Paradigm Two: Causality. With the dissection of mental illness comes the identification of causality. Borrowing from the traditional physical sciences, we can envision a world filled with billiard balls. One ball hist a second ball and the second ball is forced to move. This is the fundamental principle of causality and is clearly aligned with the right-branching (active voice) syntactic structure identified in the first essay. This billiard ball universe is now being seriously questions in the physical sciences, as it becomes clear that most physical systems in the real world are highly complex and operate in a manner that defies the standard billiard ball perspective and any hope of predictability: there are multiple causations, operating alongside self-organization and (as I noted previously) the emergence of new, unanticipated forms.
Put in a somewhat different context, the billiard ball perspectives is clearly inappropriate when applied in such “messy” and perhaps pre-paradigmatic disciplines as history, psychology (and the other behavioral sciences). We tend, for instance, to offer historical narratives that move from past to present, identifying how specific events in the past have “caused” our current condition. The analysis paradigm (focusing on special events) joins with the causality paradigm (looking for simple direct line connections) to create what is often called “historicism.” Yet, this not the way in which history is actually generated: we are always looking from the present time back to the past and are trying to figure out from our current perspective “how we got to where we are.” Past “causative” events of the past are always viewed (in a very biased way) from the present.
This same “historicism” seems to pervade the assessment of mental illness. Pointing to the perspectives of “historicism”, Szasz (1974, p 5) notes that it has traditionally been assumed that: “historical events are as fully their antecedents as are physical events by theirs.” Billiard balls hit billiard balls. Childhood trauma causes adult mental illness. Genetic defects cause schizophrenia and bi-polar disorders. Under the shadow of psychological and psychiatric historicism, we are left with a world in which there is no free will. External locus of control is the coin of the realm in this fourth assumption world. We return to Szasz (1974, p 13): “diseases happen to people Mentally sick persons did not “will’ their pathological behavior and were therefore considered “not responsible.”
At this point, the legal system comes into compliance with the dominant fourth assumptive world: there are legitimate defenses made for the declaration of “innocence” on the basis of mental illness. When we get to this point in our analysis of the fourth assumptive world, the fatal flaw (or least point of deep concern) emerges. The Weak Szasz Hypothesis would suggest that we are left with the absence of any personal accountability or any fundamental moral code if the fourth assumptive world remains dominant. According to Szasz (1974, p 263): “human behavior is fundamentally moral behavior Attempts to describe and alter such behavior without, at the same time, coming to grips with the issue of ethical values are therefore doomed to failure”
The Strong Szasz Hypothesis
As we move to Szasz’s challenge regarding the loss of morality in the fourth assumptive world, we begin our venture into what I would call Szasz’s “Strong Hypothesis.” This is where Szasz becomes quite controversial and where many members of the mental health community steer clear of Szasz and his arguments. Yet, much of what Szasz offered more than 40 years ago is disturbingly contemporary. First, we need to recognize that Szasz is not just suggesting that mental illness is a social construction. He is suggesting (in according the third assumptive world) that mental illness is an invention that was creating and is employed to suppress individuality and maintain oppressive social institutions and practices. He believes that it is not just money and mental health that are in alignment—it is also power and mental health that seem to be interwoven—and perhaps are now inextricable in many countries.
As I have repeatedly asked in this series of essays: Who is at the table when psychopathy is being discussed. Has the “God” of medicine replaces the “God” of theology and the “God” of government and societal norms. Has even a combination and coalition of several Gods (spiritual aberration and social deviance) been unequal to the task of buffering the influence of the God of medicine. (Szasz, 1974, p 7) Szasz (1974, p. 260) makes it clear as to who he thinks is in charge: “The psychiatrist [is the] social engineer or controller of social deviance. In this role, the psychiatrist acts as priest and policeman, arbitrator and judge, parent and warden: he coerces and manipulates, punishes and rewards, and otherwise influences and compels people, often by relying on the policy power of the state “
Concluding Comments
This fourth assumptive world is very powerful. Furthermore, I would suggest it has yielded both great benefits and significant harm. We must be attentive, therefore, to what Thomas Szasz has proposed – in both his weak and strong version. It is important to note that Szasz himself had been a physician and still placed “M.D.” beside his name on the title pages of his books. He is issuing a strong statement and is still regarded as a troublemaker and paradigm challenger who dwelled in in an assumptive world of the 1970s that was dominated by the medical model. This assumptive world still seems to be dominant – perhaps even more dominant in many societies that previously was in the throes of the second (or even first) assumptive world.
