________________________________________________________________
VOLUME 2, ISSUE 6      THE INTERPSYCH NEWSLETTER      JULY, 1995
________________________________________________________________
 
                        SECTION E: THE FIFTH COLUMN
 
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| The following is the first installment of a regular,      |
| independent column written by Jeffrey Schaler, PhD.       |     
|                                                           |
| Opinions and comments are invited. Please send them       |
| to the IPN Mailbox <udipn@badlands.nodak.edu              |
 -----------------------------------------------------------
 
                      PSYCHIATRIC "SCIENCE"
                   Jeffrey A. Schaler, Ph.D.
 
The ideology of biological determinism rests,
according to Lewontin (1991), on three ideas:
People "differ in fundamental abilities because of
innate differences...[T]hose innate differences are
biologically inherited[.]...[H]uman nature
guarantees the formation of a hierarchical society"
(p. 23).
 
The psychiatric application of those ideas reads
the following way:  "Mentally ill" persons are
different from "mentally healthy" persons because
of innate differences.  Those differences are
biologically inherited, e.g., "schizophrenia,"
"manic-depression," and "alcoholism" are caused by
genes.  The control of "mentally ill" persons by
"mentally healthy" persons is part of a natural,
hierarchical order of man.
 
Psychiatric and psychological institutions
that advance those ideas claim "to derive from
sources outside of ordinary human social struggle,"
i.e., they are apolitical, "descend[ing] into
society from a supra-human source."  Their
"pronouncements, rules, and results" allegedly
"have a validity and a transcendent truth that goes
beyond any possibility of human compromise or human
error."  Their "explanations"  are "true in an
absolute sense."  They use "an esoteric language,
which needs to be explained to the ordinary person
by those who are especially knowledgeable and who
can intervene between everyday life and mysterious
sources of understanding and knowledge" (ibid., p.
7) (1).  That, Lewontin tells us, is how an
institution, e.g., institutional psychiatry,
"legitimizes" the world and, I might add, how it
justifies certain policies, i.e., committing
certain acts against specific persons.  In other
words, it is how an institution that claims to be
apolitical actually effects a political mandate,
here called "right" behavior.
 
Lewontin explains how biological determinists,
contrary to being apolitical, advance a socio-
economic political agenda in the name of science.
(2)  A disciplined, scientific approach in clinical
psychology and psychiatry, it seems to me, must
recognize the political nature of its apolitical
claims.  While Lewontin has done a superb job of
exposing the political nature of biological
determinism, Thomas Szasz has done likewise for
institutional psychiatry (3).
 
HISTORY
The transition from societal control of the
individual to the idea that society is determined
by the individual coincided with the Reformation
and the birth of capitalism:
   Before the eighteenth century, European
   society placed little or no emphasis on the
   importance of the individual.  Rather, the
   activity of people was determined for the
   most part by the societal class into which
   they were born...Individuals were seen not
   as the causes of social arrangements but as
   their consequence (ibid., pp.. 10-11).
 
After the Reformation economic prosperity was
associated with godliness.  Capitalism reinforced
the economic power of the individual, i.e., he
could determine his own economic future.  A new
weltanschauung coincided whereby the part--the
individual--was viewed as having the power to
determine the greater whole--society.  Theological
explanations for the world became increasingly
replaced with scientific and mechanistic ones.
   This atomized society is matched by a new
   view of nature, the reductionist view.  Now
   it is believed that the whole is to be
   understood _only_ by taking it into pieces,
   that the individual bits and pieces, the
   atoms, molecules, cells, and genes, are the
   causes of the properties of the whole
   objects and must be separately studied if
   we are to understand complex nature
   (Lewontin, 1991, pp. 11-12).
 
The world view of an individual's relationship
to the greater whole of society extends, according to
Lewontin, to our philosophy of science.  And our
philosophy of science, what Lewontin calls "the
ideology of biology," reinforces and serves a
particular philosophy of how society should be.
 
Today, reductionism dominates the institutions of
psychiatric and psychological research, practice,
and public policy.  "Mental illness" is called a
"treatable" brain disease.  Explanations and
policies for dealing with persons labeled "mentally
ill" are reduced to identifying and changing
neurochemicals and the genes that produce them.
Yet, there is nothing scientific about those
explanations and there is everything political
about them.  Psychiatric science is an oxymoron.
Szasz's (1970) advice to examine the category
mistakes of psychiatric reductionism is helpful:
   [I]f our aim is to see things clearly,
   rather than to confirm popular beliefs and
   justify accepted practices, then we must
   sharply distinguish three related but
   distinct classes of phenomena:  first,
   _events_ and _behaviors_...;  second, their
   _explanations_ by means of religious or
   medical concepts...;  third, their _social
   control_, justified by the religious or
   medical explanations... (p. xxi).
 
BEHAVIOR IS AN EVENT
In clinical psychology and psychiatry we address
human behavior, be it normal or abnormal.  Human
behavior is an event, a "coming out."  We may
address that event in descriptive or prescriptive
ways.  Descriptive approaches imply objectivity.  A
factual assertion is made (Szasz, 1988).
 
Prescriptive approaches "describe by prescribing,"
i.e., one depicts "what is" by saying "what should
be."  To prescribe is to enjoin.  That is a
strategic recommendation, designed to effect a
particular behavioral outcome.  Prescriptions are
either fair or unfair (ibid.).  By confusing
description with prescription existence is defined
through moral commandment.  A political agenda may
then be actualized.  The "body politic" is
"treated" in name of the body human.
 
For example, we describe abnormal behavior when we
say that behavior deviates from the norm.  That is
a purely statistical assessment, a factual
assertion.  Whether the deviant behavior is "good"
or "bad" is irrelevant, for "deviant" can also
describe exceptional ability as well as inability.
We prescribe abnormal behavior when we define it as
maladaptive, subjective discomfort, deviation from
the ideal, etc.  Those are value judgments.  In
other words, we describe the behavior in terms of
what we think it should be--but actually we are
not describing it at all.  We are pretending to
describe it for strategic purposes in order to
effect a particular mode of conduct. (4)
 
What is the accurate description of human behavior?
Behavior is an intentional act, mode of conduct,
deportment.  Conduct is the expression of values
through action.  Herbert Fingarette (1975)
differentiated between behavior and neurological
reflex using the chronic drug user as an example:
   A pattern of conduct must be distinguished
   from a mere sequence of reflex-like
   reactions.  A reflex knee jerk is not
   conduct.  If we regard something as a
   pattern of conduct...we assume that it
   is mediated by the mind, that it reflects
   consideration of reasons and preferences,
   the election of a preferred means to the
   end, and the election of the end itself
   from among alternatives.  The complex,
   purposeful, and often ingenious projects
   with which many an addict may be occupied
   in his daily hustlings to maintain his
   drug supply are examples of conduct, not
   automatic reflex reactions to a singly
   biological cause (p. 435).
Szasz (1987) agrees:
   [B]y behavior we mean the person's "mode of
   conducting himself" or his "deportment"...
   the name we attach to a living being's
   conduct in the daily pursuit of life...
   [B]odily movements that are the products
   of neurophysiological discharges or
   reflexes are not behavior...The point is
   that behavior implies action, and action
   implies conduct pursued by an agent seeking
   to attain a goal (p. 343).
 
The syllogism here goes like this:  Human behavior
is intentional conduct.  "Mental illness" refers to
specific behaviors.  Therefore, "mental illness"--
the behaviors referred to as "schizophrenia,"
"addiction," "insanity," etc.--is intentional
conduct.  We know what a person values by paying
attention to how he lives (Szasz, 1994).  Since
epilepsy, diabetes, cirrhosis, cancer, heart
disease, etc. are not behaviors--i.e., they are
diseases--we do not regard them as intentional
conduct.  The syllogism does not hold true for real
diseases.  Certain behaviors may lead to or be
strongly correlated with those diseases, e.g.,
smoking, drinking, a high-fat diet, etc.  However,
a person cannot choose to have cancer, just as he
cannot choose to make cancer "go away" (5).
 
Diagnoses of mental illness are based on
observations of acts by individuals.  Persons being
diagnosed must move or make some claim about
themselves (Sarbin, 1990).  A diagnosis cannot be
made if the person does not move or speak.  The
situation is remarkably different in the diagnosis
of real disease, where movement is unnecessary.
Blood is drawn, an X-ray is taken, etc.;  when the
person is unconscious a proper diagnosis can still
be made (T. Szasz, personal communication, April
1995).  Mental illness cannot be diagnosed in such
a manner, i.e., by signs.  We cannot diagnose
mental illness through blood analysis, EEG, CAT,
MRI or PET scans.  _Claiming_ that mental illness
can be diagnosed through those tests is a political
maneuver, not a scientific or factual assertion.
 
EXPLANATIONS ARE NOT CAUSES
The institutions of clinical psychology and
psychiatry become politically active when
explanations for events are confused with the
events themselves.  An explanation for an event is
a theory about how or why the event occurs.  We may
believe that a particular event occurs because of
psychological, environmental (6), unconscious (7),
and/or biological factors.  Freud invented the
theory of the unconscious as an explanation for why
a patient of his allegedly could not remember an
emotional catharsis during hypnosis.  He did not
_discover_ the unconscious.  He _invented_ it as an
explanation for his patient's behavior.  That
invention is not a _cause_ for why people behave in
certain ways.  Yet people believe not only that the
unconscious exists but also that it _causes_ people
to act.  Explanations and causes are different.
Szasz addressed the difference in 1963:
   There is a...difference in the
   theories of physicists and laymen on the
   subject of the flow of electricity in a
   copper wire.  For the physicist, the theory
   may be a set of mathematical equations.
   The layman, on the other hand, may
   visualize electrons as little balls rolling
   along inside the wire.  In either case,
   does the _theory_ of electric flow _cause_
   a light bulb to glow or a radio to play?
   The question is improper.  It is also
   improper to ask if a murderer's
   schizophrenia caused the criminal act.  An
   explanation or theory can never be a cause
   (p. 134).
Explanations of any behavior as the _result_ of
interaction with others, environment, the
unconscious, neurotransmitters in the brain, etc.
are theoretical inventions, not empirical
discoveries. (8)  Moreover, those theories imply
that a cause-and-effect relationship between self
and internal or external entities exists, as if the
two could be separated.
 
An explanation for a behavioral event _must_ be
consistent with the definition of behavior, i.e.,
intentional conduct.  That view is at great odds with
biological explanations for behavior, explanations
viewed as causes of behavior.  Reductionist
explanations for behavior are inconsistent with the
literal meaning of behavior.  They are illogical.
Brains, neurotransmitters and genes do not _choose_
to act.  People do!
   ...[T]he view that we are totally at the mercy
   of internal forces present within ourselves
   from birth is part of a deep ideological
   commitment that goes under the name of
   _reductionism_.  By reductionism we mean
   the belief that the world is broken up into
   tiny bits and pieces, each of which has its
   own properties and which combine together
   to make larger things.  The individual
   makes society, for example, and society is
   nothing but the manifestation of the
   properties of individual human beings.
   Individual internal properties are the
   causes and properties of the social whole
   are the effects of those causes.
      Such a view about causes and effects and
   the autonomy of individual bits and pieces
   not only results in a belief that internal
   forces beyond our control govern what we
   are as individuals.  It also posits an
   external world with its own bits and
   pieces, its own laws, which we as
   individuals confront but do not influence.
   Just as the genes are totally inside of us,
   so the environment is totally outside of
   us, and we as actors are at the mercy of
   both these internal and external worlds.
   This gives rise to the false dichotomy of
   nature and nurture (Lewontin, 1991, p. 107).
 
So now we have two principles with which to
investigate and confront the political nature of
psychiatric "science":  (1) the seemingly
deliberate confusion of description with
prescription in identifying behavior as an event
and (2) the seemingly deliberate confusion between
explanations and causes for human behavior as an
event.
 
POLICIES ARE BASED ON EXPLANATIONS
How do we know what a person values?  By paying
attention to what that person does.  We understand
something about the values psychiatrists and
clinical psychologists have by examining what they
do.  They talk to people, give drugs, administer
electric shock, commit people to prisons called
"mental institutions," detain and
"deinstitutionalize" "mental patients" against their
will, and are often paid or empowered by government
to do so. What values are those practices and
policies based on?
 
Explanations (stories, inventions) for events can
be placed in two categories:  There are those
explanations that are free-will oriented, i.e., the
behavior is explained as existentially strategic.
And there are those explanations that are
deterministically oriented, i.e., the behavior is
viewed as caused, which is a contradiction in terms
(Szasz, 1987).  The policies of psychiatrists and
clinical psychologists--i.e., what they do in
relation to persons, e.g., "treatment"--are based
on our various explanations for events.
 
Contractual, i.e., voluntary, psychotherapy rests on the
accurate explanation for behavior.  Institutional
psychiatry and clinical psychology rest on the
inaccurate explanation.  All involuntary
"treatment" for "mental illness" is justified
through explanations for abnormal behavior that
confuse theory with cause, description with
prescription.  Involuntary treatment is at
irreconcilable odds with the definition of behavior
as mode of conduct executed by a moral agent.  It
is also based on biological determinism, e.g.,
"mental illness" caused by a brain disorder with
genetic origins--an attempt to remove the person's
intentional conduct.  To view a person as "missing"
intentionality in conduct is perhaps one of the
most dehumanizing ways one person can relate to
another.  Yet this thinking is an integral part of
the actions taken by institutional psychiatrists
and clinical psychologists intent on diagnosing and
"treating mental illness."
 
One can further categorize explanations for
abnormal behavior into vices and crimes.  Vices are
acts against onself.  Crimes are acts against
others.  If a person is physically self-destructive
we may do nothing. (9)  Harm to others is a
jurisprudential matter (10).  Confusing medical and
criminal justice categories is another
way a political agenda appears to be implemented in
the name of a scientific/medical one (Menninger,
1968).
 
WHAT SHALL WE DO THEN?
In the movie "The Year of Living Dangerously," the
photographer Billy, played by Linda Hunt, became
exasperated when his adopted family in the Djakarta
ghetto refused to follow his admonition about sewer
water. Soon thereafter he realized that his hero,
Sukarno, had turned out to be one more empty fraud.
Flailing away at his typewriter he wailed in
despair, "What shall we do?" (Luke 3:10-14),
helpless at the apparent impossibility of
alleviating suffering in the world.  That is the
human condition.  We cannot help someone unless
he wants our help.  As Confucius taught, we can
give a starving person a fish or we can teach him
how to fish (see Szasz, 1991).  And he will learn
to fish only when he wants to!
 
Yet we persist, using force to affirm the dominant
ethic, now called "mental health," and to rid the
world of evil, now called "mental illness," at any
cost, justifying, nay legitimizing, institutional
instruments of persecution, first through claims of
divine communion and now, with the evolution of
secular and technological society, through
scientism.  Theocracy died by the separation of
church and state.  One thing we must do is remove
the engine of the state from medicine.  How can
that be done? (11)  Exposing the proliferation of
moral management masquerading as medicine and
science seems necessary to achieve that goal.
 
The problems confronting us as therapists are human
problems in living.  These cannot be reduced to
physiological "bits and pieces," the "environment,"
and/or the "unconscious."  Man is a moral agent
making choices in the world, and his experience as a
person is an integral part of that choice that
cannot be separated and "treated."  We can no more
change intentional conduct through chemistry and
conditioning than we can do so by forcing a moral
confrontation with oneself.  That, to return to
Lewontin's third point about biological
determinism, is how the hierarchical order is
maintained by institutional psychiatry and clinical
psychology.
 
Moreover, the political nature of psychiatric
reductionism is not only unscientific, it qualifies
as moral indoctrination, the antithesis of autonomy
and liberty in a free society.  It is not enough to
show and block the prescriptions masquerading as
descriptions of behavior, the explanations
masquerading as causes for behavior, and the
illogical assault on human beings for their
intentional conduct in the name of "treatment" (12,
13).  Explanations for behavior and policies based
on those explanations must be consistent with an
accurate vision of the person and his behavior.
   The concept of free action requires,
   ultimately, that we conceive of the person
   in the moment of choice as the true
   initiator, by that choice, of the pertinent
   conduct.   To speak of choice as true
   initiation of action is to say that the
   content of the choice is not decisively
   determined by already extant conditions that
   are independent of the choice.  This is the
   freedom required by the concept of the moral
   responsibility of the  individual
   (Fingarette, 1991, pp. 216-217). (14)
 
   That seems to be the basis upon which any
scientific policy toward human behavior must proceed.
 
 
NOTES
(1)  Foucault's (1973) "gaze," for example.  "It is
not as a scientist that _homo medicus_ has
authority in the asylum, but as wise man"
(Foucault, 1965, p. 217).
(2) "No prominent molecular biologist of my
acquaintance is without a financial stake in the
biotechnology business" (Lewontin, 1991, p. 74).
(3) Like Szasz, I use the term "institutional
psychiatry" to refer to all branches of psychiatry,
psychology, social work and other mental health
professions receiving any support from the state.
(4) Objectivity is not absolute because the focus
of our attention in describing behavior is
selection or preference.  We choose the
figure/foreground of our attention because it is
meaningful to us in some way.
(5) Compassion is not the issue here.  When a
pathologist identifies cancer he controls his
feelings and makes a factual assertion.  He may
well make a strategic recommendation based upon his
description, but that prescription is clearly
differentiated.
(6) "First, there is no 'environment' in some
independent and abstract sense.  Just as there is
no organism without an environment, there is no
environment without an organism.  Organisms do not
experience environments.  They create them"
(Lewontin, 1991, p. 109).  "The definition of an
organism is the definition of an organism/environment
field..." (Perls et al., 1951, p. 259).  "Mentality
is that relationship of the organism to the situation
which is mediated by sets of symbols" (Mead, 1934,
p. 125).  "The environment, I have said, is our
environment" (ibid., p. 248).
(7)  "Unconscious thought is a contradiction in
terms."  Attributed to Albert Bandura.
(8) Lewontin (1991) suggests that the confusion
between cause and agent is an integral part of
biological determinists' attempt to effect a
political agenda in the name of an apolitical one.
Guns, drugs, genes and environment are agents, not
causes.
(9)  I differentiate here between a child and an
adult.  I also realize that the line between
childhood and adulthood is ambiguous, i.e., there
are children who are more mature than some adults
and vice versa.  Since persons at eighteen years of
age are seen as fit for military service, I prefer
that as the age of demarcation into adulthood,
i.e., persons at eighteen years of age should be
entitled to all the privileges and responsibilities
of adulthood.
(10) Harming oneself is a moral act, i.e.,
intentional conduct.  Harming others is a criminal
act.  The first case is an ethical issue.  Informal
sanctions are the proper domain for response.  The
second case is a criminal justice issue.  Formal
sanctions are the proper domain for response (see
Conrad and Schneider, 1992).  Neither case seems to
have anything to do with medicine, i.e., psychiatry
or clinical psychology.
(11) For example:  "Congress shall make no law
respecting an establishment of medicine, or
prohibiting the free exercise thereof..." (Szasz,
1970, p. 179)
(12) To this, I might add the confusion of
homology and analogy:  "There is in fact not a
shred of evidence that the anatomical,
physiological, and genetic basis of what is called
aggression in rats has anything in common with the
German invasion of Poland in 1939" (Lewontin, 1991,
p. 96).
(13) Karl Menninger, in a historic letter not long
before his death, seems to have yielded to many of
Szasz's objections to "mental illness" and
institutional psychiatry.  See Menninger (1989).
(14)  Fingarette continues:  "On the other hand, if
action is to be  responsible, it is also required
that the action be shaped by one's character, one's
values, one's  perceptions of the situation, and
also in relevant ways  by the actual conditions in
the situation.  Insofar as there is an element in
one's choice that is not conditioned by _any_ of
these, that element of choice, by  this hypothesis,
does _not_ reflect one's nature, values,  or
situation, and thus it cannot in that respect be
_responsible_ choice."  I disagree with Fingarette
here because I believe that thoughts cannot
"happen" to a person.  Thinking that they can
appears, to me, to be a form of self-deception.
 
REFERENCES
Conrad, P. and Schneider, J.W.  (1992).  Deviance
   and medicalization:  From badness to sickness.
   Expanded edition, with a new afterword by the
   authors.  Philadelphia:  Temple University
   Press.
Fingarette, H.  (1991).  Comment and response.  In
   Mary I. Bockover (Ed.)  Rules, rituals, and
   responsibility:  Essays dedicated to Herbert
   Fingarette.  (pp. 171-220).  La Salle, Ill.:
   Open Court.
Fingarette, H.  (1975).  Addiction and criminal
   responsibility.  The Yale Law Journal, 84, 413-
   444.
Foucault, m.  (1973).  The birth of the clinic:  An
   archaeology of medical perception.  A.M.
   Sheridan Smith, trans.  New York:  Pantheon.
Foucault, M.  (1965).  Madness and civilization.
   New York:  Random House.
Lewontin, R.C.  (1991).  Biology as ideology:  The
   doctrine of DNA.  New York:  HarperPerennial.
Mead, G.H. (1967).  Mind, self, and society from
   the standpoint of a social behaviorist.  In
   Charles W. Morris (Ed).  Works of George Herbert
   Mead volume 1.  Chicago:  University of Chicago
   Press.
Menninger, K.  (1989).  Reading notes.  Bulletin of
   the Menninger Clinic.  53, 350-352.
Menninger, K.  (1968).  The crime of punishment.
   New York:  Viking.
Perls, F., Hefferline, R.F., and Goodman, P.
   (1951).  Gestalt therapy:  Excitement and growth
   in the human personality.  New York:  Delta.
Sarbin, T. R. (1990)  Toward the obsolescence of
   the schizophrenia hypothesis.  In David Cohen
   (Ed).  Challenging the therapeutic state:
   Critical perspectives on psychiatry and the
   mental health system.  The Journal of Mind and
   Behavior, 11 (Nos. 3 & 4), 259-284.
Szasz, T.S.  (1994).  Cruel compassion: Psychiatric
   control of society's unwanted.  new York:  John
   Wiley & Sons.
Szasz, T.S.  (1988).  Psychiatric justice.
   Syracuse, N.Y.:  Syracuse University Press.
Szasz, T.S.  (1987).  Insanity:  The idea and its
   consequences.  New York:  John Wiley & Sons.
Szasz, T.S.  (1970)  The manufacture of madness:  A
   comparative study of the Inquisition and the
   mental health movement.  New York:  Harper.
Szasz, T.S.  (1963).  Law, liberty, and psychiatry:
   An inquiry into the social uses of mental health
   practices.  New York:  Collier Books.
 
 
Jeffrey A. Schaler, Ph.D., a psychotherapist in
private practice since 1973, received his doctorate
in human development from the University of
Maryland College Park, and lives in Silver Spring,
Md.  He teaches at American and Johns Hopkins
universities and is the listowner of
NUVUPSY@sjuvm.stjohns.edu.  <jschale@american.edu>