Kelly Brendan D, Bracken Pat, Cavendish Harry, Crumlish Niall, MacSuibhne Seamus, Szasz Thomas, Thornton Tim
Department of Adult Psychiatry,University College Dublin,Mater Misericordiae University Hospital,62/63 Eccles Street,Dublin 7,Ireland.
Mental Health Services,Bantry,West Cork,Ireland.
Ir J Psychol Med. 2010 Mar;27(1):35-43. doi: 10.1017/S0790966700000902.
In 1960, Thomas Szasz published The Myth of Mental Illness, arguing that mental illness was a harmful myth without a demonstrated basis in biological pathology and with the potential to damage current conceptions of human responsibility. Szasz's arguments have provoked considerable controversy over the past five decades. This paper marks the 50th anniversary of The Myth of Mental Illness by providing commentaries on its contemporary relevance from the perspectives of a range of stakeholders, including a consultant psychiatrist, psychiatric patient, professor of philosophy and mental health, a specialist registrar in psychiatry, and a lecturer in psychiatry. This paper also includes responses by Professor Thomas Szasz. Szasz's arguments contain echoes of positivism, Cartesian dualism, and Enlightenment philosophy, and point to a genuine complexity at the heart of contemporary psychiatric taxonomy: how is 'mental illness' to be defined? And by whom? The basis of Szasz's doubts about the similarities between mental and physical illnesses remain apparent today, but it remains equally apparent that a failure to describe a biological basis for mental illness does not mean there is none (eg. consider the position of epilepsy, prior to the electroencephalogram). Psychiatry would probably be different today if The Myth of Mental Illness had not been written, but possibly not in the ways that Szasz might imagine: does the relentless incarceration of individuals with 'mental illness' in the world's prisons represent the logical culmination of Szaszian thought? In response, Professor Szasz emphasises his views that "mental illness" differs fundamentally from physical illness, and that the principal habits the term 'mental illness' involves are stigmatisation, deprivation of liberty (civil commitment) and deprivation of the right to trial for alleged criminal conduct (the insanity defence). He links the incarceration of the mentally ill with the policy of de-institutionalisation (which he opposes) and states that, in his view, the only limitation his work imposes on human activities are limitations on practices which are conventionally and conveniently labelled 'psychiatric abuses'. Clearly, there remains a diversity of views about the merits of Szasz's arguments, but there is little diminution in his ability to provoke an argument.
1960年，托马斯·萨斯发表了《精神疾病的神话》，认为精神疾病是一个有害的神话，没有在生物病理学上得到证实的依据，且有可能损害当前关于人类责任的观念。在过去的五十年里，萨斯的观点引发了相当大的争议。本文通过一系列利益相关者的视角，包括一位精神科顾问医生、精神科患者、精神健康哲学教授、精神科专科住院医生以及精神科讲师，对《精神疾病的神话》的当代相关性进行评论，以此纪念该书出版50周年。本文还收录了托马斯·萨斯教授的回应。萨斯的观点中有着实证主义、笛卡尔二元论和启蒙运动哲学的影子，也指出了当代精神病分类学核心的一个真正复杂性：“精神疾病”该如何定义？由谁来定义？如今，萨斯对精神疾病与身体疾病相似性的质疑依据依然明显，但同样明显的是，未能描述精神疾病的生物学基础并不意味着不存在这样的基础（例如，想想脑电图出现之前癫痫的情况）。如果没有《精神疾病的神话》这本书，如今的精神病学可能会有所不同，但或许并非以萨斯所能想象的方式：将患有“精神疾病”的人无休止地监禁在世界各地的监狱里，这代表了萨斯思想的逻辑终点吗？作为回应，萨斯教授强调了他的观点，即“精神疾病”与身体疾病有着根本的不同，“精神疾病”这个术语主要涉及的习惯做法包括污名化、剥夺自由（民事收容）以及剥夺对被指控犯罪行为的受审权（精神错乱辩护）。他将精神病患者的监禁与去机构化政策（他反对该政策）联系起来，并表示，在他看来，他的作品对人类活动施加的唯一限制是对那些传统上被方便地贴上“精神科滥用”标签的做法的限制。显然，对于萨斯观点的价值仍然存在多种看法，但他引发争论的能力丝毫未减。
