Question

Read the “Dig Deeper” vignette, “The Myth of Mental Illness”, provided below. Do you think mental illness is a myth? Why or why not?

DIG DEEPER: The Myth of Mental Illness In the 1950s and 1960s, the concept of mental illness was widely criticized. One of the major criticisms focused on the notion that mental illness was a “myth that justifies psychiatric intervention in socially disapproved behavior” (Wakefield, 1992). Thomas Szasz (1960), a noted psychiatrist, was perhaps the biggest proponent of this view. Szasz argued that the notion of mental illness was invented by society (and the mental health establishment) to stigmatize and subjugate people whose behavior violates accepted social and legal norms. Indeed, Szasz suggested that what appear to be symptoms of mental illness are more appropriately characterized as “problems in living” (Szasz, 1960). In his 1961 book, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, Szasz expressed his disdain for the concept of mental illness and for the field of psychiatry in general (Oliver, 2006). The basis for Szasz’s attack was his contention that detectable abnormalities in bodily structures and functions (e.g., infections and organ damage or dysfunction) represent the defining features of genuine illness or disease, and because symptoms of purported mental illness are not accompanied by such detectable abnormalities, so called psychological disorders are not disorders at all. Szasz (1961/2010) proclaimed that “disease or illness can only affect the body; hence, there can be no mental illness” (p. 267). Today, we recognize the extreme level of psychological suffering experienced by people with psychological disorders: the painful thoughts and feelings they experience, the disordered behavior they demonstrate, and the levels of distress and impairment they exhibit. This makes it very difficult to deny the reality of mental illness. However controversial Szasz’s views and those of his supporters might have been, they have influenced the mental health community and society in several ways. First, lay people, politicians, and professionals now often refer to mental illness as mental health “problems,” implicitly acknowledging the “problems in living” perspective Szasz described (Buchanan-Barker & Barker, 2009). Also influential was Szasz’s view of homosexuality. Szasz was perhaps the first psychiatrist to openly challenge the idea that homosexuality represented a form of mental illness or disease (Szasz, 1965). By challenging the idea that homosexuality represented a form a mental illness, Szasz helped pave the way for the social and civil rights that gays and lesbians now have (Barker, 2010). His work also inspired legal changes that protect the rights of people in psychiatric institutions and allow such individuals a greater degree of influence and responsibility over their lives.

Answer 1

Vignette Review:

In late 1950s, the maladaptive behaviors or difficulty in adjusting to social norms are viewed with perspective of mental illness rather than mental health perspective which nowadays exist. The book “The Myth of Mental Illness,” published during this period.

After going through the interesting vignette, what we can understand is mental illness according to Thomas Szasz (1960) is just behaviors which are deemed socially inappropriate by majority people in the community, for example homosexuality. Also according to Wakefield (1992), it is justification for psychiatric intervention like ECT carried on certain people whose behavior not socially approved as appropriate. Here, the central idea is mental illness is not like physical illness which is visible, measurable, and treated.

Discussion:

Nowadays, views on behaviors changed from mental illness perspective to mental health and wellness perspective. Now it is not only mere absence of inappropriate behavior but also ability to adapt to social environment and have good quality of life. Example: Now it is not just cluster A or B disorders like schizophrenia, schizoid personality disorder, borderline, etc., but it presses more on ability to adapt to global environment, decision making, living in goal directed manner, etc.

According to James-Lange theory (1884-1887), the physiological arousals are responsible for emotions like pain, anger, etc; but according to Cannon-Bard theory (1920s), people can also experience emotions without physiologic arousals. These two theories actually seem counteractive to each other, but we can use here for discussion. In this era, only socially inappropriate behavior is not considered as mental illness or maladaptive behavior, but also failure to cope with existing pressure and make good decisions also considered as deficit. When we see this as whole, we can observe mental illness is not myth.

Analysis:

1. Many psychological issues may arise due to physiologic issues such as imbalance in hormones like serotonin or dopamine. This may result in inappropriate behavior. This should be treated and it can be cured in due course. If we do not recognize these behaviors as symptoms of physiologic issue, then issue may get worse affecting quality of life.

2. Dementia may be result of deterioration of brain cells. The people affected with dementia may have difficulty with activities of daily living resulting in irritable mood and affect. This irritability is the symptom of brain cell deterioration and not only socially inappropriate behavior.

3. People affected with severe anxiety due to post-traumatic stress disorder may act bit bizarre in public, but this anxious behavior cannot be considered only socially deviated behavior. This anxiety issue should be treated and can be cured through cognitive-behavioral therapy and pharmacological intervention.

4. People may find difficult to produce meaningful speech or experience difficulty comprehending others communication. This may be symptom of Broca's aphasia (expressive aphasia) or Wernicke's aphasia (receptive aphasia). Due to difficulty with communication, the affected individual may avoid people and/or act in a way which is considered as socially inappropriate. This can be corrected by intervention and it will be of great help for affected person. Neglecting this considering it as socially inappropriate behavior not to be practiced.

Conclusion:

After going through the points mentioned above, we can say concept of mental health has changed and viewed as overall ability of individual to adapt, think, behave, lead quality life; it is not only mere socially inappropriate behavior. Hence, we cannot say mental illness is myth.