Wednesday, October 06, 2010

Madness and Sanity 5

The first chapter of Roy Porter's Madness: A Brief History (OUP, 2002) provides a succinct introduction to the history of madness or insanity.  I have already pointed out that these terms are very loaded and prejudicial terms.

Indeed, the above terms "madness" and "insanity" conjure up many strange ideas, loaded with prejudices in the opinionated person's mind that are described by the following adjectives: "strange," "weird," "scary," "peculiar," "cracked," "crazed," "crazy," "unstable," "senseless," "nutty," "rabid," "unbalanced," "unsound," "unsafe," and probably "dangerous."  Obviously all of these synonyms have different shades of meaning, but collectively them sum up the range of pejorative associations linked to the concept of madness in our minds.

Porter starts by describing two exstremes or poles within psychiatry with regards to madness, the first which denies its existence as a scientific category at all and the second which upholds it as a very important such category. 

Built in 1784, Vienna's  Narrenturm, German for lunatics' tower, one of the oldest buildings which are specifically designed as a "madhouse"

Dr Thomas Szasz (1920- )
Dr. Thomas Szasz, (born Budapest, 1920), emeritus Professor of Psychiatry at Syracuse University, New York.  Szasz (pronounced Saas) denied that there was any such thing at all as "mental illness" - it was not a fact of nature, but a man-made "myth."  He put these views forward mainly in two books: The Myth of Mental Illness (1961) and The Manufacture of Madness (1970).  He was and is very scathing in his views of psychiatry which he lambastes as being "in the same category" as alchemy and astrology and quite simply is a pseudoscience.  For Szasz, mental illness simply is not a disease, whose nature can be described and elucidated by science.  It is, rather, a strong myth, fabricated by psychiatrists for reasons of personal advancement and monetary return.  This myth is in turn endorsed by society because it proposes and sanctions easy solutions for problems people have.

It is interesting that Szasz goes back to Gilbert Ryle's concept of the "category mistake" in arguing against the very existence of psychiatry as a science or mental illness as a disease. A category mistake, or category error, is a semantic or ontological error by which a property is ascribed to a thing that could not possibly have that property.

We read, in the words of Roy Porter that

All expectations of finding the aetiology of mental illness in mind or in body - not to mention some Freudian underworld - is, un Szasz's view, a category mistake or sheer bad faith: "mental illness" and the "unconscious" are but metaphors, and misleading ones at that.  In reifying such loose talk, psychiatrists have either naively pictorialized the psyche or been complicit in shady professional imperialism, pretending to expertise they do not possess. (Op.cit., p. 2)
The Anti-Psychiatry Movement:

While Porter does not use this term, Thomas Szasz belongs to a group of outspoken psychiatrists who belonged to a group called loosely the Anti-psychiatry Movement. This group emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing, along with Thomas Szasz in the USA and, in Italy, Franco Basaglia. The term was first used by the psychiatrist David Cooper in 1967.  I have outlined briefly the strong views of R.D. Laing before in these pages, chiefly here Ronnie Laing and elsewhere if you use search this blog facility on the right of this blog.  Porter does refer to the work of Michel Foucault (1926 - 1984) in his brief introduction to this book.  Foucault, sociologist, philosopher and historian of thought argued that an history of psychiatry which aimed to be comprehensive and critical would be not only an account of mental disease and its treatment but would also deal with such big and thorny questions as freedom and its denial to patients, and finally control and abuse of knowledge and power.

Michel Foucault published his famous book Madness and Civilization (in French) as early as 1961, interestingly enough the same year in which Thomas Szasz also published his.  Foucault argued that mental illness must be understood not as a natural fact but as a cultural construct sustained by "a grid of administrative and medico-psychiatric practices." (ibid., p. 3)

Porter then adverts to two English psychiatrists who were less radical but tended somewhat towards the anti-psychiatric trend in psychiatry and held a sort of middle ground.  I must admit I never heard of either of them, viz., Richard Hunter and Ida Macalpine who both insisted that psychiatry had ended up in a profound muddle - for them there was far too much subjectivity in diagnosis (subjective interpretation) and not enough scientific objectivity in the field at all.  These two psychiatrists also lamented the "ever-changing nomenclature, as well as a surfeit of hypotheses which tend to be presented as fact." (Quoted ibid., p. 3)  From perusal of the net I find that these two psychiatrists were a mother and son team who researched the history of their profession and wrote jointly two famous histories of the subject.

However, Porter balances his introductory notes with the contrary view of psychiatry.  In this regard he refers to the work of Drs Martin Roth and Jerome Kroll who argue a more orthodox medical line.  They rebut roundly and robustly the views adumbrated by these writers and scholars adverted to above.  In their The Reality of Mental Illness (1986) they counter-argue that "the stability of psychiatric symptoms over times shows that mental illness is no mere label or scapegoating device, but a real psychopathological entity, with an authentic organic basis." (Quoted ibid., p. 4) 

Sir Aubrey Lewis and wife Hilda, also a leading psychiatrist
Porter also quotes at length from Sir Aubrey Lewis's (1900 - 1974) review of Foucault's book mentioned above.  Lewis, an Australian Jew, educated by the Irish Christian Brothers on that continent, was the eminent director of The Institute of Psychiatry at Maudsley Hospital in London.  Therein, this academic leader proferred a good overview of the history of psychiatry which he saw as getting progressively more humane and more inclusive of multidisciplinary approaches.  Lewis argued in moderate and sympathetic tones that "the conventional picture" of psychiatry and its history is one of "progress and enlightenment." (Quoted ibid.,  pp. 5-7)

To be continued

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