26 Comments

This is wonderful and I'm so glad to hear the writer is doing well!

However I'm confused about how the logic is supposed to go here. The Szaszian model is, I thought, that people are depressed/anxious/etc because they *prefer* the life that affords them, for whatever reason. So in what sense can someone look at their situation, and after reading Szasz think "I guess I really just prefer depression", and use this as motivation to work on resolving their depression? This seems like clear evidence that they did *not* prefer depression!

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I am very glad your reader was able to solve his own challenges and build a better life. Frankly, it sounds like he invented his own version of Cognitive Behavioral Therapy and implemented it. Most people would not have the creativity and force of will to do that without help.

Until I was middle-aged, I suffered from what some call Social Anxiety Disorder. I've always been a strong public speaker, but in one-on-one interactions I would freeze up. Couldn't handle small talk at all. I got paranoid about every word coming out of my mouth, thinking everything was disastrously clumsy and I was being judged for it. The casual interactions that are necessary in my line of work were too much for me. It was very limiting, both personally and professionally.

I had tried therapy in college and found it a total waste of time. Then when I was in my mid 40s, I found a CBT therapist who was great. His technique was to help you identify self-defeating patterns of thought and do various real-world exercises to subdue and conquer them. Pretty much what your reader describes. The CBT folks waste no time at all on exploring your childhood or what might be the cause of your problems; they go straight to fixing them, by helping you develop a kind of discipline over your thought processes, to end self-sabotage.

It took about 6 or 7 sessions and the "homework assignments" in between to change my life. I was thrilled but also wished I could have found that help when I was in my teens or twenties. There is quite a bit of empirical evidence backing the effectiveness of CBT approaches.

As for Szasz, I think he was one of the necessary critics to tear down useless approaches to psychology and therapy. [Most notoriously, Freudian therapy has been proven useless; Freud, like Marx, seems like nothing but a pseudo-scientific quack.] I'm not aware that Szasz built anything effective as a replacement. Whether "Social Anxiety Disorder" is a "mental illness" seems like an irrelevant battle over definitions. The relevant question is, if it's an unwanted condition or pattern of behaviors, can outside, expert interventions help address it? Such approaches are available now.

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>Social Anxiety Disorder

I accidentally walked into a biker bar...

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> Cognitive Behavioral Therapy

How about rational moral values and virtues?

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GIven the lack of an equivalent to Scott Alexander's disclaimer that "Let it be known to all that I am never secretly admitting Bryan Caplan is right about mental illness", can we interpret Bryan Caplan's statement about Szasz's thought being a 'noble lie' as secretly admitting Scott Alexander is right about mental illness?

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Suppose that after thinking carefully about the matter you reach the judgment that smoking a cigarette right now would lead to a worse outcome, for you and for the world as a whole, than not doing so. Nevertheless, because of weakness of will, you take out a cigarette and smoke it. It would be misleading to call the impulse on which you are acting “your preference.” Admittedly, it would be even more misleading to call it “mental illness.”

While all metaphors are potentially misleading, I consider both of these to be objectionably so.

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I would assume the Caplan and Szasz would consider you to have a meta-preference here. You have a preference not to have a preference that you currently have for a cigarette. If you were under a gun point, you would have no trouble acting according to your meta-preference, because dying to relieve your craving isn't worth it. But due to your current incentive structure, you keep on ignoring your meta-preference in favor of your current preference. The craving is just too hard to resist, and the immediate consequences for violating your meta-preference are low.

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I think Caplan is taking *preferences* to be *revealed preferences*; the supposed “meta-preferences” would (mostly) not count. By the way, do you take it that meta-preferences *should* trump mere preferences?

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There's definitely something missing from the Szaszian taxonomy or at least Caplan's account, that's probably best resolved by being a pluralist of sorts, nevertheless with respects to many "addictions" and such, it really does seem like many people just have strong preferences and are just using medical language to justify their preferences and gain sympathy etc.

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Many people want to change their preferences, though. It doesn’t make sense to describe something as a preference unless it doesn’t involve any cognitive dissonance.

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That a certain view helps is not an argument for its truth.

Lots of people are helped by religion as well.

Edit: You mention also that it may be a noble lie.

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That's great. Good for that guy.

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My last single was a tribute to Szasz's exhaltation of the healing word: https://www.youtube.com/watch?v=Ah1CrPBN-no&pp=ygUKaWF0cm9sb2dvcw%3D%3D

There are English subtitles for non-Spanish speakers

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Don't forget Words to the Wise!

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I wish Bryan dealt with the counterposition as held by Scott Alexander more carefully. I mean, I love Bryan, and it seems so out of character for him to not this more thought

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Thank you for the book recommendations.

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I'm happy for the student-- I mean it.

Of course it would be trivially easy to find someone who has been hurt rather than helped by the same arguments, and so we shouldn't draw any conclusions from this data point.

Best,

Chris

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Most are faking mental illness to avoid work and get on disability benefits

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Thank you for providing the inevitable reductio for Brian’s thuggish, ignorant view

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PS. Do you have data to support this assertion of yours?

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> the Szaszian view that so-called “mental illnesses” usually boil down to extreme preferences.

So unprincipled compromises are psychologically healthy? Should the focused mind be compromised with "voices in my head," as the recent Maine shooter of 20 people said of his guide to murder? How about "cognitive contact w/reality," as psychologist, N. Branden, discussed?

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Congratulations! You agree with the Church of Scientology about something.

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They're practicing their own form of quackery, of course. But surely you've noticed that the field of psychiatry/psychology has been susceptible to some pretty nutty fads, including repressed memories, lobotomies, and more stuff today.

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I know a lot about psychiatry and I haven’t noticed any egregious fads operating today. What did you have in mind?

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Some of those kids really are mentally ill, though. Not all, but some.

I think the real problem there is the wokies who respond as if it’s some kind of gross human rights violation if all of society doesn’t go along with the stories trans people tell themselves so they can get through the day.

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