Jacob Sullum
The New York Times obituary for Thomas Szasz, who died this month at the age of 92, says his critique of psychiatry "had some merit in the 1950s ... but not later on, when the field began developing more scientific approaches."

That's a paraphrase of historian Edward Shorter, whose judgment reflects the conventional wisdom: Szasz called much-needed attention to psychiatric abuses early in his career but went too far by insisting on a fundamental distinction between actual, biological diseases and metaphorical diseases of the mind.

In fact, however, Szasz's radicalism, which he combined with a sharp wit, a keen eye for obfuscating rhetoric, and an uncompromising dedication to individual freedom and responsibility, was one of his greatest strengths. Beginning with "The Myth of Mental Illness" in 1961 and continuing through 35 more books and hundreds of articles, the maverick psychiatrist, driven by a "passion against coercion," zeroed in on the foundational fallacies underlying all manner of medicalized tyranny.

The idea that psychiatry became scientifically rigorous soon after Szasz first likened it to alchemy and astrology is hard to take seriously. After all, it was not until 1973 that the American Psychiatric Association (APA) stopped calling homosexuality a mental disorder.

More often, psychiatry has expanded its domain. Today it encompasses myriad sins and foibles, including smoking, overeating, gambling, shoplifting, sexual promiscuity, pederasty, rambunctiousness, inattentiveness, social awkwardness, anxiety, sadness and political extremism. If it can be described, it can be diagnosed, but only if the APA says so. Asperger's, for instance, will cease to exist when the fifth edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM) comes out next year.

As Marcia Angell, former editor of The New England Journal of Medicine, observed last year in The New York Review of Books, "there are no objective signs or tests for mental illness -- no lab data or MRI findings -- and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses in ways that would be impossible, say, in a field like cardiology." In other words, mental illnesses are whatever psychiatrists say they are.

How "scientific" is that? Not very. In a 2010 Wired interview, Allen Frances, lead editor of the current DSM, despaired that defining mental disorders is "bulls***." In an online debate last month, he declared that "mental disorders most certainly are not diseases."


Jacob Sullum

Jacob Sullum is a senior editor at Reason magazine and a contributing columnist on Townhall.com.
 
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