A dissenting view: the myth of mental illness

Government publications routinely announce that around 45% of Australians aged between 16 and 85 will experience a mental illness, while 20% will experience a mental illness in any given year. Australian businesses, we are told, lose over $6.5 billion each year by failing to provide early intervention and treatment for employees with mental health conditions. In 2006-7 there were 20.6 million mental health-related PBS/RPBS prescriptions which accounted for $670 million of benefits, or 10.8% of total expenditure.

Mental illness means, literally, an illness of the mind, as opposed to an illness of the brain. But can minds be ill? I argue that they cannot. Mental illness is, therefore, a myth. Since illness affects only the body and the 'mind' is not a bodily organ, the mind cannot be ill. 'Mental illness' is, therefore, an oxymoron.

In 'The Myth of Mental Illness', American psychiatrist Thomas Szasz argued that mental illness is a metaphor: minds can be sick only in the ways that jokes or economies can be sick. If there is no mental illness there can be no 'treatment' or 'cure' for it.

If, as many people believe, the mind is really a brain process, then mental illness is really brain illness a valid diagnosis of which must be based on objective medical signs, not on subjective communications or complaints. This is no mere semantic quibble since Australian law accepts the distinction between brain illness (e.g. multiple sclerosis) and mental illness (e.g. schizophrenia). People cannot be locked up in a hospital and treated against their will for multiple sclerosis. Similarly, people may be found not guilty of a serious crime because of their 'paranoid schizophrenia', but the same rules do not apply to people with brain tumours.

No mental illness has, or ever will be, diagnosed on the basis of medical signs, for a simple reason. If people who have been diagnosed with schizophrenia are found to have a brain lesion, they are suffering from a brain illness, not a mental illness. The presence of a medical sign in people who have been labelled mentally ill proves that they are not suffering from a mental illness. Psychiatry is, therefore, that branch of medicine where diagnoses of 'illnesses' are made in the absence of objective evidence: they are based, not on what people have, but on what they do and say. And if they act in ways that annoy, upset or offend others, they may find themselves diagnosed as mentally ill and treated medically against their will.

People change their behaviour with or without the intervention of psychiatrists or psychologists. Such intervention is nowadays called 'treatment' when, in some cases, it should be called 'torture'. When these interventions produce acceptable changes in behaviour, they are called 'cures'. The cure of mental illness, it is argued, produces a state of mental health which is universally regarded as desirable. But if mental illness is a myth, mental health is too.

Since the middle-1990s the term 'mental health literacy' has been used to describe people who endorse an illness ideology and so agree with biological psychiatrists who bemoan the public's alleged ignorance. Many attempts to reduce prejudice against the 'mentally ill' have been based on the attempt to make the public think like biological psychiatrists. This approach is based on the assumption that if you are ill your behaviour is beyond your control and you cannot be held responsible for it. Psychologist, John Read, reports evidence from seventeen countries that reveals that citizens have steadfastly resisted this propaganda, preferring to attribute mental illness to problems in living. Biological psychiatrists, eagerly supported by pharmaceutical companies, have consistently tried to tell people that they are wrong. This 'illness' approach to de-stigmatisation ignores the impressive body of evidence that biological explanations actually fuel prejudice.

The authors of the psychiatric bible known as 'The Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV-TR) admit that 'no definition adequately specifies precise boundaries for the concept of 'mental disorder''. Faced with the undeniable fact that mental illnesses cannot be diagnosed on objective medical grounds, DSM IV nonetheless provides more than 350 examples including: academic disorder, ADHD, expressive language disorder, gambling, gender-identity disorder, mathematics disorder, neglect of child disorder, partner-relational disorder, phase of life disorder, rumination disorder, written expression disorder and premature ejaculation. It seems that when females climax quickly it is 'sexy', when males climax quickly it is a mental illness!

In English there are success verbs, like 'discover' - one cannot discover something that does not exist. 'Invent' is not a success word since one can invent something that does not exist. Brain illnesses are discovered, mental illnesses are invented.

What, then, is mental illness? The popular view today is that it is 'an illness like any other', which clearly it is not. Sociologists are inclined to see mental illness as a cultural construction based on the personal experience of being unwell and choosing, or being coerced into, the role of sick patient. Thomas Szasz's view, and mine, is that mental illness is a myth whose function is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations.