For Szasz, the concept of social construction goes well beyond the usual “tame” version that social constructions are somehow arbitrary and often are founded on some random events or discoveries—such as Marie Curie’s discovery of penicillin or Salk’s discovery of a cure for polio. Szasz believes that mental illness was not some disease that had just been discovered or that the treatments employed in the treatment of specific mental illnesses were somehow arbitrarily discovered (such as Freud’s invention of the “talking cure” because he was a lousy hypnotist). Rather, mental illness was an “invention” (Szasz, 1974, p. 12): “whereas in modern medicine new diseases were discovered, in modern psychiatry they are invented (e.g. hysteria).” Thus, Freud might have “discovered” the talking cure—but he was deployed this treatment strategy in addressing a form of psychopathy that had been re-invented over many centuries. What is it like to treat an invention: are the therapist and patient sharing a delusion? We are hovering on the edge of a Strong Szasz Hypothesis.
The Technologies of Mental Illness: As I noted in the first essays, the models being used in many disciplines are often borrowed from “fashionable” technologies that are associated with and frequently generated out of prevailing paradigms in another discipline. In the case of psychiatry and psychology, these technologies have been about medical diagnoses and drug prescription. These technologies, in turn, come out of the analytic tradition to be found in both classical physics and chemistry, and the biochemical tradition to be found in both biology and chemistry.
Szasz seems to be alluding to this borrowing when he (Szasz, 1974, p. 4) indicates that: “so-called psychiatric problems continue to be cast in the traditional framework of medicine The conceptual scaffolding of medicine, however, rests on the principles of physics and chemistry Yet the fact remains that human sign-using behavior [mental and unsubstantial rather than physical and tangible] does not lend itself to exploration and understanding in these terms.” I proposed that Szasz has hit on two important underlying paradigms in his “dissection” of the fourth assumption world: (1) analysis and (2) causality.
Paradigm One: Analysis. Szasz (1974, p. 11) points to the analytic tradition of biology (what I described in the first essay as the “smashed frog” perspective) with regard to the dissection not only of frogs, but also human cadavers: “After dissection of the body was permitted, anatomy became the basis of medical science.” With the insights about human anatomy that were revealed through careful dissection, it was only “natural” that similar principles be applied to the dissection of mental “illness.” It was assumed that we can learn much from laying out the mental illness on the laboratory table and determining each of its working parts—and identifying, in particular, the “diseased” entity in the human psyche that accounts for the aberrant behavior and feelings to be found in the mentally ill patient.
