My abnormal psychology professor referred to The Myth of Mental Illness last week and I was looking up Thomas Szazs. I guess he held individual freedom as a moral North, and so opposed the marriage of medicine and government as well as the insanity defense, and held a number of other views that would be called libertarian. He even aligned with Scientology for a while. I’m going over an interview with him at http://www.psychotherapy.net/interview/thomas-szasz After they cover the neon light controversies they get into his philosophy on therapy, which is actually pretty interesting.
There isn’t any of this business that the therapist has to change the patient, or make him better, or control his behavior, or protect him from himself, and so forth. It is up to the patient to change himself. The therapist’s job is to help him change in the direction in which the patient wants to change, provided that’s acceptable to the therapist…If you go to school and have to pay for it, the idea is that you should learn something. But there is no coercion.
This is interesting to me because I used to puzzle at the idea of paying to go to college and the possibility of receiving a failing grade. Of course, it is the instructor’s duty not to pass a student who doesn’t master the material in some degree, but being made to pay for it is what puzzles me. Of course, colleges, especially community colleges, would be hard pressed to keep operating if they refunded the money of everyone who could not pass a course. I have met many students who were repeating a class, which I find mind-boggling. A class is hard enough to go through as a conscientious student, how could you stomach it if it were a struggle?
(I guess I did face the possibility of failing statistics (due to the deparmental final exam score policy). I got a B in the end. But if I hadn’t, I would be retaking the class since it’s a requirement to apply to nursing school. Maybe all these students I’ve met were retaking just that one class, and had done very well in other things, and some poor timing had defeated their efforts as it did for me in Statistics –I scheduled a GRE too close to one exam and had to appear in court on the day of another, and I had 3 other classes that semester.)
This paragraph is interesting because I’ve compare my anxiety symptoms to sneezes:
So-called mental symptoms are rather unlike medical symptoms. A cough, say, if you have pneumonia, is adaptive: it rids the body of mucus and infectious material and tissue debris as sputum. But it’s adaptive in this or other similar pathological situation only. It’s not adaptive to you as a human being. But a phobia, anxiety, depression, etc. maybe adaptive as some kind of a life strategy, economic or interpersonal strategy.
The thing is, a cough isn’t a disease either. It is a symptom. Earlier in the interview, Szasz mentions the Virchowian disease model, which I haven’t really heard of yet, but I’m familiar with Koch’s postulates, that disease is a manifestation of an isolable pathogen, which can then infect another organism which can then be again isolated. This model runs into problems with peptic ulcers, which were thought to be stress, then a bacteria, but in violation of Koch, that bacteria is not absent from healthy organisms. It only becomes a problem under conditions of stress, though killing the bacteria with medicine does help. I actually knew someone who died from an ulcer (blood loss) though they got better. They were dead for several minutes, though.
My premise is that responsibility is, morally speaking, anterior to liberty. So if a person wants to gain more freedom — in relation to his fears, his wife, his work, etc. — he must first assume more responsibility (than he has been) toward them; then he will gain more liberty in relation to them…some people say they want to do this or that — say stop smoking or be a better parent — but they don’t really want to do it, don’t want to forego the pleasures of smoking or experience the burdens of caring for a dependent.
Well, let’s try this Szasz. I have a problem with my housekeeping. I’ve often thought I should start with “showing up”. I suspect there is more to it than that. I tried to show my brother in law how to sew a halloween costume once, and the effects were pretty humorous. There is a process to learning, the scales and the arpeggios. It may seem stupid that I never learned to keep my house clean. Well, I know who to ask. And it ain’t no therapist. So I guess that’s my objection to Szasz, is why one needs to pay a therapist for his view of therapy. But I’ll let him have the last word (on the subject of managed care):
…if the patient doesn’t, in some form, pay for what he gets, and if he can’t get what he wants with the money he pays…