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VOLUME 2, ISSUE 2 PSYCHNEWS INTERNATIONAL Feb-Mar 1997
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SECTION E: LETTERS
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Note: Please send articles and letters to the
PsychNews Int'l mailbox: pni@badlands.nodak.edu,
cc'd to fu03c2dj@zedat.FU-Berlin.de
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"SERIOUS MENTAL ILLNESS:
WHAT IS IT AND WHAT DO WE DO ABOUT IT?"
THOMAS S. SZASZ, M.D. AND E. FULLER TORREY, M.D.
OCTOBER 30, 1996
TOWSON STATE UNIVERSITY, TOWSON, MD
Commentary by Leo Elliott
An annoying habit I first noticed in a former
medical-student roommate of mine was his seeming
ability to project his voice so softly that it seemed
to drop off intelligibility just as it reached my
ears, requiring me to lean in closer and closer to
follow his conversation. I later decided that this
ability was probably an acquired trait, developed by
necessity within the confines of the various privacy-
less institutions where he worked, where noise
abounded and discrete signals, much less a private
conversation, were hard to come by.
Since then the decibel level of a speaker's
voice, particularly in public places, has remained
somewhat of a private study, often revealing far more,
in my opinion, about the speaker and his agenda, that
what is written on the program. When I walked into
the lecture hall to hear Dr. Szasz debate Dr. Torrey,
my first impression was of an officious-looking man
holding forth in front of a small group in the
audience, projecting loudly enough for me to catch his
every word at the back of the hall, about the virtues
and drawbacks of various psychiatrically-prescribed
drugs. His audience seemed to be in rapt attention,
and the speaker himself seemed totally oblivious to
the volume of his voice, or to the show he was
presenting.
It was then that I realized that, judging by the
persuasions present in the audience, I was in for more
of a show than a debate, but as it turned out, it was
a show well worth the 3.5 hour drive up to Baltimore
from Charlottesville that afternoon.
Dr. Vatz introduced the speakers very briefly,
detailing the high-caliber of their credentials, their
lengthy publications, their current work, and the
length of time they had both been involved in
questions about "Serious Mental Illness -- What Is It
and What Do We Do About It?" (As Dr. Vatz confessed
his long-time association with Dr.. Szasz, so must I
confess my long-time admiration for his frank
speaking, plain writing, and his courage in calling
into question some of the foundational presuppositions
of a major institution. This was my first time to
ever hear Dr. Szasz speak, and I must confess that he
reminded me somewhat of Buckminster Fuller, except for
having more hair than Bucky; and despite Dr. Szasz's
pronounced Hungarian accent, I still found him a bit
easier to follow than I did Fuller, whose frog-like
atonality coupled with a strong Yankee accent, made
his monologues a bit of an endurance test for the
ears.)
Dr. Torrey was the first to speak, and began by
detailing his admiration for Dr. Szasz, both
personally and professionally, and by listing what he
considered to be Dr. Szasz's significant contributions
to the discipline of psychiatry, going back several
decades. However, despite his major contributions,
Dr. Szasz seems to have made some major mistakes, and
as Dr. Torrey would later point out, Dr.. Szasz's
reputation in the annals of medicine would hinge on
whether or not Dr. Szasz was able to recognize his big
mistake and correct it while there was still time.
Of course, everyone in the audience knew what Dr.
Szasz's big mistake was, his denial of the biologic
basis of schizophrenia, and so Dr. Torrey proceeded to
present his evidence, very succinctly, in the form of
a series of slides of brain scans, showing, among
other things, the enlargement of ventricular areas
supposedly associated with those diagnosed with
schizophrenia (Dr. Torrey's present area of focus is
among identical twins), and possibly showing
differentials in hippocampal areas, also supposedly
associated with those diagnosed with schizophrenia.
As I'm not sure I'd know what a hippocampal area
looked like in a brain scan, or in a cross-sectional
slide, I accepted Dr. Torrey's evidence as very
impressive (to a layman), and suggestive, if not
conclusive, to a neurological novice, of the case he
wished to prove.
Dr. Torrey also presented several tables of
evidence, showing the statistical correlations he had
made, and since I was sitting too far back to really
study them, and since I probably couldn't have studied
them and maintained aural focus on his speech, I
decided to do the latter, and it was then that Dr.
Torrey's percentages began to sound less impressive
than his brain slides -- it seems that patients
diagnosed with schizophrenia end up (on the
pathologists table) displaying these enlarged
ventricular areas and/or enlarged (or diminished?)
hippocampal areas, only on the order of five to
fifteen percent above average, which this layman
hardly found to be conclusive.
Now, interspersed with all of these statistical
and graphical slides were slides of quotes from
various of Dr. Szasz's own writings, submitted in
evidence by Dr. Torrey in his effort to reveal to the
audience the inherent contradictions and hence the
untenability of Dr. Szasz's positions on the reality
(the biological basis) not just of "schizophrenia," (a
mental condition seemingly the modern therapeutic
state's equivalent of the Church's older theological
diagnosis of "mortal sin," far removed from the "state
of grace" which could only return, _mutatis mutandis_,
by the sacramental ministrations of the priest-
therapists), but of "mental illness" in general.
To this point, Dr. Torrey seemed very respectful
and dispassionate, in proper scientific and
professional demeanor, as it were. However, once Dr.
Torrey finished with the presentation of his evidence
and began to focus on refuting the position espoused
by Dr. Szasz, it became apparent that, at least for
Dr. Torrey, the show seemed more important than the
debate. Perhaps Dr. Torrey got rushed for time in
trying to get his evidence, and his cards, out on the
table in the time allotted by Dr. Vatz, and perhaps he
skipped a few steps in his argument -- for this is the
only explanation I can draw for the incomprehensible
hiatus which led from his efforts to trap Dr. Szasz in
his own polemics, to his puerile _ad hominem_ argument
about how Dr. Szasz, if he is at all concerned about
his place in the history books, had best recant and
see the light, lest he be remembered -- CLICK TO NEW
SLIDE! -- as "The Author of The Cat In The Hat."
Dr. Szasz, fortunately, needed no such theatrical
devices, and resorted to little but cool logic and
razor-sharp rhetoric to render Dr.Torrey speechless in
his initial rebuttal, and many times thereafter. Dr.
Szasz's initial response came with gracious good
humor, thanking Dr. Torrey for his praise and frankly
acknowledging the accuracy of Dr. Torrey's portrayal
of his (Dr. Szasz's) positions.
Dr. Szasz did not initially address the data
presented by Dr. Torrey, choosing instead to state the
basic parameters of his well-wrought argument about
the unreality of "mental illness," the distinction
that "brain diseases" are not "mental illnesses," and
that there is still no definitive diagnostic tool to
provide a scientific basis for calling "schizophrenia"
a brain disease.(If schizophrenia is a brain disease,
then why isn't it treated, or even recognized as a
disease, by neurologists? Why, in this day of out-
sourcing and downsizing and "managed health care,"
haven't the schools of psychiatry been subsumed into
the schools of neurology? And how does any of this
justify "psychiatric intervention"?)
For the purposes of argumentation, however, Dr.
Szasz was willing to concede that "schizophrenia is a
brain disease" -- but challenged Dr. Torrey to show
what difference this would make in the rest of Dr.
Szasz's position regarding the morally corrosive
effect that the therapeutic state has on personal
responsibility. However, as Dr. Torrey seemed
unwilling to wade into the areas of morality or
politics, much less the area of personal
responsibility, he remained dumb in the face of Dr.
Szasz's repeated rhetorical assaults on the
credibility of psychiatry as an institution and of
mental illness as anything more than a metaphorical
disease.
However, this is not to say that Dr. Torrey chose
to concede. Rather did he revert to the standard of
_ad hominem_ argumentation, this time suggesting that
Dr. Szasz's perspectives as an old curmudgeon could be
understood, and hence forgiven, if one took into
account the fact that Dr. Szasz's anti-authoritarian
attitudes were shaped by the repression he experienced
in Communist Hungary in his youth, and the fact that
Dr. Szasz's attitude towards patients-as-malingerers
was shaped by Dr. Szasz's early professional
experience as a medical doctor with the United States
Navy, where malingering was no doubt a very common,
and rational behavior for sailors wishing to avoid
unpleasant duty. -- Dr. Szasz politely bided his
time and allowed Dr. Torrey to gain full, if
momentary, advantage by his personal slurs, before
advising Dr. Torrey that he hoped his research on
brains was better than his research on Dr. Szasz's
biography, since Dr. Szasz left Hungary long before
the Communists ever came to power, and since Dr. Szasz
first learned of malingering as a studious and clever
child, long before his service in the Navy, when he
discovered that his desires to stay home from school
(because he didn't want to go) were usually ignored by
his education-loving parents, whereas his desires to
stay home from school, because he was sick (as
evidenced by the high reading on the thermometer
brought on by its covert contact with a light bulb),
were recognized.
The one-hour debate was followed by a series of
questions from members of the audience. Several Szasz
supporters called into question Dr. Torrey's criteria
for schizophrenic diagnosis (among which was "lack of
insight" into their "condition," [by which criterion,
it would seem, most of the population could qualify at
one time or another]); however, the majority of the
question-and-answer time seemed to be taken up with
various defenders-of-the-faith endeavoring to paint
Dr. Szasz as a heinous (or at least callous) villain
(for his suggestion that John Hinckley, prior to the
20th century, would have been promptly tried for the
crime of regicide, and executed; Dr. Torrey, on the
other hand, suggested that possibly John Hinckley
_could_ be released into the community, provided only
his drug-regimen was strictly enforced).
One questioner in particular comes to mind, who
pleaded her case from a wheel-chair and suggested
that, had she done some of the things she came close
to doing in her "psychotic" or "pre-diagnosed" and
"unmedicated" state, Dr. Szasz would have had her
locked up and thrown away the key (or worse). She
later allowed, in responding to Dr. Szasz's queries,
that she did indeed see her psychiatrist, the one who
"gave her her diagnosis" (and her drugs) as a "doctor
from heaven," and that there's no way she could
consider herself in control of her life apart from her
medication.
I could only stifle my own _selbstgespracht_,
which told me that "receiving a diagnosis" came across
in the same tone as "receiving the eucharist" or
"receiving the sacraments" did, in an earlier time in
my life, and how Dr. Szasz's whole argument could
receive no better witness than this patient whose life
had been miraculously saved, by this "doctor from
heaven."
Another young questioner queried Dr. Szasz in the
same vein, suggesting that surely his artist-friend
who had stabbed his own hand because his hands were
"screaming at him," must surely be judged to be
psychotic, mentally ill, etc. On enlargement of the
scenario, in rebuttal questioning from Dr. Szasz, it
turned out that this act of self-mutilation did indeed
take place in front of an audience; and needless to
say Dr. Szasz's suggestion that this act might be a
simple (rational, even if dramatic) action of a person
in desperate need of attention, rather than a
manifestation of "mental illness," drew the same
applause and the same boos from those who had been
applauding, and booing, throughout the show.
I doubt very many minds were changed by the
arguments presented during the Szasz-Torrey debate, at
least among those at all familiar with their
respective positions, but it was, for this observer,
quite a good show, and a demonstration, up close and
personal, of the kind of courage it has taken a de-
literalizer of metaphors, of the caliber of Dr. Szasz,
to stand in the face of the aspersions and dispersions
to his character, lo these many decades that he has
been heaving dead cats into the sanctuaries of
psychiatry.
Leo Elliott
Charlottesville, VA
homeboy@esinet.net