THE MYTH OF MENTAL ILLNESSTHOMAS S. SZASZState University of New York, Upstate Medical Center, SyracuseMY aim in this essay is to raise the ques-tion "Is there such a thing as mentalillness?" and to argue that there is not.Since the notion of mental illness is extremelywidely used nowadays, inquiry into the ways inwhich this term is employed would seem to be es-pecially indicated. Mental illness, of course, is notliterally a "thing"—or physical object—and henceit can "exist" only in the same sort of way in whichother theoretical concepts exist. Yet, familiartheories are in the habit of posing, sooner or later—at least to those who come to believe in them•—as "objective truths" (or "facts"). During cer-tain historical periods, explanatory conceptions suchas deities, witches, and microorganisms appearednot only as theories but as self-evident causes ofa vast number of events. I submit that todaymental illness is widely regarded in a somewhatsimilar fashion, that is, as the cause of innumerablediverse happenings. As an antidote to the com-placent use of the notion of mental illness—whether as a self-evident phenomenon, theory, orcause—-let us ask this question: What is meantwhen it is asserted that someone is mentally ill?In what follows I shall describe briefly the mainuses to which the concept of mental illness has beenput. I shall argue that this notion has outlivedwhatever usefulness it might have had and that itnow functions merely as a convenient myth,MENTAL ILLNESS AS A SIGN OF BRAIN DISEASEThe notion of mental illness derives it main sup-port from such phenomena as syphilis of the brainor delirious conditions—intoxications, for instance—in which persons are known to manifest variouspeculiarities or disorders of thinking and behavior.Correctly speaking, however, these are diseases ofthe brain, not of the mind. According to oneschool of thought, all so-called mental illness is ofthis type. The assumption is made that someneurological defect, perhaps a very subtle one, willultimately be found for all the disorders of think-ing and behavior. Many contemporary psychia-trists, physicians, and other scientists hold thisview. This position implies that people cannothave troubles—expressed in what are now called"mental illnesses"—because of differences in per-sonal needs, opinions, social aspirations, values, andso on. All problems in living are attributed tophysicochemical processes which in due time willbe discovered by medical research."Mental illnesses" are thus regarded as basicallyno different than all other diseases (that is, of thebody). The only difference, in this view, betweenmental and bodily diseases is that the former, af-fecting the brain, manifest themselves by meansof mental symptoms; whereas the latter, affectingother organ systems (for example, the skin, liver,etc.), manifest themselves by means of symptomsreferable to those parts of the body. This viewrests on and expresses what are, in my opinion,two fundamental errors.In the first place, what central nervous systemsymptoms would correspond to a skin eruption ora fracture? It would not be some emotion orcomplex bit of behavior. Rather, it would be blind-ness or a paralysis of some part of the body. Thecrux of the matter is that a disease of the brain,analogous to a disease of the skin or bone, is aneurological defect, and not a problem in living.For example, a deject in a person's visual field maybe satisfactorily explained by correlating it withcertain definite lesions in the nervous system. Onthe other hand, a person's belie}—whether this be abelief in Christianity, in Communism, or in theidea that his internal organs are "rotting" andthat his body is, in fact, already "dead"—cannotbe explained by a defect or disease of the nervoussystem. Explanations of this sort of occurrence—assuming that one is interested in the belief itselfand does not regard it simply as a "symptom" orexpression of something else that is more interesting—must be sought along different lines.The second error in regarding complex psycho-social behavior, consisting of communications aboutourselves and the world about us, as mere symptoms113114THE AMERICAN PSYCHOLOGISTof neurological functioning is epistemological. Inother words, it is an error pertaining not to anymistakes in observation or reasoning, as such, butrather to the way in which we organize and expressour knowledge. In the present case, the error liesin making a symmetrical dualism between mentaland physical (or bodily) symptoms, a dualismwhich is merely a habit of speech and to which noknown observations can be found to correspond.Let us see if this is so. In medical practice, whenwe speak of physical disturbances, we mean eithersigns (for example, a fever) or symptoms (for ex-ample, pain). We speak of mental symptoms, onthe other hand, when we refer to a patient's com-munications about himself, others, and the worldabout him. He might state that he is Napoleonor that he is being persecuted by the Communists.These would be considered mental symptoms onlyif the observer believed that the patient was notNapoleon or that he was not being perseucted bythe Communists. This makes it apparent that thestatement that "X is a mental symptom" involvesrendering a judgment. The judgment entails, more-over, a covert comparison or matching of the pa-tient's ideas, concepts, or beliefs with those of theobserver and the society in which they live. Thenotion of mental symptom is therefore inextricablytied to the social (including ethical] context inwhich it is made in much the same way as thenotion of bodily symptom is tied to an anatomicaland genetic context (Szasz, 19S7a, 1957b).To sum up what has been said thus far: I havetried to show that for those who regard mentalsymptoms as signs of brain disease, the concept ofmental illness is unnecessary and misleading. Forwhat they mean is that people so labeled sufferfrom diseases of the brain; and, if that is what theymean, it would seem better for the sake of clarityto say that and not something else.MENTAL ILLNESS AS A NAME FOR PROBLEMSIN LIVINGThe term "mental illness" is widely used to de-scribe something which is very different than adisease of the brain. Many people today take itfor granted that living is an arduous process. Itshardship for modern man, moreover, derives notso much from a struggle for biological survival asfrom the stresses and strains inherent in the socialintercourse of complex human