Bryan Caplan  

The Psychiatry Museum vs. the Reasonable Radical

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During my last visit to LA, I visited the Psychiatry: An Industry of Death Museum.  Though I knew the Church of Scientology was heavily involved, I was still favorably predisposed.  I reject the philosophy of mind that underlies modern psychiatry, and I'm very skeptical about the net long-run benefits of psychiatric treatment.  I'm not just an explicit Szaszian; I won the 2005 Szasz Prize.  If I wouldn't appreciate this aggressively-named museum, who would?

Unfortunately, Psychiatry: An Industry of Death was a big disappointment.  I was pleased to see multiple video clips of the great Thomas Szasz.  I was fascinated by the gruesome tools of early psychiatry.  But I can't imagine any normal American finding the museum remotely persuasive.

Why not?  First and foremost, because the museum defends a radical position without admitting that it's radical!  This is a bad strategy even when your audience is a blank slate; if you manage to pique their curiosity, they'll still quickly discover that you were misrepresenting controversy as consensus.   But if your audience is already familiar with the standard story, defending a radical position without admitting it's radical is rhetorically disastrous.  You instantly sound like a brainwashed cultist, too caught up in your own weirdness to even comprehend the standard view.  And that's precisely how Psychiatry: An Industry of Death sounds.  Since almost every American adult takes the disease model of mental illness for granted, you can't credibly start with the flat-out denial of that premise.

Instead, the reasonable radical must take a circuitous path. 

Step 1: Fairly describe the conventional view - and grant that it is the conventional view. 

Step 2: Make many common-sense observations inconsistent with the conventional view. 

Step 3: Show that your radical view explains these anomalous observations.

Step 4: Now, double back and start pointing out deeper flaws in the conventional view.

Step 5: Consider and address counter-arguments.

Step 6: Tirelessly but calmly return to Step 2.

Take my writings on mental illness. 

Step 1: I unambiguously acknowledge that I'm criticizing the standard view that most people take for granted. 

Step 2: I make common-sense observations such as (a) alleged symptoms of mental illness are usually responsive to incentives, (b) delusions and even hallucinations aren't generally considered symptoms of mental illness as long as they're part of an established religion, (c) many strange lifestyles (e.g. extreme mountain climbing) aren't classified as mental illnesses, even when they're more self-destructive than other strange lifestyles (e.g. heroin addiction) that are classified as mental illnesses.

Step 3: Present my alternative view that mental illness largely (though perhaps not exclusively) amounts to extreme, socially stigmatized preferences; in other words, that the label is a moral judgment masquerading as a medical judgment.

Step 4: Cover topics like how psychiatrists "discovered" that homosexuality wasn't really a mental illness.

Step 5: Consider hard cases like visual hallucinations.

Step 6: Keep arguing - and keep listening.

You could object that I fail to live up to my own standards; I'm not the "reasonable radical" I claim to be.  But either way, my larger point holds.  If you want to sell a radical position to normal people, you have to meet them where they stand.  You have to admit that their incredulity is understandable.  And you, the radical, must assume the burden of proof.  Otherwise, you just sound crazy.

COMMENTS (16 to date)
Roy Kerns writes:

Bryan, you have provided a succinct, clear description of an excellent proposal for steps of discussion. I suspect you know that you have prescribed the process outlined in Kuhn's 'Revolutions in Scientific Thought.'

May I observe, however, a caveat. You do not recognize the psych field is a religion. It begins with the assumption that no absolutes exist (there is no God). From that it insists none have definitive responsibility (no final standard of right and wrong). No one puts it that bluntly (clearly). Instead, one hears debates about this school vs that school, with none able to say which is correct. Pointing out the absurd contradictions (your step 2) and that a given school's assertions reduce to toe may toe vs ta mah toe (your step 3) runs into a wall of faith. Instead of surrender, one meets the 'anything, anything else' response.

psmith writes:

How many people have you convinced? How many have the Scientologists convinced? writes:

Tyler Cowen and Steven Pinker noted that the English collection of irregular verbs economize by transforming with use. Caplan asserts that wise rhetoric, both substance and stance, must follow the same demands of scarce time and brainpower.

So is there an unspoken war of worldviews between behavioral economics and psychiatry?

Nate F writes:

I have to ask - have you ever had any mental "illness?" To me it sounds like someone that at worst had some minor issues that people generally grow out of.

Myself - for about the first 25 years of my life I struggled with the belief that everyone was plotting against me. It was a literal chemical "imbalance" that while I get people of your mindset will write off as not an illness, it really caused me a lot of hardship. I repeatedly made new sets of friends and broke off friendships because I believed they were plotting against me. I did not trust anyone I worked with, family, etc. I get that you might not call that an "illness" but it definitely caused me to suffer. Understanding and controlling it has turned my life around. Operating under the mental illness construct works.

I have also read your posts on depression as some sort of evolutionary thing - wow that is so off and reeks of someone that has no personal experience with mental illness trying to tell the other normal people that the crazies are faking it to get your sympathy. It reminds me of a priest that actually said being depressed was a sin because it meant you didn't appreciate the joy of God.

pyroseed13 writes:

To second what Nate F said, I find this libertarian obsession with Szasz to be troubling, and frankly, anti-science. The science of mental illness and the brain has progressed far beyond Szasz's writings. I mean, the guy basically denied the existence of mental illnesses. I agree that psychiatry can go too far at times, but to attribute all mental illnesses to just differences in preferences strikes me as insulting to people who have them.

James writes:


How would you recognize a case where the mainstream psychiatrists' view is the correct view?

For example, if my mind is malfunctioning in a way that causes me to think everyone I know is plotting harm against me I might decide to start stockpiling ammo in my basement.

A psychiatrist would say that my mind is malfunctioning (a constraint) and forming beliefs incorrectly. You would probably point out that my demand curve for bullets still slopes down and my behavior can be explained as an extreme desire for home defense supplies (a preference).

In this case, you would be wrong but it seems that you would not even know how to realize that you are wrong.

The Original CC writes:

Wow, some great comments from Nate F, pyroseed13, and James.

Bryan's rejection of the entire concept of mental illness reeks of motivated reasoning. I once read (maybe on this blog?) something along the lines of, "economics is to liberals as climate change is to conservatives as mental illness is to libertarians".

In all these cases, each camp often tries to deny the existence of some inconvenient issue instead of tackling it head-on.

So while we're on the topic, how does BC explain visual hallucinations?

And would he claim that a heroin addict simply has a "preference" for heroin over other goods?

Does BC deny that if he were forced to inject heroin several times then he too would have this bizarre "preference" for heroin over basically everything else?

Finally, has he honestly never met a depressed person who was helped by antidepressants?

Alex writes:

Where to begin?

When homosexuality was considered a mental illness the overwhelming majority of economists were either socialists or Keynesians.

Heroin addiction is not in itself a mental illness. It is a response to mental illness. So is alcoholism. (Alcohol is a very powerful antidepressant).

Calling mental illness a preference is very insulting. Think of a person with severe obsessive compulsive disorder. He washes his hands 15 hours a day. He understands his irrational behaviour and would give anything to stop, but he cant. His anxiety over contamination is just too big.
That is why its different to extreme mountain climbing. The person wants to stop, but he cant.
This exists. Thousands of people suffer from this.

Steve Z writes:

Let me attempt a response to Prof Caplan's stimulating view of metal illness through definition - for this debate smacks of a mere verbal dispute.

A mental illness just is a stable, observable discordance between an individual's method of or capacity for consensus reality testing, particularly social reality testing (the ability to perceive and "act normally"), and that of a pertinent community's, that is of the type the pertinent community classifies as a mental illness (typically because the discordance offends the sensibilities of the community, but not in a blameworthy way).

I think this definition captures and preserves all the features of mental illness, while dissolving Szaz's critiques. What remains is a normative argument over whether, and the extent to which, having a communal mechanism to enforce conformity in social reality testing is desirable. This seems to me the real issue, but unfortunately these debates always seem to get hung up on arguments back and forth about whether mental illness is akin to a broken bone.

DDD writes:

I have to admit that when I remember Bryan's position on this issue, I cant help but think less of him.

Has Bryan ever given a response to the thoughtful essay of Scott Alexander?

RPLong writes:

In response to a few commentators above, allow me to speak on behalf of the many libertarians who do not share anything like Bryan Caplan's views on psychology and mental illness. Being skeptical until having seen strong evidence is a good rationalistic practice, and many libertarians are rationalists. I don't know to what extent libertarians as a group reject psychology, but I don't count myself among them, and I wanted to put it out there that there is nothing about libertarianism that requires one to reject psychology.

Hazel Meade writes:

It seems to me like this is a kind of generalization of the position of the neurodiversity movement. If Aspergers isn't a disorder, then schizophrenia isn't a disease. And so on.

We get into some philosophical issues about what counts as an illness vs. a personality trait. Maybe Nate F just has a really suspicious disposition and that's ok, right?

But really, it NOT ok, if it's making him suffer and he wants to change. Just like it's NOT ok for an autistic child to just live with his symptoms if he's not happy. Some autistic kids are totally happy the way they are, and some aren't. Some people with Aspergers don't mind being loners and some really painfully want social acceptance. are Psychiatry provides people with tools that you can't get with "incentives". There are some mentally ill people who are violent and dangerous to others who would lead better lives not in psychiatric prison.

I find it hard to believe Caplan would prefer to keep someone in psychiatric prison over a medicated life not in prison. Nor do I believe that Caplan opposes individuals taking psychotropic drugs under the supervision of a professional for their own spiritual or mental benefit.

In sort, if you're happy with your mental illness, and it's not causing a risk of death or injury to others, don't get treated. Nobody is going to make you. But don't deny the opportunity to use psychiatric medications or seek advice from people knowledgeable about such things (i.e. psychiatrists) to others.

Not very many people seek psychiatric treatment unless they are suffering in some way.

David R. Henderson writes:

I’m with you, although the issue is about psychiatry, not psychology. Although I think the issue of mental illness has been stretched and that much of Szasz’s thinking was a good antidote, I think my co-blogger Bryan has take things way too far.

Mark Bahner writes:
I agree that psychiatry can go too far at times, but to attribute all mental illnesses to just differences in preferences strikes me as insulting to people who have them.

Yes, and to label them as "preferences" is refuted by the fact that they're generally desperately seeking help to address their problems. If they "preferred" to be depressed or to hear voices that don't exist, why would they be seeking help to stop or reduce these problems?

Thaomas writes:

These are good steps to take in any discussion where the purpose is actually to persuade and not just show off one's position. And since they are also not as much fun and harder, they are less frequently employed.

Seb Nickel writes:

I'm not aware of any reason to care much about the semantics of the term "mental illness", and I don't think I'd mind doing without it.

But this I can't make sense of: How does, e.g., feeling horrible all the time amount to a preference?

Some things commonly described as symptoms of a mental illness can clearly also be described as preferences, but some others don't fit any remotely common usage of the word "preference" at all.

We have much less control over our mental dispositions than is desirable, and some people have highly undesirable mental dispositions. Is there anything wrong with this statement?

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