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A BRIEF HISTORY LESSON by Thomas S. Szasz, M.D. | fonte |
A
1999 White House Conference on Mental Health concluded: "Research
in the last decade proves that mental illnesses are diagnosable
disorders of the brain."
President
William Clinton was more specific: "Mental illness can be accurately
diagnosed, successfully treated, just as physical illness." Persons
who reject the view that mental illnesses are physical diseases
are dismissed by today's opinion-makers as intellectual troglodytes,
on a par with "flat earthers."
That the claim
that "mental illnesses are diagnosable disorders of the brain"
is a lie ought to be evident to anyone who thinks for himself.
Here I want to show that the claim that "research in the last
decade proves [this]" is also a lie, one more in a very long list
in the history of psychiatry. The contention that mental illness
is brain disease is as old as psychiatry itself: it is an integral
part of the grand lie that psychiatry is a branch of medicine
and healing, when in fact it is a branch of the law and social
control. Hannah Arendt was right when she observed: "There are
no limits to the possibilities of nonsense and capricious notions
that can be decked out as the last word in science."
The idea that
mental illness is a bodily disease dates back to the premodern
medical conception of disease as a "humoral imbalance," comically
prefiguring the modern, supposedly scientific conception of it
as "chemical imbalance." In the United States, the idea of mental
illness as humoral imbalance was famously espoused by Benjamin
Rush (1746-1813), the founding father American psychiatry. Rush
did not discover that certain behaviors are diseases; he decreed
that they are: "Lying," he declared, "is a corporeal disease."
In a letter to his friend, John Adams, he wrote: "The subjects
[mental diseases] have hitherto been enveloped in mystery. I have
endeavored to bring them down to the level of all other diseases
of the human body, and to show that the mind and the body are
moved by the same causes and subject to the same laws."
In the nineteenth
century, the scientific concept of disease as lesion replaced
the Galenic concept of disease as humoral imbalance. Now, physicians
postulated that mental diseases are diseases of the brain. From
about 1850 until past World War I, German (more precisely, German-speaking)
psychiatry ruled the field. The very term psychiatry (Psychiatrie)
was a German invention, coined by Johann Christian Reil (1759-1813)
in 1808. Reil, not an alienist (psychiatrist), was one of the
outstanding medical scientists and physicians of his age. He was
a friend and physician of Johann Wolfgang von Goethe. In addition
to coining the term "psychiatry," he also coined the term "noninjurious
torture," to describe the methods of frightening mental patients
that he considered effective and legitimate "treatments."
It is important
to keep in mind that the German asylum system was created, in
1805, by the autocratic Prussian state: specifically, by Karl
August von Hardenberg (1759-1822), a Prussian statesman. Hardenberg
declared, "The state must concern itself with all institutions
for those with damaged minds, both for the betterment of the unfortunates
and the advancement of science. In this important and difficult
field of medicine only unrelenting efforts will enable us to carve
out advances for the good of suffering mankind. Perfection can
be achieved only in such institutions."
Writing in
1917, at the height of World War I, Emil Kraepelin (1856-1926)
-- creator of the first system of psychiatric classification,
today widely considered the father of modern "scientific" psychiatry
-- offered these revealing remarks about Hardenberg's achievement:
"The great war in which we are now engaged has compelled us to
recognize the fact that science could forge for us a host of effective
weapons for use against a hostile world. Should it be otherwise
if we are fighting an internal enemy seeking to destroy the very
fabric of our existence?"
Kraepelin's
remarks make clear that he regarded psychiatry as an arm of the
state, similar to the military forces, whose duty is to protect
the fatherland from "an internal enemy" that, like a hostile army,
seeks to destroy it. The evil genius of psychiatry lay, and continues
to lie, in its ability to convince itself, the legal system, and
the public that, in matters defined as psychiatric, there is no
conflict between the legitimate interests of the individual and
the legitimate interests of the political class in charge of the
state.
Of course,
the German psychiatric pioneers had to answer the question, "What
is mental illness?" Answer it, they did. Wilhelm Griesinger (1817-1868),
considered one of the founders of German psychiatry -- and also
of the famed Zurich insane asylum, the Burghölzli -- declared:
"Psychological diseases are diseases of the brain. ... Insanity
is merely a symptom complex of various anomalous states of the
brain."
Theodor Meynert
(1833-1892) -- a German-born Viennese neuropsychiatrist and one
of Freud's teachers -- began his textbook, Psychiatry (1884),
with this statement: "The reader will find no other definition
of 'Psychiatry' in this book but the one given on the title page:
Clinical Treatise on Diseases of the Forebrain. The historical
term for psychiatry, i.e., 'treatment of the soul,' implies more
than we can accomplish, and transcends the bounds of accurate
scientific investigation."
In a review
of Swedish psychiatry in the nineteenth century, historian of
science Roger Qvarsell states: "In the 1860s, the debate among
psychiatrists about the real nature of mental disease was over
... Almost all medical scientists and medical authorities were
at this time convinced that mental diseases were of the same nature
as somatic disorders." Plus ça change, plus c'est la même chose.
Infringement
of Freedom
What inferences
did and do doctors draw from their concepts of mental illness
as brain disease? First, as Carl Wernicke (1848-1905), a prominent
nineteenth-century German neuropsychiatrist observed, "The medical
treatment of [mental] patients began with the infringement of
their personal freedom." In addition, it began with "benevolent
tortures," such as frightening them by throwing them into a pit
of snakes, the origin of the term "snake pit" for insane asylum.
More specifically, the humoral imbalance theory led Rush to employ
"bleeding, purging, low diet, and the tranquilizing chair. "The
tranquilizing chair was a chair-like contraption for confining
the patient and rotating him until he became dizzy or lost consciousness.
This was supposed to rebalance the circulation in the brain. It
was but a small step from the nineteenth-century's tranquilizing
chair to the twentieth century's tranquilizing drug, supposed
to rebalance the chemical imbalance in the patient's brain.
Psychiatric
practice today requires that doctors and patients ignore evidence
and be ignorant of history. There was no evidence for a humoral
imbalance causing illness, but the doctrine prevailed for two
thousand years. There is no evidence for a chemical imbalance
causing mental illness, but that does not impair the doctrine's
scientific standing or popularity. Neither the American Psychiatric
Association nor American presidents remind people of the caveat
of the great nineteenth-century English neurologist, John Hughlings
Jackson (1835-1911): "Our concern as medical men is with the
body. If there be such a thing as disease of the mind, we can
do nothing for it."
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