Response to Szasz

Abstract

Thomas Szasz is justifiably famous for his critique of psychiatry. He was instrumental in focusing an important debate on the status of ‘mental illness' and its social implications for which we are all deeply indebted. However times have moved on. Holloway and I seek to cast different “skeletons from the closet” to those of Szasz. We seek to destigmatise mental illness, so it no longer constitutes a secret source of shame or pain to a family or person. We ask that mental illness be treated neither better nor worse than physical illness. Only if a person suffers from mental incapacity, whatever the cause – brain injury, exsanguination, schizophrenia, learning disability, stroke, toxic infection – and it is in that person's ‘best interests', carefully defined, should they be treated against their will. Szasz seems oblivious that every day, many more patients with a physical illness (associated with incapacity) are treated non-consensually than those with mental illness. It is just that we don't draw attention to it, and society accepts it is right. A little bit of homework on his part would have told him that in this country, exactly opposite to his assertion, the law does justify the “medical treatment of incompetent persons, say one who has a stroke or is unconscious as a result of an accident” (if it is in the patient's ‘best interests’). Again, exactly opposite to his claims, in this country no other person can consent on behalf of an incompetent patient. We argue that all patients in this position should have similar safeguards. Mental illness does not automatically confer incapacity, nor does it raise special issues requiring specific mental health legislation. But of course Szasz does not believe mental illness exists.