Saturday, January 24, 2009

Ooh-Boy Ruminations

Francesco writes: "My thinking had and continues to be shaped a great deal, by the writings of Thomas Szasz."


Francesco's comments to a recent blog post here were very thoughtful and much appreciated, and I hope he continues to post. As for the S-name, one look at the photo above and you see why every neuron in my limbic system lit up like a Christmas tree.

Thomas Szasz is a giant in the mental health movement, a deep thinker, and an uncompromising champion of our cause. The catch is that these days I hear his name invoked in the context of various nihilist anti-science, anti-intellectual agendas.

Believe me, I hate these people.

Dr Szasz was a catalyst for the reforms of the 60s and 70s that put an end to institutions and their concomitant abuses, and for this alone he deserves our undying gratitude. Dr Szasz also recognizes that psychiatric imprisonment isn't just about walls and restraints. It can be a subtle state of coercion that gets us buying into the idea that unapproved behavior needs to be medicated out of us.

It's a complex argument, but trust me, Dr Szasz has a point. Too often, we simply assign values to symptoms with no thought to context. Yes, depression is a bitch, but it can also be a time of healing, of recouping and regrouping. I know - I have experienced this.

But Dr Szasz and his followers would have us believe that we actually choose to have depression - or psychosis or a panic attack. It's as if the brain were nothing more than undifferentiated tofu. It's one thing to take psychiatry to task for imposing a particular set of values on us. It's another to deny, as Dr Szasz does, that there is no biological component to our behavior.

Dr Szasz's influence has fallen by the wayside in the face of scientific discovery. But psychiatry may suffer a similar fate. Psychiatry shows every sign of embracing science, but to what end? As long as they fail to address the basic question - What is good? What is bad? - then Dr Szasz will remain relevant.

Perhaps science can offer an insight. In behavioral genetics, there is neither a good gene nor a bad gene. Depending on context, the same gene variation may be an asset or a liability. Can the same be said of symptoms? For instance, hypomanic behavior may yield bad results. But what if we learned to control the hypomania?

These are issues that go to the core of our beings, to what we experience, to what we want out of life. This is a conversation we need to have, that we need to own. Antipsychiatry would love to crash this party. So would psychiatry.

From mcmanweb:

The Two Toms

My totally surreal encounter with the Bizarro World parallel psychiatric universe of Tom Cruise and Thomas Szasz and how it didn't change my life.


Tom Wootton said...

This is what real growth looks like; recognizing our triggers, introspecting, gaining insight, letting our understanding guide our decisions, and changing our behavior. It is great to see it in action; even better to take the action ourselves.

What a great blog that shows the process in action. Thank you for sharing it with us. It illustrates in a powerful way that "Knowledge Is Necessity." Knowing ourselves and how we react is the first step. Giving wisdom a chance to step in and resolving to follow its guidance might be the hardest thing we will ever do, but doesn't it feel great when we do?

Many say we are incapable of becoming a better person because of our condition. Thank you John for proving them wrong. From hate to acceptance of another point of view to rational argument based on it in one day - amazing.

John McManamy said...

Hey, Tom. From hate to acceptance to rationality and beyond. Why on earth would I want a doctor to medicate all that out of me? I guess that is the point we're both driving at. We live much fuller lives through experiencing the full range of our emotions - even the ones we regard as "bad."

There's another side to this equation: My actions and behaviors may not always be so enlightened. Wrong decisions are inevitable, especially in dealing with large emotions in stressful situations. But how else do we learn? How else do we grow?

Tom Wootton said...

If someone is suffering from their inability to understand the stimulus of depression or is in danger of causing harm from their inability to control their mania, then medicating it out may be a viable option. The anti-psychiatry types may disagree, but if their alternatives are not working what is wrong with using a more powerful tool?

My issue is with getting rid of the condition as an endpoint. It may be a necessary start on a path to true recovery, but it certainly is not an acceptable conclusion once you see what is possible. There may be a reduction in symptoms, but that is hardly growth. Medicating it permanently out is more like cutting off your leg because it hurts to walk. It might be better to first check for a pebble in your shoe.

John McManamy said...

Hey, Tom. Just so readers don't misunderstand me: I'm all for a smart medications strategies, and encourage patients to work with their pdocs on this. A major part of "Knowledge is Necessity" is figuring out who we are. To stick with your leg metaphor - we may be four-minute milers who fail to get out of the way of traffic. A successful meds strategy would keep us running four minutes, likely even faster now that we don't go running into traffic, without being run over. Not amputating our splendid running gift out of us.

To keep the metaphor going further: At the beginning of treatment, our leg may need to be in a cast. Patients with bone fractures etc accept this, knowing that the cast will eventually come off.

Far too many of us are walking around with the cast still on, told by our doctors we will have to spend the rest of our lives this way. Not surprisingly, meds noncompliance rates tend to be 70 to 80 percent across all classes of psych meds, far higher than for meds that treat other ills.

Tom Wootton said...

I agree, I am all for smart medication strategy too, and smart therapy strategy. I am also for seeing both the good and bad aspects, accepting that we have issues that we need to address, introspection, developing mental skills, creating a viable plan for success, getting help, and doing the work it takes to grow into a better person. I know you agree wholeheartedly.

I love the cast metaphor. It is perfect!

franjan said...

Funny you should mention this. Szasz was interviewed yesterday on the psych. today blogs:

Looks like he's everywhere lately.

John McManamy said...

Hi, Franjan. Interesting interview. I don't think he or his followers, however, can have it both ways regarding antipsychiatry. There he is, with his arm around Tom Cruise.

Antipsychiatry is a fairly mild term, and a fairly accurate one to describe those systemically opposed to all forms of medication and who deny that mental illness has a biological component.

We badly need informed people to challenge psychiatric conventional wisdom and practice. I would love to see the term, enlightened psychiatry, applied. But, sadly, I fail to see the enlightenment.

Anyway, much appreciate your post. Welcome to "Knowledge is Necessity." Please keep posting.