My argument was limited to the proposition that mental illness is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations.
My great, unforgivable sin in The Myth of Mental Illness was calling public attention to the linguistic pretensions of psychiatry and its preemptive rhetoric. Who can be against ‘helping suffering patients’ or ‘treating treatable diseases’? Who can be for ‘ignoring sick people’ or, worse, ‘refusing patients life-saving treatment’? Rejecting that jargon, I insisted that mental hospitals are like prisons not hospitals, that involuntary mental hospitalization is a type of imprisonment not medical care, and that coercive psychiatrists function as judges and jailers not physicians and healers, and suggested that we view and understand ‘mental illnesses’ and psychiatric responses to them as matters of law and rhetoric, not matters of medicine or science.
The notion of mental illness thus serves mainly to obscure the everyday fact that life for most people is a continuous struggle, not for biological survival, but for a ‘place in the sun,’ ‘peace of mind,’ or some other human value. For man aware of himself and of the world about him, once the needs for preserving the body (and perhaps the race) are more or less satisfied, the problem arises as to what he should do with himself. Sustained adherence to the myth of mental illness allows people to avoid facing this problem, believing that mental health, conceived as the absence of mental illness, automatically insures the making of right and safe choices in one’s conduct of life. But the facts are all the other way. It is the making of good choices in life that others regard, retrospectively, as good mental health!… Our adversaries are not demons, witches, fate, or mental illness. We have no enemy whom we can fight, exorcise, or dispel by ‘cure.’ What we do have are problems in living—whether these be biologic, economic, political, or sociopsychological. In this essay I was concerned only with problems belonging in the last mentioned category, and within this group mainly with those pertaining to moral values. The field to which modern psychiatry addresses itself is vast, and I made no effort to encompass it all. My argument was limited to the proposition that mental illness is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations.
The phrase ‘The myth of mental illness’ means that mental illness does not exist. The scientific concept of illness refers to a bodily lesion, that is, to a material—structural or functional—abnormality of the body, as a machine. This is the classic, Victorian, pathological definition of disease and it is still the definition of disease used by pathologists and physicians as scientific healers. The brain is an organ—like the bones, liver, kidney, and so on—and of course can be diseased. That’s the domain of neurology. Since a mind is not a bodily organ, it cannot be diseased, except in a metaphorical sense—in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc. In other words, talking about ‘sick minds’ is analogous to talking about ‘sick jokes’ or ‘sick economies.’ In the case of mental illness, we are dealing with a metaphorical way of expressing the view that the speaker thinks there is something wrong about the behavior of the person to whom he attributes the ‘illness.’
Mental illness, of course, is not literally a ‘thing’—or physical object—and hence it can ‘exist’ only in the same sort of way in which other theoretical concepts exist…. While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist. Like the personal and social troubles which people had in the Middle Ages, they are real enough. It is the labels we give them that concerns us and, having labeled them, what we do about them. While I cannot go into the ramified implications of this problem here, it is worth noting that a demonologic conception of problems in living gave rise to therapy along theological lines. Today, a belief in mental illness implies—nay, requires—therapy along medical or psychotherapeutic lines.
By problems in living, then, I refer to that truly explosive chain reaction which began with man’s fall from divine grace by partaking of the fruit of the tree of knowledge. Man’s awareness of himself and of the world about him seems to be a steadily expanding one, bringing in its wake an ever large; burden of understanding (an expression borrowed from Susanne Langer, 1953). This burden, then, is to be expected and must not be misinterpreted. Our only rational means for lightening it is more understanding, and appropriate action based on such understanding.
For more than fifty years I have maintained that mental illnesses are counterfeit diseases (‘nondiseases’), that coerced psychiatric relations are like coerced labor relations (‘slavery’) or coerced sexual relations (rape), and spent the better part of my professional life criticizing the concept of mental illness, objecting to the practices of involuntary-institutional psychiatry, and advocating the abolition of ‘psychiatric slavery’ and ‘psychiatric rape.’
Not surprisingly, the more aggressively I reminded psychiatrists that individuals incarcerated in mental hospitals are deprived of liberty, the more zealously they insisted that ‘mental illnesses are like other illnesses’ and that psychiatric institutions are bona fide medical hospitals. The psychiatric establishment’s defense of coercions and excuses thus reinforced my argument about the metaphorical nature of mental illness and importance of the distinction between coerced and consensual psychiatry.
The first fact is that there is no mental illness…. Although mental illness might have been a useful concept in the 19th century, today it is scientifically worthless and socially harmful.