Quixotic jousting over mental states

Neither Thomas Szasz ¹ nor Edward Shorter ² grasps the nettle of mental pain, which is at the heart of the psychiatric experience. As in any institution, consensus in medicine is a political process; Shorter represents the one we have now, which is that doctors treat lesions. (The neurologist Henry Miller declared over 40 years ago that ‘psychiatry is neurology without physical signs’. ³ ) Szasz’s charge is that this stance deprives patients of a responsibility to make use of the help they seek. When asked to ‘to raze out the written troubles of [Lady Macbeth’s] brain’, Macbeth’s physician is right to imply that there is more to this than cerebral pathology. Many people suffer terribly; some - like Lady Macbeth - through their own deeds, others through events or diseases beyond their control. But what is Szasz’s ‘active patient’ to do with a doctor who only wants to look at his or her brain? Psychiatry is diminished to the extent that it cannot face the experience of patients and their desire to be understood, as well as treated.