Sacred radical of psychiatry

The Myth of Mental Illness: 50 years after publication: What does it mean today?

In 1960, Thomas Szasz published The Myth of Mental Illness, arguing that mental illness was a harmful myth without a demonstrated basis in biological pathology and with the potential to damage current conceptions of human responsibility. Szasz's arguments have provoked considerable controversy over the past five decades. This paper marks the 50th anniversary of The Myth of Mental Illness by providing commentaries on its contemporary relevance from the perspectives of a range of stakeholders, including a consultant psychiatrist, psychiatric patient, professor of philosophy and mental health, a specialist registrar in psychiatry, and a lecturer in psychiatry. This paper also includes responses by Professor Thomas Szasz.

Szasz's arguments contain echoes of positivism, Cartesian dualism, and Enlightenment philosophy, and point to a genuine complexity at the heart of contemporary psychiatric taxonomy: how is ‘mental illness’ to be defined? And by whom? The basis of Szasz's doubts about the similarities between mental and physical illnesses remain apparent today, but it remains equally apparent that a failure to describe a biological basis for mental illness does not mean there is none (eg. consider the position of epilepsy, prior to the electroencephalogram). Psychiatry would probably be different today if The Myth of Mental Illness had not been written, but possibly not in the ways that Szasz might imagine: does the relentless incarceration of individuals with ‘mental illness’ in the world's prisons represent the logical culmination of Szaszian thought?

In response, Professor Szasz emphasises his views that “mental illness” differs fundamentally from physical illness, and that the principal habits the term ‘mental illness’ involves are stigmatisation, deprivation of liberty (civil commitment) and deprivation of the right to trial for alleged criminal conduct (the insanity defence). He links the incarceration of the mentally ill with the policy of de-institutionalisation (which he opposes) and states that, in his view, the only limitation his work imposes on human activities are limitations on practices which are conventionally and conveniently labelled ‘psychiatric abuses’.

Clearly, there remains a diversity of views about the merits of Szasz's arguments, but there is little diminution in his ability to provoke an argument.

Promoting critical perspectives in mental health nursing education

This paper explores themes relevant to mental health nursing using the example of one educational module of a nursing degree. The authors argue that the educational preparation of mental health nursing students in higher education must address certain contested philosophical, conceptual, social and ethical dimensions of contemporary mental health care practice. These themes are discussed within the context of a third-year mental health nursing module within a Scottish nursing degree programme. By interlinking epistemology and ontology, the notion of student as 'critical practitioner', involving the encouragement of 'critical thinking', is developed. This is shown via engagement with parallel perspectives of the sciences and the humanities in mental health. Narratives of student nurse engagement with selected literary texts demonstrate the extent to which issues of knowledge, self-awareness and personal development are central to a student's professional journey as they progress through an academic course. The paper concludes by suggesting that these 'critical perspectives' have important wider implications for curriculum design in nursing education. Insights from critical theory can equip nurse educators to challenge consumerist tendencies within contemporary higher education by encouraging them to remain knowledgeable, critical and ethically sensitive towards the needs of their students.

The convenient myth of Thomas Szasz

Thomas Szasz's original critique of the concept of 'mental illness' is almost 50 years old. Over that half century Szasz has maintained a consistent campaign against the 'Therapeutic State', challenging the paternalism of coercive psychiatry and defending liberty and autonomy. Despite his widespread celebrity Szasz continues to be misread and misrepresented. In this paper we review some of Szasz's key ideas, in the light of Clarke's recent critique, setting this within the context of 'mental health nursing' and the problems in living affecting persons worldwide.