Thank you so much for this! Their agenda is far clearer when you look at what they are trying to do in addiction, which is get rid of the only two treatments proven to cut the death rate from opioid addiction by 50% or more and replace them with their "spiritual" 12-step wellness farms —despite the fact that abstinence-only treatment is actually linked to HIGHER death rates than no treatment at all. As I wrote recently in the Times, SAMHSA now wants doctors and patients to re-evaluate the use of these medications annually, which sounds like a nice worry about overprescribing, but in reality, most people come off of the meds way too soon rather than staying on too long. They also say they will no longer fund "medication only" use of these treatments, despite the fact that they just spent the last few years implementing new regulations to *encourage* medication only / low threshold care because there's no evidence that forced counseling or daily pick up requirements do anything other than increase treatment dropout and overdose deaths.
Thanks Maia! Maintenance treatment for opioid addiction via suboxone or methadone is one of the effective interventions we have in medicine and among the things I truly consider life saving. Sad to see their use being discouraged.
I think it's important to note that they're also against therapy, trauma-informed care, psycho-education, and gentle parenting. From the MAHA report, right after it discusses supposed overdiagnosis of ADHD:
"Dominant mental health approaches, often relying on reductive diagnoses and targeted treatments, face scrutiny for overlooking environmental factors. Some interventions may even cause harm. For example, universal school-based mental health programs can inadvertently increase distress in certain adolescents by encouraging rumination, though evidence is debated.
"Such over-pathologization may lead to interventions that fail to address root causes. Echoing these concerns, Abigail Shrier’s 2024 book, Bad Therapy: Why the Kids aren’t Growing Up, contends that interventions like therapy and Social-Emotional Learning programs may weaken resilience by pathologizing normal emotions. This perspective raises concerns that practices like trauma-informed care and gentle parenting potentially pathologize normal emotions, undermine resilience, and contribute to rising anxiety and depression rates among children and teenagers. Though controversial and disputed by many experts, this perspective remains viable and warrants rigorous scientific investigation to either confirm or refute its validity."
When they say "environmental factors" causing mental health problems, they're not talking about poverty, racism, intimate partner violence, child abuse, harsh work environments, pollution known to adversely affect development that occurs in racist distributions*, suburban social isolation as a deliberate capitalist ploy to increase consumerism and decrease labor organizing**, etc. They're talking about any cultural practice that isn't in line with fascist ideology. There is no common ground between MAHA and people who want a society where people are cared for and there are real solutions for mental distress.
* They will talk about pollution since it lines up with fascist ideology around the purity of the body, but e.g. they mention agricultural chemicals only in terms of the small amounts on foods that children are eating, not the much-larger exposures of children in mostly-Latino farm worker families. And their actual policy exists to further sabotage already-weak environmental regulations.
** They like blaming social isolation on screen time for kids, not a hostile, car-centric built environment and generations of urban development deployed deliberately to destroy thriving cultural communities in urban areas. It is of course easy to loop Christian moralizing into their arguments around social isolation.
“The binary of disease-based reductive psychiatry on one side and “critical psychiatry” on the other nudges us to assume there is nothing in between. In fact, the space between is large and well populated.”
Thank you for recognizing the middle. It’s a space I live in… as a pediatric NP who cares for way too much mental illness (3 of my 15 patients yesterday were for serious mental illness… not just the “garden variety” depression and anxiety I also see so much of). I talk about lifestyle and how this matters AND sometimes I also prescribe meds.
I’m also a patient who recently finished a 26 month taper off Prozac… neither myself nor my own psych NP had any idea how awful this can sometimes me (an attempted 7 week taper at the beginning was a disaster). I found the info and support I needed to successfully do this in the peer community… which is amazing, but, yes, sometimes frustratingly very one sided.
I would be intellectually and spiritually impoverished without this newsletter! I appreciate this post in particular, because it articulates what I find here in this newsletter (and when I'm lucky, in the New York Times op-ed page!)--a thriving space between the poles of biological psychiatry and anti-psychiatry, defined not be one angle or position, but instead a commitment to the the messy, overwhelming work of trying to understand psychopathology in all its complexity. I sense your commitment to getting it right, which I attribute to your skin in the game as a practicing psychiatrist. And I deeply value the clarity that you bring to this topic as a philosopher.
The only minor issue I have is with the notion that Whitaker-Moncrieff "lost the argument inside medicine" and that their position is "scientifically exhausted." That may be true. But to share one anecdote, when I was in graduate school (circa 2012), a prominent psychologist studying treatment outcomes in depression wanted to invite Whitaker to speak at the medical school's grand rounds. This psychologist was highly critical of SSRIs, but he was not antipsychiatry, and he changed his position when the data called for it (e.g., embracing combined treatment). His colleagues in the medical school rejected the idea of inviting Whitaker on the grounds that trainees would find it demoralizing. During these same years, there were multiple high-profile talks on the serotonin transporter gene.
I guess my quibble is that while Whitaker and company lost the scientific argument, it wasn't the free and open discourse upon which a scientific consensus earns its credibility (at least not at my university in the early 2010s). And that strengthens their case to the public (even though it is largely bogus).
One last anecdote that contrasts with the previous one: when I was completing my internship (~2014), I rotated through a first-episode psychosis clinic directed by prominent psychiatrist. At one of the meetings, he encouraged his colleagues to attend a talk on Open Dialogue by visiting clinicians, and he took to heart their critique. I remember him saying something along the lines of "the way we often treat our psychotic patients would make anyone feel paranoid and alienated." In the Open Dialogue trailer, Whitaker claims that if "Western Psychiatry" would just pay attention to what is happening in Finland, it would be revolutionary. He was wrong on both fronts. At least some psychiatrists paid attention, but what was called for was reform (listening to patients with curiosity and empathy, continuing to recognize and reduce the harm of "expressed emotion"), not revolution (stopping anti-psychotic treatment altogether and reconceptualizing psychosis as an acute condition that was chronified by mistreatment).
Thank you Thomas! I appreciate your kind words as well as your comments and observations. I agree that there usually wasn’t open-minded engagement with Whitaker’s arguments in mainstream academic psychiatry. When I first read Anatomy of an Epidemic, I found it very compelling and persuasive, and I had a really hard time finding people in academia who had engaged with it properly. Fortunately there were enough academics who took the arguments seriously enough to investigate these issues in a careful manner. I also agree with your conclusion.
Thank you, as always, for complicating what others try to over-simplify and polarize. I agree with all the main points, but your view that the psychiatric mainstream practitioners have been moving (slowly) in the right direction understates the huge problem that the public, many of whom are taking prescribed psychiatric meds, have not come close to catching up with this change. For most of the families I encounter, they are still caught in the “chemical imbalance” and “diagnosis as disease” mindset. This is not some relic of the 1989s that the public has left behind. I have occasion to complicate this mindset for almost every patient I work with (many of whom are non psychiatrist physicians) other than the rare few who do a ton of research into the online debates. I have hope this is changing and will change soon, but so much depends on whether psychiatrists and primary care docs and clinical therapists all communicate a more nuanced picture to their patients each and every time a patient seeks help.
Thanks Trysa. I agree and I observe similar things on the ground too. Hopefully efforts like my recent NYT article help facilitate change in public understanding.
Awais thank you for writing this. It is a must read for every psychiatrist practicing today and for anyone who thinks seriously about mental health reform. Your intellectual rigor and honesty here are exactly what this conversation needs.
The false binary you expose is the heart of it. The Szaszian undercurrent running through the Moncrieff-Whitaker world is something I've felt for years but you name it with a precision I haven't seen elsewhere. And your point about MAHA's moderate-sounding entry points concealing a much more radical philosophical program underneath is sharp and a little alarming.
The one thing I want to add, and maybe I'm biased because I'm the founder of Vanna Health, is on your closing line that psychiatry and its allied fields are "the only game in town." I love the institution and I believe in the science. And yet I've watched it move slowly, sometimes painfully slowly, on the things that matter most for people with serious mental illness. Not because the people inside didn't care but because institutions are what they are.
New models have grown outside those walls and frequently in the for-profit world they are doing it brilliantly, with a speed and a focus on outcomes that the institution has rarely matched. So maybe the answer isn't the institution or the critics. Maybe it's new architectures that take the biology seriously and build from there.
Thank you, Awais, for pushing back on Mr. Bergner's binary perspective on psychiatry; i.e., as you summarize it,
"The binary of disease-based reductive psychiatry on one side and “critical psychiatry” on the other nudges us to assume there is nothing in between.""
You rightly point out that there is much "in between," including the biopsychosocial model (BPSM) developed by George Engel. Whatever the flaws and deficiencies in the BPSM, it has been the "solid center" of American academic psychiatry for more than 50 years. Yes, market forces have pushed the field hard toward pharmacologic treatments, but that is despite--not because of--psychiatry's holistic model. [1,2]
I had to smile--and wince a bit--at seeing the ghost of Thomas Szasz re-materialize in Bergner's piece. As you may recall, Szasz was one of my professors during residency, more than 45 years ago. Szasz's views have been so thoroughly discredited [3,4], it is astonishing that he has emerged as a central driving force behind the so-called "critical psychiatry" forces you describe. (I think "anti-psychiatry" would be a more accurate term, though Szasz himself never accepted that label).
Equally astonishing is the continued credibility given to the work of journalist Robert Whitaker, whose bogus claims of an "epidemic" of mental illness driven by psychiatric medications have also been thoroughly debunked. [5,6].
And while I readily acknowledge the (relatively rare) occurrence of severe and prolonged withdrawal syndromes following the abrupt discontinuation of some antidepressants [7,8], self-help organizations that take a blatantly anti-medication, anti-psychiatry stance do their clients no favor. Withdrawal from antidepressants is a complicated issue that requires sophisticated medical expertise--not ideologically-driven advice from people with no medical training. And, yes--I realize these groups arose in response to a paucity of medical guidance, though in truth, there are notable exceptions to that claim in the psychiatric literature going back more than 25 years. [9,10]
As for RFK Jr.'s outrageous claims (antidepressants compared to heroin, implicated in school shootings, etc.), we must push back hard, lest the well-being of our severely depressed patients suffer. [11,12]
3. Pies R. On myths and countermyths: more on Szaszian fallacies. Arch Gen Psychiatry. 1979 Feb;36(2):139-44. doi: 10.1001/archpsyc.1979.01780020029002. PMID: 369469.
4. Pies RW. Thomas Szasz and the language of mental illness. In: Thomas Szasz, an appraisal of his legacy. Edited by Haldipur, Knoll and Luft. Oxford University Press, 2019
7. Henssler J, Schmidt Y, Schmidt U, Schwarzer G, Bschor T, Baethge C. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. Lancet Psychiatry. 2024 Jul;11(7):526-535.
10. See, e.g., Maixner & Greden, 1998: "If antidepressant medications must be discontinued, a gradual taper is preferable, perhaps extending three to six months or longer to prevent discontinuation effects, enable adaptation at the receptor level and allow earlier recognition and treatment of recurrent depressive symptoms." https://pubmed.ncbi.nlm.nih.gov/9809213/
Now Ron, you know very well that Tom’s work has not been “totally discredited.” Go back and read Tom’s reply to your invited contribution to my book, Szasz Under Fire: The psychiatric abolitionist faces his critics, and all of my pieces on Tom’s outstanding work over the years. See my last book with Zvi Lothane and Rick Vatz entitled Thomas Szasz, The Man and His ideas, published by Transaction and Routledge in 2017. Very few of those scholars who have disagreed with him have used arguments ad rem. By far they rely on argumentum ad hominem, the way you often do. I invite interested observers to subscribe to my substack, Drjeffreyaschaler.substack.com. It is free.
As Charles Krauthammer remarked years ago, (something to the effect) - many people have heard of Thomas Szasz but few understand him. Tom, the late Ron Liefer, MD, MS, and so many of the outstanding people who agreed with and admired Tom and his work, people such as myself and Zvi and Nelson, do not take your ad hominem criticism seriously.
As you know, I had the honor and privilege of being very close to Tom for many years. I founded and still keep www.szasz.com with Tom’s approval. My account of what happened to him at Upstate after The Myth of Mental Illness was published is the only accurate description (in Szasz Under Fire) and every word was approved of by Tom. What continues is the ATTEMPT to discredit him. I believe Mantosh Dewan, MD, then chair of the dept of psychiatry and now president of Upstate, and C. Haldipur, MD (I remain friends with both of them, would agree with me, as would another colleague of both Tom’s and mine, Nelson Borelli, MD, (still alive and kicking’’ and in his 90s. Nelson and I threw the 80th birthday party for Tom, under the auspices of Mantosh Dewan and the Upstate Dept of Psychiatry. Mantosh gave one of the most beautiful appreciations of Tom at the symposium Nelson and I held at Weisskotten in conjunction with the birthday party.
Please be more respectful towards Tom and his legacy, Ron. Jeff Schaler, PhD, MEd., ijas@me.com
As a resident and in my later years as a faculty member of Upstate Medical University, I always had affectionate feelings for Tom, even though we were perennial "sparring partners" (a term he once told me he liked). And while I stand by my statement that Tom's views on mental illness (which he regarded as a "myth" or a "metaphor") have been soundly refuted by nearly all philosophers of science and psychiatry [1], I must add that Tom and I were in agreement regarding so-called "medical aid in dying" --which Tom (in his book, Fatal Freedom) rightly characterized as bureaucratized killing. I also have considerable respect for Szasz's work on autonomy in psychotherapy. I will leave to readers of this page whether the arguments I put forth in my two publications
[refs. 3 & 4] are ad hominem, or whether they merely reveal the numerous logical fallacies in Szasz's case against the reality of mental illness.
Ronald W. Pies, MD
Professor Emeritus of Psychiatry
Lecturer on Bioethics & Humanities
SUNY Upstate Medical University
1. See, e.g. Thomas Schramme, "The Legacy of Antipsychiatry." In: Philosophy and Psychiatry, edited by T. Schramme and J. Thome, pp. 94-119, Berlin. Walter de Gruyter, 2004.
Szasz asked interesting questions but his answers have largely been debunked early on. He has his defenders but on the basis that they would like his claims to be true and ignore the evidence against him.
Thank you, Samei. Yes, Tom Szasz raised important philosophical questions that provoked all of us in the field to think long and hard about the underlying assumptions of psychiatry. For that alone, he deserves credit. He was a courtly and clever polemicist, who was kind to me, even when I was a medical student. His Old World charisma and witty epigrams ("If you talk to God, you are praying; if God talks to you, you have schizophrenia") made him something of a "rock star" in our department at Upstate (I was there from 1979-82).
Szasz also made important contributions to the ethics of the psychotherapist-patient relationship, as my Upstate colleagues, Mantosh J. Dewan and the late Eugene Kaplan write in their chapter, "The clinical wisdom of Thomas Szasz" [in Thomas Szasz, an appraisal of his legacy. Edited by Haldipur, Knoll and Luft. Oxford University Press, 2019]
And yet, as philosopher Eric v.d. Luft succinctly notes, "Szasz cannot use many philosophers to his advantage, since almost all of them--whatever they may deem to be the entity status of "illness" or "disease" in general--accept the reality of mental illness, while Szasz, of course, as a central ideological point, does not." [op cit Haldipur et al].
I received the following comment from Martin Smith, forwarded to me by Jeffrey Schaler. My response follows:
"I think Luft and Pies are wrong. Their concept of "the reality of mental illness" requires dualism, but most current philosophers are monists, not dualists. They argue for physicalism, which holds that everything is ultimately physical. So if most current philosophers are physicalists, but they accept the reality of mental illness, then they must be using "mental illness" metaphorically, so they can avoid arguments like the one started by Ronald Pies."
Martin Smith
Oslo, Norway
From Ron Pies:
Thank you for your comment, Martin. I do not accept the premise that asserting the reality of mental illness requires dualism, or that anyone's claim that mental illness is "real" requires dualism; i.e., that mind and brain are somehow separate or distinct "substances" (to use a term from medieval philosophy). Nor am I aware of actual statements by philosophers of science, or philosophers of language, that their use of the term "mental illness" is merely metaphorical. (If you have such statements, please quote and cite the source).
We can assert the "reality" of mental illness without endorsing any particular metaphysical model of "mind" and "brain." The reality of mental illness resides in its manifestation as prolonged or severe suffering and incapacity (not due to an obvious external cause, like a knife wound) in the cognitive, emotional and behavioral realm, all of which can be observed empirically--and not just by psychiatrists, but by family, friends, and other observers. There is room, of course, for metaphysical debates on what the terms "real" and "reality" mean--a debate as old as the nominalist/realist debates of the medieval scholastic philosophers. But that would be a very, very long discussion!
What “questions”? Please cite evidence supporting your assertions. You try to reduce over fifty years of Tom’s writings, hundreds of books and extremely important papers, debates, and talks to “asked interesting questions”? More attempts at character assassination instead of evidence. Ron and Samei give no evidence supporting their toxic attacks on Tom and his outstanding work over the course of his lifetime. He has long been praised by intellectual giants, people like Karl Popper and those cited in Tom’s many writings. READ. LISTEN. I refuse to engage in dialogue with people who are so disrespectful of Tom. Argumentum ad rem, not ad hominem.
His claim that medical conditions have to have a biological lesion as answer to his implicit question “on what basis do we regard mental health conditions as medical conditions?” have long been debunked eg see my book. In terms of never detaining people as his answer to his implied question “under which circumstances should we detain people for mental health problems ?” at least 2 people has told me that in conversation he would agree for his son to be detained if he was suicidal. I don’t read a lot of what he wrote as Szasz never struck me as that good at thinking through answers to his questions and then he accepted money from Scientology to set up an anti psychiatry group.
I have just posted important correspondence between Karl Menninger and Tom that appeared years ago in Bulletin of Menninger Clinic on my substack at http://Drjeffreyaschaler.substack.com . It is free to subscribe.
I was unsurprised to learn that Daniel Bergner is a journalist like Robert Whitaker, Ethan Watters, and Michael Pollan who have also delved into neuroscience, psychiatry, and consciousness. The complexities of these topics is why I typically avoid books written by journalists, though I did like We’ve Got Issues by Judith Warner who is also a journalist. Overall, I much prefer the insights you provide on this site. Thank you.
Dr Aftab, a psychiatry based on a biopsychosocial model, a psychiatry which pays "attention to natural history, multi-level causal explanation and a wide treatment armamentarium that includes, but is not exhausted by, pharmacology" is something to be aspired to, to encourage and to work hard at creating. But that is nothing like the mainstream psychiatry which is practiced today. From what I understand, the typical visit to a psychiatrist lasts for about 15 minutes and consists of taking down symptoms and prescribing a medication. Mainstream psychiatrists may want to know something about the life history and life situation of their patients but they are not willing to spend much time in that pursuit and spend no time helping their patients learn how to use their thoughts, emotions, intentions, perceptions and behavior to live the way they want to live. The typical psychiatrist is, in fact, limited to prescribing medication. And medication is not going to help people learn to live the way they want to live. It may be a necessary part of that process but certainly not sufficient. Today's psychiatry students learn very little about psychotherapy and mainstream psychiatrists, as far as I understand, do not practice psychotherapy at all. So today's mainstream psychiatry is based on a biobiobiomodel. When a mainstream psychiatrist hears that a patient is hearing voices, does s/he ask the patient about the voices? Does s/he spend hours with the patient, listening, supporting, affirming and helping the patient work at understanding the meaning of the voices? Does s/he help the patient learn to engage with, manage, live with the voices? No. S/he tells patients they have a brain disorder and prescribes antipsychotic medication.
Szasz was right in his finding that the states of being moods, emotions, thoughts, intentions, perceptions and behavior associated with diagnoses of mental illness are reactions to problem in living. They are emotional distress, life crises, difficult dilemmas, spiritual emergencies, overwhelm, manifestations of concerns people have about their lives and themselves. He was wrong in that he didn't acknowledge that the symptoms of mental illness are impairing to people, very painful, troubling, upsetting. In the sense that mental illness impairs functioning - makes it difficult for people to love the way they want to love, express themselves the way they want to express themselves and enjoy life the way they want to enjoy life, they are illnesses. But they are much more than illnesses. They are also wake-up calls, signs that something is wrong, invitations to do some inner work, opportunities for growth. The practice of seeing them only as illness and working only on getting rid of the symptoms is not good treatment. Would that psychiatrists spent some time with their patients, helping them to explore the symptoms and use them to begin the lifelong task of developing a good relationship with themselves. Would that psychiatrists helped people to live better lives.
In fact, the way psychiatry is practiced today is, indeed, reductionist and not very helpful to people. You suggest that critics of psychiatry have not described what they want to see as an alternative. How about more and better psychotherapists, thousands of Soteria houses and peer-run crisis respite houses, thousands of Open Dialogue practitioners, more hearing voices groups, more psychiatrists who can help people withdraw from medication, support groups, supported housing, case workers to help people get housing, jobs, meaningful work, connection with other people, art therapy, mindfulness mediation, etc..
Had psychiatrists embraced and practiced according to the biopsychosocial model, they could have become holistic practitioners. But they went towards the medical model, towards paying attention only to things that could be quantified, measured, seen on brain scan - and lost that opportunity.
Scientology is a religion. You appear anti -Scientology the way many people are antisemitic. Do you dislike people because of their religious identification? Please share your feelings about people who like Scientology in the same way people like certain religions. I will bet your feelings toward Scientology are based on myth and bias. please tell us.
Samei you do not know what you are talking about. Tom never took money from Scientology. Why would you lie? You could be sued for saying that. As i mentioned he qualified three conditions in which he would help someone without permission. children, someone who is literally unconscious,’and to protect others re contagious disease. Yours is the kind of emotional toxicity that is hard to take. Anyone who lies and makes irresponsible accusations like that has no business being a therapist. How old are you and how many years have you been in practice? If you read my piece that appeared as a transcript of my debate with Allen Frances you might learn something. i go over these issues carefully. it is on my substack. Incidentally, Frances agreed with me and Tom. Many outstanding people praises Ton and his work. I posted letters from them at the website I produced and own as a public service at www.szasz.com
Ron wrote: “ I had to smile--and wince a bit--at seeing the ghost of Thomas Szasz re-materialize in Bergner's piece. As you may recall, Szasz was one of my professors during residency, more than 45 years ago. Szasz's views have been so thoroughly discredited [3,4], it is astonishing that he has emerged as a central driving force behind the so-called "critical psychiatry" forces you describe. (I think "anti-psychiatry" would be a more accurate term, though Szasz himself never accepted that label).”
Ron, with all due respect, Tom did not take you seriously. I encourage those interested to read Ron’s contribution to my edited book entitled Szasz Under Fire. I invited Ron. More important is Tom’s reply to Ron. Res ipsa ….
Pathologists do not include “Mental illness” in standard books on pathology because symptoms don’t meet the nosological criteria for disease inclusion and classification. Take your whining up with pathologists. Ask them why they don’t include mental illnesses as diseases. Ron, it seems you clearly believe in ghosts, as you say! My advice to anyone seeking a psychiatrist: If he or she believes in psychiatric ghosts, that is, that something not physical can be physical, run don’t walk the other way. That is called a hallucination, a self reported imagining.
I encourage interested parties to read the late psychologist Ted Sarbin’s excellent essay entitled On the Obsolescence of the Schizophrenia Hypothesis. His article is in my substack. You may subscribe for free. Drjeffreyaschaler.substack.com. See also the correspondence between Tom and Karl Menninger, also posted there. plus the transcript of my debate with Allen Frances, Jacob Sullum, and one other person, I have forgotten her name. By the way, Frances began by saying he agreed with Tom and myself about the nonexistence of mental illness. Mental Health Law sponsored and published at Cato Unbound.
There are important issues related to all this. Do those who believe in psychiatric ghosts, that is, mental illness, believe they have a right to participate in involuntary commitment and the insanity defense? As Tom emphasized repeatedly, involuntary commitment and the insanity defense are the real issues.
I have debated top forensic psychiatrists before who claim they can tell who will commit suicide and/or homicide. When I confront and inform them that extensive research shows consistently they are no more accurate than chance, they concede (if they know the research). However, they continue to believe they can tell. You know what that means…
Szasz was very clear about how disease is diagnosed in his book Insanity:The Idea and its consequence. The majority of disease is diagnosed through signs, not symptoms. He abides by the standard nosological criteria for disease classification/identification as do pathologists. He explained three criteria where treatment proceeds without consent- children, unconsciousness, and contagious disease. See my online debate transcript with Allen Frances at Cato Unbound- Mental Health Law. He and I are atheists not Scientologists. He and I never received money from CCHR for anything other than plane and travel expense to give a talk. i accepted an award from CCHR, no money, gave a widely praised speech which is online. search the following terms:Schaler szasz award, cchr, speech. See my chapter on cults in my last book with Zvi Lothane, MD entitled Thomas Szasz The man and his ideas. You apparently discriminate against people for their religious affiliation. Tom and I do not. you have proved nothing, debunked nothing. You still have presented no evidence. clearly you know very little about science and law. Evidence is required to support your libelous accusations.
Thank you so much for this! Their agenda is far clearer when you look at what they are trying to do in addiction, which is get rid of the only two treatments proven to cut the death rate from opioid addiction by 50% or more and replace them with their "spiritual" 12-step wellness farms —despite the fact that abstinence-only treatment is actually linked to HIGHER death rates than no treatment at all. As I wrote recently in the Times, SAMHSA now wants doctors and patients to re-evaluate the use of these medications annually, which sounds like a nice worry about overprescribing, but in reality, most people come off of the meds way too soon rather than staying on too long. They also say they will no longer fund "medication only" use of these treatments, despite the fact that they just spent the last few years implementing new regulations to *encourage* medication only / low threshold care because there's no evidence that forced counseling or daily pick up requirements do anything other than increase treatment dropout and overdose deaths.
Thanks Maia! Maintenance treatment for opioid addiction via suboxone or methadone is one of the effective interventions we have in medicine and among the things I truly consider life saving. Sad to see their use being discouraged.
I think it's important to note that they're also against therapy, trauma-informed care, psycho-education, and gentle parenting. From the MAHA report, right after it discusses supposed overdiagnosis of ADHD:
"Dominant mental health approaches, often relying on reductive diagnoses and targeted treatments, face scrutiny for overlooking environmental factors. Some interventions may even cause harm. For example, universal school-based mental health programs can inadvertently increase distress in certain adolescents by encouraging rumination, though evidence is debated.
"Such over-pathologization may lead to interventions that fail to address root causes. Echoing these concerns, Abigail Shrier’s 2024 book, Bad Therapy: Why the Kids aren’t Growing Up, contends that interventions like therapy and Social-Emotional Learning programs may weaken resilience by pathologizing normal emotions. This perspective raises concerns that practices like trauma-informed care and gentle parenting potentially pathologize normal emotions, undermine resilience, and contribute to rising anxiety and depression rates among children and teenagers. Though controversial and disputed by many experts, this perspective remains viable and warrants rigorous scientific investigation to either confirm or refute its validity."
When they say "environmental factors" causing mental health problems, they're not talking about poverty, racism, intimate partner violence, child abuse, harsh work environments, pollution known to adversely affect development that occurs in racist distributions*, suburban social isolation as a deliberate capitalist ploy to increase consumerism and decrease labor organizing**, etc. They're talking about any cultural practice that isn't in line with fascist ideology. There is no common ground between MAHA and people who want a society where people are cared for and there are real solutions for mental distress.
* They will talk about pollution since it lines up with fascist ideology around the purity of the body, but e.g. they mention agricultural chemicals only in terms of the small amounts on foods that children are eating, not the much-larger exposures of children in mostly-Latino farm worker families. And their actual policy exists to further sabotage already-weak environmental regulations.
** They like blaming social isolation on screen time for kids, not a hostile, car-centric built environment and generations of urban development deployed deliberately to destroy thriving cultural communities in urban areas. It is of course easy to loop Christian moralizing into their arguments around social isolation.
Indeed, you’ve outlined it well. It’s important to recognize that these are not pro-therapy, pro-environment movements.
“The binary of disease-based reductive psychiatry on one side and “critical psychiatry” on the other nudges us to assume there is nothing in between. In fact, the space between is large and well populated.”
Thank you for recognizing the middle. It’s a space I live in… as a pediatric NP who cares for way too much mental illness (3 of my 15 patients yesterday were for serious mental illness… not just the “garden variety” depression and anxiety I also see so much of). I talk about lifestyle and how this matters AND sometimes I also prescribe meds.
I’m also a patient who recently finished a 26 month taper off Prozac… neither myself nor my own psych NP had any idea how awful this can sometimes me (an attempted 7 week taper at the beginning was a disaster). I found the info and support I needed to successfully do this in the peer community… which is amazing, but, yes, sometimes frustratingly very one sided.
Thank you! Good to hear from you and thanks for practicing in this manner!
I would be intellectually and spiritually impoverished without this newsletter! I appreciate this post in particular, because it articulates what I find here in this newsletter (and when I'm lucky, in the New York Times op-ed page!)--a thriving space between the poles of biological psychiatry and anti-psychiatry, defined not be one angle or position, but instead a commitment to the the messy, overwhelming work of trying to understand psychopathology in all its complexity. I sense your commitment to getting it right, which I attribute to your skin in the game as a practicing psychiatrist. And I deeply value the clarity that you bring to this topic as a philosopher.
The only minor issue I have is with the notion that Whitaker-Moncrieff "lost the argument inside medicine" and that their position is "scientifically exhausted." That may be true. But to share one anecdote, when I was in graduate school (circa 2012), a prominent psychologist studying treatment outcomes in depression wanted to invite Whitaker to speak at the medical school's grand rounds. This psychologist was highly critical of SSRIs, but he was not antipsychiatry, and he changed his position when the data called for it (e.g., embracing combined treatment). His colleagues in the medical school rejected the idea of inviting Whitaker on the grounds that trainees would find it demoralizing. During these same years, there were multiple high-profile talks on the serotonin transporter gene.
I guess my quibble is that while Whitaker and company lost the scientific argument, it wasn't the free and open discourse upon which a scientific consensus earns its credibility (at least not at my university in the early 2010s). And that strengthens their case to the public (even though it is largely bogus).
One last anecdote that contrasts with the previous one: when I was completing my internship (~2014), I rotated through a first-episode psychosis clinic directed by prominent psychiatrist. At one of the meetings, he encouraged his colleagues to attend a talk on Open Dialogue by visiting clinicians, and he took to heart their critique. I remember him saying something along the lines of "the way we often treat our psychotic patients would make anyone feel paranoid and alienated." In the Open Dialogue trailer, Whitaker claims that if "Western Psychiatry" would just pay attention to what is happening in Finland, it would be revolutionary. He was wrong on both fronts. At least some psychiatrists paid attention, but what was called for was reform (listening to patients with curiosity and empathy, continuing to recognize and reduce the harm of "expressed emotion"), not revolution (stopping anti-psychotic treatment altogether and reconceptualizing psychosis as an acute condition that was chronified by mistreatment).
Thank you Thomas! I appreciate your kind words as well as your comments and observations. I agree that there usually wasn’t open-minded engagement with Whitaker’s arguments in mainstream academic psychiatry. When I first read Anatomy of an Epidemic, I found it very compelling and persuasive, and I had a really hard time finding people in academia who had engaged with it properly. Fortunately there were enough academics who took the arguments seriously enough to investigate these issues in a careful manner. I also agree with your conclusion.
Thank you, as always, for complicating what others try to over-simplify and polarize. I agree with all the main points, but your view that the psychiatric mainstream practitioners have been moving (slowly) in the right direction understates the huge problem that the public, many of whom are taking prescribed psychiatric meds, have not come close to catching up with this change. For most of the families I encounter, they are still caught in the “chemical imbalance” and “diagnosis as disease” mindset. This is not some relic of the 1989s that the public has left behind. I have occasion to complicate this mindset for almost every patient I work with (many of whom are non psychiatrist physicians) other than the rare few who do a ton of research into the online debates. I have hope this is changing and will change soon, but so much depends on whether psychiatrists and primary care docs and clinical therapists all communicate a more nuanced picture to their patients each and every time a patient seeks help.
Thanks Trysa. I agree and I observe similar things on the ground too. Hopefully efforts like my recent NYT article help facilitate change in public understanding.
Awais thank you for writing this. It is a must read for every psychiatrist practicing today and for anyone who thinks seriously about mental health reform. Your intellectual rigor and honesty here are exactly what this conversation needs.
The false binary you expose is the heart of it. The Szaszian undercurrent running through the Moncrieff-Whitaker world is something I've felt for years but you name it with a precision I haven't seen elsewhere. And your point about MAHA's moderate-sounding entry points concealing a much more radical philosophical program underneath is sharp and a little alarming.
The one thing I want to add, and maybe I'm biased because I'm the founder of Vanna Health, is on your closing line that psychiatry and its allied fields are "the only game in town." I love the institution and I believe in the science. And yet I've watched it move slowly, sometimes painfully slowly, on the things that matter most for people with serious mental illness. Not because the people inside didn't care but because institutions are what they are.
New models have grown outside those walls and frequently in the for-profit world they are doing it brilliantly, with a speed and a focus on outcomes that the institution has rarely matched. So maybe the answer isn't the institution or the critics. Maybe it's new architectures that take the biology seriously and build from there.
Again, brilliant piece. Sharing it widely.
I’m so glad you wrote this. I listened to the whole conference and recognized it needed a subtle response that I did not feel capable of writing.
Thanks Rahul!
Thank you, Awais, for pushing back on Mr. Bergner's binary perspective on psychiatry; i.e., as you summarize it,
"The binary of disease-based reductive psychiatry on one side and “critical psychiatry” on the other nudges us to assume there is nothing in between.""
You rightly point out that there is much "in between," including the biopsychosocial model (BPSM) developed by George Engel. Whatever the flaws and deficiencies in the BPSM, it has been the "solid center" of American academic psychiatry for more than 50 years. Yes, market forces have pushed the field hard toward pharmacologic treatments, but that is despite--not because of--psychiatry's holistic model. [1,2]
I had to smile--and wince a bit--at seeing the ghost of Thomas Szasz re-materialize in Bergner's piece. As you may recall, Szasz was one of my professors during residency, more than 45 years ago. Szasz's views have been so thoroughly discredited [3,4], it is astonishing that he has emerged as a central driving force behind the so-called "critical psychiatry" forces you describe. (I think "anti-psychiatry" would be a more accurate term, though Szasz himself never accepted that label).
Equally astonishing is the continued credibility given to the work of journalist Robert Whitaker, whose bogus claims of an "epidemic" of mental illness driven by psychiatric medications have also been thoroughly debunked. [5,6].
And while I readily acknowledge the (relatively rare) occurrence of severe and prolonged withdrawal syndromes following the abrupt discontinuation of some antidepressants [7,8], self-help organizations that take a blatantly anti-medication, anti-psychiatry stance do their clients no favor. Withdrawal from antidepressants is a complicated issue that requires sophisticated medical expertise--not ideologically-driven advice from people with no medical training. And, yes--I realize these groups arose in response to a paucity of medical guidance, though in truth, there are notable exceptions to that claim in the psychiatric literature going back more than 25 years. [9,10]
As for RFK Jr.'s outrageous claims (antidepressants compared to heroin, implicated in school shootings, etc.), we must push back hard, lest the well-being of our severely depressed patients suffer. [11,12]
Best regards,
Ron
Ronald W. Pies, MD
References:
1. https://www.psychiatrictimes.com/view/can-we-salvage-biopsychosocial-model
2. https://psycnet.apa.org/record/2016-05673-006
3. Pies R. On myths and countermyths: more on Szaszian fallacies. Arch Gen Psychiatry. 1979 Feb;36(2):139-44. doi: 10.1001/archpsyc.1979.01780020029002. PMID: 369469.
4. Pies RW. Thomas Szasz and the language of mental illness. In: Thomas Szasz, an appraisal of his legacy. Edited by Haldipur, Knoll and Luft. Oxford University Press, 2019
5. https://www.psychiatrictimes.com/view/bogus-epidemic-mental-illness-us
6. https://www.psychiatrictimes.com/view/there-really-epidemic-psychiatric-illness-us
7. Henssler J, Schmidt Y, Schmidt U, Schwarzer G, Bschor T, Baethge C. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. Lancet Psychiatry. 2024 Jul;11(7):526-535.
8. https://www.psychiatrictimes.com/view/antidepressant-withdrawal-syndromes-listening-to-the-patient-and-taking-it-slow
9. https://journals.lww.com/psychopharmacology/citation/2019/05000/antidepressant_discontinuation__a_tale_of_two.1.aspx
10. See, e.g., Maixner & Greden, 1998: "If antidepressant medications must be discontinued, a gradual taper is preferable, perhaps extending three to six months or longer to prevent discontinuation effects, enable adaptation at the receptor level and allow earlier recognition and treatment of recurrent depressive symptoms." https://pubmed.ncbi.nlm.nih.gov/9809213/
11. https://www.psychiatrictimes.com/view/no-antidepressants-do-not-provoke-mass-shootings
12. https://www.medscape.com/viewarticle/935846?form=fpf
Now Ron, you know very well that Tom’s work has not been “totally discredited.” Go back and read Tom’s reply to your invited contribution to my book, Szasz Under Fire: The psychiatric abolitionist faces his critics, and all of my pieces on Tom’s outstanding work over the years. See my last book with Zvi Lothane and Rick Vatz entitled Thomas Szasz, The Man and His ideas, published by Transaction and Routledge in 2017. Very few of those scholars who have disagreed with him have used arguments ad rem. By far they rely on argumentum ad hominem, the way you often do. I invite interested observers to subscribe to my substack, Drjeffreyaschaler.substack.com. It is free.
As Charles Krauthammer remarked years ago, (something to the effect) - many people have heard of Thomas Szasz but few understand him. Tom, the late Ron Liefer, MD, MS, and so many of the outstanding people who agreed with and admired Tom and his work, people such as myself and Zvi and Nelson, do not take your ad hominem criticism seriously.
As you know, I had the honor and privilege of being very close to Tom for many years. I founded and still keep www.szasz.com with Tom’s approval. My account of what happened to him at Upstate after The Myth of Mental Illness was published is the only accurate description (in Szasz Under Fire) and every word was approved of by Tom. What continues is the ATTEMPT to discredit him. I believe Mantosh Dewan, MD, then chair of the dept of psychiatry and now president of Upstate, and C. Haldipur, MD (I remain friends with both of them, would agree with me, as would another colleague of both Tom’s and mine, Nelson Borelli, MD, (still alive and kicking’’ and in his 90s. Nelson and I threw the 80th birthday party for Tom, under the auspices of Mantosh Dewan and the Upstate Dept of Psychiatry. Mantosh gave one of the most beautiful appreciations of Tom at the symposium Nelson and I held at Weisskotten in conjunction with the birthday party.
Please be more respectful towards Tom and his legacy, Ron. Jeff Schaler, PhD, MEd., ijas@me.com
Dr Schaler, good to hear your perspective on this. I’ll check out your writings!
As a resident and in my later years as a faculty member of Upstate Medical University, I always had affectionate feelings for Tom, even though we were perennial "sparring partners" (a term he once told me he liked). And while I stand by my statement that Tom's views on mental illness (which he regarded as a "myth" or a "metaphor") have been soundly refuted by nearly all philosophers of science and psychiatry [1], I must add that Tom and I were in agreement regarding so-called "medical aid in dying" --which Tom (in his book, Fatal Freedom) rightly characterized as bureaucratized killing. I also have considerable respect for Szasz's work on autonomy in psychotherapy. I will leave to readers of this page whether the arguments I put forth in my two publications
[refs. 3 & 4] are ad hominem, or whether they merely reveal the numerous logical fallacies in Szasz's case against the reality of mental illness.
Ronald W. Pies, MD
Professor Emeritus of Psychiatry
Lecturer on Bioethics & Humanities
SUNY Upstate Medical University
1. See, e.g. Thomas Schramme, "The Legacy of Antipsychiatry." In: Philosophy and Psychiatry, edited by T. Schramme and J. Thome, pp. 94-119, Berlin. Walter de Gruyter, 2004.
Szasz asked interesting questions but his answers have largely been debunked early on. He has his defenders but on the basis that they would like his claims to be true and ignore the evidence against him.
Thank you, Samei. Yes, Tom Szasz raised important philosophical questions that provoked all of us in the field to think long and hard about the underlying assumptions of psychiatry. For that alone, he deserves credit. He was a courtly and clever polemicist, who was kind to me, even when I was a medical student. His Old World charisma and witty epigrams ("If you talk to God, you are praying; if God talks to you, you have schizophrenia") made him something of a "rock star" in our department at Upstate (I was there from 1979-82).
Szasz also made important contributions to the ethics of the psychotherapist-patient relationship, as my Upstate colleagues, Mantosh J. Dewan and the late Eugene Kaplan write in their chapter, "The clinical wisdom of Thomas Szasz" [in Thomas Szasz, an appraisal of his legacy. Edited by Haldipur, Knoll and Luft. Oxford University Press, 2019]
And yet, as philosopher Eric v.d. Luft succinctly notes, "Szasz cannot use many philosophers to his advantage, since almost all of them--whatever they may deem to be the entity status of "illness" or "disease" in general--accept the reality of mental illness, while Szasz, of course, as a central ideological point, does not." [op cit Haldipur et al].
Kind regards,
Ron
I received the following comment from Martin Smith, forwarded to me by Jeffrey Schaler. My response follows:
"I think Luft and Pies are wrong. Their concept of "the reality of mental illness" requires dualism, but most current philosophers are monists, not dualists. They argue for physicalism, which holds that everything is ultimately physical. So if most current philosophers are physicalists, but they accept the reality of mental illness, then they must be using "mental illness" metaphorically, so they can avoid arguments like the one started by Ronald Pies."
Martin Smith
Oslo, Norway
From Ron Pies:
Thank you for your comment, Martin. I do not accept the premise that asserting the reality of mental illness requires dualism, or that anyone's claim that mental illness is "real" requires dualism; i.e., that mind and brain are somehow separate or distinct "substances" (to use a term from medieval philosophy). Nor am I aware of actual statements by philosophers of science, or philosophers of language, that their use of the term "mental illness" is merely metaphorical. (If you have such statements, please quote and cite the source).
We can assert the "reality" of mental illness without endorsing any particular metaphysical model of "mind" and "brain." The reality of mental illness resides in its manifestation as prolonged or severe suffering and incapacity (not due to an obvious external cause, like a knife wound) in the cognitive, emotional and behavioral realm, all of which can be observed empirically--and not just by psychiatrists, but by family, friends, and other observers. There is room, of course, for metaphysical debates on what the terms "real" and "reality" mean--a debate as old as the nominalist/realist debates of the medieval scholastic philosophers. But that would be a very, very long discussion!
Kind regards,
Ron Pies
What “questions”? Please cite evidence supporting your assertions. You try to reduce over fifty years of Tom’s writings, hundreds of books and extremely important papers, debates, and talks to “asked interesting questions”? More attempts at character assassination instead of evidence. Ron and Samei give no evidence supporting their toxic attacks on Tom and his outstanding work over the course of his lifetime. He has long been praised by intellectual giants, people like Karl Popper and those cited in Tom’s many writings. READ. LISTEN. I refuse to engage in dialogue with people who are so disrespectful of Tom. Argumentum ad rem, not ad hominem.
His claim that medical conditions have to have a biological lesion as answer to his implicit question “on what basis do we regard mental health conditions as medical conditions?” have long been debunked eg see my book. In terms of never detaining people as his answer to his implied question “under which circumstances should we detain people for mental health problems ?” at least 2 people has told me that in conversation he would agree for his son to be detained if he was suicidal. I don’t read a lot of what he wrote as Szasz never struck me as that good at thinking through answers to his questions and then he accepted money from Scientology to set up an anti psychiatry group.
I have just posted important correspondence between Karl Menninger and Tom that appeared years ago in Bulletin of Menninger Clinic on my substack at http://Drjeffreyaschaler.substack.com . It is free to subscribe.
I was unsurprised to learn that Daniel Bergner is a journalist like Robert Whitaker, Ethan Watters, and Michael Pollan who have also delved into neuroscience, psychiatry, and consciousness. The complexities of these topics is why I typically avoid books written by journalists, though I did like We’ve Got Issues by Judith Warner who is also a journalist. Overall, I much prefer the insights you provide on this site. Thank you.
Thank you!
Dr Aftab, a psychiatry based on a biopsychosocial model, a psychiatry which pays "attention to natural history, multi-level causal explanation and a wide treatment armamentarium that includes, but is not exhausted by, pharmacology" is something to be aspired to, to encourage and to work hard at creating. But that is nothing like the mainstream psychiatry which is practiced today. From what I understand, the typical visit to a psychiatrist lasts for about 15 minutes and consists of taking down symptoms and prescribing a medication. Mainstream psychiatrists may want to know something about the life history and life situation of their patients but they are not willing to spend much time in that pursuit and spend no time helping their patients learn how to use their thoughts, emotions, intentions, perceptions and behavior to live the way they want to live. The typical psychiatrist is, in fact, limited to prescribing medication. And medication is not going to help people learn to live the way they want to live. It may be a necessary part of that process but certainly not sufficient. Today's psychiatry students learn very little about psychotherapy and mainstream psychiatrists, as far as I understand, do not practice psychotherapy at all. So today's mainstream psychiatry is based on a biobiobiomodel. When a mainstream psychiatrist hears that a patient is hearing voices, does s/he ask the patient about the voices? Does s/he spend hours with the patient, listening, supporting, affirming and helping the patient work at understanding the meaning of the voices? Does s/he help the patient learn to engage with, manage, live with the voices? No. S/he tells patients they have a brain disorder and prescribes antipsychotic medication.
Szasz was right in his finding that the states of being moods, emotions, thoughts, intentions, perceptions and behavior associated with diagnoses of mental illness are reactions to problem in living. They are emotional distress, life crises, difficult dilemmas, spiritual emergencies, overwhelm, manifestations of concerns people have about their lives and themselves. He was wrong in that he didn't acknowledge that the symptoms of mental illness are impairing to people, very painful, troubling, upsetting. In the sense that mental illness impairs functioning - makes it difficult for people to love the way they want to love, express themselves the way they want to express themselves and enjoy life the way they want to enjoy life, they are illnesses. But they are much more than illnesses. They are also wake-up calls, signs that something is wrong, invitations to do some inner work, opportunities for growth. The practice of seeing them only as illness and working only on getting rid of the symptoms is not good treatment. Would that psychiatrists spent some time with their patients, helping them to explore the symptoms and use them to begin the lifelong task of developing a good relationship with themselves. Would that psychiatrists helped people to live better lives.
In fact, the way psychiatry is practiced today is, indeed, reductionist and not very helpful to people. You suggest that critics of psychiatry have not described what they want to see as an alternative. How about more and better psychotherapists, thousands of Soteria houses and peer-run crisis respite houses, thousands of Open Dialogue practitioners, more hearing voices groups, more psychiatrists who can help people withdraw from medication, support groups, supported housing, case workers to help people get housing, jobs, meaningful work, connection with other people, art therapy, mindfulness mediation, etc..
Had psychiatrists embraced and practiced according to the biopsychosocial model, they could have become holistic practitioners. But they went towards the medical model, towards paying attention only to things that could be quantified, measured, seen on brain scan - and lost that opportunity.
Samei, what is your religion?
Scientology is a religion. You appear anti -Scientology the way many people are antisemitic. Do you dislike people because of their religious identification? Please share your feelings about people who like Scientology in the same way people like certain religions. I will bet your feelings toward Scientology are based on myth and bias. please tell us.
Samei you do not know what you are talking about. Tom never took money from Scientology. Why would you lie? You could be sued for saying that. As i mentioned he qualified three conditions in which he would help someone without permission. children, someone who is literally unconscious,’and to protect others re contagious disease. Yours is the kind of emotional toxicity that is hard to take. Anyone who lies and makes irresponsible accusations like that has no business being a therapist. How old are you and how many years have you been in practice? If you read my piece that appeared as a transcript of my debate with Allen Frances you might learn something. i go over these issues carefully. it is on my substack. Incidentally, Frances agreed with me and Tom. Many outstanding people praises Ton and his work. I posted letters from them at the website I produced and own as a public service at www.szasz.com
Ron wrote: “ I had to smile--and wince a bit--at seeing the ghost of Thomas Szasz re-materialize in Bergner's piece. As you may recall, Szasz was one of my professors during residency, more than 45 years ago. Szasz's views have been so thoroughly discredited [3,4], it is astonishing that he has emerged as a central driving force behind the so-called "critical psychiatry" forces you describe. (I think "anti-psychiatry" would be a more accurate term, though Szasz himself never accepted that label).”
Ron, with all due respect, Tom did not take you seriously. I encourage those interested to read Ron’s contribution to my edited book entitled Szasz Under Fire. I invited Ron. More important is Tom’s reply to Ron. Res ipsa ….
Pathologists do not include “Mental illness” in standard books on pathology because symptoms don’t meet the nosological criteria for disease inclusion and classification. Take your whining up with pathologists. Ask them why they don’t include mental illnesses as diseases. Ron, it seems you clearly believe in ghosts, as you say! My advice to anyone seeking a psychiatrist: If he or she believes in psychiatric ghosts, that is, that something not physical can be physical, run don’t walk the other way. That is called a hallucination, a self reported imagining.
I encourage interested parties to read the late psychologist Ted Sarbin’s excellent essay entitled On the Obsolescence of the Schizophrenia Hypothesis. His article is in my substack. You may subscribe for free. Drjeffreyaschaler.substack.com. See also the correspondence between Tom and Karl Menninger, also posted there. plus the transcript of my debate with Allen Frances, Jacob Sullum, and one other person, I have forgotten her name. By the way, Frances began by saying he agreed with Tom and myself about the nonexistence of mental illness. Mental Health Law sponsored and published at Cato Unbound.
There are important issues related to all this. Do those who believe in psychiatric ghosts, that is, mental illness, believe they have a right to participate in involuntary commitment and the insanity defense? As Tom emphasized repeatedly, involuntary commitment and the insanity defense are the real issues.
I have debated top forensic psychiatrists before who claim they can tell who will commit suicide and/or homicide. When I confront and inform them that extensive research shows consistently they are no more accurate than chance, they concede (if they know the research). However, they continue to believe they can tell. You know what that means…
Szasz was very clear about how disease is diagnosed in his book Insanity:The Idea and its consequence. The majority of disease is diagnosed through signs, not symptoms. He abides by the standard nosological criteria for disease classification/identification as do pathologists. He explained three criteria where treatment proceeds without consent- children, unconsciousness, and contagious disease. See my online debate transcript with Allen Frances at Cato Unbound- Mental Health Law. He and I are atheists not Scientologists. He and I never received money from CCHR for anything other than plane and travel expense to give a talk. i accepted an award from CCHR, no money, gave a widely praised speech which is online. search the following terms:Schaler szasz award, cchr, speech. See my chapter on cults in my last book with Zvi Lothane, MD entitled Thomas Szasz The man and his ideas. You apparently discriminate against people for their religious affiliation. Tom and I do not. you have proved nothing, debunked nothing. You still have presented no evidence. clearly you know very little about science and law. Evidence is required to support your libelous accusations.