Because of his potent arguments that seek to dismantle the notion of “mental illness”, the maverick Hungarian born US psychiatrist, Thomas Szasz, has quite often and quite mistakenly been associated with the aims and philosophy of the 60’s anti-psychiatry movement – a movement which he actually sought to distance himself from. Both challenged the notion of mental illness’ but as we shall see, for somewhat different reasons. The anti-psychiatry movement, following R.D. Laing, David Cooper and the Jungians would tend to see the breakdown’, as a positive formative event and regard the family dynamic as the primary dysfunctional element with the wider socio-political framework being chiefly culpable for its role in the reproduction of what it termed alienating’ social structures.
Szasz on the other hand, less concerned with the phenomenology of the condition, instead focuses attention on what he sees as a slow motion coup d’etat by the psychiatric establishment to expand its jurisdictional competence by including the neuroses’ within its ambit of concerns. He locates particularly as a pivotal moment in these territorializing ambitions the expansion of the category mental illness under the tenure of Jean-Marie Charcot at the Salpetriere asylum in Paris at the end of the 19th century. Prior to Charcot’s influence, the term “mental illness” was only properly applied to those who had identifiable lesions or structural abnormalities found after a post-mortem analysis of brain tissue. For the rest, the term neurosis’ was used to apply to nervous diseases without apparent organic causes. Because of this lack of physical evidence, however, a considerable body of opinion, rejected the label, some in fact declaring that they were simply charlatans’ or malingerers’ feigning the symptoms for their own ends. Similarly, George Cheyne, physician to Samuel Richardson, argued in “The English Malady” (1733) that those of the aristocracy who had fallen victims to a variety of nervous conditions; spleen’, vapours’, lowness of spirits’ hysteria’ and hypochondria’ were in fact victims of their own success, determining their origin to lie in too many luxuries; spicy foods, sensual pleasures and indulgent excesses. Nervous Disorders’, he declared are the Diseases of the Wealthy’.
It was the Scottish physician William Cullen who in the mid-18th century first coined the term neuroses’ defining them as “all those preternatural affections of sense or motion.” A neurotic condition thus originally conceived comprised a disturbance of one or both of the functions of the nervous fibres. These functions were believed to quite simply relay messages from the brain to the motor impulses thereby coordinating the musculature and in turn to send messages from the body to the brain. Robert Whytt, a contemporary of Cullen, summed up the limitations of the time with respect to their knowledge of the manner by which these messages were conveyed. An ethereal fluid’ passing through nervous tubes’ was the most common perception;
“But altho’ the minute structure of the nerves, the nature of their fluid, and those conditions on which depend their powers of feelinglie much beyond our reach; yet we know certainly, that the nerves are endued with feelingand I have thought it better to stop short here, than to amuse myself or others with subtile speculations concerning matters that are involved in the greatest obscurity” .
It is important to note from this description of Whytt that the neuroses were still viewed primarily in bodily terms that centre around sensations’ and feelings’. This is a view echoed by Peter Melville Logan who in Nerves and Narratives: A Cultural History of Hysteria in 19th Century British Prose’ opined that the essential quality of the nervous temperament was that it destroyed the body’s assumed ability to resist the ill-effects of impressions’. For him, the malady was more like a social document for it creates;
“an overly inscribable body, one that is too easily written upon by the stimulus of its day-to-day experience. These gradually accumulated impressions create a narrative within the nervous body that details its interaction with the larger social order. Within each nervous body lies the story of the social conditions that created it and, having created it, compel it to act out its nervous fit. This narrative is also a history of its own production, a somatic bildungsroman that tells the story of how it came into being, of how this particular body came to have a story to tell.”
We can see from these brief descriptions that there were many potential paths that the study and treatment of the neuroses could have taken. Their treatment may have remained within the domain of general practitioners or they may even have been viewed as a reflecting mirror of the maladies that afflicted society. Instead, as Szasz has argued, they have become the almost exclusive preserve of psychiatry mainly because of the power and influence of Charcot who threw his weight behind the idea that hysteria and hypochondria (the principal neuroses) were mental’ illnesses that could be ‘cured’. As we have done our research we know that the potential social critique embedded and inscribed in the nervous body’ of the early 19th century ceased to become a reflecting mirror, a document of contradictions in the social body, but had instead itself become the original repository of disease. As Szasz points out;
“Charcot made it easier for the sufferer, then commonly called a malingerer, to be sick.. Charcot, Kraepelin, Breur, Freud, and many others lent their authority to the propagation of this socially self-enhancing image of what was then hysteria’ and what in our day has become the problem of ‘mental illness’ labelling people disabled by problems in living as mentally ill’ has only impeded and delayed recognition of the essential nature of the phenomena. At first glance, to advocate that an unhappy or troubled person is ‘sick’ seems humane’ for it bestows upon him the dignity of suffering from a real illness’. But a hidden weight is attached to this viewpoint which pulls the suffering person back into the same sort of disrepute from which this semantic and social reclassification was intended to rescue him.”
For Szasz, this early territorializing of Charcot, the father of modern psychiatry’; marks the beginning of the modern study of so-called mental illness’ as well as the major logical and procedural error in the evolution of modern psychiatry’. And that it appears to me is as good a summary of our present difficulties as we are likely to find. This hidden weight that Szasz speaks of has only grown heavier in proportion to the distance we have travelled from the original social need that was addressed by introducing this semantic and social reclassification. They are sick’ and they are ill’ as opposed to, shall we say different. For whom where these, no doubt, palliative words uttered for, again and again as we approached the turn of the century, bearing in mind the work of Logan which made it clear that the ‘inferior orders’ were at least spared, for the time being anyhow, these early posturings of the pan-European Victorian upper-class.
Freud certainly wasn’t sluggish in swathing his brand new science’ with terms derived directly from the medical textbooks. The study of the unconscious was to become, of all things, the study of pathology, for, after all, the young master must earn, not only his own keep, but that of a whole generation of encrusted lightfoots. But how grotesque an art it is that must find pathological determinants in every corner of the newly discovered’ psyche. Jung, to his credit, found the entire charade somewhat unsettling and finally took his leave just before the outbreak of the war . The disrepute’ of which Szasz speaks is the impossibility of their narrative’ ever being heard outside of this all-embracing context of mental illness’. Think of this. A diseased mind. An ill mind. I once heard the noted biologist Richard Dawkins being asked what was his one worst fear and he replied that to lose the ability to think, the faculty of reasoning was in many ways a fate that he would have the most extreme difficulty in reconciling himself to. What then, of those, who are falsely assumed by others, because of a historically determined semantic and social reclassification’ to have a congenitally faulty thinking apparatus and yet know themselves that their thinking and perceptions are equally as clear if not more so than the general populace.