Creative Arts with Patrick Moore


The Myth of Mental and Physical Illness
October 14, 2014, 1:16 pm
Filed under: Uncategorized

Are people responsible for their troubles and behaviors if they are mentally ill? Are they excused if they are physically ill? For fifty years, Psychiatrist Thomas Szasz answered, no, and yes. What could a massage therapist add to this discussion?

 “There is no such thing as mental illness” said psychiatrist Thomas Szasz (1920-2012). He maintained this claim through 35 books and renewed it in a new preface, “The Myth of Mental Illness Fifty Years Later” :

What was Dr. Szasz really trying to say, when he said there is no such thing as “mental illness”? As the preface above shows, most of his readers misunderstood what he meant, and had reactions to things he never even meant. To him, what he means was always clear. Though Dr. Szasz was very intelligent and logical, I too found it difficult to come to the core of his meaning, even after reading him multiple times over three years. I believe I have found the essence of his point and hope to share it with you, more simply than he shared it. I believe what he discovered has dramatic implications for all healthcare.

One thing Dr. Szasz did not mean is that there is no such thing as mental disturbance, or mental troubles. In fact, he maintained a private practice in which he offered psychotherapy and talk-support to those with mental disturbances.

If “Illness” means “Not Responsible,” then “Mental Disturbance” is not “illness”.

I’d like to take you on a logical journey. Dr. Szasz’ thinking follows a syllogism. Only he doesn’t tell you one of his assumptions. One of his assumptions is the definition of illness. He adopts a cultural view of “illness,” or “disease,” to mean the victim of illness is not responsible for it, and assumes everyone already knows this, so he doesn’t have to say these assumptions aloud:

  • Illness is something that happens to a person through random chance, damage or infection. The person is not responsible for having caused it.
  • The person is not capable of curing illness himself. Since he is not capable, he is not responsible for curing himself. A Physician must do it. Patients play a passive role in the curative process. The Doctor is like an artist, the Patient is his canvas.
  • If the person did bad deeds or crimes during the time he was a victim of illness, he is not morally or legally responsible for those. He should not be blamed or punished.
  • Since the person is not capable of curing himself, he should not be held financially responsible for treatment–this should be provided for him by insurance or the government.

Dr. Szasz’ big discovery, after having provided talk sessions for many people with mental disturbances, was that what they had, did not fit the above definition of illness. In fact, he believed the opposite. He said about people with mental disturbances:

  • The person is responsible for having caused his own mental disturbances.
  • The person is capable of curing his own mental disturbances, so he is responsible to cure himself.
  • A doctor or therapist cannot fix mental disturbance for the person, so the doctor is not responsible.
  • Since the person was capable of doing better, he is morally and legally responsible for all bad deeds he has done. If he has done crimes, his punishment should not be reduced based on finding he had mental disturbances.
  • The person is financially responsible. He needs help, and he should be the one to pay out of pocket for talk therapy, psychotherapy and counseling assistance. If he cannot pay, his family should pay.

A syllogism is when you tell two premises and draw a conclusion. Here is Dr. Szasz’ logic:

A: “Illness” is defined as something a person is not responsible for.

B: “Mental disturbance” is something a person is responsible for.

Therefore,

C: “Mental disturbances” are not “illnesses”.

To make his point more clearly, Dr. Szasz quoted from, and commented on Shakespeare’s play, Macbeth.

Dr. Szasz: Overcome by guilt for her murderous deeds, Lady Macbeth “goes mad”: She feels agitated, is anxious, unable to eat, rest, or sleep. Her behavior disturbs Macbeth, who sends for a doctor to cure his wife. The doctor arrives and quickly recognizes the source of Lady Macbeth’s problem:

Doctor: This disease is beyond my practice. … Unnatural deeds do breed unnatural troubles. Infected minds to their deaf pillows will discharge their secrets. More needs she the divine than the physician.”

Dr. Szasz: Macbeth rejects this “diagnosis” and demands that the doctor cure his wife. Shakespeare then has the doctor say these immortal words, exactly the opposite of what psychiatrists and the public are now taught to say and think:

Macbeth: How does your patient, doctor?

Doctor: Not so sick, my lord, as she is troubled with thick-coming fancies that keep her from her rest.

Macbeth: Cure her of that! Canst thou not minister to a mind diseased, pluck from the memory a rooted sorrow, raze out the written troubles of the brain, and with some sweet oblivious antidote cleanse the stuffed bosom of that perilous stuff which weighs upon her heart?

Doctor: Therein the patient must minister to himself.

Dr. Szasz uses logic correctly. The conclusion is valid but we don’t know if it is true yet. The way logic works, his conclusion is true only when both his premises are true. Are they? Let’s review them.

Is “mental disturbance” something a person is 100% responsible for causing, and for curing?

First, who is responsible for curing mental disturbances? I have had my own mental disturbances, and my disturbances have significantly lightened over two decades receiving help. Did they lighten because of me, or because of the helper? I believe, both. I believe my helper was at least 50% responsible for the progress I have made, and he continues to remind me how influential I have been in my progress. I see the responsibility for cure as shared, an equal partnership. Already I am doubting the truth of Dr. Szasz’ assumptions.

How responsible was I for causing, and for worsening the disturbances I developed? My helper helped me take responsibility for the things I was truly responsible for causing. I also learned to not take responsibility for things that I was coerced, manipulated or conditioned into, before I was old enough to discern the difference. Could the Catholic church share responsibility for my though, I am not deserving? Could my family history share responsibility for my reckless crashes, fistfights, thrill seeking, drugs and alcohol, manipulation, sarcasm, competition and advantage-taking?

What is Responsibility? Is it different from Accountability?

Before answering who is responsible, we should probably ask what responsibility is. There is a difference between accountability and responsibility. Accountability is, did you do it? Responsibility is, did you know better? Included in responsibility is, were you operating freely or to what degree were you conditioned? And, did you see you had options but chose this path anyway?

Using this improved definition of responsibility, I would say I was accountable for causing my mental disturbances, and so were others. Which of us knew better? Which of us were operating free from conditioning, coercion and manipulation? Which of us clearly recognized all our options and foresaw their consequences, and chose from among these? I am not trying to escape my responsibility. I was the one who put the bottle to my lips. I was the one who turned the key.

The reason I am bringing up my responsibility is to question Dr. Szasz’ premise, that people with mental disturbances are responsible. If there is reasonable doubt that any person with mental disturbance was 100% responsible as the cause, or as the cure of his disturbance, then Dr. Szasz’ premises are not true, at least not always true. If one of his premises is not 100% true or not always true, then logic no longer proves his conclusion true.

Can People be 100% Responsible for their Mental Disturbances?

Yes. You occasionally read about people like Viktor Frankl , author of Man’s Search for Meaning, who cured themselves against great odds (in his case by serving others). Would I have done this for myself? Very unlikely. Could I have? Yes, we are capable. Does capability prove responsibility? Apparently Dr. Szasz thought so. But what if you don’t know, or don’t believe you are capable? What if you don’t know you have options, or don’t see them? What if you’ve never seen examples of people being different?

Is Responsibility for Physical Illness, That Different from Mental?

Our culture wants to believe that people are not at all responsible for illness. Not responsible for the causes. Not responsible for the cures. But how often is this really true?

How often are physical illnesses completely random? How often is it that a person with a “real” disease, had zero influence in its occurring?

Antonio Damasio, in his book Descartes’ Error, uses the example of Phinneas Gage, the railway worker who had an on-job accident with explosives and metal pieces that sent a rod through his head. Gage lived through the accident, but part of his brain was torn out. After this, his behavior changed for the worse. Dr. Damasio uses this as an example of Gage having no responsibility for what happened to his behavior. Gage was, in Damasio’s opinion, 100% not-responsible. I think this is the kind of example Dr. Szasz had in mind when he differentiated physical, or “real” illness from the mental kind.

Gage’s thoughts and behavior changed for the worse. He did not choose to begin swearing, insulting and lying. He had brain damage, so he was not responsible. What I want to know is, is it fair to ask if he played a part in the steps that led to his brain damage?

Gage was accountable for choosing to work in a situation where he was using explosives and metal pieces. It was he who placed the explosives where he did, and placed the metal piece where he did, and it was his actions that set off the explosive. but accountability does not prove responsibility. What was he thinking in the weeks, days, hours and minutes before the explosion? Can we really say he had zero responsibility in his “accident?”  Is this truly an example of a person having zero responsibility for the disease that happened to him?

My brain sustained injuries in my late teens. If you had asked me after any one of the injuries, I would have said absolutely no, I was not responsible. These were just things that happened to me. They were 100% random accidents, I believed at the time. But looking back thirty years, it puzzles me how I just happened to have twenty accidental head injuries in a six-year span. What are the chances of this happening randomly? There must have been some agency that placed me in all these dangerous situations with motorcycles, football players, water and snow rushing at me at high speed, and other people’s fists. Who could that agent have been, but me? I couldn’t tell you what I was thinking. I remember being depressed and angry in those years. I didn’t think, If only I had twenty brain injuries, I could lower my test scores by fifty percentiles and flunk out of grad school, which would excuse me from becoming a math teacher, and would justify my being sarcastic and pessimistic and drinking too much for a decade. Or did I? Did Phinneas Gage?

People who have physical illness (sometimes) were (at least partially) responsible for causing these illnesses.

How Responsible can people be for their Cures?

Our culture wants to believe that it is doctors, or Healthcare that is responsible for curing illness. Our culture wants to believ that individuals play no part in making progress, for if we did play a part, then we would be responsible. We are not responsible, our culture cries.

How often are physical diseases cured by the doctor’s efforts alone, with zero participation from the patient? Are patients simply canvas, that the doctor, like an artist, works upon?

What happens when a person with a disease decides to begin:

  • Eating healthier,
  • Reducing toxins,
  • Exercising more, spending more time outdoors,
  • Working with professionals who help the body move toward better physical health,
  • Mending relationships, with the help of a counselor, social worker or therapist,
  • Finding love and support,
  • Volunteering and doing compassionate service for others,
  • Finishing that novel, or other life purpose,
  • Resting, playing and spending time in creative activities weekly, or
  • Shifting to more cooperative attitudes, and de-escalating quickly whenever “Fight Flight” occurs?

Would you think a sick person who begins doing some of these things consistently, would boost his immune system? Would you expect his disease might begin to reverse? Have there been examples of people healing, when doctors said there was no hope? May we (sometimes) divert (some of the) credit from his doctors, and give (some) credit to the person for having participated in his own healing?

What was Dr. Szasz Right About?

Please forgive that I took so much of your reading time in picking apart Dr. Szasz’ logic. The reason for this blog post is not to discredit what Dr. Szasz has done, but to show he has actually done something much better and bigger than even he realized.

I think Dr. Szasz made a very good point about mental disturbance, not really being an illness, when illness is defined as something that happens to you, something you do not participate in the cure of. Where I doubt him is when he says physical illness is different. He wasn’t an expert on physical illness, he was an expert on mental illness. I trust his feeling about mental illness. But he may have had a diminished view of physical illness. But his misunderstanding of physical illness, actually makes his discovery much more important.

He said there is no such thing as mental illness. What he really discovered is that there is no such thing as physical illness. There is no such thing as illness. Here is what he really proved, starting from truer premises:

A: “Illness” is that which people have no responsibility for causing or for curing.

B: People did have influence in the onset of their disturbances, and they continue to have influence in resolving their disturbances.

C: Therefore there is no such thing as illness.

Thank you, Dr. Szasz, for bringing up the idea there is no such thing as mental illness, fifty four years ago.

The Benefit of Claiming Some Responsibility

I believe Dr. Szasz intention all along was to empower people. While mental illness was thought of as something that happened to them, they were helpless. He worked with people to help them see they had power.

His books harped on responsibility. People participated in the onset of their mental problems. This is a tough pill to swallow, and maybe this is why people resisted his writing for fifty years. But once his message is digested, it turns out to be a wonderful blessing.

  • If I had influence back then, then I have influence now.
  • If I could cause this to appear, I can cause it to disappear.
  • If I made it worse, then I can make it better.

This gives people hope they can change. Once they do change, it shows them a second time, how powerful they are.

Empowering the Person through Melting their Muscles

My experience as a provider of muscle massage has proven to me that people have some responsibility in the causes and cures of their tensions. People come to see me to get rid of some long-standing tension. They arrive with certain concepts and expectations:

  • Muscle tension happened to them.
    • Sometimes they can trace it back to a car “accident” or other trauma, that happened to them.
    • Other times they appear puzzled–they have no idea how this happened to them. “Are you curious,” I ask. Sometimes they are not.
  • They expect that I will fix it. They expect to be passive while I work.

On arrival, they take zero responsibility for the onset cause of the tension, for the worsening of the tension over time, and for the things that must occur for it to be resolved.

I tell them (gently, and maybe not in the first session):

  • Muscle tension is something your brain is doing, right now. Your brain is sending voltage to that muscle.
  • There was a certain day in the past when your brain felt it could not handle what was occurring, so it began sending more voltage to your muscles, hoping this would protect you. Since that time your brain has not yet come to a different conclusion.
  • Ah, your muscle is melting. I feel it sinking. Do you feel my fingers sinking in? This is proof that your brain is now changing its mind. You are doing that, not me. You are letting go of your tension right now. Good job!In essence I am telling them, you had a part in the origin of your trouble. You were influential then. Over time you continued to have influence, perhaps making it worse. Now you are making it better, which proves again how influential you are now, and always were.

There is No Such Thing as Therapy

If “Therapy” is defined as one person curing another person’s illness, there is no such thing as therapy. There are no such things as therapists.

What we do, who are considered therapists, is to assist the person to heal herself. We guide, clarify, support, challenge and inspire the person, and then she does the actual healing.

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