Mental Illness & Demons


Jon Rowe

Jon Rowe is a full Professor of Business at Mercer County Community College, where he teaches business, law, and legal issues relating to politics. Of course, his views do not necessarily represent those of his employer.

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42 Responses

  1. I do have a question about Szasz’s–and your–use of the word “myth.” In everyday language, “myth” tends to mean “that thing some people believe or used to believe but that we know is false.” But “myth” can also mean “a story people tell to make sense of the world around them.” Those two meanings are not mutually exclusive but they can be distinct. Something can be a “myth” in one sense and not another.

    My question, then, is in what sense is Szasz (and you) using the term?

    A further comment, partially related to that question. Maybe the real issue isn’t whether mental illness is “really” an illness, but whether the “disease model”/”medical model” works for approaching mental illness and helping the mentally ill. I imagine it depends on the illness. Schizophrenia…probably yes. Subclinical OCD…probably depends. Maybe for some mental illnesses, even if they’re “caused” by chemical or other empirically measurable things, non-traditional or non-scientific approaches–and yes, in some cases maybe exorcisms–can help some sufferers.

    Thanks for writing this. This is the type of thing I like to think about but often don’t have the words and I therefore come across as being “anti-science.”Report

    • Avatar Kim in reply to Gabriel Conroy says:

      I think that people who write bubbe-maise like this haven’t actually seen someone being given an exorcism.Report

      • Avatar Jon Rowe in reply to Kim says:

        I linked to an exorcism.Report

        • Avatar Kim in reply to Jon Rowe says:

          Did you perhaps link to an involuntary exorcism?
          You do realize that if parents figure their kid has a demon, they get the kid exorcised, sometimes repeatedly, even if the kid doesn’t want to?

          Kids run away from homes because of crap like this shit.

          [By this, to be clear, I’m not speaking of the Catholic definition of exorcism, which apparently includes part of the Easter service, where literally telling the Devil to get out of you counts as a minor exorcism].Report

  2. Avatar Damon says:

    Since my classes in Biology were 25 years ago or more and I only took one, you’ll excuse any ignorance…

    But I’d expect that a healthy brain, one not provably ill, could have it’s “wires crossed”. Everything works, it’s just not connected to the same places most other brains are. Assuming we can’t determine this through brain scans or such, wouldn’t this explain mental illness in otherwise healthy brains?Report

  3. Avatar Kim says:

    “the hard-nosed, skeptically-minded scientific perspective teaches, accordingly, there is no evidence for god(s), devils, the soul, etc.”

    Not actually true, if you’re willing to apply Occam’s Razor as a scientific principle — and parsimonious explanations are a hallmark of the scientific method. You see some remarkable stuff if you start looking for simple explanations of high energy physics

    Interestingly, this method also shows there is no such thing as “the mind” separate from “the brain.” And the brain, as it were, is provably a bag of chemicals.

    When you have computer programs passing the Turing test, I’d like to hope that we can stop assuming that all brains are bags of chemicals.

    if the brain is, for all we know, “physically healthy” then it’s not provably “ill” in the sense that the other “illnesses” for which we see medical doctors are.

    Sentient brains, in general and specific, are brain damaged. All of them, not simply the ones you want to label as “mentally ill.” This argument stems from the concept that sentience provably costs a ton of fuel, and slows reaction time to boot. It’s not normally an adaptive trait (something that we could have gotten to by slow and steady adaptive mutations)– natural selection doesn’t generally select for intelligence. What we have in humans is a mutation that caused a large-scale change, and just happened to be adaptive. This time.

    The brain can get “sick,” something for which one needs to seek medical attention.

    And so what the fuck do you say when your brainstate makes your liver fail? Psychosomatic illnesses are real, and you can either treat the fucking symptoms, or you can treat the brain. Cause and effect can be proven for some of these (cortisol mediated, among other things).

    If the medical issue isn’t in the brain, are you suddenly not broken? Are you not going to die anyhow, and fuck all if you don’t think we should treat it at the source??

    In libertarian utopia, all drugs would be legal for consenting adults and parents probably would be able to give drugs to their children. But we don’t live in that world.

    Does anyone seriously think that parents should be allowed to suppress a child’s sex drive?Report

  4. Avatar Doctor Jay says:

    I think that “illness” is basically “suffering”. I am of the opinion that many conditions that the people of old referred to as “having demons” were probably conditions we would today call “mental illness”. So I’m kind of on board with the description, if not the recommendation for treatment. Of course, it gives me the impression you want to associate psychiatry with “casting out demons” in an attempt to discredit it.

    Since a good portion of my life has consisted of caring for people with mental illness, I’m not about to endorse the idea that it doesn’t exist, or even put scare quotes on it.

    It is true though, that there are some conditions which some might call “mental illness” that simply might be the result of genetic variation, which exists because it’s valuable to the human genome. Sometimes, for instance, one refers to “gender dysphoria” as an illness, a birth defect, even. This is uncomfortable at some level. I think that the people with this condition end up being very useful to humanity, but many would call it an illness. And indeed that status gives people access to funds that help them make changes that they find desirable and beneficial.

    But even schizophrenia has a genetic component. Families can be schizophrenigenic. Why is this? Why hasn’t evolution simply eliminated these genetic lines? It would seem to be a highly maladaptive trait, and here we are. Perhaps it isn’t as maladaptive as we think?

    Now the part that some find upsetting is that there is often not much of an anatomical model for this stuff. Mostly a differential diagnosis of schizophrenia is the result of “response to treatment”. We give you certain drugs, and the delusions stop. Ergo, you had schizophrenia. Likewise with bipolar disorder, or dissociative disorder. This is less than desirable, perhaps, but to say there was no “illness” is to enshrine one’s ignorance in pronouncements of absolute truth. The lack of model might make a physicist (or even a surgeon) uncomfortable, and hence pronounce it “unscientific”. All I can say is that we “practice” medicine, and not just in the mental health field, either.Report

    • Avatar Francis in reply to Doctor Jay says:

      My question is what is the value of labelling mental illness as a myth? Do Caplan and Szasz really doubt the existence of people who understand the world very differently from the rest of us and are very unhappy about it?

      We have prisons full of these people, not getting any useful treatment. (Psych ward beds are few and far between.) Even if the treatment is a placebo and a chat with a priest instead of a psychologist, anything that can be done to ameliorate the visible suffering of the mentally ill is something we should be pursuing with scientific rigor.Report

      • Avatar Art Deco in reply to Francis says:

        No, they do not.

        Critics of Szasz maintain he successfully avoided schizophrenic patients during his residency and had little direct experience of them. Szasz contended (among other things) that psychiatry has no jurisdiction over actual illnesses, that actual illnesses are the business of neurologists, that the disease categories used by psychiatrists were contrivances which reflected the practitioner’s value scales, and that schizophrenic patients were often playing games with practitioners.

        One ratchet over from Szasz but quite critical of him has been Fuller Torrey. Torrey’s contention has been that schizophrenia, pace Szasz, is a real disease with observable physiological effects. Torrey’s complaint has been that psychiatry abandoned schizophrenics in asylums and took up office practice ‘treating’ ‘patients’ Torrey describes as ‘the worried well’ (“these people need counseling, not therapy, and counseling is a division of education, not medicine”). It was also Torrey’s contention that working psychiatrists, ca. 1985, often did a lousy job with schizophrenic patients and that a GP with some interest in schizophrenia could do just as well or better.

        One ratchet over from Torrey is Paul McHugh, who was chief of psychiatry at Johns Hopkins. His contention for lay audiences has been that psychiatry is underdeveloped and has a retrograde 19th century modus operandi. He also contends, with Torrey, that psychoanalytic concepts led to arrested development of the subdiscipline, and that the years running from 1935 to 1975 were lost ones.Report

    • Avatar greginak in reply to Doctor Jay says:

      We don’t’ diagnose schizophrenia or bi polar or depression based on responding to treatment. All those, most mental illnesses really, are diagnosed based on symptoms and not in reference to any treatment.Report

  5. Cat parasite

    That’s redundant.Report

  6. In other words, according to Caplan and Szasz, if you’ve got a malfunctioning computer, the problem is always hardware, never software.Report

  7. Avatar Bert The Turtle says:

    Unsurprisingly, Scott Alexander wrote a long takedown of Caplan’s take on mental illness a few months back. Between my personal relationships with various individuals who have mental illnesses and Scott’s article I have a hard time taking Szasz seriously. I like Caplan a lot, but I think he’s wrong on this issue.Report

    • Caplan is the guy who thought women were freer when they couldn’t own property than they are today, right?Report

      • Avatar Bert The Turtle in reply to Mike Schilling says:

        Admittedly, I could see him saying something like that after looking at some dataset and working through some set of torturous logical inferences (kind of like he did for mental illness). Still, I doubt it’s the sort of conclusion he would die on a hill for.Report

        • Avatar Saul Degraw in reply to Bert The Turtle says:

          Caplan strikes me as the type to die on the hill for all of his conclusions.

          Caplan is a prime example of the problem of really smart people with ideologies. He is obviously academically accomplished but he needs to fit everything into his ultra-economics and ultra free-market view point. Anything that does not fit (like mental illness) gets discarded or turned around. I wonder if this is because mental illness is the kind of problem that demands state intervention at a certain scale. Lots of mentally ill and developmentally disabled people might outlive their caretakers. So someone has to take over and that person is the state. There are also tricky and expensive questions about crime and mental illness and how to treat the mentally ill who commit crimes.

          But if you call mental illness a personal preference, then it becomes easy to deal with and does not nag on the libertarian and anti-welfare state mind frame.Report

          • Avatar LeeEsq in reply to Saul Degraw says:

            It doesn’t necessarily have to be the state but it ends up being the state because taking care of mentally ill people well seems to be something difficult to do with markets. For the really mentally ill, the ones that need constant supervision or something close to it, private mental institutions have the same perverse incentive as private prisons.Report

  8. Avatar Jon Rowe says:

    “Not actually true, if you’re willing to apply Occam’s Razor as a scientific principle — and parsimonious explanations are a hallmark of the scientific method. You see some remarkable stuff if you start looking for simple explanations of high energy physics


    “When you have computer programs passing the Turing test, I’d like to hope that we can stop assuming that all brains are bags of chemicals.”

    Tell me more.Report

    • Avatar Kim in reply to Jon Rowe says:

      Subatomic physics, the science of the smallest and simplest things that we can find in the universe (including wave-particle duality), only really makes sense, is only really simple, if you look at it from a data storage perspective. G-d (whatever that entity is) only keeps track of the barest minimum of data — and it is very, very easy to model.

      If you were going to model our universe, with all it’s complexity, and do so in the minimal amount of space — that’s what makes sense, Occam’s Razor sense, anyway.

      Our universe resembles something designed to be run as a simulation in a really, really big computer.

      It’s circumstantial evidence at best, anthropocentric at worst, but it really does point towards the existence of a clockmaker G-d.

      p.s. If you do find a loophole in the laws of physics, for god’s sake don’t exploit it. Whoever G-d is, they may Turn Us Off.Report

    • Avatar Kim in reply to Jon Rowe says:

      Computer programs write poetry, create sleeper agents, and earn money through designing websites.Report

  9. Avatar Saul Degraw says:

    So this is probably going to be TMI.

    As I have written about before, I graduated law school in 2011 which was among the world’s worst times to graduate law schools. All things in all, I guess I have done all right in a stasis kind of way. However, I have been doing a lot of long term temp projects. It took me around 3.5 years of long term temping (with multiple employers) to land an actual associate position. That ended in a lay off two months ago. I mentioned this here.

    So that makes five major employers in four years and a salary that has remained stagnant. The employment market for lawyers still looks rather rough.

    Meanwhile lots of people I know seem to be hitting their mid-30s career and life strides. Maybe it is all just facebook boasting and I am not getting the real story but I see people buying property, starting families, doing great career things. Even people I went to law school with seem to be doing okay. I know people who dealt with underemployment or unemployment at stretches as well but they all seem to have found their places and a good number have even managed to make lateral moves.

    So I feel stuck and not very optimistic about these things improving soon. Society seems to demand that we always put on a happy and brave face and pretend everything is awesome. I live in a city where the economy is booming and unemployment is supposed to be very low and it feels like there is this general prosperity that I can’t participate in because of a lack of relevant skills and just getting passed by. It seems like taking the time to get those skills will just result in more wasted time and opportunity costs.

    This creates a lot of stress and that stress can be very draining both mentally and physically. I am not quite a stay in bed all day depressive but I do have a lot of doubts about career success and feelings of economic decline and these are scary and not pleasant.

    Is this a choice? I don’t think so. My mental state is connected to my actual experiences.Report

    • Sorry Saul, I didn’t realize you’d been laid off. That sucks.Report

    • Avatar North in reply to Saul Degraw says:

      That blows buddy, I hope you land something even better soon.
      For the love of God(ess?) thought do not give any weight to Facebook.Report

      • Avatar Kazzy in reply to North says:

        Best of luck. Not sure I have much useful advice aside from echoing North’s recommendation to ignore Facebook and other carefully curated representations of people’s lives for the top being (if not forever).Report

    • Avatar j r in reply to Saul Degraw says:

      It’s the internet, Saul, you are way below the threshold of too much information. Personally, I think the beauty of the internet is that it gives us all a chance to share and hear what other folks are going through with a modicum of anonymity. And I appreciate you sharing your experiences. Social media is a double-edged sword, though, because it allows us to interact with people that we might otherwise lose contact with, but there is that pressure to keep up appearances.

      Is this a choice? I don’t think so. My mental state is connected to my actual experiences.

      I would say that there is a connection here, between choices and experiences. The problem is that there is a lag. You decide to go to law school and you can’t see five years into the future, so you have to take a leap. Maybe the most important thing to realize, IMO at least, is that there is no shame in taking that leap. You do the best you can and you wait for the results.

      My only advice is to not spend too much time thinking about other people’s successes or failures. The other day, my wife told me that I’m the happiest person that she knows. And my only secret is that I spend almost no time comparing myself to other people. The only metric that I take seriously is “am I better version of me today than I was yesterday?” Sometimes the answer is yes, often the answer is no, but we get up again tomorrow morning and try it all over. Hang in there.Report

    • Avatar greginak in reply to Saul Degraw says:

      Sorry to hear about this Saul.

      Oversharing. Egads not even close. I have a friend who posted pix of the bruises her abusive husband gave her and long story about her massive ethical violations that led her to lose her SW license. This isn’t even close.

      Facebook. Pertinent

    • Avatar notme in reply to Saul Degraw says:

      You can always apply to the join JAG Corps.Report

  10. Avatar LeeEsq says:

    Sasz’s theory strikes me as bad because there are a range of mental health problems just like they are a range of physical health problems. With physical illnesses you have everything from annoying things that you could live for awhile to deliberating diseases and pandemics. Its the same with mental illnesses. Some people are so mentally ill that they are a danger to themselves and others. Many other people have the mental health equivalent of a common cold and others something in-between. They might need some treatment from a psychologist or psychiatrist but are able to live on their own.

    Caplan’s nonsense seems to be trying to get around a particular problem for his ideology. Caplan’s belief system really depends on nearly every adult able to take care of themselves in the short and long term. Mental illness is a sign that many adults can not take care of themselves. The only way around this is to try to argue that mental illness does not really exist.Report

  11. Avatar Badtux says:

    Then there is the behaviorist theory, which states that mental “illness” is learned behaviors caused by the interaction of environmental stimulus with the biology of the organism. For example, you can make a mouse “neurotic” by stunning it randomly as it approaches a chunk of cheese. At a certain point, the mouse wants the cheese, but is afraid of being shocked if it approaches the cheese, but then realizes it doesn’t *always* get shocked approaching the cheese… the end observable behavior is a lot like someone with an anxiety disorder attempting to do something they know *should* be harmless, but they have an unreasonable anxiety that it *isn’t* harmless. There are mental “illnesses” that have in fact been “cured” via behavior therapy. For example, cognitive behavioral therapy has an almost 100% success rate treating phobias and related anxiety disorders.

    However, I’m reluctant to state that *all* mental illnesses are caused by learned behaviors instilled via an interaction of environment with the organism. For one thing, this doesn’t explain the hallucinations described by schizophrenic patients. If someone is seeing things that clearly aren’t there, then something is clearly wrong at an organic level, and yes, hopefully one day neurobiologists will be able to nail it down and have a cure for it.

    Note that not all illnesses are “caught”. Some are congenital. For example, I suffer from chronic allergies, where my immune system attacks harmless objects. This can be controlled with medication or in some cases by temporarily convincing the immune system that certain harmless objects are in fact harmless via continually presenting them in large subcutaneous doses, but there is no cure. My suspicion is that some mental illnesses such as schizophrenia are similarly congenital features of the brain that will only be able to be controlled with medication. We just don’t know enough yet to target the medications effectively, the current ones have many unwanted side effects, such as, for some, permanent Parkinson’s tremors (tremors that don’t go away if the medication is discontinued). It is neurobiologists, not pipe-smoking psychotherapists, who are going to develop those medications though, and at some point we’re going to have to decide whether it is psychiatrists or neurologists who are going to prescribe the medications. Since these illnesses also have a large number of undesirable learned behaviors that are going to require behavioral therapies to remedy, I suspect we’re going to end up with psychiatrists doing the honors, because they can address those learned behaviors as well as the underlying biological issue that caused those learned behaviors when interacting with environments that would have done nothing of the sort for you and I.

    But that’s all speculation, of course. Right now we’re barely getting psychiatry out of the woowoo stage and getting it into properly addressing biology and behavior. Oedipal conflicts make for good fairy tales, but there’s no evidence that psychoanalytic talk therapy is any more effective than just having the patient talk to an untrained janitor with a calm demeanor…Report

    • Avatar Kim in reply to Badtux says:

      “For example, cognitive behavioral therapy has an almost 100% success rate treating phobias and related anxiety disorders.”

      show me some stats on that one. Preferably from people who don’t have their entire ego on the line.

      “This can be controlled with medication or in some cases by temporarily convincing the immune system that certain harmless objects are in fact harmless via continually presenting them in large subcutaneous doses, but there is no cure. ”
      … well, there are drugs that gank your immune system (basically giving you AIDS)… That does actually cure the issue — at the cost of the rest of your immune system.Report

      • Avatar Badtux in reply to Kim says:

        I’m not sure what you’re asking for. Are you asking for a list of scientific research papers on the question? I can likely dig one up for you, but I’d have to go dig out a standard psychology textbook out of storage and shuffle back to its list of references, because this (cognitive behavioral therapy) is the standard treatment for phobias taught in psychology curriculums today.

        Even single-session phobia treatments based on cognitive behavioral approaches have a 90%+ long-term success rate in some studies, e.g.,

        More complex anxiety disorders such as social anxiety have a smaller success rate but have also been successfully treated via cognitive behavioral approaches.

        In any event, my point was not a specific number but, rather, that there was a set of what is considered “mental illness” that appears to be related to behaviors learned via interaction of environment and organism rather than to specific brain malfunctions.Report

        • Avatar Kim in reply to Badtux says:

          “Are you asking for a list of scientific research papers on the question?”
          ” I’d have to go dig out a standard psychology textbook out of storage and shuffle back to its list of references, because this (cognitive behavioral therapy) is the standard treatment for phobias taught in psychology curriculums today.”
          Then the proper response is: “pull any psychology text, this is standard.”

          Just because I’m asking for something doesn’t mean the proper response is to provide it.Report

  12. There’s rather a lot we still don’t know about the structure and function of the human nervous system. Consciousness, subjectivity, that vivid sense of interiority, underlie not only our everyday experience, but also Szasz’s critique. The categories of life problems and illness both depend on that subjectivity which itself is likely reducible to the structure and function of the HNS.

    Perhaps when human scientific knowledge about the HNS has advanced to the point at which we know more than we don’t, that subjectivity itself will be commonly seen as an illness.Report

    • Avatar Stillwater in reply to Atomic Geography says:

      I’m not sure I understand that last part…

      but I’d say in response that a “completed science of the brain” will always leave out subjectivity, hence, mental illness requires a different paradigm of understanding than (eg) the neurochemical. In my view, the answer is more holistic than that, even if drugs ameliorate some of the behavioral effects.

      But we already know that in the absence of a mature neuroscience: lots of people like to drink their cares away. And by doing so they’re not resolving their cares, they’re masking an emotional response to them.Report