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The Historical Context of Szasz’s Theories -- Introduction

The history of psychiatry is often recounted rather naively. Its course over the years is generally described as a line on a graph that only rises. Every new development is considered an improvement. Wrongs are considered things of the past and obsolete. The current state of affairs is a final destination, a climax.

Other writers report a kind of cyclic movement. Ideas, views, and innovations are lost, only to resurface later. Schoeneman states that in much historical writing, events of the past have been reinterpreted. Quoting Kirsch, he calls this the “whig interpretation” of history. Behavior that today is considered abnormal is retroactively labeled psychopathological. Ideas that do not correspond with current scientific thinking are ascribed to ignorance or maliciousness or both. In this way the present state of knowledge and insight is presented as the pinnacle of psychiatry.

If taking into account the historic, social, and intellectual context when studying behavior in former times and the ideas people had about it in those days is desired, then relating history turns complicated. It is exactly this reason that Pearson and Jones object to the method Szasz uses in The Manufacture of Madness. In this book Szasz compares the Inquisition to modern psychiatry. (See Chapter I, 4.2.2.) Pearson calls it ahistorical, and Jones adds that Szasz has followed the Levi-Strauss method by lifting events and institutions from different eras out of their context for the sake of comparison.

A typical example of “whig interpretation” is found on page 47 of The Myth of Mental Illness. First Szasz quotes Charcot, who, at a party, remarked about a hysterical patient, “Mais dans ces cas pareils c’est toujours la chose génitale, toujours … toujours.” [“But in such cases it is always a sexual thing, always, always.”] Then he states that this indicates that Charcot must have known that he was deceiving himself by assuming that hysteria is a disease of the nervous system. In my opinion this conclusion cannot be made from Charcot’s statement. Observing that hysteria always involves sexual problems is not the same as declaring sex to be the prime problem, and thus arriving at the supposition that any organic-cerebral aberration is absent. Szasz is explaining Charcot’s statement through his own ideas about hysteria.

Another example is pointed out by Stone. In Law, Liberty, and Psychiatry Szasz quotes Freud who commented on a test by Jung in 1906. The object of the test was to determine whether someone had committed a certain crime. Szasz accuses Freud of failing to emphasize the suspect’s privilege to refrain from self-incrimination. Stone notes that in 1906 Freud was addressing students in Vienna, where, at that time, there was no such privilege. So Szasz was accusing Freud of not defending modern American insights. Regrettably, Stone does not carry through this idea. Szasz continues by saying that Freud was opposed to incorporating psychoanalytic insights about the defendant in a trial, and that is perhaps more important than what precedes.

Although Szasz is greatly preoccupied with the history of psychiatry, and he often compares past events to current ones, it is not my intention to comment on the historical-scientific merit of his work in this chapter.

My object in this chapter is twofold. First I wish to briefly examine whether, and if so, when, problematic behavior and feelings that nowadays we associate with mental illness in the past were also considered illness. Secondly, I wish to sketch an image of psychiatry as it must have been when Szasz began his career, and shortly thereafter, as this must no doubt have contributed to his critical stance. The risk inherent in such a brief sketch is that it is so incomplete as to falsify the image of the past rather than clarifying it. Two considerations are of significance here, because they help justify matters and place them in perspective. The first is that I am not concerned with history for its own sake, but rather as a backdrop to Szasz’s work. The second is that Szasz himself has indicated in many places what it is in recent American psychiatry that appeals to him and what he thinks about all sorts of developments. On the one hand, placing his writings in historical perspective provides the opportunity to clarify certain aspects of his work. On the other hand, it provides a tool for comparison, as Szasz’s historical placing can either be or not be supported by what to him was important or deserving of condemnation in the reality of the time.
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