The Myth of Mental Illness: Dr. T. Szasz. Secker and Warburg. 35s. 337 pp.
Towards the turn of the 19th century, Charcot and Freud instituted a major change in the classification of the sick and the well, when they assigned at least some of those previously described as “malingerers”—since no organic physiological cause for their behaviour could be found—to the ranks of the sick. This began a revolution in medical and lay thought, one which is still continuing today, a revolution in attitude towards people whose behaviour problems cannot be satisfactorily accounted for by organic conditions, and who are currently termed “the mentally ill”.
It is Szasz’s contention that this “reclassification” should never have occurred. Or, as he unfortunately prefers to say, that mental illness is a “scientifically useless and socially harmful myth” that should be abandoned immediately.
Szasz shows quite clearly that people do not “have” mental illnesses in the way that they have physical illnesses, and he analyses, in particular, hysterical behaviour at some length to show that such behaviour can be regarded as a type of communication, a move in a complicated interpersonal game, but not as the “product” or “symptom” of a disease. Hysterical action is action: it is not a series of happenings for which the hysteric is ultimately not responsible, and Szasz declares that to reward hysterical action with an allocation to the “sufferer” of the privileges and status of the “sick” is to encourage them to persist with this type of communication, to continue to play this type of interpersonal game. To exemplify his approach, he considers the “illness” of hysteria in detail:
“. . . Hysteria is a form of non-verbal communication, making use of a special set of signs. It is a system of rule-following action, making special use of the rules of helplessness, illness and coercion . . .”
The hysterical “symptom”, to be rendered intelligible, must be translated back as a personal communication, a communication using, not conventional signs in a discursive language, but iconic signs in a bodily language. It is important to understand not only the actual meaning of the communication but also to understand why the individual uses the language of hysteria. The functions of language, according to Szasz, are three: informative, affective, and promotive. The discursive language that we normally use is admirably suited for informative purposes, but, if we wish to arouse emotions in the other (affective) or to bring him to act in a certain way (promotive), then bodily language may be far superior. This is particularly so where there is a social convention that bodily language is to be considered as to some extent to be outside the control of the communicant. A hysterical “seizure” can induce attention and concern from significant others, where a simple verbal request for “attention” might produce indifference or even scorn.
Hysteria can also be considered as a system of rule-following behaviour, as a game characterized by the rules of helplessness and helpfulness. Following Nietzsche, Szasz criticizes contemporary morals and institutions as producing a constant succession of helper-helped relationships in which the helper dominates and “infantilizes” while the helped learns the rhetoric of helplessness and is thus enabled to blackmail and coerce others.