So I recently listened to some podcasts with Thomas Szasz and I thought of this thread.
Now I agree for the most part with Szasz's position. The point is basically this:
There would be no problem with psychiatry if psychiatry were simply a descriptive science. There would be no problem with psychiatry if the theoretical entities of psychiatry (to wit, "mental disorders") were simply entries in a taxonomy of behavior. But psychiatry is not simply descriptive; it is normative. And it's theoretical entities are evaluative. A disorder is bad. People with disorders are sick.
But why on earth should we call the theoretical entities of psychiatry "disorders" and why should we think that the people to whom they apply are "sick"?
For instance, looking at the wikipedia page on Personality disorder, I see the following definition attributed to the DSM-IV: "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it."
This is bizarre. Clearly the definition given describes deviant behavior. On what possible grounds should we say that the behavior is also "sick"? Moreover, suppose we transplanted our sick patient into another culture or subculture where his behavior is not deviant. Would we now say that he is cured? I am reminded of something R.D. Laing said, to the effect that a bird flying out of formation might still be flying the right way.
Now to be fair, earlier in this thread ganstaman was arguing with OP and pressing the point that one wouldn't be diagnosed with a personality disorder unless one was also "distressed" about it. Well, I have no problem with this. If someone comes to you and says, "doctor, I am in distress, my brain and body are not working as intended, please help me," well of course you should help this person. And if this means giving him pills, then give him pills.
But again, to say that this person is distressed is not to say that he is sick. So now, what's the point? Well, the point is this. If I am in distress over finals and I come to you and I say, "doctor give me some modafinil" or whatever, why shouldn't you give it to me? Well, you might want to say, because I am not sick. But look, why do you say that any of your other patients are sick? Well, they have certain problems in their life that they can't overcome apparently, without medication. But look, I have this problem of the finals, and maybe no matter how hard I try I won't get the grade that I want unless I take something.
When I look at how psychiatric disorders are diagnosed, I see basically two sets of criteria. Either the behavior is abnormal or the behavior causes distress to the patient, or both. Now, try as I might I can't see how either of these criteria could ever be sufficient to say, "so-and-so is sick; he has a mental disorder". I don't care if a behavior is abnormal. Abnormality is just variation; it isn't sickness.
Finally, there is this other point about the biological underpinnings of the disorders. When I was listening to the Szasz podcast, a sentiment was expressed to the effect that Szasz isn't very relevant anymore, because now psychiatry is on a firmer basis, theoretically. Now, sorry, but I don't get this at all. The best you can do is point to some abnormality in genetics, or in the brain architecture and say that it correlates with some abnormality in behavior. But so what? You wouldn't say that the neural or genetic abnormality was indicative of sickness unless you thought that the behavioral abnormality was a disorder. It is totally circular. Again, the problem isn't that the theoretical entities of psychiatry are purely imaginary. Of course they are not. The problem is that they have a purely imaginary evaluative function.