[xenophanes]

> he did all the things he was supposed to do to get help in a moment of crisis - made multiple calls to his care providers, to 911 and even went to the hospital.  He had been experiencing symptoms for several years but was in a highly-respected treatment program that was working intimately with him.

So in other words, conventional psychiatry failed. And the author's solution seems to be to spread it more.

Maybe after a failure like this, where we see that the care providers, hospital and "highly-respected treatment program" don't work, it's time to stop respecting that treatment program so much and consider different approaches.

http://www.szasz.com

[PhasmaFelis]

I've just spent 20 minutes (all I can spare right now) reading up on Thomas Szasz, both at your link and on Wikipedia. He certainly had some good ideas (he's against homophobia and the drug war), but his position on mental illness seems to be that it doesn't exist, that people with debilitating mental conditions are faking it for attention or to get out of responsibilities, and that the correct response to someone considering suicide is to hand them a noose and say "have at it."

If you want me to take you or Szasz seriously, please demonstrate that all three of my assertions are incorrect, with citations.

[ceejayoz]

Szasz thinks mental illness has no biological basis, which flies in the face of the empirical fact that twin/adoption studies have shown a clear hereditary basis for a variety of conditions like bipolar, schizophrenia, etc.

Arguing that someone dying despite psychiatry invalidates psychiatry is like arguing cancer treatment is useless because some people die of cancer.

[xenophanes]

Do you want to discuss this seriously? If so, cite an actual study and say specifically what conclusion it reaches and specifically how that contradicts Szasz.

You seem to be implying that Szasz and I hold our positions due to scientific ignorance, which is demonstrably false, and insulting. But maybe you didn't mean it that way.

[ceejayoz]

http://www.szasz.com/manifesto.html

> Mental illness is a metaphor (metaphorical disease). The word "disease" denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term "mental illness" refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. As the whale is not a fish, mental illness is not a disease. Individuals with brain diseases (bad brains) or kidney diseases (bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors), like societies with economic diseases (bad fiscal policies), are metaphorically sick. The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment.

Again, this is refuted by twin/adoption studies, which allow for control of environmental causes. One example: http://www.massgeneral.org/psychiatry/assets/Smoller2003_Fam...

[harshreality]

What does that say, other than: that, in a modern sociological environment, certain genetics-mediated brain differences cause people to behave (react) in different ways to their environment?

It says nothing about what inherently is a mental disease and what is not. Perhaps genetic differences causing certain mental "diseases" in average American society (or whatever society in which you conduct a study) actually benefit the individuals in societies with different cultures or structures. In the same way that certain non-psych heritable "diseases" confer some advantages and disadvantages (sickle-cell anemia and malaria, for instance). Fact is, many genetic differences that some people regard as undesirable are not even classified as diseases, even though they have advantages and disadvantages, if not for lifespan, certainly in social mobility within social environments.

tl;dr: it's patently obvious and beneath discussion that in certain genetic differences might lead two otherwise identical individuals to differ on whether they have different behavior, just as they might differ in many other ways. It's the determination that different behavior in some cases is a "disease" that seems to be at the heart of Szasz's critique of psychology.

[buzaga41]

Yes, I don't understand how is this study conduced since the diagnosis for bipolar disorder is not conclusive itself.. It doesn't tell anything on how it's purported that the brain is 'faulty'

[aforrester]

How do twin studies rule out "environmental" that is, non-genetic, causes. Twins look alike, so if there are ideas about how people who look alike ought to act alike we would be expect a correlation between genes and behaviour that has nothing to do with the content of the genes. Rather, that behaviour would be motivated by similar ideas.

[ceejayoz]

> How do twin studies rule out "environmental" that is, non-genetic, causes.

http://en.wikipedia.org/wiki/Twin_study

[aforrester]

I have pointed out that there can be correlations between genes and behaviour that are not caused by genes but by culture. Your link is irrelevant.

[BlackDeath3]

So thoughts, feelings, and behaviors are outside of biology? How does that work?

I realize that you are simply quoting a passage and not necessarily personally espousing what you wrote.

[ceejayoz]

Just a note, I'm quoting that passage because I (and scientific evidence) disagree with it.

Thoughts, feelings, behaviours, and mental illness most certainly have biological bases, which makes Szalz's theories pretty loony.

[floody-berry]

Szasz entire screed appears to be based on mental illnesses not being able to be concretely diagnosed or detected, but then jumping to the conclusion that they are completely made up and abused by society to control everyone's behavior.

Once you "accept" his conclusion, it doesn't seem possible to be argued out of it until science advances to an arbitrary point where one feels it adequately explains mental illnesses. "accept" in quotations as I honestly can't tell if his supporters are trolling or honestly believe what they're posting.

[vonmoltke]

You could start by countering Kendell, Shorter, and Clarke: https://en.wikipedia.org/wiki/Thomas_Szasz#Criticism

[aforrester]

Kendell point (1). Szasz's position is not that diseases must be diagnosed by looking for chemical or structural abnormalities. Rather, such abnormalities are a criterion for having the disease. It may not be possible to find those abnormalities until after the person dies.

Point (2): the existence of such abnormalities is required for a person to have a disease, but not all abnormalities are considered diseases. This is as irrelevant as saying that not all ice cream contains water because some water is not ice cream.

Point (3) is also irrelevant. Szasz's claim is that mental illness is behaviour that a person undertakes for a reason, albeit a reason that people don't like. That idea that such behaviour will turn out to be caused by a disease is like looking for a hardware fault in your iPhone because you have installed an app your dislike.

I addressed (4) earlier. For my reply to point (5) see my reply to point (3).

As for Shorter, note that his statement that mental illnesses are brain diseases is incompatible with Kendell's points since Kendell is attacking the idea that lesions are necessary for disease while Short alleges that such lesions exist. So which position does the poster actually hold? I have already addressed points (1) and (3) by explaining that mental illness is not biological, so let's skip to point (2). Szasz's point was that if a person was found to have a brain disease, brain doctors would treat him with his consent. Psychiatrists don't do this and so there is some difference between psychiatrists and doctors who deal with brain diseases.

Clarke. Point (1): if a person claims to be mentally ill then he is claiming to have an illness when he doesn't. It is better to face up to this squarely and discuss why the person in question is acting the way he acts. If a person claims he is not a moral agent and refuses to face up to his moral disagreements with others, you're not doing him any favours by agreeing.

Point (2): people get labelled as mentally ill because they have a moral problem, that is, behaviour that is regarded as undesirable by somebody who may or may not be the patient. It is true that such problems would not vanish if we stopped calling them mental illness but Szasz didn't claim that they would. Rather, he claimed that we should face up to those problems squarely and stop using quasi-medical excuses to coerce the kind of people commonly labelled mentally ill. If you want to coerce somebody you should have to make an explicit argument that his behaviour should be treated as a crime.

As for point (3), abandoning treatments that the public dislikes is entirely compatible with picking some other set of treatments that the patient dislikes and imposing it on him.

[PhasmaFelis]

It doesn't work that way. You have to provide evidence for your own claim before you get to demand counter-evidence from your detractors.

[PhasmaFelis]

It sure is interesting that your two primary supporters in this discussion (JustinCEO and aforrester) were created more than a year ago but haven't posted anything on HN until today, when they showed up to support you.

No, wait, aforrester made one post on the day it was created, supporting your position in a totally different discussion of suicide. My mistake.

Still waiting for that evidence I asked for, by the way.

[JustinCEO]

I don't appreciate the implication that I'm not a person. Xenophanes posted the link to this discussion to a public email list where (you may find this shocking), some people agree with him and are interested in this kind of discussion.

He also mentioned that HN is blocking him from posting more, so maybe you can blame Paul Graham for you not getting the answers you wanted. But there's still hope.

Want answers? Want a discussion on a forum that without censorship? Want a discussion where you won't be punished if you say "What You Can't Say"[0], as xenophanes dared do today? I think he, myself, and others would be happy to answer your questions at:

https://groups.yahoo.com/neo/groups/fallible-ideas/info

If you don't come, and instead stick to a forum where hardly anyone continues a discussion for more than 12 hours, then I for one will figure you aren't really that interested, and I won't be motivated to write answers for you.

[0] http://www.paulgraham.com/say.html

[benatkin]

Does the person behind Xenophanes consider each of their online identities to be a "person"? Nice dodge with that choice of word. It's easier to claim that a fake online identity is a person than it is to claim that a fake online identity is a human.

> Want a discussion where you won't be punished if you say "What You Can't Say"[0], as xenophanes dared do today?

I smell astroturf.

[xenophanes]

Justin and Alan are not me.

[PhasmaFelis]

Glad to hear it.

Since you are apparently not, as JustinCEO claimed, hellbanned, I'll remind you that I'm still waiting on those citations. You demanded them from everyone else, it's only fair that you should provide your own.

[xenophanes]

i was blocked from posting for around 3 hours, which is why i didn't answer most of my critics. email me [e-mail] if you want to discuss it further.

[benatkin]

Check and mate.

[dchuk]

Per your logic, we should abandon heart transplant surgeries as soon as one doesn't go as planned.

Anecdotal evidence against the efficacy of any medical treatment is not reason enough to abandon it.

[JustinCEO]

Quite a lot of attempts at suicide prevention efforts don't go as planned. Do you disagree?

[ceejayoz]

Pancreatic cancer kills about 75% of patients within a year and 95% within five. From this, we take away "let's improve treatment methods", not "oncology is a scam that the free market should eradicate".

[ChrisClark]

I'm sorry that everyone commenting here is against your religion, but please leave your baseless beliefs at home.

Or are you just trolling? Pretending to be a religiously intolerant bigot? Is this an example of Poe's law in action?