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Strictly speaking, disease or illness can only affect the body; hence there can be no mental illness.
This is the first of Thomas Szasz' ten points summarising his famous and notorious book The Myth of Mental Illness (Szasz 1961). If it is true, it seems to me to have profound implications for the way we conceptualise the psychotherapeutic process which we practise. I think it is in more than our terminology that we imply a medical model of our work. The words themselves - patient, treatment, cure, neurosis, schizophrenia and so on - convey an implicit agreement with the localisation of psychotherapy in the area of social activity which may be called ‘healing the sick’. But if the patients are not sick, and hence not patients in an ordinary sense, then this perception of our work will not do, and in the interests of consistency we are required to re-evaluate the processes going on in our consulting rooms.
Some months ago I saw a television programme in which Szasz argued his position with the BBC's house psychiatrist Anthony Clare and Ian Kennedy who is a law professor with interests in medical ethics. Clive James was in the chair. At the time it felt to me like watching a tadpole oversee two minnows fighting with a shark. Szasz' name was known to me only peripherally; he was the strange American psychiatrist with outlandish ideas about mental illness. He had never been seriously discussed in my training, and I rarely came across references to his work in the literature. And yet on hearing him speak I was impressed, in fact almost spellbound. His ideas seemed reasonable, well argued; his opponents missed the point and looked weak by comparison. More than this, though, Szasz seemed to be presenting a radical change of perspective on a recurrent problem I have concerning the nature of my work, just what it is I am doing in my sessions as a psychotherapist. Here was the promise of a paradigm shift in psychology which relieved me of the idea I was curing someone of someth