Agency, mental illness, and psychiatry: A response to Thomas Szasz

Szasz’s understanding of persons as agents underwrites his ideas about mental illness and clinical psychiatry as a medical specialty. He asserts that the phenomena of mental illnesses, including suffering, signal “problems in living” or difficulties in determining the best use of one’s agential powers. The goals of the relationship are to enhance the client’s knowledge of his or her personality, to refine his intentions and sense of responsibility for his “symptoms” and other actions, and to achieve his aims and satisfy his desires, as long as he does not, by his actions, harm others. For the author of this chapter and other clinicians, the experience of phenomena exhibited by persons judged to be mentally ill are, to some extent and sense, apprehended as events that happen, rather than as actions authored by the person as agent. These untoward activities suggest a undesirable organismic condition of a person as agent, a diminution of the agent’s capacity for living a life, the signal of a organismic disorder, a problem with the human organismic equipment for living a life—not solely a problem about the best use of that equipment (as Szasz contends) but a state of ill health and a suffering person in need of treatment.