a critique of Szasz’s aforementioned argument through the analysis of the soundness of his linguistic, moral, and political arguments against the concept of ‘mental illness’ .
As was noted above, Szasz’s argument consists of three strands: linguistic, moral, and political. All of these arguments aim to support his view that “mental illness is a myth whose function is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations” (Szasz, 1974, p.50). The assumptions of his view can best be seen by presenting an outline of his linguistic, moral, and political arguments against the concept of ‘mental illness’ and the institution and discipline of psychiatry. What follows is his linguistic argument.
Szasz’s linguistic critique is based on the view that the social institution of language determines the origin of consciousness. It is important to note that such a view may be traced to the philosophical debate between dualism and monism regarding the mind-body problem. Dualism refers to the view that “the universe as a whole or in some area of concern is composed of two fundamental entities or kinds of entity or properties” (Lacey, 1996, p.85). As opposed to this, monism refers to the view that “the universe as a whole or in some area of concern is composed of one fundamental entity or property” (Lacey, 1996, p. 120). In the mind-body problem, dualists thereby state that the mind exists as a separate entity from the body whereas monists state that the mind and body are one fundamental entity. Szasz’s view regarding the social construction of facts as a result of the social construction of language may be categorized within the scope of the later.
In his discussion of the concept of mental illness along with the institution and discipline of psychiatry, he notes the problems entailed by psychiatry’s creation of “a symmetrical dualism between mental and physical symptoms” (Szasz, 1974, p. 44). This symmetrical dualism is evident in the comparison of anatomical or physiological conditions to the conditions of the mind. This is problematic as it assumes that mental illness is caused by a physiological process. However, if mental illness is a physiological process, it follows that its manifestation is also a physiological one- in the form of a neurological defect. Such however is not the case since mental illness manifests itself as a form of belief impairment. The assumptions of his argument are as follows: (1) Diagnoses are social constructs which vary from time to time and from culture to culture, (2) Diseases are demonstrable anatomical or physiological lesions that may occur naturally or be caused by human agents, (3) Mental illness is a condition in which people are known to manifest various peculiarities or disorders of thinking and behavior, (4) A person is diagnosed with mental illness if he exhibits a psychiatric symptom-symptoms of mental illness, (5) A psychiatric symptom refers to a condition wherein ideas, feelings, inclinations, and actions are considered undesirable, involuntary, or alien to the individual, and (6) Mental illness is classified as a disease.
The linguistic aspect of the aforementioned criticism is evident if one considers the mind-body problem stated in the initial part of the paper. As was noted above, Szasz may be classified as a dualist. In his book The Meaning of Mind, he states, “the monist is…partly right (as) there can be no self or thought without a material substrate. But he is fundamentally mistaken (since) there can be no monist account of language, much less of human existence as personal experience” (Szasz, 1996, p.76). Szasz claims that is impossible to conceive of a monist account of human existence that is able to explain or take into account personal experience since it is impossible to account for the existence of the ‘mind’ with a purely material basis. It is important to note that Szasz’s criticism here is veered towards the criticism of monism in the form of materialism. Materialism refers to the view that matter is the only component of reality and hence everything can be explained as a physical phenomena (Lacey, 1996, p. 142). To account for the existence of the ‘mind’ with a purely material basis is not possible if one perceives of the ‘mind’ as a social construct-a product of language.
In The Meaning of Mind, Szasz points out that the concept ‘mind’ “functions not only as if it were an agent or cause, but also as if it were an agency to which it is proper to attribute intentionality and non-intentionality, guilt and innocence” (1996, p.105). If such is the case, it follows that psychiatry’s view that the mind is a referent to a biological entity is not possible and hence its view regarding the cause of mental illness is also not possible as the concept fails to have cognitive meaning. It is important to note that cognitive meaning is dependent upon “the conditions revealing its status” (Gregor, 2003, p.375). Since the cognitive meaning governing the status of the concept ‘mental illness’ as it is understood within the field of psychiatry is dependent upon the physiological manifestation of mental illness, it follows that the conditions revealing its status are empirical in nature. Within that context, it is fallacious to conceive of mental illness as such hence it follows that the concept lacks cognitive meaning. It is at this point that it is possible to introduce the moral strand of Szasz’s argument.
Given that the concept ‘mental illness’ lacks cognitive meaning, Szasz claims that the concept possesses an instrumental meaning which it derives from the ethical aspect involved in the process of claiming that a person is mentally ill. It is important to note that the instrumental meaning of a concept is derived from “all public uses to which language can be put…that can be characterized as having ‘utility’ or being ‘appropriate’ rather than aspiring truth status” (Gregor, 2003, p. 375-6). The bases for Szasz’s moral critique of mental illness as it is presented in The Myth of Mental Illness are the following assumptions: (1) Mental illness is used to identify or describe some feature of an individual’s personality, (2) A person is rendered mentally ill if and only if a patient’s communication about himself, the other, and the world around him is inconsistent with the belief of other people, (3) To state that X’s belief is inconsistent with Y’s is equivalent to making a judgment, (4) To state that a person is mentally ill is equivalent to making a judgment, (5) Judgments are within the scope of ethics.
Szasz’s aforementioned claims assume that the concept ‘mental illness’ possesses instrumental value as it is used by individuals to label individuals who deviate from the norms. He states, “the concept of illness… implies deviation from some clearly defined norm. In the case of physical illness, the norm is the structural and functional integrity of the human body…. (In the case of mental illness, the norm is) a psychosocial and ethical one” (Szasz, 1972, p.45). If such is the case, it follow that the goal of psychiatry as a discipline is non-medical but ethical since it aims to resocialize the individual in order for him to adhere to the norm of society. Szasz states this succinctly as he claims, “Psychiatric diagnosis is not pathology driven but are driven by non-medical, that is, economic, personal, legal, political, or social considerations and incentives (that)…allude to human behaviors and human problems” (1994, p.37).
It is at this point that the treatment of individuals labeled as ‘mentally ill’ becomes problematic since to be labeled as ‘mentally ill’ sometimes involves the loss of an individual’s autonomy. Autonomy refers to the “freedom to develop one’s self…to increase one’s knowledge, improve one’s skills, and achieve responsibility for one’s conduct…It is freedom to lead one’s own life: to choose among alternative courses of action so long as no injury to others results” (Szasz, 1965, p.19). Instances wherein loss of autonomy occurs as a result of being labeled ‘mentally ill’ are evident during cases of involuntary mental hospitalization. It is at this point that one considers whether the loss of autonomy as a result of involuntary mental hospitalization may be deemed justifiable. It is important to note that according to Szasz’s argument, such a loss of autonomy is the result of misleading the individual to believe that he possesses a physiological disease. In order to assess whether such a loss of autonomy is justifiable, what follows is a consideration of the condition brought about by the of label of ‘mental illness’ in line with various ethical theories specifically the utilitarian theory, deontological theory, ethics of care theory, and rights based theory.
Utilitarianism, as an ethical theory, maximizes the function of the welfare of the individual members of society. Within the context of utilitarianism, an act is good if and only if its consequences prove to be beneficial to the well-being or welfare of the individual members of society. The overall welfare enabled by an action within society is measured in terms of the benefits and harms that it inflicts on the individual members of society and then considering whether an action enables greater benefits as opposed to harms to the larger number of individuals within a social group. The question as to whether the concept of ‘mental illness’ enables greater benefits than harms to the greater number of individuals within a social group needs to be seen within the context of the Szasz’s linguistic critique of the concept. Given that the concept misleads individuals to believe a false claim, one might note that it would lead to greater harm to the members of society. If however, one is to disregard Szasz’s aforementioned claim, it is possible to state that the concept of ‘mental illness’ may prove to enable greater welfare within society as it necessitates and enables the control of the individuals within the state-it enables the control of the individuals who fail to adhere to the norms of society.
Although, the utilitarian theory focuses on maximizing the utility or preference satisfaction of all the individuals within a social group thereby leading to the imposition of the majority group’s preference satisfaction over the minority group’s preference satisfaction, the appeal of the theory lies in its assumption that the individual is an individualistic and independent person capable of making rational choices. Utilitarian theory may be said to necessitate the existence of autonomous individuals who are capable of determining their own actions and in a sense their own preferences. The theory however is consequentialist as it aims to benefit those who adhere to the norms as opposed to those who are classified as deviant individuals thereby placing the individual labeled as ‘mentally ill’ in a pejorative position. In addition to this ethical theory, another theory which assumes the existence of individualistic and independent autonomous subjects is the deontological theory.
The deontological theory places importance on the duty and rights of an individual. Deontological theories attempt to derive obligations apart from the consideration of the good. Kantian deontological theory, for example applies the universalizability test in order to consider whether an act is morally good. In the same manner that the utilitarian theory proves to be beneficial to individuals labeled ‘mentally ill’ within the context of Szasz’s linguistic critique, deontological theories as they place importance on the autonomy of the individual- a component of which is knowledge of one’s self-will consider as immoral the conception of the individual as mentally ill based on fallacious grounds. Outside the context of Szasz’s linguistic critique, given that the aim of psychiatric treatment is to enable the individual to achieve autonomy, it may seem that the treatment of individuals labeled mentally ill will be considered as a moral action.
Another ethical theory which is highly similar to the deontological theory, in the sense that it places importance on the rights of the individual, is the rights based ethical theory. A rights based ethical theory makes rights fundamental to the ethical theory. The bases for the determination of the fundamental rights vary in the different versions of the ethical theory however the commonality between these different versions may be attributed to the recognition of liberty and/or equality as a fundament right. The right liberty enables the autonomy of an individual. In the same way that the aforementioned ethical theories conceives the treatment of individuals labeled ‘mentally ill’ within the context of Szasz’s linguistic critique, the aforementioned theory also perceives such an action immoral as it prevents the individual to practice his right of liberty. Outside the context of the Szasz’s critique, one might note that given the fact that the ability to practice liberty requires autonomy and since autonomy is not present in an individual who is considered mentally ill, the psychiatric treatment of individuals who are mentally ill may be considered as moral within the context of this theory.
In addition to the aforementioned theories, another ethical theory that may be used in the assessment of the matter at hand is the theory presented by the ethics of care. As opposed to the theories mentioned above, the theory given by the ethics of care does not provide a system of principles or universalizable maxims to be used in dealing with ethical situations instead it places emphasis on the personal aspects of ethical situations. It is based on the conception of morality as concerned with the act of caring for the other. In the same manner that the aforementioned theories consider the treatment of individuals labeled as ‘mentally ill’ to be immoral within the context of Szasz’s linguistic critique above, the ethics of care would also consider such actions as immoral as it fails to practice care-it fails to recognize the personal elements at hand in the situation as a result of an outright deception. Outside the context of Szasz’s theory the action will only be moral if it considers the personal aspects involved in the treatment of the individual considered to be mentally ill.
As can be seen above, the problem faced by psychiatry is evident if one considers that it stands as an institution that imposes a certain form of morality upon society at large specifically to those individuals that it labels to be mentally ill. Szasz claims that the reason for this imposition may also be due to the society’s acceptance of a “therapeutic state”. It is within this context that Szasz presents his political critique of the psychiatric institution as well as its concept of ‘mental illness’.
The correlation of the ethical and political aspects of social realty are evident if one considers the confinement and control enabled by a ‘therapeutic state’ that uses the label ‘mentally ill’ as a means for controlling the life, liberty, and autonomy of individuals. Szasz’s argument is based on the assumption that through the imposition of the label ‘mentally ill’ it is possible for society to control cases of deviance as well as to control the autonomy of an individual. Individual autonomy is controlled as a result of allowing individuals not to be accountable for his actions when he deems his beliefs deviate from those prescribed by societal norms. Unaccountability for one’s actions is enabled since mental illness is perceived as a physiological state and not a mental state that mirrors an individual’s struggle with life. As a result of this, it becomes impossible for some individuals to realize the individualistic as well as the collectivistic aspects of freedom and thereby it becomes impossible for the individual to attain autonomy.
Given Szasz’s linguistic, moral, and ethical critique of the concept of mental illness, it is possible to state why he perceives mental illness to be a myth. The reason for this lies in the continuous proliferation of a false concept along with the false meanings that it entails. In the end of The Myth of Mental Illness, Szasz argues that it is necessary for individuals to realize the repercussions of the continuous adherence to such a myth and that it is necessary to take hold of one’s existence in order to live an autonomous life.
The importance of Szasz’s argument, as I reckon, may be traced to his emphasis on the existential effects caused by the symmetrical dualism between physiological and mental states which enabled the conception of mental illness as a physiological disease that has mental manifestations. By initially giving a linguistic criticism of the concept ‘mental illness’ he was able to show how language affects the moral and political domains of existence to the extent that it affects an individual’s attainment of autonomy. Despite of this, his conception is based on the assumption that all the manifestations of mental illness are mental in character as they are only evident in the deviance of the belief system of an individual as it is perceived by the individual himself or another individual. However, it is important to note that there are instance wherein conditions categorized as mental illness also have physiological manifestations. Anxiety, for example, is manifested by an individual’s change of mood. Although it might be argued that the change of mood may be categorized as a mental act as opposed to a physiological act, it may also be argued that mental illness enables physiological changes in an individual who is considered to be mentally ill.
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