In my September 29 blog entry, I introduced a little tidbit with the following long subhead:
“On the misconception on the background of issues noted in a recent obituary of Thomas Szasz, the famous anti-psychiatry doctor; New York Times writer Benedict Carey notes him as if he featured in a debate as if it was only between Freudianism and a medical approach to psychiatric issues, but actually the debate in the 1960s and 1970s was within the area of psychology in general (there was not yet a hard practical and philosophical divide between psychology and psychiatry, as there seems to be today); the debate, more specifically, was between Freud’s deterministic approach and more patient-centered, will-based, and other such non-deterministic approaches)….”
This confused a couple things. Dr. Szasz’s famous position (as an “anti-psychiatrist”) was in suggesting that mental illness was not a real entity.
The point in the Times obituary (leaving aside the callout in the print version) that I felt was not in accord with the historical reality was: “Dr. Szasz…published his critique at a particularly vulnerable moment for psychiatry. With Freudian theorizing just beginning to fall out of favor, the field was trying to become more medically oriented and empirically based.” (The New York Times, September 12, 2012, p. A29)
A few responses:
1. There were a variety of divisions between schools, over a length of time. First, you must implicitly understand the difference between psychology and psychiatry. (Of course, people could go to both types of professionals—psychologists and psychiatrists—at the same time for what each had to offer.) Dr. Szasz was a psychiatrist, and psychiatrists had, among their tools, traditionally practiced talk therapy (along with the option of prescribing medication, when it became more routine starting in about the late 1950s). And while this option of talk therapy included Freudianism (not the only kind of talk therapy) for some years, the trend (with psychology and psychiatry considered in the aggregate) to utilize other treatment styles (with the trend motivated either by patients or by doctors) was varied and not simply between two very different, and seemingly mutually exclusive, schools of thought.
On another level, the opposition between what could be called a “talk therapy” approach (in the very general realm of psychology) and a more medical approach (among psychiatrists) was in a formative stage in the 1960s, regarding whether one was better than the other, more “scientific,” etc.
For another thing, within the talk therapy realm, specifically among psychologists, various schools of thought that were alternatives to Freudianism, along the lines of very different presuppositions (such as abandoning a deterministic viewpoint as Freud had), were springing up in a particular ferment in the 1960s and 1970sl; and indeed this fact of alternatives appearing had started with Freud’s immediate disciples, such as Carl Jung and Alfred Adler.
Regarding the division between a talk-therapy approach and a medication-based approach, one example shows this development, over a period of time, in the more specific development of the category of borderline personality disorder, where there were schools of thought that were holding distinct sway by the late 1970s that divided into a talk therapy/Freudian type and a medication-oriented (M.D.-administered) type. (I also reference borderline personality disorder in particular because, in how it is manifested in informal settings and “presented” as an issue for professionals by its sufferers, it seems only explainable (and treatable) via terms that derive both from talk-therapy-type schools—terms such as “separation/individuation” conflicts—and from a medication-related school of thought (where they seem to share features of long-term, biologically based mood disorders).
A specialist offers scholarship
Jerome Kroll, M.D., in The Challenge of the Borderline Patient: Competency in Diagnosis and Treatment (New York: W.W. Norton & Company, Inc., 1988), writes (pp. 15-16):
Although the term borderline would seem to carry the same theoretical baggage as pseudoneurotic schizophrenia and therefore be open to the same objections regarding the concept of a continuum of psychiatric conditions, ... there were nevertheless additional reasons why borderline endured and flourished and pseudoneurotic schizophrenia died. As the dominant forces in American psychiatry shifted away from a psychoanalytic [a type of talk-therapy, the term usually meaning Freudian] orientation in the late 1960s, pseudoneurotic schizophrenia, which was closely identified with psychoanalytic theory, became superfluous and unacceptable. Borderline, although carrying the same implications within psychoanalytic circles, had nevertheless been established relatively independently of psychoanalytic theory...[by an empirical study published in 1968]. [italics for the diagnostic terms were added]
Kroll goes on to describe the equally tortured development of the category of borderline personality from the standpoint of the conflict between the biochemical versus the talk-therapy schools of thought, particularly with regard to how the category, with its group of somewhat disjointed symptoms, was instated in the third (1980) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (Challenge of…, pp. 15-16).
A Manhattan area doctor offers a colorful view
Ivan K. Goldberg, M.D., who has said psychiatrists like himself initially received Freudian training (through the early 1960s) before psychiatry became so much more oriented to treatment with medication, has spoken on borderline personality disorder also from a perspective that seems to mix talk-therapy and medical-doctor viewpoints:
The other thing that's sort of so difficult when dealing with borderline people is their capacity to upset others. As kind of a survival skill...from their early traumatic childhoods, they've learned all kinds of emotional techniques that basically get under the skin of other people and make other people sort of impotently furious in many cases. So a good deal of anger is generally expressed by such folks [borderlines]—they can rapidly alternate between loving you and hating you. You have someone who has apparently been your best friend for a long, long time, and then suddenly, over what appears to you to be an absolutely trivial incident, ...you're at the top of their shit list.
This was said at an educational lecture at Newton Memorial Hospital , Newton , N.J. , on June 6, 2003, sponsored by DBSA Sussex County Columbia-Presbyterian Medical Center and retired from the faculty of the Department of Psychiatry of the College of Physicians
To repeat a point above, “talk therapy” for many decades has not meant simply Freudian, or psychoanalytic, therapy. As my September 29 entry suggested, there have been several types of talk therapy (the entry references the one kind of humanistic psychology, which is among numerous other types).
In recent years I have noted in The New York Times, whenever discussion is made where the distinction between talk therapy and medication-oriented psychiatry is done, that “talk therapy” and “Freudianism” seem equated, as if all talk therapy is “Freudian,” which is wrong. Calling all talk therapy Freudian is no more accurate than saying that all philosophy is Plato.
2. Szasz, historically, as a firebrand within the culture. Somewhat relatedly, Dr. Szasz’s place in the culture does not simply reflect, or did not herald, the trend to a focus on medical approaches that seems so common now (with non-medical therapy today seeming almost limited to cognitive behavioral therapy, or CBT). In the 1960s and 1970s, Dr. Szasz’s seemingly radical view denying the reality of mental illness came, of course, within the ferment of many different kinds of talk therapy gaining popularity, as I said, and thus his views could be a burr under the saddle of many within the talk therapy realm—and this could include patients as well as practitioners—who felt he was a sort of theoretical spoilsport, if not a crank. But his broad pronouncements about mental illness applied—with presumably equal disturbing skepticism—to mental illness as regarded by both psychologists and psychiatrists. It would be a stretch at best to believe that he heralded the largely pharmacological approach to mental illness today.
More personally, I have long thought of him as, in recent decades, the one true crank among the “hard critics” of psychiatry and psychology or of certain received wisdom within the fields; such critics have also included R.D. Laing and Peter R. Breggin, both M.D.s and both of whom I’ve felt, despite their flaws, have had more to offer to the general debate about psychology and psychiatry than Szasz.
3. The red herring of associating such a critic with Scientology. A note might be made on the issue of whether Dr. Szasz was a member of Scientology, as the obituary makes passing reference to. There is some whiff, in what the obit says with laudable discretion, about his relationship of any sort with that church. I might strongly point out that any broad (or incisive on certain points) critic of psychiatry or psychology need not be a Scientologist. It sometimes seem that, if you speak with hard criticism of the fields, in the view of people who wholeheartedly accept them, you must be a Scientologist, which to me smacks of bloc thinking, a sort of black-and-white mentality reflective of “You’re either for us or against us,” which seems to me most suited to the 1930-40s kind of political paranoia, where among stupid people (say, in Europe), you had either to be a Nazi or, if opposed to this, a Communist, and there was no other option.
When I’ve discussed Dr. Peter Breggin with someone, it was also suggested that Dr. Breggin might be, or must be, a Scientologist. Again, whether he had been this in the past (which I doubt; his Wikipedia bio states he has not been a member), that is not what he has been through the bulk of his public life that I am aware of, and any idea that a critic of psychiatry must therefore be a Scientologist is engaging in peasant, bloc thinking.
Incidentally, I think many of Dr. Breggin’s ideas on specific drug issues are wrongheaded or distorting, but in some general respects he has an important point; and his crusade to inveigh against the broad negatives of psychiatric drug treatment (leave aside the issue of how he addresses electroconvulsive therapy) starting in the early 1980s was in some ways justified by more recent developments such as the FDA’s requiring black-box warnings of suicidal ideation as side effects, and so on, on labeling and product-information sheets for psychiatric medications. His book Psychiatric Drugs: Hazards to the Brain (New York: Springer, 1983), despite its flaws, is about as important as a sort of bellwether of an important, healthy critical attitude as was R.D. Laing’s The Divided Self of 1961. (Indeed, I got my first tips about important, well-regarded psychiatric researchers such as Ross J. Baldessarini from Breggin’s 1983 book.) This area of the value of the controversial Breggin and Laing is a complex issue that I leave stated simply here.
