Issues
The Two Toms
My totally surreal encounter with the Bizarro World parallel psychiatric universe of Tom Cruise and Thomas Szasz and how it didn't change my life.
Please forgive me for the highly opinionated flavor of this article. Once a year or so, I need to get a thing or two out of my system, so I kindly beg your indulgence:
On July 10, 2005, Jeffrey Schaler PhD, a psychologist who has authored a number of books on substance use and teaches public policy at American University, sent me an email inviting me to read a blog he had posted on his website.
At the end of his blog, Dr Schaler makes this extraordinary assertion:
"What is most upsetting to those in the psychiatry cult? That someone who attracts a lot of attention should dare to point out that the emperor called psychiatry has no clothes. That is exactly what Mr Cruise has done. In so doing, his head sticks out above the crowd, to be sure, speaking truth to power, but largely because he is standing on the shoulders of Thomas Szasz."
For the benefit of those who have been filming emperor penguins in Antarctica, actor Tom Cruise on a series of talk show appearances in May-June 2005 criticized actress Brooke Shields for taking antidepressants for her postpartum depression. "There’s no such thing as a chemical imbalance," he claimed on the Today Show.
Cruise had originally volunteered that he was glad he'd never been given stimulants for ADHD as a kid, and had this been all he said everything would have been kosher. But as well as attacking Brooke Shields, he also accused Carl Jung of working for the Nazis and spouted other bizarre fabrications (which makes Dr Schaler's extraordinary claim about Cruise as upholder of the truth all the more extraordinary).
Cruise made his comments in the context of jumping on furniture on Oprah, making a spectacle of himself at the Eiffel Tower, nearly throttling a squirt gun-wielding prankster, and otherwise going ballistic in public
The media made much of Cruise's connection to the Church of Scientology, but Dr Schaler in his blog pointed out that Cruise's real inspiration is Thomas Szasz: "Cruise has read a lot of Szasz’s writings and he admires Szasz a great deal. (See a photograph taken last year of Szasz with his arm around Cruise.) His words echo Szaszian ideas."
My first reaction was to ignore the email. Then I wondered where this would lead. "This is my reply," I laconically responded, followed by a link to an article that used to be on this Website.
Read on …
Introducing Thomas Szasz
In that article on my Website, I say:
"The grandfather of the antipsychiatry movement is Thomas Szasz MD, 85, a psychiatrist whose 1960 book, The Myth of Mental Illness, proved instrumental in bringing about necessary changes to forced commitment laws during the sixties and seventies. But to this day, Dr Szasz has not deviated from his extraordinary claim that there is no such thing as mental illness."
According to Dr Szasz: "A laboratory technician can blindly make a diagnosis of anemia simply on the basis of vials of blood submitted to him or her, without having any idea of whose blood it is. As soon as that can be done with schizophrenia, it will be a brain disease, exactly as neurosyphilis was recognized as a brain disease."
In my article, I point out this thinking equates to the "tree falling in the forest" fallacy. No one around to hear it falling, no sound. Using the same logic, one can argue that there was no plague during the fourteenth century because the physicians of the day were blind to the bacterial cause.
The Plot Thickens
Dr Schaler got back to me pointing out a minor citation error in my article and taking issue with my characterization of Szasz as antipsychiatry. "It would be good if you corrected these errors," he rebuked, "as it undermines your credibility. At least get the facts straight!" (This from a guy who sees Tom Cruise as a beacon of truth.)
Dr Schaler also made this comment: "The brain lesion thing: Schizophrenia, etc, are not found in standard textbooks on pathology. Why? No brain lesion."
To which I replied, in full:
"Thanks for pointing out the mistake. I corrected it. Guess no one can question my credibility now. Got my fact – singular – straight. I actually read Fatal Freedom, by the way. My interpretation of Dr Szasz as antipsychiatry falls under 'fair comment.' As to the brain lesion thing, let me see if I have your logic straight. If it’s not mentioned in an outdated textbook, they don’t exist. Kind of like that tree in the forest crap all over again. The place to look is PubMed, as a person in your situation would well know."
A PubMed search turns up a number of studies linking brain lesions to depression in seniors.
"I have no doubt you’re an expert in your field of substance use," I concluded, "and if a Thomas Szasz approach helps these people then you’re doing a wonderful service."
Rather surprisingly, Dr Schaler got back to me with a long email, saying (among other things): "Schizophrenia is a behavior. The cause you're looking for is physical. If such a cause existed, it would be called a specific brain lesion, or biochemical imbalance. As it stands, neither exist."
Therein lies the heart of the Szasz argument. What society calls mental illness is really behavior. What psychiatry calls abnormal behavior is nothing more than a value judgment.
Actually, Dr Szasz was dead-on with regard to psychiatry classifying homosexuality as a mental illness. Back in the bad old days, individuals who were gay were subjected to the abuse of "aversion therapy." Dr Szasz was very influential in removing both the diagnosis and the "treatment," and for this alone he deserves our gratitude.
Dr Szasz also merits our attention in regard to today’s tendency to medicalize all and sundry types of behavior and medicate same. His voice may be extreme, but his influence on psychiatry has been a beneficially moderating one.
But then comes his claim that behavior has nothing to do with biology. Even if one could show the biology – which no one supposedly can – the two are as separate as oil and water. This is why most of Szasz’s supporters have abandoned him and why he is largely unknown to this generation of students and clinicians. Scientific discovery has passed him by and rendered him a relic, too dogmatically inflexible to adjust to the times.
But Dr Schaler is working very hard to rehabilitate Szasz: "Look, there's no point in being angry about this," came the invitation. "Let's discuss it and see what's fact and what's fiction."
Is It Really Possible to Have a Dialogue?
Okay, then, let's see how a Szasz disciple reacts to a discussion:
"Thank you for your thoughtful response," I began. "I agree that behavior for the most part is not a disease or a pathology."
Actually, you won’t find psychiatry talking much about behavior, either, at least not in illnesses like ours.
"Many of the symptoms of mental illness are not behavior-related or only marginally behavior-related," I explained. Since he brought up schizophrenia, I pointed out that at best only one of the three domains of that illness can be called behavior-related, and all three have to do with a breakdown in brain function. For example, you certainly can’t categorize psychosis as a behavior (though it obviously affects behavior).
No sense in stopping now:
"At least four of the nine DSM symptoms of depression," I went on to say, "are physical rather than mental (sleeping, eating thrown out of whack, etc)." As for bipolar, I ventured that the mania symptoms mostly relate to behavior largely because the DSM writers were forced to be descriptive and give examples. But a commonality in these symptoms clearly points to a malfunction in the control switch.
Just the Facts, Szasz
Then I went to the show-me-the biology argument, which is like shooting fish in a barrel:
"16,500 of our 25,000 genes are expressed in the brain. Something is clearly happening. Mental illness is a misnomer. Something physical is happening with a physical organ, the one most metabolically sensitive."
A lot of what you can read in the Science section of this Website, I regurgitated for his benefit. Hariri, Sapolskly, Kandel, Insell, Manji, and others. The stress connection, phenotype, endophenotype, signaling pathways, I spelled it all out. Sure, we’re not likely to find the genes that code for making us dance on tables or max out our credit cards, but we’re hot on the trail of finding out what screws up our sleep and hotwires our fear response and messes up our neurons’ ability to function efficiently and so on.
These are the type of brain disturbances that clearly influence our behavior.
I was careful to point out that I don't consider mental illness to be something as simple as a defect in the brain that could be fixed with minor tinkering. "The perfect pill," I wrote, "at best, will get me and others back on our feet. There’s still the matter of personal, social, and coping skills which we need to master."
I also acknowledged that "we have yet to find the biological smoking guns." On the other hand, "we’re turning up plenty of strong evidence. For obvious reasons, I choose to look forward and see how this all turns out." What we are learning about the brain is comparable to the excitement of the space race back in the 1960s. We were shooting for the moon and we reached it.
But Dr Szasz and his dwindling supply of followers are living a different version of the sixties, when Freudians ruled the roost, next to nothing was known about the brain, and Eric Kandel was just embarking on his remarkable career. In this kind of static mindset, you can’t shoot for the moon because the moon is not real.
Did I Say Something Offensive?
In his blog and correspondence, Dr Schaler argued that Dr Szasz is not antipsychiatry and has no objection to those who consent to it, which is rather disingenuous coming from someone who says the psychiatric emperor has no clothes. What Dr Szasz is really against, Dr Schaler explained, is forced psychiatry.
This leaves the dirty work to the Tom Cruises of the world, who is on record as wanting to outlaw all psychiatry (which echoes the Church of Scientology’s stand). So why on earth would Dr Szasz have his arm around the last person on earth he needs to be seen with? Believe it or not, Dr Szasz was on his home turf, at a function put on by the Citizens Commission on Human Rights, a group started by both Szasz and the Church of Scientology. The photo of the two of them together, I ventured to say, is as "ridiculous a picture as Nixon with Elvis."
But why would Dr Schaler choose to play up this link? Dr Szasz, after all, is his intellectual hero, a visionary and humanitarian who commands respect and admiration even amongst his critics. "The public will wind up tarring both of them with the same brush," I warned. Accordingly, I urged my correspondent to take down his blog.
But the toothpaste was already out of the tube. Dr Schaler’s original email to me was part of a mass mailing. By the time I could get off a first response, the blog had been reposted by different people on numerous websites and web forums. One of these repostings appeared on the USA News Press Release Network with no attribution to an independent third party. A link to a page on the Church of Scientology website appears at the bottom. Dr Schaler assures me he had nothing to do with this reposting or with the link.
On the other hand, he accused me of "writing about Scientologists the same way anti-Semites write about Jewish people." Needless to say, he never got back to me on the substantive issues, despite his invitation for a "discussion." Quite the contrary, following my clarification email he demanded I never contact him again.
What was he expecting, a love fest?
Concluding Remarks
Eighty years after the Scopes Monkey Trial, the airwaves are dominated by ideologues and zealots who assert such things as there is no global warming and that dinosaurs roamed the earth 6,000 years ago. This would be amusing but for the fact that much of this misinformation resonates in the corridors of power, and that the US is suffering an alarming brain drain in the form of fewer science graduates every year. Meanwhile, a mere five years following the decade of the brain, a high school drop-out is invited to parade his arrogance and ignorance on national TV while his academic apologist lands a spot on a New York radio talk show. No doubt, one or the other or both will be invited to testify before a congressional committee.
By contrast, someone who has dedicated his or her life to improving ours and publishes a ground-breaking piece of research in an obscure journal is lucky to get read by 30 people.
Is it just me, or has the world gone truly crazy? At least I’m being treated.
Sept 17, 2005, reviewed Feb 11, 2008
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