Mental Disorders Are Not Diseases

By Szasz, Thomas | USA TODAY, January 2000 | Go to article overview

Mental Disorders Are Not Diseases


Szasz, Thomas, USA TODAY


Psychiatrists and their allies have succeeded in persuading the scientific community, courts, media, and general public that mental illnesses are phenomena independent of human motivation or will.

THE CORE CONCEPT of mental illness--to which the vast majority of psychiatrists and the public adhere--is that diseases of the mind are diseases of the brain. The equation of the mind with the brain and of mental disease with brain disease, supported by the authority of a large body of neuroscience literature, is used to render rational the drug treatment of mental illness and justify the demand for parity in insurance coverage for medical and mental disorders.

Reflecting the influence of these ideas, on Sept. 26, 1997, Pres. Clinton signed the Mental Health Parity Act of 1996, which took effect on Jan. 1, 1998. "This landmark law," according to the National Alliance for the Mentally Ill, "begins the process of ending the long-held practice of providing less insurance coverage for mental illnesses, or brain disorders, than is provided for equally serious physical disorders." Contrary to these views, I maintain that the mind is not the brain, that mental functions are not reducible to brain functions, and that mental diseases are not brain diseases--indeed, that mental diseases are not diseases at all.

When I assert the latter, I do not imply that distressing personal experiences and deviant behaviors do not exist. Anxiety, depression, and conflict do exist--in fact, are intrinsic to the human condition--but they are not diseases in the pathological sense.

According to the Oxford English Dictionary, disease is "a condition of the body, or of some part or organ of the body, in which its functions are disturbed or deranged; a morbid physical condition." Diagnosis, in turn, is "the determination of the nature of a diseased condition ... also, the opinion (formally stated) resulting from such investigation."

The core medical concept of disease is a bodily abnormality. Literally, the term "disease" denotes a demonstrable lesion of cells, tissues, or organs. Metaphorically, it may be used to denote any kind of malfunctioning of individuals, groups, economies, etc. (substance abuse, violence, unemployment, et al.).

The psychiatric concept of disease rests on a radical alteration of the medical definition. The mind is not a material object; hence, it can be diseased only in a metaphorical sense. In his classic, Lectures on Clinical Psychiatry, Emil Kraepelin--the founder of modern psychiatry--wrote: "The subject of the following course of lectures will be the Science of Psychiatry, which, as its name implies, is that of the treatment of mental disease. It is true that, in the strictest terms, we cannot speak of the mind as becoming diseased."

If we accept the idea that the diagnoses of mental illnesses refer to real diseases, we are compelled to accept them as diagnoses on a par with those of bodily diseases, albeit the criterion for what counts as a mental disease is completely different from what counts as a bodily disease. For instance, in Psychiatric Diagnosis, Donald Goodwin and Samuel B. Guze, two of the most respected psychiatrists in the U.S., state: "When the term `disease' is used, this is what is meant: A disease is a cluster of symptoms and/or signs with a more or less predictable course. Symptoms are what patients tell you; signs are what you see. The cluster may be associated with physical abnormality or may not. The essential point is that it results in consultation with a physician." According to these authorities, disease is not an observable phenomenon, but a social relationship.

In contrast to Goodwin and Guze's assertion that mental illness need not be associated with physical abnormality, Allen Frances, the chief architect of the American Psychiatric Association's Diagnostic and Statistical Manual, DSM-IV, states: "The special features of DSM-IV are . …

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