Reading focus
Syllabus: What Is a Mental Disorder?
Identify what Szasz means by illness and how that definition supports his argument. Keep a dispute about classification separate from the reality of someone's suffering.
Why you’re reading it. Begin with a challenge to the boundary that later authors try to defend or redraw.
A question to consider. Someone is distressed by a conflict with their family. What would Szasz need to know before describing the problem, and which part of his reasoning depends on his definition of illness?
Why this reading
Szasz challenges the medical interpretation of problems in living. The short polemic makes assumptions about disease, norms, and professional authority unusually explicit. It belongs as a historical argument to analyze: identify what would have to be true for its conclusion to follow, and which objections later accounts of disorder try to answer.
Before you read
Know the mid-century context. Psychoanalytic thinking dominated American psychiatry, involuntary hospitalization was common, and the diagnostic manual of the day (DSM-I) defined disorders in loose, theory-laden language. Szasz writes as a psychiatrist against his own profession.
Be clear about the distinction he relies on between a disease, understood as a physical lesion or physiological abnormality, and deviance from social, ethical, or legal norms.
Read for
- The criterion Szasz uses for something to count as an illness, and whether medicine itself actually meets it.
- The move from medicine to ethics: his claim that psychiatric "symptoms" are judged against norms that are social rather than biological.
- What work the phrase "problems in living" is doing. Is it a redescription, or an alternative explanation?
- Which of his premises later definitions (in particular Wakefield's) accept, and which they reject.
Consider afterwards
- Suppose a condition Szasz would call a problem in living were shown to have a specific neural basis. Would he accept it as an illness? What does your answer reveal about the definition he is using?
- Szasz argues that calling a norm violation an illness disguises a moral judgment as a medical one. Is the reverse error, treating an illness as a moral failing, made less likely by his position or more?
Editorial context
The essay should not be used as empirical evidence that psychiatric suffering is unreal or that treatment cannot help. Separate its account of illness from its critique of the normative and social uses of diagnosis. Wakefield's harmful-dysfunction analysis offers a different way to combine factual and evaluative considerations; disagreement between the arguments does not make either a settled account of every condition.