Thomas Szasz and the language of mental illness

Szasz famously declared mental illness a “myth” and a “metaphor,” arguing that psychiatry’s diagnostic categories are only temporary stops on the road to “real” and “legitimate” bodily diseases. He argued that conditions once regarded as “mental illnesses” would rightly be reclassified as “brain diseases,” insofar as scientific investigations would uncover their neuropathology. Based on a critique of six foundational claims in Szasz’s writings, the author of this chapter argues that psychopathology and neuropathology are complementary rather than contradictory or disjunctive. Just as some mental illnesses may be considered brain diseases, some brain diseases may manifest as “mental illness.” The locution, “mental illness,” remains useful, albeit imperfect, shorthand to describe a particular kind of suffering and incapacity, usually affecting cognition, emotion, reasoning, or behavior. Even if all mental illnesses were conclusively and causally linked to specific brain abnormalities, we would still need “mental language” in both ordinary discourse and the vocabulary of clinical work.