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ti-prychiatrYmmdthe wwffinntmXnnXms$dffibateIn this article Jane McGee evaluates psychiatry' one of themain biologicat/medical models of abnormatity and mentalillness. She explores the work one of the most influentialwriters in the fietd of anti-psychiatry' Thomas Szasz

ince the 1960s, there has been awide-ranging debate about thevaliditY ol th" tonttPt of mentalillness' ln this article I study a selec-

tion of different views falling broadly und,erit . ttug of anti-psychiatry and then brieflyexamiie anti-psychiatry and psychiatrytodaY.Thomas Szasz was one of the firstanti-psychiatrists to attack psychiatryf ri.t.iry on conceptuat s'"":d: n^i.lijfrad an enormous impact on the ways ln*f,i.f, *. think about the nature of mentalillness.The medital modeAccordingto l(enny (1969)' Plato inventedat'r. .on.."pt of mental health' Plato definedmental health as a harmonY betweenJiii"r"n, parts of the soul' while mentaliiin"tt it an unresolved conflict of theJiff...n, parts. Kenny indicates that Plato's.on..pt otrt't. healthy soul was not a moralon" Uu, a medical one' lf it was Plato whointroduced an early medical model 2'O0Oy.urt ugo, the modern causal theories of[.} AQA (A) PsYchologY Review

mental illness did not appear until thesecond half of the nineteenth century lnfrlr uoor., The Pathologlt and Therapy ofPsychic Disorders, William Criesingeriniirt.a that all forms of psychologicaldisorder can be explained in terms of brainfu*of ogy. His famous aphorism' 'mentalilln.rr.r"ur. brain disease" emphasises hisnatural scientific approach to psychiatry'The discovery that a general paresis of theinsane (a disorder characterised by a dete-liorution in thought Processes andmemory) was caused by a micro-organism1rt.t. ,ypt.titit spirochete)' coupled withiinainlt relating to the adverse effects.*"rr.i by toxins and infections' gave themedical model immense Prestige'The early success of this medical modelwas based-largely on showing that mentaldisorders could be linked to the grossJert.uction of brain tissue As l(enny (1969)stated, 'when medicine is the mostsuccessful discipline then the scientific,tuay of tf'. mind will seem best cast in themedical model' ln contrast to the previousdemonological and unscientific treatment

Thomas Szasz

of the mentally ill, the medical model led tomore humane treatment'According to Macl

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terms of an underlying diseased state ofthe organismmental illness is an illness lil

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Some writers on this topic argue that it isimpossible to define health in non-evalua-tive terms and health judgements are valuejudgements with ethical relativism' Theresulting view is that society is the finalauthority on what constitutes a disease'Shakespeare portrayed Ophelia's with-drawal and eventual suicide as productsof the social influences in her immediateenvironment. The social definitions ofmental illness have been an influencewhether the mad were revered, feared,pitied or simply accepted; whether theywere honoured for their unique powersor incarcerated, treated or abandonedbecause of their madness.The consequences of SzasztsargumentSzasz mounted a strong and direct chal-lenge to the medical model of mentaldisorder. His work anticipated the wholepatient power movement because the ideahe explored in the early 1960s is what wewould now call 'empowerment" This hasbeen important pradically as it gave rise topatient centredness in healthcare' lt isimportant to add thal empowerment isespecially significant in mental health'Psychiatric patients are amongthose disad-vantaged groups which remain notoriouslyvulnerable to abuse. Rosenhan's (1973)classic study illustrated the sense of power-lessness and depersonalisation experiencedby people who are regarded as beingmentally ill. The 1983 Mental Health Actprovides legal authority to assess and treatpeople with a mental disorder in hospitalwithout their consent, where this is neces-sary for their own health or for the protec-tion of others.The central importance of Szasz's workhas been to counter the idea that mental ill-ness is just like physical illness. He alsohelped to give the anti-psychiatry move-ment a high profile by taking a strong anduncompromising line' However, it is thisstrong line which renders his position opento criticism. Szasz has received criticism onboth theoretical and practical levels'Theoretital criticisms

His characterisation of physical illnessexcludes conditions such as migraine, forwhich the bodily causes are unknown'

His characterisation of mental illness asdefined by social-evaluative norms seemsto exclude the factual information(including knowledge of brain structureand functioning) currently available andlikely to be discovered in the future'li.,i:, AO-A A) PsYchologY Review

R"^", ^"*k "f itito ona iitiiiol of philosophers, Pompeii. Plato invented the concept of mentalhealthHis approach has been afiacked as dual-istic because it would result in a false

wedge being driven between mind andbody - a wedge which PsYchiatrY isseeking to remove.Practical criticismsSzasz's extreme position would excludemany patients from the help they reallyneed. Wing (1978), the British socialpsychiatrist, described Szasz's work as'repellent' because he would deny treat-ment to someone with suicidal depression'Peter Campbell (1993), of the Britishmental health group Survivors Speak Out'gives a balanced account of his own manicdepressive illness and for the need to adopta balanced position between the twoextremes. He suggests using physical treat-ments such as drugs when required andinsists on the importance of involvingpatients in decisions about how and whenthe drugs are used.

Szasz himself only practises what hepreaches up to a point. He offers a form ofcounselling aimed at helping people redis-cover and build on their own resources, buthe does not take on highly disturbedpsychotic Patients.

Other forms of anti'PsYchiatrYSome of the main models advanced by theanti-psychiatrists are summarised below.These models offer well-definedapproaches to mental disorder.

Hans Eysenck (1968) was among thosewho argued that mental disorders arelearned abnormalities of behaviour. Psycho-logical treatment methods are now thetreatment of choice for many commonnon-psychotic disorders such as depressionand anxiefz.

This model has been advanced by sociolo-gists such as Scheff (198+)' who viewmental illness as the violation of socialnorms. Rosenhan (1973), in his classicstudy, referred to the stickiness of diag-nostic labels. This approach emphasisesthe extent to which the features of thisdisorder are no more than a response t0the individual being labelled as deviantThe power of labelling in reinforcing thefeatures of long-term mental illness hasbeen emphasised, especially in socialpsychiatrY.

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These cover versions of anti-psychiatrywhich emphasise the hidden meaningful-ness of apparently meaningless (or irra-tional behaviour). ln The Divided SeLf'R. D. Laing (1960) gave a detailed accountof how each gf the apparently meaninglesssymptoms of someone with schizophreniacould be decoded, once their origins inthe patient's contradictory experienceof others were recognised. Schizophreniamay not be, as Laing argued, a saneresponse to an insane society, but a partic-ular l