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Reviews of the Literature
Schizophrenia: The Sacred Symbol of Psychiatry Thomas Szasz. (Basic Books, 1976)
The Eden Express. Mark Vonnegut. (NY: Praeger, 1975, paper 1976 Bantam, NY)

by Ross V. Speck

If Laing is loco, and Szasz is sappy, and Eden is a mythology, then we begin our pilgrimage. As in most of his previous books, Szasz has written a highly readable, intelligent, polemic, moralistic work. Schizophrenia: The Sacred Symbol of Psychiatry relentlessly pursues the psychiatric profession as the inventor, purveyor, promulgator, and persecutor of persons "whose lives are disordered" (p.74). The author states flatly that schizophrenia is not a disease (p.184), but that the term is not meaningless, just as the term marriage is not meaningless. "As husbands and wives create each other through the existential bond between them, so mad men and mad-doctors also create each other." To this point in the argument Szasz can have little to quibble with R.D. Laing's most quoted definition of schizophrenia (also an existential one) "a special strategy that the patient invents in order to live an unlivable situation."

And yet Szasz spends 38 pages plus numerous references throughout the book attacking antipsychiatry for the same reasons he attacks psychiatry. Also, according to Szasz, the followers of Laing are invariably leftists, and Laing himself is a poetic, mystical theologian. Szasz does not seem aware that a schism occurred between Laing and Cooper as far back as 1967 (Dialectics of Liberation) or even earlier with Aaron Esterson (Sanity, Madness and the Family). There may be some truth to the suggestion that Laing's Glasgow, Scottish, and perhaps mystical or mythical Presbyterian cultural heritage contribute to his moral, even theological stance (Why was I born? To praise God), as well as to his preoccupation with the creation, prenatal consciousness, etc.(The Facts of Life). And maybe he is a leftist in his political sympathies.

However, throughout Szasz's book there is an austere, almost Holy Roman Empire morality, castigating the heretics, the psychiatrists-from Kraepelin and Bleuler to Kallman, Laing, and Cooper. Whereas Laing and Szasz's views on labeling in psy chiatry, persecution, involuntary incarcera tion, "primum non nocere" evolved at about the same time and werc expressed idiosyncratically on different sides of the Atlantic, we now see Szasz-with his Jesuitical-style theology (1 do not know any-thing about this personally except what I experience) and rightist political views- attacking Laing, the fundamental Presbyterian with leftist views. The attacks on Laing have a dedication, perhaps even a viciousness (Lionel Trilling is extensively quoted to substantiate them) but, again, they seem to stein from a difference in philosophical stance-Szasz as logician; Laing more phenomenological, strongly influenced by Edmund Husserl.

Since the central question of this book is whether schizophrenia is a disease, Szasz seems to be using something of a red- herring in comparing Kraepelin, Bleuler, and conventional psychiatry on the 'right' with Laing, Cooper, and anti-psychiatry on the psychiatric 'left' (pp 60-61). What is the relevance of either right or left wing political stance to the issue of whether schizophrenia is a disease? Szasz obviously feels that antipsychiatry is more dangerous than conventional psychiatry. He thinks of anti-psychiatrists as the Romanoff-Lenin effect; "He who liber ates you despotically from another despot will surpass in his cruelty the worst cruel ties of his erstwhile antagonist" (p.61). But Szasz is himself an anti-psychiatrist. Certainly his views on conventional psychiatry, from The Myth of Mental Illness to this new book, would superbly qualify him.

I have known Laing as a friend since 1962, and I believe that Szasz has missed the compassion and the complexity that is in Laing. I see far more similarities between Laing's and Szasz's views on schizophrenia than differences. One major difference might be in Szasz's apparent willingness to rely on due legal process in dealing with persons who disturb the social order. Laing's asylum concept at least at tempts to allow persons to experience deeply their madness in the hope they will come out on the other side as reborn, having gone though what they had to go through, with a minimum of pharmacologic or "biologic" intervention. The emphasis is on the community or milieu. It is democratic and bears some similarities to Maxwell Jones's therapeutic community method.

I felt frustrated, reading Szasz, in trying to get his definition of key words - schizophrenia, psychiatry, psychiatrist, psychotic, healthy, sick, soul, mental, etc. Yet I think he and I are in agreement about the dangers of labeling, of defining our terms too finely, of categorizing, especially when there is no pathology (in the medical sense). Szasz begins his book with:

What is schizophrenia? What does the term schizophrenia mean?.... we might say that schizophrenia is a word-an idea and a disease-invented by Eugen Bleuler, just as psychoanalysis is a word-an idea and a "treatment" -invented by Sigmund Freud, and Coca Cola is a name - an idea and a soft drink - invented by whoever invented it. (p.3) . - the psychiatrist treats healthy people as if they were sick patients, imprisons them as if they were convicted offenders, and uses the name "schizophrenia" to conceal his deeds. (p.42)

Szasz's opening chapter, "Psychiatry: The Model of the Syphilitic Mind," develops the thesis that psychiatry has literally accepted the model of syphilis as brain disease and applied the same model to schizophrenia. He maintains that the symbol which most distinguishes psychiatrists from other doctors is the concept of schizophrenia, and that the ritual is exemplified by diagnosing this disease.

When a priest blesses water, it turns into holy water- and thus becomes the carrier of the most beneficent powers. Similarly, when a psychiatrist curses a person, he turns into a schizophrenic-and thus becomes the carrier of the most maleficent powers. (pp. xiii-xiv)

Szasz is political with words and can move swiftly from a medical to a religious metaphor (or even a legal or social one).

The fifth and final chapter, "Madness, Misbehavior, and Mental Illness," presents Szasz's own position on "so-called psychiatric problems:

First, in a free society, the relations between experts and clients must be maximally contractual and minimally coercive. Penological interventions (and certain other state-coerced measures, such as collection of taxes or drafting of soldiers) ought to be sharply distinguished from those that clients seek for their own benefit and are free to accept or reject. Second, in such a society, psychiatric practices that 'patients' seek and professionals supply, and that both wish to define as medical, would be allowed to fall into whatever class the parties concerned want to place them, whereas those practices that either party rejects would be punished by law ...

Third, the words and deeds of both psychotic and psychiatrist should be frankly recognized for what they usually are: coercions and countercoercions-sometimes literal, sometimes metaphoric. (pp.196-97)

I have quoted from Szasz extensively be cause it is difficult to condense his positions on schizophrenia-which, as he says, is just a word waiting for a psychiatrist to literalize it and turn it into a religious symbol. The whole thesis of this book seems to me to have a basis in Jesuitical logic-i.e., if theorem A is accepted, then B, C, D will follow. If we accept that psychiatrists view schizophrenia from the medical view of the syphilis model, then the absence of a demonstrable brain lesion leads to the conclusion that there is no illness. It then follows that schizophrenics are persons with stubborn dedication and unacceptable behavior. This behavior may be painful to themselves or others. But it is morally wrong.

It is this issue of morality in Szasz (if "they" would just stop being so stubborn, get their act together, stop being so dedicated, such hyper-honest discontented seekers) that makes me fear a new inquisition. We are becoming a society of lawyers, bogged down by legalistic concepts from insurance to equal rights-and it is the process of the law that is too frequently proclaimed, instead of the content.

The Eden Express is a moving account of a young man's struggle with madness. The author is a very talented writer, who also happens to be Kurt Vonnegut's son. I'm not convinced that the psychotic episodes described were a "pure" schizophrenia. There is ample evidence of psychedelic drug use, bad trips, malnutrition, sensitivity to a variety of mind-altering drugs. A case might be made for manic-depressive episodes. There certainly was elation, megalomania, push of speech, euphoria, even ecstasy. That Mark Vonnegut is now enrolled in Harvard Medical School and appears to be able to so clearly and keenly divide the lines of his madness from what is "normal" for him seems to violate all the old teachings that recovery from schizophrenia is always with deficit or scarring of the personality. The claims for a biochemical deficiency, and "cure" by rnegavitamins, are suspect to me. I've seen too many persons labeled schizophrenic who have failed to get any benefit from treatment in the well-known megavitamin clinics. The staff's enthusiasm (which may account for the placebo effect or psychotherapeutic persuasion) is frequently manifested by even putting themselves and their own families on megavitamins and psychotropic drugs. I once knew a professor of psychiatry who administered electro-convulsive therapy to himself because he said it made him feel good, and because he wanted to prove to his patients that it was harmless.

Personal accounts of journeys through madness have been written by numerous sufferers, including Perceval, the son of an 18th Century Prime Minister; Schreber, a judge, the son of a 19th Century German child-rearing expert; Mary Barnes, a British painter, writer, poet; Hannah Green, a contemporary American novelist; and many others, from Clifford Beers to Sylvia Plath.

It is interesting that young Vonnegut, once a dévoté of Laing and Szasz on philosophical grounds, now rejects their teachings ("Schizophrenia is a sane response to an insane society." "Mental illness is a myth." "The Sanskrit word for crazy means touched by the gods.") Vonnegut led a group of 1969 Swarthmore College graduates to Eden, the Promised Land, in British Columbia. He and his group were doing the super-hippie trip, and generally were economically and intellectually superior to their college peers. They were an in-group, defended against most outsiders. Their sociopolitical and moral stance was perhaps reflected by their superstar, Mark Vonnegut. And they persevered with him even when it was obvious to all that he was psychotic. Now Vonnegut tries to tell us it was all biochemical.

"Why I Want to Bite R. D. Laing" was the title of an article by Mark Vonnegut in Harper's Magazine in April 1974. The following is an excerpt:

He's said so many nice things about us: we're the only sane members of an insane society, our insights are profound and right on, we're prophetic, courageous explaorers of inner space, and so forth... But what I felt when I found myself staring out of the little hole in the padded cell was betrayal. I did everything just like you said, and look where I am now, you bastard." (Going Crazy: An Inquiry Into Madness in Our Time, Otto Friedrich, Avon books, NY 1975, p.97)

Who has the answer to what is schizophrenia? Vonnegut? Szasz? Laing? Pauling? Others? It seems to mean different things to different people - psychiatrists and schizophrenic persons alike. The crucial factors still are - who can the patient trust, and what intervention seems to work best? Alas, the final word on schizophrenia is not yet here. However these are both valuable books; the one telling it like it is, the other telling it like it isn't.

"When I use a words," said Humpty Dumpty, "it means just what I intend it to mean, neighter more nor less." "The question is," said Alice, "whether you can make words mean so many different things?" "The question is," said Humpty Dumpty, "which is to be master, that's all."


Review of the Literature in
American Jounral of Orothopsychiatry
Ross V. Speck, M.D., Philadelphia
(date unknown)

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