Posted on June 16th, 2005 by Curt in Science | permalink | 10 comments »
An interesting review of an anthology of Thomas Szasz and his critics, although the seeming intellectual conflict of interest of this article appearing in Reason, to which Szasz is a contributing editor, and written by a man who has received something called “the Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties,” is a bit suspect, but it nonetheless raises some interesting points. Szasz is the professor of psychiatry who became mildly famous in the ’70’s for his fervent denunciations of not just the abuse but the very concept of “mental illness.” However, from what I have read of Szasz his opposition to it seems to be essentially dogmatic, i.e. predicated on the foundational belief that the mental and the physical are inherently separate, and that therefore the application of conditions associated with the body, such as illness, can only inappropriately be applied to the mental. Sure, that debate has been carried on for hundreds of years, but with medical science having advanced as it has, it seems quite obtuse to me to reject a priori the notion of a fundamental indivisibility or even unity between the two. In other words, it seems pretty evident that a host of physical factors and chemicals have been shown to have a profound effect on personality, and so it would not be unfair to speculate that any and all personality traits are the result of some chemical condition in the brain. Granted, psychiatrists seem to be inclined to assert an absolutism diametrically opposite to Szasz’, i.e. that the mind is totally physical in nature, and the American Psychiatric Association sneering at an archaic belief in “mind/body dualism” seems almost equally presumptuous, although slightly more supported scientifically (though we should not be surprised by that since, as I have argued before, science is pretty much materialist by its very nature).
In a way, this whole discussion up to a certain point is pretty irrelevant. If one wishes to pursue medicinal solutions to one’s mental problems, no one but the bill collector will get in the way. If not so be it. But the real issue is when free choice is revoked–in other words, whenever the legal system gets involved. Now it would be too facile to insist that everyone should be able to make a choice about whether they wish to be treated for mental disorders in all cases. There is always going to be a division between relative competency and incompetency, and there is always going to be a certain number of people that are considered incapable of making their own decisions in this, although in this regard curiously it is probably precisely the diagnosis of insanity that will often result in the loss of discretionary rights. But in any case, those distinctions are not my concern to define and develop here. Suffice it to say that it all pretty much pertains to the well-being of the individual, which except in cases of true incapacity should ultimately be within their own powers to decide.
Where I diverge from this sort of libertarian attitude towards psychiatry are in those cases that touch upon the welfare of society, particularly criminal cases. Psychiatry and mental illness have obviously become institutionalized concepts in the judicial system, and Szaszians seem particularly irate about criminals being “let off the hook” via the insanity defense, and in fact the first anecdote in the article consists of Szasz giving a quasi-religious sermon about moral responsibility at a trial to which he was called as an expert witness. I have to wonder, though, what the Szaszians think the real point of the criminal justice system is. When the author makes a distinction between “deterrence” and “justice” in his evaluation of punishments of criminals it seems to give an indication, and I hope it will not be construed as an exaggeration if I take “justice” in this context to basically mean revenge. I have never understood the privileged position that revenge, under whatever euphemism it goes, continues to enjoy in our judicial system, but I think it’s almost indisputable that it plays a primary role, for example given the fact that a murderer is actually more likely to be executed if it be established that the crime was entirely rationally premeditated and directed against a specific target, on the grounds that that proves that he or she really was fully responsible for the deed, whereas the real maniacs who get some uncontainable sensual pleasure from killing are less so, because of course they are mentally ill and therefore not responsible for what they did! In my opinion the reverse should be true. The killer whose crime was entirely directed against a specific target is probably less likely to kill again simply because of the specificity of the crime, whereas the person who kills for the sheer pleasure of it is almost bound to, therefore it is that person that may need to be excised from society, due to the unlikliehood of their being re-integrated into the community without posing a constant danger to it. It is only to the extent that I doubt in the redeemability of such people that I remain open to the validity of capital punishment.
If someone steals money, the crime can be compensated by the return of the money. But the killing or injuring (and the various other crimes of this nature) cannot be reversed. To rather crudely employ an analogy from economics, they are conceptually similar to sunk costs. In this case the only thing of value that can be extracted from a prosecution of the criminal is the prevention of future crimes of a similar nature (this consideration plays a role even in crimes, like robbery, where the crime is reparable). These fall broadly into two classes evoked by the rather clichéd terms of deterrence and rehabilitation, in other words preventing the criminal from repeating their crime and discouraging anyone else from doing so. Revenge, I repeat, is absolutely to be avoided, it being an indulgence of a morally unjustifiable passion and prerogative, one rather similar to the even more repulsive envy. Now if a diagnosis of mental illness holds the promise of a treatment of the criminal that really will cure them of the motivation to commit future crimes, this would supersede morally and practically the deterrent value of punishment, and prevent a rather shameful indulgence in an orgy of vengeance. Whether this is really feasible is of course debatable, and as the example above indicates, psychiatric practice can of course be abused to lead to the opposite result, but the word “abuse” itself indicates a perversion of something with a greater underlying validity. In any case, I am rather incapable of sympathizing for this mania for “holding the guilty accountable.” You want a better world, focus on preventing future crime. You want to assume the mantle of acting as a surrogate for the Lord on Judgment Day, go ahead and have their hides. As Nietzsche wrote: “the categorical imperative smells of cruelty.”
p.s. I recall a newspaper article that got some national circulation by seemingly holding up to ridicule a study which concluded that 47% of Americans have suffered at some point from some form of mental illness. How this number was arrived at, I have no idea. But I don’t at all find it prima facie absurd, as so many others seem to. After all, if one takes as a premise that the mind is at least partly a physical system, this almost seems like a low figure. After all, I would guess that the number of people who have at one point suffered from a physical illness is near 100%, and the medical treatments available for the mind are at this point far more remedial, and the afflictions less well-understood, than those of the body