Reflections on social factors, meaning and social constructionism
Szasz suggests that the idea that mental illnesses exist is based on the idea that they are some sort of ‘deformity of the personality’ which explains human disharmony or more generally life problems. But, Szasz objects:
‘Clearly, this is faulty reasoning, for it makes the abstraction ‘mental illness’ into a cause of, even though this abstraction was originally created to serve only as a shorthand expression for, certain types of human behaviour’
Here’s the argument:
Mental illness is an abstraction from a description of behaviour. So it is defined in terms of behaviour.
Mental illness is supposed to be a cause of behaviour.
Nothing can cause itself.
So there is no such thing as mental illness defined this way.
As was suggested in discussion, Szasz assumes that mental illness is an abstraction from behaviour in much the way that in the past infectious disease might have been thought of as an abstraction from its symptoms. But we now understand the latter to have a biological underpinning with causal effects. On a similar understanding of mental illness, Szasz’ behaviourism can be contested.
Szasz has a second related argument:
"The concept of illness, whether bodily or mental, implies deviation from some clearly defined norm. In the case of physical illness, the norm is the structural and functional integrity of the human body…
What is the norm, deviation from which is regarded as mental illness? This question cannot be easily answered. But whatever this norm may be, we can be certain of only one thing: namely, that it must be stated in terms of psychological, ethical, and legal concepts…
Yet the remedy is sought in terms of medical measures that – it is hoped and assumed – are free from wide differences of ethical value. The definition of the disorder and the terms in which its remedy are sought are therefore at serious odds with one another…
Since medical interventions are designed to remedy only medical problems, it is logically absurd to expect that they will help solve problems whose very existence have been defined and established on non-medical grounds."
Here’s the argument:
Mental and physical illnesses answer to different norms (bodily function vs social / ethical / legal).
Because mental illness answers to a different norm it cannot be treated using physical medicine, or ‘medically’ more generally.
Hence mental illness (as something can be so treated, rather than as life problems) is a myth.
Again, the same diagnosis seems to work. Even if mental illnesses are identified via their effects which in this case include deviation from a set of social / ethical / legal norms and values, they can still be underlying causes of those effects. And thus medical treatment is not logically absurd.
However, that still leaves a problem. Why do we take a physiological or a mental state or condition to be pathological? Szasz’ premiss is that we take mental illnesses to be deviations from societal values and norms. But that seems to suggest that what societies value or take to be correct ways of living determine what counts as pathology and what not. And that seems unsettling. (The identification of physical particles does not seem to work this way.) In support of this line of thinking, even if sexual orientation and anorexia were equally the result of underlying causal processes, that would not settle which was a pathology and which not.
One response is to deny Szasz’ first premiss and argue that both mental and physical illnesses answer to the same kind of norm: a biological norm fixed by the biological or proper function of traits of the human body, themselves determined, as Darwin has taught us, via evolutionary theory. Jerome Wakefield is the most obvious such theorist. But this attempt to reduce the norms of disorder to something more basic, faces criticisms.
In fact, however, things are not so quickly a matter of social constitution even without Wakefield's biological turn.
Discursive psychologists take meaning to be socially constructed and thus a matter of social constitution. Some take the content of mental states to be constructed in the same way (and thus use this to argue against ‘cognitivism’ or ‘representationalism’ about the mind). Others take personal identity to be. But those arguments can be contested. It is by no means clear that meanings are socially constructed. And so equally, it may not follow that just because illness is an evaluative matter that values are made up by societal views.