Month: March 2021

Psychiatry’s Neoliberal Philosopher – Review: Thomas Szasz

Review: C. V. Haldipur, James L. Knoll IV, and Eric v. d. Luft (eds.), Thomas Szasz: An Appraisal of His Legacy. Oxford: Oxford University Press, 2019. xv and 298 pp. ISBN: 9780198813491

Alexander Dunst, Paderborn University, Germany

70 years after the publication of The Myth of Mental Illness, the book’s enduring impact can seem puzzling. Built on a series of outrageous simplifications and argumentative slips, Szasz’s polemic generalized its denial of mental illness from an understanding of hysteria as “malingering“, never engaged with the intricacies of long-term care it sought to deny to patients, and upbraided the sick for cheating the healthy. Nevertheless, Szasz emerged as the pre-eminent critic of psychiatry in the United States. He at once relished this status and vehemently distanced himself from the left-wing practitioners and theorists, from Franco Basaglia to Michel Foucault, that he was often lumped with. Szasz’s distinction was to be the only conservative so-called anti-psychiatrist, and his writings were feted by right-wing intellectuals and the counterculture alike. For patients and radical psychiatrists, The Myth of Mental Illness promised to remove the stigma of disease and seemed to offer freedom from paternalistic institutions. Despite its numerous shortcomings, then, Szasz’s work proved useful to a wide range of readers and inspired an institutional practice of mental health that combined self-help, state neglect, and psychopharmacology under the aegis of personal autonomy.

Unfortunately, Thomas Szasz: An Appraisal of His Legacy fails to answer, or even seriously ask, how his flawed ideas could have such enormous consequences. The editors and authors are psychiatrists and analytic philosophers and have surprisingly little to say about the real-world contexts of their subject’s writing, either at the height of his career or in our present moment. Neither does the volume contain contributions by former patients, a particularly disappointing oversight because the social movements that formed against institutional psychiatry were an important locus of Szasz’s reception in the United States and abroad. Instead, the chapters largely focus on his philosophical influences, extend Szasz’s reflections on psychoanalysis, suicide, and schizophrenia, or apply his writings to legal and theoretical issues in contemporary psychiatry.

A historical appraisal of Szasz’s legacy must therefore move along the edges of the volume’s dominant concerns. Many of its contributors note the significant impact The Myth of Mental Illness had on their professional development and testify to their lasting friendship with its author, lending the publication the air of a posthumous Festschrift. Even the contributors that disagree most strongly with Szasz assert his importance to critical debates within a field dominated by biomedical assumptions. Such personal testimonies reveal Szasz’s continued appeal to a small minority of philosophically minded psychiatrists. Coming from a generation of researchers that underwent graduate training in the 1960s or soon thereafter, these comments also emphasize the historical situatedness of Szasz’s critique. Writing with real rhetorical verve, Szasz attacked institutional psychiatry where and when it was weakest, exploiting the uncertain etiology of major mental illnesses as the psychodynamic consensus of the postwar years unraveled.

Throughout his writings, Szasz built on the central opposition between physical and mental illness. Adopting Rudolf Virchow’s definition of disease as cellular pathology, Szasz denied that psychological suffering could constitute an illness, or that it involved any suffering to begin with. If all illness was physical in this purposefully narrow sense, then mental illness was merely a metaphor or myth—a rhetorical ploy “to force others to provide for one’s needs“ (Szasz 171). This notion of myth was inspired by Gilbert Ryle, who saw the mind as a philosophical category mistake. Yet, it seems to have been Szasz, rather than any of his conservative forebears, who reinforced this argument with a psychiatric voluntarism that was breathtaking in its lack of empathy: So-called mental illness was merely an abdication of personal autonomy and society owed little to those who shirked responsibility in this manner. There was one decisive exception for Szasz—involuntary treatment. In the late 1960s and early 1970s, he founded two organizations that fought forced hospitalizations in court. The results, coming as large psychiatric hospitals closed, were decidedly mixed. Although some wards were rife with abuse and the quality of treatment varied considerably, Szasz and his followers saw no need to extend care to those freed from hospitalization. The only person worthy of attention became the freely contracting participant in a capitalist marketplace, the individual who paid for therapy out of their own pocket.

Several contributions to the volume point to the fallacies of this philosophy—Szasz’s misreadings of Virchow, Thomas Hobbes and Ryle, and his naive positivism that at once idealized medical science and denied any role for public health. In a memorable passage, the psychiatrist Allen Frances recounts that Szasz refused to treat severely ill patients during his residency in Chicago. When ordered to do so, he moved to Syracuse where he exclusively saw outpatients for the rest of his career. The man who routinely dismissed mental suffering, who railed against the laziness and stupidity of people with severe psychological problems, never actually worked with them.

Given these accounts, it’s difficult to agree with the praise accorded Szasz throughout the book, from describing his unmatched analytical rigor to lionizing him as the greatest defender of patient rights since Philippe Pinel. In part, these adulations stem from shared commitments, such as rejecting “statist medicine” (60). This opposition to public healthcare is widely shared in the United States, where it extends to a medical establishment that benefits from the inflated costs charged by private hospitals and resident doctors, pharmaceutical and insurance companies. Although Szasz was often dismissed out of hand by mainstream practitioners, his program shares more with the psychiatric status quo than may be apparent. As early as 1961, Szasz advocated a mental health policy that married conservatism with libertarianism and anti-communism, the main pillars of the Republican party that emerged under Ronald Reagan. Reagan had already implemented drastic cuts for psychiatric care during his time as governor of California, and state budgets have only shrunk further since. On the one hand, these measures have instituted a modern version of laissez-fare capitalism, with intensive psychotherapy for wealthy individuals and cheaply produced but highly profitable medication for the masses. On the other hand, a punitive regime has built on the moral condemnation that Szasz personified, pushing the desperate and needy into poverty and homelessness. For thousands, prison terms have replaced the mental hospitals that campaigners decried as incarceration. Szasz himself might have found punishment more palatable than treatment. For their part, patients and mental health workers proved pawns in a cynical, yet effective, game of cutting costs while crying freedom.

References

Szasz, T. S. (1971) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Harper & Row.

Review: Psychologies in Revolution

Hannah Proctor, Psychologies in Revolution. Alexander Luria’s ‘Romantic Science’ and Soviet Social History. Palgrave, 2020; 259 pages, Hardcover £59.99, eBook £47.99; Hardcover ISBN 978-3-030-35027-7, eBook ISBN 978-3-030-35028-4

by Lizaveta Zeldzina

Psychologies in Revolution is dedicated to the work of Soviet psychologist and neurologist Alexander Luria: an early enthusiast of psychoanalysis in Russia, and ‘the father’ of Soviet neuropsychology, Luria was known internationally as a prolific writer and experimenter. He was an inspiration to a new generation of scientists in the Soviet Union in the mid-twentieth century, and managed to stay in touch with intellectual currents in the wider world. Together with Lev Vygotsky, Luria has become a figure of intense interest for many scholars of Soviet science, and especially for so-called ‘revisionists’. Unlike existing studies, however, Psychologies in Revolution examines Luria in his social and historical circumstances, ‘contending that analysing Luria’s research in isolation from the historical circumstances it emerged from and influenced would be like analysing someone’s personality by examining their brain on a glass table’ (p. 4). In this text, Proctor provides us with our first detailed history of Luria’s ideas and his work.

Psychologies in Revolution entails the discovery of a previously unknown Luria. The text is structured around his major scientific projects: studies of the criminal, the ‘primitive’ (Uzbek peasants with no formal education), the child, the aphasic (brain-injured Red Army soldiers) and the synaesthete. Eponymous chapters move the reader chronologically from the Revolution of 1917 to the late 1970s, opening out new dimensions for critical inquiry. Proctor shows how Luria, ‘developed a form of scientific writing capable of fully attending to the utterances and experiences of the people he dedicated his career to observing, understanding and treating’ (p. 22). But she makes this claim by considering the inherent constraints on such an approach within Soviet Russia in the early and mid-twentieth century. As Proctor emphasizes, the contribution of her study is not to draw our attention to new primary sources or texts, but to offer a new reading of Luria’s existing texts, already published in English, and thereby rehabilitate Luria as a potentially important figure for contemporary scholarship.

In the Chapter ‘The Criminal’, based on experiments from Luria’s The Nature of the Human Conflicts, Proctor shows how Jungian theory was embedded in the criminology and associative techniques involved in the development of a predecessor of the polygraph machine. The devastation caused by the October Revolution had resulted in a wave of crime, and the details of criminal acts available to Luria often seemed senseless: “a baker accused of killing his wife; a man found in a pile of snow having been hit with a sledgehammer; a factory worker who broke a window at his workplace to steal a ventilator; a man who killed his fiancée and threw her dead body into water tied to a cast-iron wheel” etc. (p. 48). Luria’s ambition was to incorporate psychoanalytic theory into his work as a Soviet psychologist, even though it was to criminals rather than patients that he turned. Proctor notices, though, that Luria’s focus was on whether the people he observed had commited murder, rather than on why they had commited murder. Thus, Luria consequently failed to reflect on the role of the social order in fostering criminal behaviour, being focused instead only on the application of psychological theories, and in experimental proofs of his associative technique. The author also points out that his theoretical views expressed in the paper ‘Psychoanalysis as a System of Monistic Psychology’ in 1924 are in conflict with his later clinical writings.

In Luria’s defence, this lack of social reflection may have derived from his own need to shield himself from the devastating loss and disruption which accompanied the post-Revolutionary years. Besides, between the 1920s, a period of active involvement in the psychoanalytic movement in Russia and the publication of The Nature of Human Conflicts in 1932, significant changes occurred. The experimental psychoanalytic project Detski Dom (or International Solidarity Laboratory) and the State Psychoanalytic Institute in Moscow was shut down in 1925 by decree of Narkom RSFSR. It was a time of growing attacks on psychoanalysis, and Luria resigned from the Russian Psychoanalytic Society in 1927, the year of the exile of Trotsky, a political associate of psychoanalysis. Then, in 1930, Psychoanalytic Society was shut down. These socio-historical circumstances of Luria’s career are downplayed in the book.

To Proctor, Luria’s psychological approach was never primarily psychoanalytic. Luria’s ambition to engage psychoanalysis with Marxism and other psychological theories, such as Gestalt, resulted in an alternative model, which “paradoxically failed to retain the elements of Freud’s theory… praised for being dialectical in the first place (the ongoing tension between the life and death instincts)” (p. 43). The paper she refers to is Luria and Vygotsky’s introduction to the Russian translation of Freud’s Beyond the Pleasure Principle published in 1925. My reading of this paper is different. I’d argue that Luria and Vygotsky’s failure is not in their impossibility to retain to the dialectic of life and death drives, as there is no sign in this text that they deny this tension. The resulting ‘third’ in this dialectical tension for them – the belief in the possibility of sublimation of the death drive – is what constitutes their failure for Proctor. She contrasts this theoretical optimism with the apparent regression that has occurred in society as a result of the revolutionary movement. This illuminates further that their theoretical hopes for the ability of psychoanalysis to provide a basis for monistic psychology were dashed more by the growing reality of Stalinism than by their theoretical failure to remain faithful to psychoanalysis.

The chapter ‘The Primitive’ explores Luria’s failure to find his place under the Soviet political regime. Central Asian expeditions of 1931 and 1932, were, as Proctor writes, Luria’s most explicit political endeavour: an attempt to demonstrate the cognitive benefits of collectivisation. The results, however, did not satisfy the State and his work was denounced before he published his findings. While not being able to contribute to the First Five Year Plan, Luria’s findings in this expedition were for Vygotsky of the highest importance and deepened his understanding of the interrelations between language and thought. Proctor’s analysis of the interrelations between ‘primitive’ people and the Soviet idea of collectivisation in Luria’s work elaborates the nuances of the revolutionary movement in its oppressive rather than ‘progressive’ character.

The chapter ‘the Child’ illuminates the period of Luria’s experimental work with children and his published work with Vygotsky. Conducted between 1923 and 1936, a time of relative freedom of thought and the institutionalisation of psychoanalysis in Russia, as well as progress in pedology, these observations and experiments focused on the the future citizens of the Soviet state, and therefore with understanding the processes of child development. Proctor covers an extraordinary range of material, providing not only a clear picture of Luria and Vygotsky’s position on the role of language, play and historical context for mental development, but also vividly imagining the atmosphere in which Soviet children were raised, the toys they played with, the tales they read, and just how many of them survived without parents. We also learn how the Soviet state gradually abandoned its ‘kids’, as successive decrees constricted Luria’s and Vygotsky’s scientific activity.

By the late 1930s, a period when psychology as a discipline disappeared in Soviet Russia, and calling Freud by his name was equated with high treason, Luria lost both of his foundations – psychology and psychoanalysis, and also lost his dear colleague Vygotsky. He found shelter in medicine, and the patriotic appeal of World War II left him no choice but to discover a new object of research – the brain. However, some of Luria’s work on the brain kept its distance from dry neurological language and instead, as Proctor notes of his late case histories, ‘Luria composed the text in a self-consciously literary style.’ I would argue that this was possible due to the relative freedom of after-Stalin years, which allowed for more open expression of Luria’s long-standing beliefs.

The chapter ‘the Aphasic’ focuses on a rather unusual story of a brain-injured patient, Zasetsky. It shows how far Luria the neurologist was from studying the inanimate tissues of the brain, and how close he was instead to questions about the animate vicissitudes of the individual. It is no wonder, as Proctor writes, that Oliver Sacks in the introduction to The Man with a Shattered World, claims Luria’s work was ‘always and centrally concerned with identity’ and suffused with ‘warmth, feeling and moral beauty’. ” (p. 169) I would suggest that an optimistic belief in the ability of ‘monistic psychology’ to hold to the ‘dialectic of the whole organism’ was still alive for Luria, and resulted in his approach to brain injuries. At that time Luria was also in favour of the idea of functional systems. According to this theory, restoration of lost functions was possible through compensation and reorganisation of nervous connections. Luria’s texts Traumatic Aphasia and Restoration of Function after Brain Injury illustrate this approach and demonstrate successful results of restorations of functions after brain damage, including the restoration of a sense of self. Luria’s approach to aphasia departs from the localisation of damages and, I would argue, his understanding and classification of aphasia are based on the same principles as proposed by Freud in 1891. Luria’s later texts could be read fruitfully alongside Freud’s texts, despite Proctor’s suggestion that their theoretical grounds had moved apart. This fact is also noted in the article of Solms (2000), to whom Proctor refers in a previous chapter, but who is left unmentioned in this one.

The chapter ‘the Synaesthete’ continues to draw on the ‘brain’ period of Luria’s career and his synaesthetic patient Solomon Shereshevsky, going back and forth in time describing his friendship with Eisenstein and his engagement with Freud’s texts and the lost tradition of ‘romantic science’. In these case histories, Luria eventually succeeds as an exemplary scholar within the tradition of his own social-historical approach, as he is not concerned with describing symptoms in isolation from a person’s whole personality, but to ‘allow for the preservation of ‘the manifold richness of the subject’. In my view, the case histories discussed in these two chapters are an illustration of the historical continuity of theoretical views of Luria.

Psychologies in Revolution is indeed so much more than just a study of Luria’s heritage or a socio-historical analysis of the period in which he lived. Proctor’s main proposal is that Luria’s ‘romantic’ science offers a model for approaching human nature and can therefore contribute to the current rupture between the ‘brain’ and the ‘subject’, and the departure of the neurosciences from the social sciences. It is a pertinent study offering Luria’s ‘romantic science’ to scholars in the neurosciences and medical sciences searching to approach their subjects in a more humane way. However, the complexity of the Soviet years remain to be explored further, and it is still necessary to investigate archival resources and personal connections of Luria beyond those who are already well known, and to translate more of his theoretical heritage into English. It would also be interesting to bring his neuropsychological studies back into discussion within the psychoanalytic field. There is still much scope for incorporating Luria’s ideas into a contemporary theory of mind.

Lizaveta Zeldzina is a psychologist and a PhD candidate at Birkbeck, University of London. Her research is dedicated to the vicissitudes of psychoanalysis in Soviet Russia 1930-1980. It explores Soviet studies of the unconscious in psychology and physiology, and theoretical engagement with the psychoanalysis of Alexander Luria, Bluma Zeigarnik, Pyotr Anokhin, Filipp Bassin and Dmitry Uznadze in the socio-historical context of their times.