How would you know how much or how little of “the research” on this topic I have read? The short answer is that you have no idea, because you haven’t begun to engage with the arguments at hand. If you want to demonstrate that there are important facts of which I am not aware you will have to, you know, actually point them out, and not just wave your hands at The Science and The Research without discussing any concrete findings.

Jonathan: For example, because the study of race was used in the past for nefarious purposes, discount any current data on race, even if it means potentially more effective medications for people of certain races.

This is a strawman. Nobody suggested that you should “discount any current data” on so-called “mental illness.” I said that the history of psychiatric abuse is a good reason for caution in appeals to consensus, which is something different. Similarly, people certainly should be cautious of research on racial difference, given the history of racialist pseudoscience. The epistemic authority of a scholarly community depends (in part) on its reliability in getting to the truth, and when there’s a long history of pseudoscience being promoted in order to provide ideological cover for prejudice, there is nothing logically askew in exhibiting a healthy degree of skepticism.

This is hardly ancient history. For example, Homosexuality was a recognized “disorder” until 1974, and so-called “Gender Identity Disorder” remains in the DSM to this day. Walter Freeman was still cutting up people’s brains not 40 years ago.

Of course, if you have an actual argument or empirical data to present, rather than just an appeal to The Science, then that argument and that data can and should be evaluated on its own merits, independently of whatever historical worries one may have. But since you have produced nothing of the sort, there is nothing to be assessed on its own merits; we have only the appeal to authority.

Jonathan: I’m not making an appeal to authority or scientific consensus.

Dismissing an argument on the grounds of an assertion, without further evidence, that its conclusion is “backwards, anti-science, and ignorant” is one of two things. Either it’s (1) an appeal to authority, which can sometimes be a cogent form of argument in the right context, or (2) simple abuse in place of an argument, which never is. I took the more charitable interpretation of supposing that you intended for your remarks to be (1), and so gave an argument as to why the appeal is misplaced, in this context.

If I misunderstood you, and should have adopted the less charitable interpretation, well, I guess I apologize.

Micha,

Two things.

1. You write: “If people who suffer from mental illnesses believe (or are convinced by believing friends and family) that mental illness is a myth, they may not get the help they need, and suffer greatly as a result.”

But Szasz’s views, if implemented, would not deprive the people currently labeled “schizophrenic,” “bipolar,” “depressed,” etc. from “getting help” for their problems. The notion that it would is based on a common but extremely careless misreading of Szasz’s argument. Szasz is quite explicit that the symptoms on which a diagnosis of these pseudo-“diseases” are based are quite real, and pose real problems for people’s lives. What he objects to is the philosophical and political leap of organizing the understanding and “treatment” of those symptoms under pseudomedical terms like “schizophrenia,” “bipolar disorder,” “depression,” etc., which ultimately have a lot more to do with the legal requirement that someone have a diagnosed “disease” in order to get most drugs, than they do with any real scientific basis for the claim that all these symptoms trace to a single, identifiable disease.

In Szasz’s ideal society, people who are suffering from what is now mistakenly called “mental illness” would in fact have far more access to help than they have now, since the abolition of pharmaceutical laws and government licensure laws would remove a couple of the major barriers to entry and price floors on psychiatric “help.”

Szasz also believes that psychiatrists should not have the power to force “help” onto their “patients” against those patients’ wills. But the power to force “help” on unwilling “beneficiaries” is quite a different issue from the ability to “get help” when one needs it.

1. You write: “But shouldn’t one of our goals be truth?”

Sure. But summary dismissal of an argument based on an unsubstantiated assertion that it is “backwards, anti-science, and ignorant” is not, as I see it, a reliable method of getting to the truth. Especially not when there are specific historical reasons to be cautious of “consensus” in the field in question, and when the person whose arguments are being thus dismissed without discussion is in fact a dissenter within the same community of experts whose authority is supposedly being referred to. (In this respect, Szasz’s position, as a professionally trained medical psychiatrist, is quite different from that of creationists who have no training in paleontology and evolutionary biology, or Holocaust deniers who have no training in history. That makes an appeal to authority, rather than an critical engagement with Szasz’s specific arguments, rickety in the extreme.)

Well, hell, if someone in a white lab coat says it, it must be true.

Certainly there is no reason to be cautious of appeals to scientific consensus in this field. There are certainly no prominent examples of appeals to scientific authority, or to psychiatry in particular, that had little to do with science and lots to do with providing cover for coercive normalization, inhuman “treatment” of so-called “patients,” or torture and brain damage posing as “cures.” No need to think for yourself, citizens; the experts have already done it for you.

Meanwhile, we can just safely ignore Szasz’s actual arguments, ignore the extent to which common criticism and “embarassment” over Szasz is based on easily refuted strawmen (such as the claim that he believes that hallucinations are “made up”), and substitute an appeal to authority and an ad hominem (abusive form).

The wikipedia entry on Szasz clearly states he believes schizophrenia is a “fake disease.”

Yes, he does, as do I. But you seem to have grossly misunderstood what that means.

Szasz does not deny that there are people who really have hallucinations. As a practicing psychiatrist he has often treated people who had persistent hallucinations. What he denies is the popular pseudomedical theory that mainstream psychiatrists use to explain those experiences–the theory that they are “symptoms” of a single, identifiable disease, called “schizophrenia.”

Back in the 19th century, psychiatrists believed that there was a mental illness called “hysteria,” which they used to explain all kinds of experiences that many women of a certain class reported having — emotional fragility, psychosomatic reactions, inability to enjoy sex, etc. Nowadays most psychiatrists regard “hysteria” as a bogus diagnosis. That doesn’t mean that they deny that many woman experienced certain kinds of emotional fragility, or psychosomatic reactions, or were unable to enjoy sex. Rather, they now realize that there were various explanations for these experiences, some personal, some medical, and some cultural, and that these experiences were not best understood as common symptoms of some single, identifiable disease. Szasz believes the same thing about “schizophrenia,” and in fact about the category of “mental illness” broadly.

I don’t want to be rude, but Szasz has spent a great deal of time making this point carefully in his writing, both in articles and in book-length treatments of the topic. Maybe you would be better off engaging with what he says there, rather than trying to puzzle out his views from the brief descriptions in a WikiPedia article?

or, he believes seeing spiders that aren’t there isn’t a disease (or symptomatic of a disease).

The claim that hallucinations aren’t necessarily symptoms of an underlying disease is certainly not ridiculous; in fact it’s true, and easily demonstrated. For example, you can get hallucinations right now, without having anything that could be identified as a “disease.” For example, by depriving yourself of sleep for a long period of time, or by consuming a lot of liquor.

Now, for all I know, and for all that Szasz says, it may well be that there is some neural disease that explains Tiffany Sitton’s hallucinations. But if so, then it’s incumbent on those who propose that explanation to give a description of the disease, its etiology, and its causes, and to give some evidence that Tiffany Sitton has it. For the reasons I explained, just saying “schizophrenia” doesn’t count as such giving such a description. “Schizophrenia” is defined in such a way that that does no more explanatory work than if you had said, “Tiffany Sitton has hallucinations because she has the hallucination-causing disease.”

My point remains that seeing spiders that aren’t there is not, as Caplan claims, merely “bad behavior.” Do you, or Szasz, disagree?

This is a crude strawman. Caplan doesn’t claim that having hallucinations is “bad behavior.” If you think that he has, you have misread him very badly. What he suggested is that “schizophrenia is a linguistic excuse for bad behavior.” Again, the issue here is the use of the category “schizophrenia,” not the specific experiences that she reports having. What he’s challenging is the use of a psychiatric diagnosis to excuse specific behaviors (e.g. drug abuse and inflicting emotional suffering on her mother). Not the claim that she really does have hallucinations about spiders.

Scheule: Even if one girl lies about hearing demons, it’s nonsense to believe this explains the entirety of diagnosed schizophrenics.

I can’t vouch for Caplan’s views, but certainly Thomas Szasz has never claimed anything of the sort.

Scheule: Alternatively, Caplan thinks the girl is telling the truth but doesn’t want to call it a disease–but c’mon, she feels non-existent spiders itching around subdermally. If that’s not an illness, please, what is?

Smallpox is a disease. Feeling non-existent spiders itching around under your skin is a hallucination, not a disease.

Depending on the breaks, the hallucination may be a symptom of some identifiable neural disease. Or it may not be. Lots of well-defined neuropathologies can result in hallucinations, such as Parkinson’s disease, or brain tumors, or for that matter the syndromes that result from certain kinds of drug abuse. But lots of unpleasant things can also happen to your body without being to anything that you could call a “disease.” If you intend to bring in the medical model, it’s up to you to explain what the disease actually is and produce some evidence that it’s present in this case.

You might say, “Oh, well, the disease here is schizphrenia.” But just referring back to a term explicitly defined through a grab-bag of loosely-related symptoms, rather than in terms of etiology, doesn’t cut much ice. Since schizophrenia is defined in terms of things like the experience of hallucinations, citing it as the explanation for hallucinations is either tightly circular, or at best an unbacked promissory note for a physiological explanation, rather than the explanation itself. It’s hard for me to see what function, if any, pseudomedical terms like “schizophrenia” serve in helping us to understand what’s going on with someone like Tiffany Sitton.