Szasz starts by recounting the history of schizophrenia. At the beginning of the twentieth century, dementia paralytica was discovered. That was a mental illness that turned out to be caused by syphilitic infection of the central nervous system. This discovery was all the more impressive as a large percentage (Szasz quotes examples of 20% to 30%) of the patients in psychiatric institutions during 1900-40 turned out to be suffering from dementia paralytica. (p. 7) To a certain point that justified the expectation that other psychoses would also turn out to be caused by somatic factors.
In spite of immensely comprehensive research on the matter, however, no criteria for diagnosing schizophrenia were ever found other than behavioral criteria. Kraepelin and Bleuler believed that an organic disorder would be discovered, but what is the value of such belief, considering that the people in whom such a “disease” was diagnosed were involuntarily incarcerated? Szasz posits that the conclusion that they suffered from an illness called schizophrenia actually had only strategic significance, namely, that it justified locking these people up against their will. Society, the medical establishment, and judges demanded such a point of view. If Kraepelin and Bleuler had published everything they discovered – namely that no consistent physical aberrations whatsoever could be found in these people – instead of what they believed, they would have compromised the prestige of the psychiatric profession and their own careers.
Contrasted to the syphilis model for schizophrenia, Szasz describes the model offered by the antipsychiatrists Laing and Cooper as the model of the “plundered mind.” The schizophrenic is viewed as a victim of his environment. He has been squeezed and drained to the point that he has lost his own identity. Szasz condemns the duplicity of rejecting the concept of schizophrenia and denying its existence, whereas schizophrenia and the best way to treat it is constantly discussed, suggesting that it exists after all. In many ways Szasz views antipsychiatry as the mirror image of psychiatry. Their theories and explanations are diametrically opposed, yet formally very much resemble each other. It makes little difference whether a person has become schizophrenic because of a sick brain (the traditional psychiatric explanation), because of a weak ego or strong id (the psychoanalytic explanation), or because family and society have driven one crazy (the antipsychiatric explanation). Psychiatry treats psychotic patients as minus entities, who at most ought to be regarded as irresponsible children who must be guarded against themselves. Antipsychiatry treats them as plus entities. Both distinguish the schizophrenic from the rest of society. Both use a metaphor as though it were literal. Psychiatry claims that schizophrenia is an illness, whereas it but resembles illness. Antipsychiatry claims that schizophrenia is a journey through madness, whereas that, too, can be meant only metaphorically. Both psychiatry and antipsychiatry imply idealization of people: psychiatry, by assuming that everybody could be well-adjusted and happy if only the brain were not affected by disease; antipsychiatry by assuming that everybody could be his own authentic self if only he were not plundered by others.
Szasz rejects the term antipsychiatry, calling it “imprecise, misleading, and cheaply self-aggrandizing.” (p. 48) He notes that the coining of the word is erroneously ascribed to Cooper, because Beyer already used it in 1912, meaning a publication that is critical of psychiatry. Approvingly, Szasz quotes some of Laing and Cooper’s critics, in particular Martin and Trilling. The former, according to Szasz, portrays Laing as “an angry prophet, an intolerant religious fanatic.” The latter analyzes the concept of authenticity as a meaningless concept, and both antipsychiatrists as people who value prophetic visions more highly than facts and reality.
Finally, Szasz criticizes Cooper’s Marxist-collectivist political premises that are formulated in Cooper’s ideas much more explicitly than in Laing’s. Szasz compares the elevation of the schizophrenic above ordinary people to the communists’ elevation of the poor above the wealthy.
Afterwards Szasz states that he wishes to examine what exactly is meant by schizophrenia, but – stating that its phenomenology is too vague, and that the term is often used to describe just about any behavior that the doctor rejects – examines several authors on schizophrenia instead. He labors from the premise that schizophrenia is an irrelevant concept and that its only purpose is the justification of involuntary commitment and force. The age-old practice of institutional psychiatry needs a scientific rationalization to justify itself. The word schizophrenia suggests the presence of an illness whereas in reality it is no more than a word. Statements by several authors are held up to this central hypothesis. When their statements do not conform to his hypothesis, they are condemned. It seems to me that this is faulty logic and procedure, because this way Szasz keeps repeating his own position instead of demonstrating it. (See also Chapter IV, 4.)
At the same time it becomes obvious that to Szasz the word schizophrenia is synonymous to psychosis, and more specifically means: any behavior for which somebody may be involuntarily hospitalized. Szasz seems only interested in that no clear and consistent physical defects have been found in the manifestation of schizophrenia, and that therefore it cannot be a disease.
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