The Anti-Psychiatry Guys Were Wrong and Also Right

Thomas Szasz published The Myth of Mental Illness in 1961 and the psychiatric establishment has been furious about it ever since. His central claim was blunt to the point of provocation: mental illness is not illness. There is no lesion, no pathogen, no broken bone. What psychiatry calls disease is actually a set of problems in living, and calling them diseases is a rhetorical trick that empowers doctors to control behavior they find inconvenient. The move from “this person is struggling” to “this person has a disease” is not a scientific discovery. It is a political act.

Szasz was wrong about important things. He was also pointing at something that the mainstream has spent sixty years failing to adequately address. Understanding where he was wrong and where he was right is not an exercise in intellectual history. It is directly relevant to the question of what your diagnosis actually means.

Szasz and the Libertarian Overcorrection

Szasz was a psychiatrist, which made his attack on psychiatry particularly venomous and particularly difficult to dismiss. His argument had a core that was genuinely sharp: the concept of mental illness borrows its authority from physical medicine, but the analogy breaks down at every point that matters. A broken leg shows up on an X-ray. Depression does not show up on any scan in any way that reliably distinguishes it from non-depression. The diagnostic criteria for psychiatric disorders are behavioral descriptions, not biological measurements. Calling them illnesses imports a framework of objectivity that the evidence does not support.

Where Szasz went wrong was in drawing a political conclusion from an epistemological observation. Because psychiatric diagnoses lacked biological markers, he argued, they were fundamentally illegitimate; tools of social control masquerading as medicine. Involuntary commitment was, in his framework, imprisonment without trial. Psychiatric diagnosis was a mechanism for pathologizing dissent, eccentricity, and nonconformity.

The problem with this position is that it requires you to believe that the suffering described by psychiatric diagnosis is either not real or not medical in any meaningful sense. Szasz could make this argument about homosexuality, which was indeed a psychiatric diagnosis used as a tool of social control and was removed from the DSM in 1973. He could make it about drapetomania, the nineteenth-century “diagnosis” applied to enslaved people who tried to escape. These were genuine examples of psychiatry functioning as political enforcement.

But schizophrenia is not homosexuality. Whatever is happening in the brain of a person experiencing persistent auditory hallucinations, disorganized thought, and a progressive inability to maintain contact with shared reality, it is not a problem in living in the way that Szasz meant the term. There is something wrong, even if we cannot yet specify what it is with the precision of a virologist identifying a pathogen. Szasz’s framework had no room for this. His libertarian commitments required him to deny the medical reality of conditions that are, by any honest assessment, medical in nature. The overcorrection was total.

Laing and the Romantic Overcorrection

R.D. Laing came at the same question from the opposite political direction and landed in a different kind of error. Where Szasz was a libertarian who wanted the state out of people’s heads, Laing was something closer to a mystic who wanted to honor what was happening inside them.

Laing’s early work, particularly The Divided Self in 1960, contained observations about schizophrenia that were genuinely brilliant. He described the schizophrenic experience not as a random malfunction but as a comprehensible response to an impossible relational environment. The person wasn’t broken; they were making a kind of sense that the people around them couldn’t hear. The family, in Laing’s framework, was often the pathogenic agent; the double binds, the contradictory demands, the emotional violence disguised as love created conditions in which psychosis was less a breakdown than a breakthrough. The mad person was the one telling the truth about a sick system.

This was electrifying. It was also, as a general theory of schizophrenia, wrong. The evidence for the “schizophrenogenic mother” and the double-bind theory of psychosis has not held up. Schizophrenia has a substantial genetic component. It occurs across cultures, including cultures with radically different family structures. The romantic notion that psychosis is a rational response to irrational conditions does not account for the neurological deterioration that accompanies untreated schizophrenia, or the fact that antipsychotic medication, for all its brutal side effects, actually reduces symptoms in a significant proportion of patients.

Laing’s later work drifted further into mysticism. He began to frame psychosis as a kind of spiritual journey, a voyage through inner space that the medical establishment interrupted and suppressed rather than facilitated. He ran Kingsley Hall, a therapeutic community where people in psychotic states were allowed to “go through” their experience without medication, sometimes for months. Some people found it helpful. Others deteriorated. The experiment was not replicated in any systematic way, and the romantic framework that supported it made rigorous evaluation almost impossible, because the framework defined the very concept of “deterioration” as a product of the medical gaze rather than a real phenomenon.

The thing Laing got right, underneath the romanticism, was that the experience of the diagnosed person matters. That what it feels like from the inside is data, not noise. That the relational context in which symptoms emerge is relevant, not incidental. That psychiatry’s tendency to locate the problem entirely inside the individual brain, ignoring the family, the culture, the economic conditions, the power dynamics, was a genuine failure of the model. These observations did not require the framework Laing built around them, and they have proven more durable than the framework itself.

Foucault and the Structural Critique

Michel Foucault was not a psychiatrist or a psychologist. He was a philosopher and historian, and his contribution to the anti-psychiatry conversation was different in kind from Szasz’s or Laing’s. Foucault was not interested in whether mental illness was “real” in the biomedical sense. He was interested in how the category of madness functioned as a technology of power.

Madness and Civilization, published in 1961, traced the history of how European societies dealt with madness from the Renaissance to the modern era. Foucault’s argument was that the creation of the asylum in the eighteenth and nineteenth centuries was not a humanitarian advance but a new form of confinement. The mad were separated from the rest of society not because medicine had discovered what was wrong with them, but because the emerging bourgeois social order required the exclusion of unreason. The asylum replaced the leper colony. The psychiatrist replaced the priest. The function was the same: to draw a line between the acceptable and the unacceptable, the rational and the irrational, the productive citizen and the person who must be managed.

Foucault’s later work extended this analysis to medicine in general, to prisons, to sexuality. His core insight was that institutions that present themselves as neutral; as simply describing and treating objective conditions; are always also exercising power. The psychiatric diagnosis is not just a medical observation. It is an act of classification that determines who is normal and who is deviant, who governs themselves and who must be governed, who speaks with authority and who speaks from pathology.

The structural critique is the one that has aged best, precisely because it does not depend on the claim that mental illness is fake. Foucault was not saying that people don’t suffer, or that the suffering is merely political. He was saying that the system built to address the suffering is also a system of power, and that these two functions cannot be cleanly separated. The same institution that helps a person manage debilitating anxiety also produces the category of “anxiety disorder” that defines what counts as debilitating, who gets to decide, and what interventions are authorized. The help and the power are braided together.

What the Mainstream Still Hasn’t Absorbed

The psychiatric establishment responded to the anti-psychiatry movement by largely ignoring its substantive points and winning the institutional argument. DSM-III, published in 1980, was explicitly designed as a response to criticisms of diagnostic unreliability. Robert Spitzer’s symptom-checklist approach was meant to put psychiatry on a firmer scientific footing; to replace the Freudian subjectivities that Laing and Szasz had attacked with something that looked more like objective measurement.

The irony is that DSM-III solved the wrong problem. It made diagnosis more reliable without making it more valid. It gave psychiatrists a shared language without giving them a shared reality. The checklist approach created the illusion of precision; five of nine symptoms for this, four of seven for that; while the underlying categories remained as theoretically ungrounded as they had been before. The anti-psychiatry critics had said that psychiatric diagnosis was a social construction rather than a scientific discovery. The response was to standardize the social construction and call it science.

This is the piece that mainstream psychiatry has never fully reckoned with. Not the extreme claims. Not Szasz’s insistence that mental illness is a myth, or Laing’s romanticism about psychotic journeys, or Foucault’s occasional implication that all institutional medicine is primarily about control. Those overcorrections were wrong and deserved to be rejected. But underneath the overcorrections were three observations that remain unanswered.

The first, from Szasz: psychiatric diagnoses lack the biological grounding that would make them genuinely analogous to medical diagnoses, and pretending otherwise is intellectually dishonest. The field has been promising biomarkers for decades and has not delivered them. Every few years a study announces a brain scan that can detect depression or a genetic signature for schizophrenia, and every few years the finding fails to generalize. The honest position is that psychiatric diagnosis remains primarily behavioral and descriptive, not biological and explanatory. This does not make it useless. It makes it less certain than it claims to be.

The second, from Laing: the person’s experience of their own condition is not an artifact to be corrected but information to be integrated. The biomedical model’s tendency to reduce the patient to a collection of symptoms; to treat the report of suffering as evidence for a diagnosis rather than as a communication from a person; remains a failure mode of modern psychiatry. The fifteen-minute medication check, in which a psychiatrist adjusts dosages based on symptom checklists without engaging with the human being reporting those symptoms, is Laing’s nightmare made routine.

The third, from Foucault: the diagnostic system is not a neutral tool. It carries power. It determines who is normal and who is disordered, and those determinations have consequences that extend far beyond the clinical encounter. A diagnosis follows you. It shapes your self-concept, your legal standing, your insurance, your employment, your custody arrangements. The people who assign diagnoses wield real power over the people who receive them, and the system is structured to make that power invisible; to present it as mere description, as though the psychiatrist is simply reporting what the microscope reveals.

These three observations are not anti-science. They are not anti-treatment. They are not arguments against helping people who are suffering. They are arguments against pretending that the help being offered rests on firmer ground than it does. The anti-psychiatry movement overcorrected badly, and the mainstream was right to push back. But the pushback went too far in the other direction, using the extremism of Szasz and Laing as an excuse to avoid engaging with the legitimate core of their criticism.

The result is a clinical system that practices as though the anti-psychiatry critiques were entirely wrong, when in fact they were partly right about the most important things. Your diagnosis is real in the sense that your suffering is real. It is not real in the sense that it names a discrete biological entity that has been scientifically validated. That gap between what diagnosis claims to be and what it actually is remains the central unsettled question in mental health, and it was the anti-psychiatry movement, for all its errors, that first put that question on the table.