Thomas Szasz is a name synonymous
with critique of psychiatry. From the time of his 1960 publication "The
Myth of Mental Illness" Szasz has maintained a caustic stance towards his
fellow psychiatrists, and anyone else who supports the idea of mental illness
and psychiatric treatment. Szasz is now 87, and his cutting edge remains. If
anything this latest book goes further, castigating psychiatrists, patients,
antipsychiatric theorists, deconstructionists and patient advocates alike: all
are the misguided allies of the psychiatric enterprise, equally complicit in
its oppressive practices. Szasz is one of the most prolific critics of
psychiatry, and one of the most trenchant. In a publishing career spanning
almost half a century, Szasz has published an extraordinary number of books
(the front of the current publication lists 30), as well as over 60 journal
papers indexed to Medline. Of Szasz’s journal publications a little over half
are full length essays; the remainder are relatively brief responses, letters
and opinion pieces. Szasz’s oeuvre contains no research, and only two co-authored
publications, the mark of a singular man. The themes of Szasz’s work are
familiar: psychiatric coercion, the myth of mental illness, assault by the
therapeutic state on the freedom of the individual, the appropriation of
scientific discourse to legitimise repressive practices.

My Madness Saved Me  is
Szasz’s analysis of the life of English novelist and essayist Virginia Woolf.
It is not an objective analysis; Szasz makes no claim to disinterest in
unpicking the life of one of English literature’s most troubled souls. Szasz’s
start and end point is that psychiatry is a sham, and that Woolf, being an
intelligent and skilful manipulator of people, exploited the gullibility and
conceit of contemporary medical practitioners. She played the role of madwoman
to perfection. Historians, especially historians of psychiatry, have been
similarly duped into believing Woolf to be mentally ill. She is a celebrated
case of "mad genius": a woman whose madness and creative skills have
a common basis in an innate characteristic that is the peculiar lot of the
gifted lunatic. Szasz is derisive of Woolf’s claims to madness, and of Woolf as
a person, describing her (p. 46) as "a conformist, an exhibitionist…a
first class snob and [a] coward." Later she is described as "boorish,
meddling and nasty" (p. 52). Szasz also takes the trouble to single out
feminist theorists who have characterized Woolf as a misunderstood victim.
Woolf was no victim in Szasz’s estimation; she was a responsible agent. There
are two parts to Szasz’s analysis. One is that mental illness has no validity
as a concept and so no-one, including Virginia Woolf, can be mentally ill. The
other is that there are better explanations for Woolf’s behavior. Thus it is
possible for Szasz to be wrong in the first part of his argument, and correct
in the other. It may be that there are people who might properly be thought of
as mentally ill, but that Virginia Woolf is not one of them.

The book is relatively brief; only
100 of its 126 pages are devoted to Woolf. The two remaining sections focus
more on the activities of psychiatric publicist Kay Jamison
than it does on Woolf, and on an historical analysis of "the mad genius
problem". But in a short amount of space Szasz performs a thoroughgoing
character assassination of Woolf and her husband Leonard, dismissing any claim
for Woolf as a person with mental illness deserving sympathy and compassion;
instead she is callow, racist, pretentious and conniving. Leonard is a pathetic
dupe ensnared by his scheming wife into a loveless, sexless marriage, redeemed
only by Virginia’s concession that he could act as her nurse, protecting her
from the ravages of madness. Woolf’s suicide was not the result of mental illness,
it was a self chosen act of self aggrandizement performed in fulfillment of her
self chosen role of lunatic extraordinaire.

In the first chapter Szasz sketches
Woolf’s early life, and it’s not long before the arch critic is up to his old
tricks. There is no attempt to outline events free of authorial interpretation.
Szasz might argue that any rendering will be an interpretation, and so it will,
but readers are entitled to at least a stance of objectivity before Szasz takes
over and gives his construction of events. For example Szasz takes issue with
Woolf’s biographer, her nephew Quentin Bell, who stated that from early age Virginia ‘knew she had been mad, and might be mad again’. Szasz won’t allow this. Virginia was only thirteen, he protests. She can’t have ‘known she had been mad’, she can
only have known what people told her. Szasz seems to discount as personal
knowledge the views of a thirteen year old who had not yet learnt to reason
about concepts such as madness and psychiatric power. There is a quick lesson
on the myth of mental illness for those who have missed it over the years. This
includes Szasz’s definition of medicine, his views on the invalid use of
metaphor to talk about "mental" illness, a summary of Kant’s contrast
between analytic and synthetic arguments. The conclusion is the usual one, that
psychiatry is a non-science built on fallacious reasoning for the sole purpose
of oppression. There is no halfway point. Subsequent chapters explore Woolf’s
madness and marriage in more detail, including a suicide attempt that Szasz
seems to suggest was in part engineered by Leonard. There is a chapter on
Freud, who was known to Woolf. Much of that chapter is taken up with Szasz’s
views of Freud rather than analysis of Woolf’s views.

In relation to Szasz’s claims about
psychiatry as a medical science I can do no better than bring the attention of
readers to an excellent article by Michael Schwartz
and Osborne Wiggins (2005). Few psychiatrists and almost no philosophers
trouble themselves to respond seriously to Szasz. In the case of psychiatrists,
they frequently fall into trap of their own making by meeting Szasz on
empirical rather than conceptual grounds. Szasz argues that the concept of
mental illness is incoherent, and it is this claim that Schwartz and Wiggins
address directly. Citing the rather exaggerated claim by prominent psychiatrist
E Fuller
Torrey that schizophrenia is a "biological brain disease",
Schwartz and Wiggins reject that claim, noting that Torrey and Szasz occupy
similar territory with regard to their philosophical commitments about
medicine. Both agree that the focus of medicine is the body (rather than the
person), and both agree that claims for the legitimacy of psychiatry rest on
its status as a natural science. Torrey believes that psychiatry has achieved
such a status; Szasz denies such an achievement. Schwartz and Wiggins discuss
psychiatry as a practical rather than a natural science, and make the telling
point that this is true of medicine generally, not just the discipline of
psychiatry. Thus medicine is not (as Szasz believes) a natural science concerned
solely with illnesses that have a known biological basis; it is social and
cultural institution concerned with the complaints that people present to
physicians and, where possible, the alleviation of those complaints.

If Szasz makes few friends amongst
psychiatrists for his views on mental illness as a myth this comes as no real
surprise. Szasz has long since given up any expectation that there is any
common ground to be found between himself and those who he sees as wedded to
the ill conceived project of appropriating medical science in the name of
social control. But Szasz may well have made some new adversaries for his views
on the role of sexual abuse and trauma in the development of psychosis. He
discounts Virginia’s experiences of abuse at the hands of her brothers, citing
the example of her sister Vanessa, who lived in the same family and may well
have experienced similar abuse. Szasz notes that we don’t know about the
effects of abuse on Vanessa because "she never complained about them"
(p. 92). By contrast, Virginia became obsessed with her abuse: "she
treasured it as a memory justifying the lifestyle she had chosen for herself,
and with the consequences of which she was now stuck" (p. 92). But Szasz
goes further to argue that the experience of violation is universal in children,
and is an artifact of childhood rather than of objective events. This view
might find favor with those who wish to normalize sexual relationships, even
secretive ones, between adults and children, but it will put Szasz well out of
step with trauma theorists such as John Read who
point to the relationship between abuse and dissociation, and to the subsequent
diagnosis of trauma victims with schizophrenia, but Szasz allows little room to
engage with such ideas.

If there is something that can be
taken from this book it is Szasz’s message about agency in relation to mental
illness. Virginia Woolf is not a particularly good case study with which to
demonstrate that the conceptual foundations of psychiatry are fundamentally
flawed. She does indeed seem to have been a willful creature driven as much by
her own self absorption than any innate "illness". But her case does
ask important questions about the extent to which individuals’ character traits
and self motivated behavior should be the subject of psychiatric intervention. In
a time when mental illness more easily led to committal Woolf was never subject
to involuntary treatment (although she came close), and yet her case has
assumed status as a paradigmatic example of someone whose behavior and suicide were
driven by mental illness. By any analysis of Woolf’s life, "mental illness"
is too simplistic an explanation for her impulsiveness, moodiness, and her at
times tumultuous relationship with Leonard. Her behavior is not dissimilar to
many of those who present to mental health services, and for whom an appeal to
personal responsibility should be an integral part of care. Similarly, the
assumption of the need for paternalistic intervention needs careful
consideration and should not be made on the basis of mental illness alone. As
Szasz argues, some people lead troubled lives and are not helped by diagnostic labeling.

My Madness Saved Me is
vintage Szasz. His challenges to psychiatric orthodoxy remain undiminished. If
mainstream psychiatry feels it can afford to marginalize Szasz’s views, that is
because Szasz has provided one of its most sustained and clearly articulated
challenges, and that challenge has demanded a coherent response. Szasz’s
radical individualism may go too far, but it does serve to remind mental health
professionals that there are limits to justifications for paternalistic
intervention. What is perhaps surprising is that standard psychiatric defenses
against Szasz’s arguments are so frequently naïve and reductionist. But as
psychiatry, at least in its more enlightened moments, demonstrates greater
theoretical pluralism, Szasz’s critique, especially its core component the "myth
of mental illness" seems increasingly anachronistic.

© 2006 Tony O’Brien

Tony O’Brien RN, MPhil,  Senior
Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz

Categories: Memoirs, Philosophical