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Szasz is an anti-psychiatric thinker or philosopher, working to de-legitimize psychiatry. I've read a little, and find his argument itself poor, but have a question for the social psychology that it underpins.

Two standout claims are that delusions are best treated as "stubborn lies", presumably to the self and then repeated to others. And that "mental illness" is a deception for people to take on the sick role.

But then Szasz must, it seems (I'm not sure cos he's actually a very deficient writer IMHO), believe that psychiatry is coercive to some of the people it treats.

How is that tension reconciled: between a "symptom" as a lie to get help, and help being forced upon those with "symptoms"?

virmaior
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  • fwiw i see delusions etc. as a form of ignorance... learning and unlearning how the world works –  Mar 20 '16 at 21:42

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Szasz central organizing principle is that mental problems are simply "difficulties solving the problems of living." We all face difficulties following definitions, accumulating evidence and making sense of the result. Some of us have a harder time with this than others, but those people do not fall into some discontinuous category of 'delusional psychotic' that absolves them of the responsibility to meet the challenge.

We fall along a continuum. They can be given tools to help solve or work around their problems, just as anyone else can. But only "just as anyone else can."

Patients do not wish to play the sick role, we want them to. We want to disown the continuum of functioning, because it threatens our ability to rely on rationalist institutions. We want to pretend the people upon whom we rely do not have those kind of problems, only this separate disconnected class does.

So a symptom is not a marker used by someone to escape into the category of the sick, it is a marker we want to use to define the sick.

There is not a point where a belief goes from being a tenet to being a delusion. There is not a level where a fear of transgression goes from excessive conscience to obsessiveness. These are all simply problems that are part of the human experience, and they should be addressed more philosophically and less medically.

  • that's a fair reply, tho some references for this would be good –  Mar 21 '16 at 17:22
  • http://www.szasz.com/manifesto.html –  Mar 21 '16 at 17:30
  • i specifically meant how patients who refuse the sick role aren't pretending to, whether or not this is a continuum, etc. –  Mar 21 '16 at 17:50
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    Statements on that page like "Involuntary mental hospitalization is imprisonment under the guise of treatment;" point out that Szasz emphasis is on those who are made patients and not on those who would choose the sick role or whose symptoms are 'a cry for help'. –  Mar 21 '16 at 17:54
  • ok. tho i now think the question was a fairly poor one: in that szasz reconciles any tension by pretty much ignoring it –  Mar 21 '16 at 17:58
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    His focus is not on those seeking treatment. But the idea is that even most of those people are tricked into the transaction by fear of the handling that the extreme cases get. So, he is looking the opposite direction, and does not see the conflict you point out. In a society where we have more Borderlines than Psychotics, your question is good. But he is not going to answer it. –  Mar 21 '16 at 18:07
  • (Or his answer is 'Who cares? People can do whatever they want with the advice from quacks'.) He believes that psychiatry is abusive to everyone it treats, even when the patient sees it as helpful. Because they should be given that advice as advice, and not as medical truth. So the case where the patient wants it too bad is just an epiphenomenon not worth of mention. –  Mar 21 '16 at 18:14
  • I answered from his perspective, but I don't agree. I think focusing on the conflictual side is really biased, in a strongly gendered way. He is ignoring the more common case of abuses, because it undercuts his logic. The symptom that is a lie to get help is an *unconscious lie* which, under the rubric of mental disease, no longer serves the purpose for which it evolved. It lets people off the hook for exactly the weaknesses they should be helped to confront. We end up helping people (especially women) stay children forever. –  Mar 21 '16 at 18:19
  • ok. you don't have to believe that one is responsible for any mental "illness" to find stuff like this appalling http://www.theguardian.com/global-development/2016/mar/21/living-in-hell-indonesia-mentally-ill-people-chained-confined-human-rights-watch-report –  Mar 21 '16 at 18:23
  • Right, and that is the kind of world Szasz is focussed on, but it is not the world he or we really live in. The West has more of a 'psychology as religion' problem than a 'psychology as crime' problem. –  Mar 21 '16 at 18:25