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Quixotic jousting over mental states

Published online by Cambridge University Press:  02 January 2018

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Abstract

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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2011

Neither Thomas Szasz Reference Szasz1 nor Edward Shorter Reference Shorter2 grasps the nettle of mental pain, which is at the heart of the psychiatric experience. As in any institution, consensus in medicine is a political process; Shorter represents the one we have now, which is that doctors treat lesions. (The neurologist Henry Miller declared over 40 years ago that ‘psychiatry is neurology without physical signs’. Reference Miller3 ) Szasz’s charge is that this stance deprives patients of a responsibility to make use of the help they seek. When asked to ‘to raze out the written troubles of [Lady Macbeth’s] brain’, Macbeth’s physician is right to imply that there is more to this than cerebral pathology. Many people suffer terribly; some - like Lady Macbeth - through their own deeds, others through events or diseases beyond their control. But what is Szasz’s ‘active patient’ to do with a doctor who only wants to look at his or her brain? Psychiatry is diminished to the extent that it cannot face the experience of patients and their desire to be understood, as well as treated.

References

1 Szasz, T. The myth of mental illness: 50 years later. Psychiatrist 2011; 35: 179–82.CrossRefGoogle Scholar
2 Shorter, E. Still tilting at windmills. Commentary on … The myth of mental illness. Psychiatrist 2011; 35: 183–4.CrossRefGoogle Scholar
3 Miller, H. Psychiatry: medicine or magic? Br J Hosp Med 1970; 3: 122–6.Google Scholar
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