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The social model of mental illness emphasizes the social environment and the roles people play. Thomas Scheff maintains that people diagnosed as mentally ill are victims of the status quo, guilty of often unnamed violations of social norms; thus the label “mental illness” can be used as an instrument of social control. I agree with Scheff’s analysis, and I strongly concur with the view Thomas Szasz takes on the notion of mental illness. Szasz argues that much of what we call “mental illness” is a myth; it is not an illness, but simply “problems in living”, troubles caused by conflicting personal needs, opinions, social aspirations, values, and so forth (Szasz 13). It thus follows that the widely accepted medical model of mental illness is inherently flawed; that mental illness should, then, certainly not be treated much like physical illness. Szasz is extremely critical of contemporary psychiatry as a discipline, arguing that psychiatrists are not benign professionals helping to liberate individuals and improve their lives by diagnosing and treating mental illnesses, but instead act as agents of social control; silencing, stigmatizing and dehumanizing people who disturb the prevailing social order. Every society rewards conformity; those with more serious problems in living often do a very poor job of conforming, and are punished accordingly.
In Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man, Thomas Szasz writes that
“on the one hand, by seeking relief from the burden of his moral responsibilities, man mystifies and technicizes his problems in living…on the other hand, the demand for “help” thus generated is now met by a behavioral technology ready and willing to free man of his moral burdens by treating him as a sick patient. This human need and the professional-technical response to it form a self-sustaining cycle, resembling what the nuclear physicist calls a breeder reaction; once initiated and having reached a “critical” stage, the process feeds on itself, transforming more and more human problems and situations into specialized technical “problems” to be “solved” by so-called mental health professionals (Szasz 3).”
Szasz, noting that psychiatry has laid claims to progressively larger areas of personal conduct and social relations, goes on to say that “the conquest of human existence, or of the life process, by the mental health professionals started with the identification and classification of so-called mental illnesses, and has culminated in our day with the claim that all of life is a “psychiatric problem” for behavioral science to “solve” (Szasz 3, italics mine). In his view, today, particularly in the affluent West, all of the difficulties and problems in living are considered psychiatric diseases, and everyone (but the diagnosticians) is considered mentally ill (Szasz 4). However, there is very little evidence supporting the popular view that for the most part “mental illnesses” are mental diseases; that is, of a legitimate biological, physiological, neurological or chromosomal nature. Instead, as Szasz writes, “what people now call mental illnesses are, for the most part, communications expressing unacceptable ideas, often framed in an unusual idiom (Szasz 19).”
Szasz summarizes the essence of the problem in this way: in contemporary social usage, the finding of mental illness is made by establishing a deviance in behavior from certain psychosocial, ethical or legal norms. The judgment is made, as in medicine, by the patient, the psychiatrist or others. Remedial action is then sought in a therapeutic-or covertly medical-framework, creating a situation in which it is claimed that psychosocial, ethical, and legal deviations can be corrected by medical action. But medical interventions are designed to remedy only medical problems, and thus it is logically absurd, Szasz says, to expect that they will help solve problems whose very existence have been defined and established on non-medical grounds (Szasz 17).
The expression “mental illness” is a metaphor that we have come to mistake as a fact, and it is for the most part not a useful social metaphor. Szasz claims that the idea of mental illness functions to obscure certain difficulties that are presently inherent (not that they can’t be modified, he says) in the social intercourse of humans; the idea of “illness” is in fact a disguise, a mask. According to Szasz, instead of calling attention to conflicting human needs, aspirations and values, the concept of mental illness provides an amoral and impersonal “thing”-an illness-as an explanation for problems in living. The only question asked is “What’s wrong with the individual?” (namely, what’s the diagnosis) instead of the deeper, more fundamental question, “What’s wrong with society and this individual’s role in it?” Individual relief is the goal, rather than any attempt at societal change. This relief is given in the form of a “quick fix”, usually medication which may (but certainly not always) provide symptomatic relief, helping to control -not cure- the problem, toning down or eliminating the more acute symptoms of the “disease” (Awake 7).” This way of treatment is not entirely bad; I’ll admit that medical treatment that may offer symptomatic relief is better than no treatment at all. But this intervention is just that; an intervention. It is not a “cure” for mental “illness.”
The correct intervention would be not to medicalize mental problems, as we have done, but to address the social and normative causes of these problems. To think of mental illness as “illness” is to overlook the simple fact that “human relations are inherently fraught with difficulties”, as Szasz acknowledges, “and to make them even relatively harmonious requires much patience and hard work (Szasz 20).” So what, if anything, can be done? To put it simply, what is it about life in our society that makes so many people depressed or drives them nuts? If 1 in 4 or 1 in 5 people in our country suffer from a “mental illness” at one time or another, then something is fundamentally wrong with the way we live, the way we have organized our society. I cannot propose a solution for each societal ill that causes so many problems in living, but to start with we certainly could make some fundamental changes in the way we think about mental illness.
Do people need to be drugged, medicated for problems in living that are non-medical in nature? They shouldn’t. Do they need to be imprisoned in hospitals, isolated and dehumanized as deviants? They shouldn’t. Modern psychiatry in its present state can’t really be part of the solution, because it is part of the problem, failing to address the true nature of what it calls “mental illness.” A massive overhaul and refocus of the psychiatric field in the proper direction is highly unlikely, if not absolutely implausible. The focus should be on listening, talking and understanding, not labeling, diagnosing and medically “treating.” Szasz asks if the goal of psychiatry is the advancement of knowledge in understanding human behavior; or the regulation of misconduct and thus the control of human behavior? (Szasz 10). Psychiatry’s goal, as well as ours as a society, must be the former. Instead of trying to speculate as to the malfunctioning in their brains, we should try to identify and understand the malfunctioning in their lives, however hard that may be. Perhaps in trying to understand and properly treat what is known as mental illness, we should give some credibility and responsibility back to those who are labeled “mentally ill,” looking to them for ideas, for suggestions, for guidance. Those who have more severe problems in living (as well as their families and/or friends) may know more about their predicament than those who do not, and may be able to propose, indirectly or directly, remedies that may alleviate their unfortunate plight.
/Bibliography
Awake! Magazine. “Hope for the Mentally Ill.” September 8, 1986 ed, pgs.3-10. Watchtower Bible & Tract Society of New York, Inc, 1986.
Kaysen, Susanna. Girl, Interrupted. Turtle Bay Books. New York, NY, 1993.
Szasz, Thomas. Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man. Syracuse University Press. Syracuse, NY, 1991
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