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Comparisons Between Different Presentations of Argumentation

In addition to that which was discussed in sections 3 and 4, I will now attempt to compare different presentations of argumentation using examples from various publications. Such an approach can provide insight into the consistency of certain arguments and their use. It can also provide an impression of opportunistic and speculative reasoning, depending on which conclusions one wishes to draw. I wish to make the comparisons from two points of view.

1. The first point of view.

Here I base myself on Szasz’s classification which he makes on page XXI of The Manufacture of Madness. He states that if we wish to view matters clearly, and not conform to “popular beliefs” or participate in the justification of common practices, we mush sharply distinguish between three classes of phenomena, even though they are undeniably also interrelated. They are firstly, the facts (events and observable behavior); secondly the way we interpret or explain them; and thirdly the measures for social control which are justified by that explanation. I agree with Szasz that distinguishing these different classes of phenomena is indeed important. Let us see how he does so.

Example 1.
In “Legal and Moral Aspects of Homosexuality” Szasz calls homosexuality an immaturity, and perhaps an illness, because there are signs that it may be determined by heredity. In itself it is rather interesting that Szasz, the indefatigable opponent of declaring behavioral patterns to be diseases, here makes an exception, and that of all things for a category that American psychiatrists would shortly afterwards remove from their list of diseases. Even more interesting is his own commentary on that. “The issue, in fact, is not so much whether or not, as psychiatric theoreticians, we conceptualize homosexuality as a type of disease. The issue is what we do on the basis of our concepts.” One might rub his eyes. Would this author, who has written so many books condemning the concept of mental illness as a falsification and more, and has attempted to demonstrate that position, in this spot resort to a concept of illness for the sake of a most uncertain consideration, and then even posit that that conceptualization is not so important? It cannot be coincidence because also in The Manufacture of Madness he writes about homosexuality. “Clearly, the question that is really posed for us, is not whether a given person manifests deviation from an anatomical and physiological norm, but what moral and social significance society attaches to his behavior.” (p. 168) Another such comment is to be found on page 176. These passages are of utmost importance regarding Szasz’s basic premises. The relationship here between conceptualizing behavior as illness and the consequences of such may illuminate a very important point, namely, that the conceptualizing of illness need not automatically be connected with certain measures of social control. (See Chapter III, 2.5.)

Example 2.
On page 26 of The Manufacture of Madness Szasz states that the inquisitors were truly convinced that their beliefs about witchcraft were correct, and that they may not be accused both of believing the wrong things and acting according to their beliefs. Thus explanation and social control remain united. I wonder whether this is correct. The concept of “witchcraft” does not necessarily imply the necessity to torture and burn. In Spain there was almost no burning of witches although their existence was not denied (footnote on page 71 of The Manufacture of Madness). More important is Szasz’s following remark about institutional psychiatry. “Insofar as a psychiatrist truly believes in the myth of mental illness” (that is ambiguous, in what does he believe, in mental illness or in a myth?) “he is compelled, by the inner logic of this construct, to treat, with benevolent therapeutic intent, those who suffer from this malady even though his ‘patients’ cannot help but experience the treatment as a form of persecution.” (p. 26) Is that true? Does the assumption of illness imply a justification for forced treatment? It is precisely characteristic of medicine that such never happens, except in psychiatry. Szasz seems unjustified in not maintaining a distinction which he himself claims to consider of utmost importance, namely between interpretation and social control. Besides, that last quote contradicts the quotes in the first example regarding homosexuality.

Example 3.
In “What Psychiatry Can and Cannot Do” (Ideology and Insanity, from p. 81) Szasz posits that “psychiatry has accepted the job of warehousing society’s undesirables.” One of his examples is a man with what today is called Alzheimer’s disease. But Alzheimer is a condition that is generally linked to an organic disorder, and thus according to Szasz’s views should be called a neurological illness (see for instance Ideology and Insanity, p. 13), and thus is beyond the scope of an article on psychiatry. The problems of social control are not affected by whether the disorder is considered psychiatric or neurological. In other words, here Szasz does not consider the existence of an organic disorder relevant regarding the issue of social control. The interpretation, however, is very different. In one case Szasz speaks of “disease,” in the other of “problems in living”! So here the interpretation is omitted. Behavior and social control are linked together without further explanation. Yet in “Schizophrenia – a Category Error” he states that “If an objective, biomedical definition of, and test for, schizophrenia existed, then its diagnosis and treatment would of necessity conform to the diagnosis and treatment of other (real) diseases.” From the context we can derive that that would in any case rule out involuntary interventions. How, then, would a schizophrenic patient be treated, one may wonder. Similarly to someone with pneumonia? Or as the man with Alzheimer in Ideology and Insanity? The interpretation of the facts are again considered central to determining the social control.

Conclusion: Szasz sometimes does not keep to his own distinctions between behavior, interpretation, and control, but combines two of the three here and omits one of the three there. This produces a certain inconsistency in the argumentation.

2. The second point of view.

In Szasz’s work ambiguity can be found regarding whether he is a revolutionary who seeks radical changes or an evolutionary who seeks gradual changes and is willing to be satisfied with gradual developments in the desired direction. Many of his writings request revolutionary changes: the abolition of the concept of mental illness, the cessation of involuntary commitment and forced treatment in psychiatry, etc. These are fundamental, not gradual changes. He categorically rejects the idea that involuntary hospitalization would be illegitimate when a patient is not treated, implying that it would be legitimate if treatment were offered. “… [I]n a society such as ours is and aspires to be, involuntary mental hospitalization is an unjustifiable moral and legal wrong. Hence, attempts to illegitimize it on the grounds that psychiatrists fail to treat involuntary mental patients is as faulty logically and as unworthy morally as are attempts to legitimize it on the grounds that psychiatrists protect society from madmen or madmen from themselves. Because each of these justifications is premised on the legitimacy of depriving innocent persons of their liberty under psychiatric auspices, supporting such justifications validates, implicitly, but therefore all the more powerfully, the legitimacy of psychiatric coercion.” (Psychiatric Slavery, p. 9)

On the other hand, he says that he opposes sudden changes. “… I agree with Popper that ‘piecemeal social engineering’ is the most desirable method for effecting social change.” (Law, Liberty, and Psychiatry, p. 225) It must be a very special kind of gradual change, because it has to lead to a very far-away destination that has already now been determined. This is quite different from Popper’s “trial-and-error” method of gradual change, in which the search and learning from experience are more important than the utopic destination. Thus is engendered the ambiguity about the changes that Stone observes, partly as a result of Szasz’s influence – such as limiting the criteria for involuntary commitment, the implicit right to suicide, and improved legal protections during trial. On the one hand, in personal interviews, Szasz concedes that these are valuable improvements towards a development which he supports. On the other hand, compared to the changes he advocates, they are hardly worth mentioning. The deinstitutionalization movement in the United States, that seems to have been partly inspired by Szasz’s work, prompted him to comment that first patients were involuntarily hospitalized, and now they are tossed out on the street against their own wishes, so that essentially nothing has changed. This illustrates the problems that Szasz’s theories can pose for us. (See Chapter III, 4.2.)
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