Infinite Jester v. Steve Wiseman (On Thomas Szasz)

Background information: Steve Wiseman produced a set of videos criticizing Thomas Szasz's arguments and I replied on one of the blogs in which his video appeared. Wiseman deleted the comment and emailed me his rebuttal. I replied and have not heard anything back as of Sep. 16. In the interest of fairness I've chosen to post both his and my own responses in a public forum to let readers decide whether or not Szasz's contention that there is no such as a mental illness still holds true.

Original video + Transcript

http://www.suppressiveperson.org/sp/archives/1371

Infinite Jester's First Rebuttal

As exciting as it is to see a licensed and practising psychiatrist deal with the arguments of Thomas Szasz, it's unfortunate that Wiseman didn't adequately address his central claims: that predicating illnesses and diseases to minds is a metaphorical use of medical terminology that is incoherent when taken literally. Of course, we know what it means for a person to be sick but a mind? For this, we're left in the dark. Wiseman seems to argue that "mental illness" is just a façon de parler for "brain diseases" however, this is confused. If Wiseman really believed "mental illness" to be just a façon de parler for brain diseases he would not reason as he does that schizophrenia by it's nature is unobservable.

Wiseman contends that the overwhelming evidence showing that "mental illnesses" have neurological, biochemical and hereditary basis demonstrates that "mental illnesses" are indeed real entities that persons possess not a metaphor as Szasz contends. However, this is also confused. Whether or not "person A has a sick mind" is a metaphor has nothing to do with neurobiology. Instead, it has to do with the meaning of the psychological and medical concepts which are being consider namely "mind" and "illness". Given that a "mind" is anything but an entity let alone the type of entity that could be the bearer of psychological and medical predicates ("illness", "disease", etc.), it seems altogether incoherent to carry on talking about minds as being sick or healthy.

As a point of irony, Wiseman is vehemently against Cartesian dualism (see his remarks about Descartes) but seems to still hang on to his mental vocabulary including "mental illness"!

The final point Wiseman fails to acknowledge is Szasz's claim that psychiatrists use their system of classification to medicalize deviance as a way of making rhetorical points about patterns of behaviour they do not like. Psychiatrists describe juvenile delinquency as a "conduct disorder", narcissism as a "personality disorder", masochism as a "sexual disorder", transgenderism as a "gender identity disorder". What exactly are psychiatrists saying? Are these illnesses? Diseases? Medical conditions? Why are these in a medical system of classification? Wiseman provides no argument at all for why this is appropriate.

If my arguments hold, which I think they do, Thomas Szasz is indeed still relevant and psychiatrists who want to take him on will have to address his claims directly (no rhetorical tricks either! Come on Steve you know better than to call Szasz a follower of Rene Descartes! Who was a genius by the way and someone you owe thanks to every time you are allowed to dissect a corpse). Psychiatrists need to roll up their sleeves and do some conceptual clarification dealing with, yes I'm going to say it, "simply words and definitions".

Again, regards are warranted for Dr. Wiseman's attempted refutation but there is more to problems of psychiatry than Wiseman let's on or is willing to admit. These problems require clarification not experimental research and it is unclear who's going to do it.

Steven Wiseman's Response

Hi,

[name removed] forwarded your comments re: my Szasz clips for approval, and I just wanted to take this opportunity to thank you for your thoughtful engagement which I appreciate very much.

I don't think brief video-clips from a sweaty office, or email, are ideal venues for discussing much of what you have brought up...clearly there is much to discuss in such areas, as there has been for fifty years already.

I'm not sure you have convinced me to change my mind (brain?) about what I have tried to say, however. At the heart of Szasz's thesis, there really is a profoundly circular, semantics-driven argument that is growing less and less relevant in the face of modern neuroscience. He appears to really believe that "mental illness" is not physiological, so it cannot be a proper illness or disease, and a psychiatrist therefore not a proper doctor. If anything we consder to be a "mental illness" is found to have a physiological underpinning, then, well, it was never a "mental" illness to begin with, but a proper physical one all along, so it should be treated by a neurologist. Accordingly, no "mental illnesses" are EVER physiological, and no psychiatrist can be a real doctor. Hmmm...

My day job [removed for privacy reasons], and I would encourage you to learn as much as you can about the history of fibromyalgia as another excellent metaphor for the dismal state of Szasz' dualism in 2012. It has in turn been thought to be purely medical, called "fibrositis" on account of the belief that there was tissue/muscle pathology. It has also in turn been considered to be "all in your head"...i.e. because there has essentially been NO tissue pathology discovered, it MUST be somehow emotional, or psychological or not a "real" condition.

In the past 10 years, however, there has been an enormous amount of work about central nervous system sensitization. Central sensitization...central sensitivity...essentially, the pathology arising at a functional or process level in the spinal cord and brain. So yes, NEITHER the peripheral tissues NOR the "mind" or personality or just someone's choices or character really have much to do with fibromyalgia...it is located, for lack of a better word, in the central nervous system pain processing physiology that actually connects body and brain. Szasz would say it is a non-illness because you can't measure, suture, scan, or see it. But the last decade of reasearch shows this to be, frankly, anachronistic #######4. Pain without commensurate tissue pathology is a "myth" for him, a "problem in living". But try telling that to researchers who are seeing gene expression changes and neurophysiological shifts in the dorsal horn neurons of rats who are subjected to sudden facet-joint loading in laboratory experiements, versus rats exposed to sham "whiplash" events.

Anyhow, please accept my best wishes.

Infinite Jester's Second Rebuttal


Hi Dr. Wiseman,

I'm very taken back and flattered that you would take the time to respond to post. I know you're a busy man so I will try to keep my rebuttal short.

To say that Szasz's thesis is a "profoundly circular, semantics-driven argument" is correct, Szasz's argument that there is no such thing as a "mental illness" involves an appeal to the meaning of words in our language and their logical relationship with each other, but I think you're missing the point if you think that any empirical research or findings in neurobiology have shown that Szasz is wrong. In fact, it's unclear how any empirical finding would have any bearing on whether or not minds can really be sick. The question of whether or not minds can be sick is a conceptual question that's answered by appealing to what we mean by concepts we use namely "mind", "sick", etcetera. In your original video you dismissed Szasz's argument as being "simply words and definitions" but if you're making a claim that is incoherent, that someone with profound deficits in attention has a "sick mind", then you're really wrestling with windmills and calling it science. There are so many more linguistically accurate ways of talking about people than saying that they have "sick minds" that it's unbelievable that the myth of mental illness is still carrying on.

Your example of fibromyalgia (a horribly painful condition) is interesting. However, I don't see what that has to do with "mental illness". I'm sure as a materialist you don't believe people with fibromyalgia have "sick minds".

I suppose you meant that fibromyalgia is an example of a medical condition with no known etiology that, given it's grammar, is not observable or demonstrable however, the medical community accepts this to be bona fide illness so why shouldn't we do the same for mental disorders? That's a good argument and I agree to some extent as long as we're clear that it's not the schizophrenic's mind that is sick!

However, there are some important distinctions between mental disorders and illnesses: (1) mental disorders are declared not discovered, (2) the diagnosis of a mental disorder is predicated on the basis of behaviour not objective evidence and (3) mental disorders most often share their grammar with common-or-garden psychological concepts (belief, thinking, feeling, hoping, wanting, etcetera).

There are also practical/ethical objections to the current measurement practices in mental health including the fact that disorders are predicated to an individual for their entire life, that clinicians don't have to consider context at all, poor inter-rater reliability for many disorders, conceptual similarities between many disorders (Borderline Personality Disorder v. Bipolar Disorder, Anorexia [Purging type] v Bulimia) and that diagnostic labels are incredibly impersonal and stigmatizing.

It's also questionable whether or not the medical paradigm will succeed at it's objective of destigmatizing "mental illness". It's as if mental health care professionals are saying "these people have 'sick minds'; don't discriminate against them".

I imagine as a registered and practising psychiatrist you know this already.