Thomas Szasz on diagnostic malpractice

In this keynote address, Professor Thomas Szasz appeals to the history of psychiatry in making his argument against the labeling of children as having, for example, ADD/ADHD. (In the speech, he calls this “stigmatization not diagnosis.”) But does the history to which he refers simply show progress in the medicalization of moral treatment? Or is it, as he claims, evidence of something more sinister?

Disclaimers:

  1. This video has been edited, but not by us. (The full text of this speech, or one very much like it, can be found here.)
  2. Professor Szasz is famous for, among other things, his anti-psychiatry bias. That, however, is not what’s on display for our purposes here.

AHP has covered similar issues in the past, most notably here (on changing the DSM), here (on how psychiatry is financed), and here (on the removal of homosexuality from the DSM). A bibliography of readings related to Professor Szasz’ comments, for interested students, is appended below the fold.


Bibliography: Kramer-Pollnow/Hyperactivity/ADD/ADHD

 

  • Healy, D. (2006). [Review of the book Framing ADHD Children by Adam Rafalovich.] Social History of Medicine, 19(1), 177-178. This is a book to concern anyone with an interest in a history of childhood mental or behavioural disorders and their treatment, but it is not the history of ADHD and related therapies. It is a sociological analysis of the current situations that physicians, clinical psychologists, teachers, parents and children, caught up in what is at present largely a North American phenomenon, find themselves in as regards the diagnosis and treatment of ADHD. In investigating this specific diagnosis, the book provides a valuable building block for those seeking to understand the broader processes of the bio-medicalisation of childhood disorders.
  • Lakoff, A. (2000). Adaptive will: The evolution of attention deficit disorder. Journal of the History of the Behavioral Sciences, 36(2), 149-169. The increasing prevalence of attention-deficit disorder among American school children was a source of significant controversy in the 1990s. This paper looks at the social and historical contexts in which ADD evolved in order to understand its emergence as a coherent and widespread entity. Changes in expert models of child behavior interacted with the formation of new identities around disability to shape a milieu in which the disorder could thrive.
  • Mayes, R. & Rafalovich, A. (2007). Suffer the restless children: the evolution of ADHD and paediatric stimulant use, 1900-80. History of Psychiatry, 18(4), 435-457. This article traces the historical evolution of Attention Deficit/Hyperactivity Disorder (ADHD) and the controversial use of stimulants as a treatment for children diagnosed with the disorder in North America. While the children in question have exhibited similar behaviour over the last century, the diagnostic labels used to identify them have changed due largely to cultural, medical and scientific changes and discoveries. For decades, children’s treatment with psychotropic drugs was sufficiently controversial that pharmaceutical companies would not finance research in the area. The only substantial source of research funding for paediatric psychopharmacology in the USA from the 1950s to the 1970s was the National Institute of Mental Health (NIMH). In 1970, the first in a long-running series of controversies erupted over children’s treatment with stimulants.
  • Neumärker, L.-J. (2005). The Kramer-Pollnow syndrome: a contribution on the life and work of Franz Kramer and Hans Pollnow. History of Psychiatry, 16(4), 435-451. In 1932 Franz Kramer (1878–1967) and Hans Pollnow (1902–43) described a hyperkinetic syndrome in children. Basically the symptoms described coincide with what is nowadays regarded as Attention Deficit Hyperactivity Disorder (ADHD) or Hyperkinetic syndrome. The authors of the study thus went down in the history of child and adolescent psychiatry with their eponymous Kramer-Pollnow syndrome, and have had a lasting influence on the development of the concepts relating to this topic. Both worked together at the psychiatric and neurological hospital at Berlin’s Charité under its head Karl Bonhoeffer, but as they were both Jewish they were forced to emigrate after the Nazis seized power. Until now, little has been known about their further fate and careers, so this study gives the first comprehensive account of their lives, based on documents found in the archives. It also presents an overview of their work.
  • Petrina, S. (2006). The Medicalization of Education: A Historiographic Synthesis. History of Education Quarterly, 46(4), 503-531. Why does it matter whether we recognize how, when, and why education was medicalized? If we fail to recognize that merit and the regulation of mobility only partially account for the persistence and power of examination and remediation industries in North American education, we cannot understand the increasingly complex role that medicine plays in the lives of students. We will merely wonder at the fact that between 5 and 10 percent of North American school-age students are diagnosed with ADHD and about three million are prescribed Ritalin and generic derivatives of methylphenidate. Historians and educators ought to understand that a process of medicating kids for school is completely interdependent with a complex of psychotherapeutic practices and historical contingencies. This historiographic synthesis should leave little doubt that this practice has a deep and complex history that demands sustained attention.
  • Vanobbergen, B. (2007). ‘Soon He Will Boil over like a Kettle': Visualizing the Invisible—The Representation of Hyperactivity in Women’s Magazines and Professional Journals for Teachers in Flanders (1965-2005). History of Education, 36(2), 173-189. This article takes a relational approach to childhood to focus on the discourse surrounding children’s ‘hyperactive’ bodies, currently defined as children with Attention Deficit Hyperactvity Disorder (ADHD). Based on analyses of articles in the major women’s magazines and professional journals for teachers, published in Flanders from 1965 until the present, the article examines how the notion of ‘the hyperactive child’ has been constructed and reconstructed during the last four decades.

See also:

  • DeGrandpre, R. (2006). The cult of pharmacology: how America became the world’s most troubled drug culture. Durham, NC: Duke University Press. Drugs have come to be regarded as “all-powerful” substances, their effects on the user and society determined simply by their pharmacology. DeGrandpre exposes the fallacy of such a belief through an analysis of the characterization of drugs as either “demons” or “angels”. Cocaine, he maintains, is seen as a “demon” drug, a dangerous and addictive substance that corrupts all those who come into contact with it. Ritalin, on the other hand, is regarded as an “angel”, widely used in the treatment of children with Attention Deficit Hyperactivity Disorder (ADHD). Yet, according to DeGrandpre, chemically the two drugs are very similar: it is social context which has shaped their meaning, not pharmacology.

Related at AHP: Bibliography: Psychopharmacology

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About Jeremy Burman

Jeremy Trevelyan Burman is a senior doctoral student in York University’s Department of Psychology, specializing in the history of developmental psychology and its theory (especially that pertaining to Jean Piaget). Prior to returning to academia, he was a producer at the Canadian Broadcasting Corporation.

5 thoughts on “Thomas Szasz on diagnostic malpractice

  1. Something that goes unremarked upon here and in the youtube comments is that this an address before the Citizens Commission on Human Rights, the anti-psychiatry wing of Scientology. Of course, that alone does not mean his views are compromised. He does, however, deploy “behavior” to describe the object of diagnosis, although others would use “symptom” to describe the object. There’s certainly a deep question about the role of the will, or the deformity and weakness thereof (in Aristotle, akrasia; cf. crazy), in mental illness, but Szasz suggests here that all such behavior is, in some sense, voluntary or willed, and, if willed, then a moral question.

  2. You can watch Frontline’s investigation, The Medicated Child (2008), at their website here.

    They describe the program as follows:

    Six million American children are taking psychiatric drugs, but most have never been tested on children. Is this good medicine—or an uncontrolled experiment?

    This follows an earlier investigation, Medicating Kids (2001), which is also available online. Find it here.

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