Episode 198: Is Mental Illness a Myth? (Thomas Szasz's "The Myth of Mental Illness")

[00:00:00] Very Bad Wizards is a podcast with a philosopher, my dad and psychologist Dave Pizarro having an informal discussion about issues in science and ethics. Please note that the discussion contains bad words that I'm not allowed to say and knowing my dad some very inappropriate jokes.

[00:00:17] It's a continuing series of small tragedies that send a man to the madhouse. Welcome to Very Bad Wizards, I'm Tamler Sommers from the University of Houston. Dave, the first of three presidential debates was last night. Shockingly you watched the whole thing so give us some punditry.

[00:01:23] Who won the debate? I'm David Pizarro from Cornell University and yeah, I came prepared. I'm into politics now. I'm officially into politics. You're like an MSNBC stan. I actually am. I can't wait until all three debates are done so I can finally decide who to vote for.

[00:01:42] I know they're both great so it's tough. No, you know. So my daughter got assigned as, I don't know if it was for English class or I don't remember what, but Ithaca is just a liberal communist activist kind of community. So of course they assigned her to watch.

[00:02:03] They said she had to watch half an hour of the debates and write down three quotes or something. And so it was right at dinner time for us so I was forced to watch even though we're watching VEEP which is as political as I want to get.

[00:02:17] The entire love which is awesome. It's such a good show. We had to watch the debates and nobody needs me to say this and anything I say will be completely non-informative. But what a fucking shit show.

[00:02:33] Like I cannot believe that those two people are in charge of like our futures and the futures for our children. It's just incredible. It's depressing. It's like writing down quotes was like very bad wizards out of context. Right. What is she right? Like what were her quotes?

[00:02:52] I don't remember. They were like, there was nothing substantive to write down. What about telling the proud boys to stand down and stand by? Did you put that in? No because we turned it off before. I couldn't. I just couldn't. I lasted an hour.

[00:03:12] Actually, you might have, we chatted last night briefly about this episode and I think that's, he was starting to talk about that when you called. So I blame you for my... Yeah, no, I didn't see that right. I didn't see hardly any of it.

[00:03:24] My wife Jen, she refused. How will you know about the issues? Well, yeah, no, I wanted to know their climate policy and like... No, they could not stop talking over each other. It was ridiculous. Yeah. Oh, that's both sidesism.

[00:03:39] Are you saying Biden was interrupting just as much as Trump? Yeah, no, I didn't. I mean, I... Debates, presidential debates are always painful. I don't know why everyone decided that they had to watch this one even though I had been

[00:03:53] telling people it could be funny, like two old fading guys yelling at each other but then I had no interest in watching it really either. We were watching Fargo season one, which is good. Oh, I haven't started watching it. No, we were not watching the new season yet.

[00:04:10] We're watching season one because... No, season one is awesome. Yeah, it's really good. I feel like it got... Because season two is such a masterpiece. Season one just got a little bit short shrift. Is season one Billy Bob? Yes, Billy Bob. Yeah, I really like that. He's great.

[00:04:25] Yeah, he really is. So today we're going to talk about... Patreon. Yes, we're going to talk about Patreon. The founding of Patreon. Now, it is a Patreon selected episode our beloved Patreon supporters voted on this pretty decisively. Thomas Zazz, how do you... Zazz. Zazz.

[00:04:48] The myth of mental illness. Yeah, so we're going to talk about that in the second segment. In the first segment, well this is episode 198. We were thinking about maybe doing like a live show of some kind for episode 200 but

[00:05:01] I don't think that would be a great idea right now. No, because if we do it I want to be able to shake hands with our dear listeners and you know... And you want to be able to smoke from the same joint. Yeah, collapse on the same only.

[00:05:19] So we decided and we thought this would be a fun exercise. We're not sure if it ended up being a fun exercise but we thought that we would do our top three dream guests. Yeah, so should we launch into that?

[00:05:34] I suggested a couple of constraints on our picks. You want to talk about what our rules were? Sure. So it was one, our main list they had to be alive and I was deeply concerned that Tamler would only pick like Boston Red Sox players and Celtics players because

[00:05:55] that's who he wanted to talk to. So I tried to institute a formal rule that the guests would have to be someone good for the show. That is somebody who would be very bad wizard Z in the sense that like both of

[00:06:06] us would have something to talk about. I think Tamler adhered in spirit to the rule if not in letter to my specific. Well, we'll see. We won't. But then it turned out to be a really difficult exercise. Yeah, and I don't know exactly why.

[00:06:22] A difficulty and also not as fun like I thought this would be fun. I had kind of a long day today and during whatever breaks in between meetings and stuff I was like okay I gotta think, I gotta think. It felt like a job.

[00:06:37] The other thing that we informally said was like we didn't include some academics I think like that we that we've always talked about having on the show because I think we were aiming for a dream guest, which to me means somebody who's out kind of out of reach.

[00:06:54] So I didn't know that because I tried to put one person on our list who I thought we could actually get if we just make the effort. That's I should say that's not a rule. That's more than what I was thinking because like there are people like,

[00:07:06] I don't know. I would like Richard Dawkins to be on the show at some point. I just didn't. I just thought actually maybe. Oh really? No, but but that's a good example. Well, this is the problem, right?

[00:07:19] A lot of like I want people from like 25 years ago or 20 years ago. Like here's somebody I considered Christopher Bohm, like the cultural anthropologist and then so I look him up and he's 88. It's like, wow. I don't. Does that count?

[00:07:32] Richard Dawkins now would just be coming on like whining about social justice and the fact that people still believe in God. Yeah, yeah. And like Muslims and Muslims. So yeah, ill formed, ill formed question, difficult solutions. So why don't we just dive right in?

[00:07:53] Oh, and we said top three, top three. All right. You want to go first? Sure. My first one is James Lindsay. No. Oh, for a second time. OK, I'll go first. I don't know if you could you would see this coming as dream guests.

[00:08:09] Like my mind obviously goes to like people who are famous and for me like they're people who are in show biz because we obviously have like a fondness for a lot of that kind of media.

[00:08:19] So my first pick is the creator of I think my favorite show of all time, the Sopranos and there would be David Chase. If I could get David Chase, I think we'd have some pretty interesting conversation. Yeah, that would be good for the show too. Yeah.

[00:08:35] And I actually don't know. I haven't I don't listen. I think you listen to more podcasts and stuff with creators. So I actually don't know how good he would be as a guest. But even if we just stuck to talking about like the themes of the Sopranos

[00:08:49] or something, I think it would be a fun, fun thing and definitely a dream for me. Yeah, I don't know. Like it's true that I listened to a lot of podcasts with creators and I've never heard him on on anything.

[00:09:02] So I don't know if he would be a good guest. That was definitely something I thought about is like, is this person a good guest and have I heard them before? And yeah, that's a good one. I like that one. All right.

[00:09:13] Well, my number three is Eric Weinstein. We have the same joke. Yeah. I just want to tell I've seen the light. I finally get what the intellectual dark web was all about. I mean, this is what it was all about the whole time. The whole time. Yeah.

[00:09:30] Getting naked and like jerking off to like police videos militarized police. No, my real number three. So now this is the thing that you possibly anticipated. And I want to make it clear. Yes, this is a former Red Sox player.

[00:09:49] But right now, as of right now, as of this recording, I'm not even a Red Sox fan. I'm so pissed that they traded Mookie bets that I said at the like before all this COVID stuff, like I'm just not rooting for them

[00:10:01] for at least one year and probably two years. I'm like, that's going to take me that long to get over trading Mookie. So. Wow. So the reason I'm choosing this person isn't necessarily because I'm a Red Sox fan, because I'm not. Although obviously I have been.

[00:10:16] It's Pedro Martinez. I recognize the name. He I have to justify that he would be good for the podcast. But first, let me just say that he is my favorite athlete of all time. Like, and there's it's not that close.

[00:10:29] Like if I don't have to think about it, he was an incredible pitcher. He's an enormously thoughtful guy. Like I think he could on our show talk about like the honor codes of baseball, how they've evolved, how he understood them, how teammates understood them.

[00:10:45] I think he could talk about honor codes and just codes and being an athlete in general and maybe being an athlete in today's world, where athletes have some more power than they used to. And just all the rivalries and feuds.

[00:10:59] And just to say a couple of things about him. Number one, maybe that not necessarily like something you'll be interested in. But I think the most underrated part of the Red Sox comeback from 3-0 against the Yankees is when Pedro faced Hideki Matsui

[00:11:17] in game five and Matsui was hitting like 600 and he was just dominating the plate. Every about he was just like and he was crowding it too and just hitting doubles off the monster and sorry. Can I just say, Pedro Martinez is a pitcher?

[00:11:31] I don't know if you said that. And so so it's important that one of the great Red Sox pitchers of all time had two years that were practically were pretty incomparable for the Red Sox. Anyway, so Matsui was killing us.

[00:11:43] We were down 3-0, then we won that great game 3-1. Pedro is facing Matsui. He just throws inside like up and in, you know, not at his head exactly. But, you know, close to his head. It's a little warning shot across the bow.

[00:11:58] Knocked him down like Matsui just hit the dirt. And that was the last we heard of Hideki Matsui for that whole season. Wait, he actually hit him? No, but he knocked him down like he was diving out of the right. Right.

[00:12:14] That was like that was Pedro, even when he was not at his best at that point. He was past his prime at that point. But the main reason I think it would be good for the podcast is he's like having watched him as a studio sports analyst,

[00:12:24] like he's one of the best I've ever seen do that studio sports thing. There aren't many people that are good at that like Barkley, I guess. Barkley is entertaining. I mean, he's just entertaining. He's entertaining. He's getting a little cranky.

[00:12:37] But but yeah, like Pedro is like what I think John McNough is to color commentary. Just really good at it. And I remember that after a big poppy retired, Pedro had been retired for a few years.

[00:12:48] I'll always remember him talking about what it's like for an athlete to retire. So he gave this kind of he was just off the cuff, just asked about what it is like to retire when you're an athlete.

[00:12:58] And he's like, you know, for the first few months, maybe even a year, it's fine. Your family is so happy to have you around so much. You're happy to be able to spend time with them.

[00:13:07] And then some time goes by and your family, you know, they have lives. They have lives that they've cultivated while you've been playing sports this whole time. And they go back to them, their jobs, schools, and you're in the house now.

[00:13:20] They are gone and you start turning on the TV at 11 a.m. And you just start like you don't you have no idea how to pass the day. And that's when it like hits you like this is the rest of your life.

[00:13:31] Your whole life has been spent doing this one thing. And now you have this. And while it was great at first, what I thought was so interesting about it was it's the fact that like a good amount of time has passed since you've retired

[00:13:46] before like the reality really sinks in. And that's when he says that's when the depression can start. That's when the drinking or the substance abuse can start. And so I don't know, I just thought that was such an interesting perspective. And he's I just love him.

[00:14:00] You know, well now I'm just depressed about like these guys living great lives and like the way that you said that your their loved ones are cultivating lives without them is has to be true. Of course. So I think he would be a really good thoughtful guest.

[00:14:13] I think you would like him to. Yeah, I'm sure I would. And and he's Dominican, one of my as the white people say, one of my Latin ex brothers. Yeah, because they love that they're really insistent on being called it's Latin. Dominican.

[00:14:28] It's not just like white people and on the coast. All right. So are yours ranked? No. OK. Like he might be like my number one. Yeah. For this category. So I had a category in mind and the category was a, you know, me like I

[00:14:48] there's a part of me that is that loves nerdy geeked them like computerish, like technology, like I'm a big fan of that stuff. And and to have somebody on who could talk about maybe maybe like future ology, like, you know, like artificial intelligence, that kind of thing.

[00:15:07] And I had a few people in mind and I settled on something that that I don't want it to sound like in any way endorsing or liking this person. But I think he would be a good guest. It's Elon Musk.

[00:15:21] And and I'll tell you who I really wanted was maybe a guy named Stephen Wolfram, who is like just a genius beyond geniuses. But but I was thinking for the for the podcast, for the podcast, because. Oh, man, we would get numbers. Exactly.

[00:15:43] We were getting numbers and he's somebody who might fuck around with ideas. If we got him in the good, if we got him in a good moment, like if we got him a bad moment, he'd talk about his shitty techno music.

[00:15:54] But but if we got in a good moment, maybe maybe if we got him to smoke a joint, he could tell us about his his desire to put implants, you know, these. Have you heard of his his attempt at making these implants,

[00:16:09] a brain implants to help us out? Well, like, how would it help us? Actually, like just making us smarter or improving our memory. But I know he's like really doing it. I could use it.

[00:16:21] That's the kind of shit I want to talk to him about, not not his douchiness. But with all of the people, it's weird, because with all of the people I was considering in this category, they were all potential douchebags. And I that's just a weird thing.

[00:16:36] Like I'm like, they shouldn't shouldn't they be kind of like mild-mannered scientists? No, they all like have stories of like groping somebody or other like saying something. I'm going to pull a tameler and say the third person on my list was

[00:16:49] might imagine Ray Kurzweil who has just he's a futurist, but he's done so much like across these people who've done so much across all these different domains that I'm sort of fascinated. I think I kind of have a fetish for high IQ, like white men.

[00:17:04] Yeah, I think you do definitely more than me. Like those kind of people, like you would have to talk me into Elon Musk just for the numbers alone, but those two others that I have never heard of. That's why I didn't go with those guys.

[00:17:16] That's why Elon made my. All right. All right. My number two is Lori Santos. I know she's been on the podcast a few times, but she's now she now just like won't even follow me on Twitter. And even though we got her invited to Davos, we did.

[00:17:37] No, I'm not going to go with the Lori Santos because because we have a we have a shot. That's why I was saying like people I would love to have Lori back, but you know, we could email her. Right. Exactly.

[00:17:47] Here's another person I wanted to have somebody who is an academic and I am really interested at this point in Plato, like how to understand Plato as a philosopher, as an artist. Like how do you understand the dialogue form and what it means?

[00:18:03] And I would like to talk with somebody who is an expert in that who specialized in ancient philosophy. I'm really fascinated by Plato as a person, even though I think he's pioneered like some of the philosophy that I hate. I also think he's like really fascinating to read.

[00:18:20] And I wish more people wrote in the way that he wrote in the form that he wrote the genre. So Agnes Calard is somebody who I mean, and I honestly think we could hopefully get her on if she'd be willing.

[00:18:33] She I think she liked a tweet where somebody suggested that we would have her on. She's written about it. She she's doing a course. I just looked her up and she's doing a course on Plato's Gorgias, which would be really interesting to talk about with her.

[00:18:46] Like I think it would be very cool to have her on and you and I read a dialogue and we talk with her about that dialogue. I think that would be very cool. Super fun. That's that's so yeah, when we were talking before,

[00:18:57] I was when I was saying somebody who is out of reach. This is actually, I think, an academic like who we could actually email. Yes. So we should make that happen. You know, you say that the part of Plato that that you don't like

[00:19:12] might be that he gave birth to this form of analytic philosophy. You don't like that's exactly what I think got me into reading philosophy where his dialogues where I had the realization like I picture the Greeks having this realization, maybe Plato himself

[00:19:29] having this realization that we can sit and actually analyze these concepts like justice. I remember as just, you know, a young man, probably late high school, realizing that for the first time and being like, especially being raised in a religious upbringing where it's not encouraged,

[00:19:48] just seeing and following like that you can follow his thinking and be convinced at the end is amazing for somebody who was lived thousands of years ago. It's great. Yeah. We and I'm surprised we haven't done it. Yeah, it is. It's unfortunate that we haven't done any Plato,

[00:20:03] but I like that image of a young David Pizarro from a religious background. I was kind of like, why do I have these pubes and feel funny when like my Sunday school teacher walks into the room with her skirt and then is also like really into Plato.

[00:20:24] I didn't get pubes last 22. All right, I'll do my last one on the list is as you anticipated from our pre taping conversation, Donald Glover. Such a good one. Such a good one. Yeah, I've been rewatching Atlanta and it's amazing. It's brilliant in all of the way.

[00:20:46] I don't know. I could sit and talk forever about Atlanta. And I was pitching to you that we might do a Patreon episode on at least one of those episodes, because I think it spans. You know, it's not that shows not just Donald Glover.

[00:20:58] I know that, but it's so largely Donald Glover. And the episodes go from every kind of, I don't know, there's something that is just about experiencing life as a human being that he gets to in like this existential kind of way

[00:21:14] that just it scratches that itch for me, that kind of art that I love. And he's also he's younger than than us, but he feels of a generation that that I really resonate with. And he's also a hilarious. He's done stand up.

[00:21:31] He did community, which is one of my favorite if I had a list, favorite sitcoms. That's one of my favorite. He wrote for 30 Rock. He has his finger on. So he seems to understand race and racial dynamics in a way

[00:21:46] that I think very few people probably do, including me. He's just somebody who makes me angry at how talented they are, like even as a musician. Like and I would just love to have an hour with talking to him about all of this.

[00:22:00] He's a real artist and that show is it's remarkable. It's it's very funny and very weird. I can't wait till it comes back on. I don't know if they've even filmed another season. Yeah, they I think they have or but at least they've announced

[00:22:13] that it's going to be released in 2021. Yeah, it's a show. There is something about like it's hard. The show is hard to describe in a good way. Like I like it when shows are hard to describe in that way. What's I'm blanking on the name, but the actor.

[00:22:27] Lucky Stamfield. Yeah. Oh, so I would love that guy. He would be on my list too. If I had a longer list, he's so fucking good. He's actually from where I'm from, from the Riverside area in Southern California. Really? Yeah.

[00:22:40] And so so I feel kinship with with him. He does quasi deep pot head so well, like that kind of kind pot head. Exactly. Like so so good intention and good willed and that kind of warmth and also smart, like just smart in ways that you wouldn't expect

[00:22:57] like has. He has a little bit of Ted Lasso in him in it. But he's kind of cool and warmhearted. Oh, have you been watching that? Yeah, we're watching and we're enjoying it. That's good. Right. Yeah. Yeah, exactly. Exactly. That kind of like sincerity.

[00:23:12] He's not a sucker, but he's he's a nice guy. All right. My number one is actually connected to that and it's obvious and I don't care, but it's also like a supreme artist. It's David Lynch and I know it's like anyone would predict

[00:23:28] that I would do it, but fuck it. I almost put him on my list for you because I thought I thought maybe you wouldn't be willing to because it's so obvious. Yeah, it's so obvious, but he is the artist that I obsess about the most.

[00:23:42] I've spent so many hours watching all of his movies. He definitely brought my daughter and I closer together just in our dual obsession. He's totally one of a kind to do like I think like I don't he's not going to talk about it.

[00:23:54] I'm going to tell you what his movies are about, but it would be a fun interview no matter what. And I'd be interested to talk to him about really anything like art transcendental meditation. He's into a lot of mystical shit too, like that I think is

[00:24:08] it would be fun to talk with him about. He's got that great voice and that great kind of manner. And it would make you finally watch Twin Peaks season three. You would finally do it. You would find the time and you would just sit down

[00:24:21] with Nikki and Bella maybe and just watch it and fire walk with me. All right, dead people. Let's do this quick because. OK, this one this one was was hard for me because obviously Borges. Yeah, I had him do. I picked Maya Angelou.

[00:24:39] I would love to talk to Maya Angelou and she is dead. She just dripped poetry from her mouth. Like she just really like the things she said, anything she said was so beautiful. And also she just had this wisdom and like experience in life

[00:24:55] that I think very few people have. Like she was part of history from being young to being old. Like she was part of this enormous change. And you could just tell that she had this wisdom of somebody who had.

[00:25:09] I'm not a big poetry guy, but every time I would see her on TV, like I would stop and watch. But Borges. All right, I had a few here. Like I'm reading The Iliad again. And every fall I read like either The Iliad or The Odyssey.

[00:25:29] And I would love to talk to you like whatever, whoever, like it might not even be a person, but whatever or whoever Homer is. Like I want to talk to you because it's just like how do you how do you do something that is like

[00:25:45] still like one of the top five, two of the top five greatest things ever done? Like it's just phenomenal. And the fact that we don't know anything about him or even if it's just like a him or a her or just one person or many people

[00:25:59] or like we just don't know and we don't even know when could be within like 400 years and we don't know. So like that's something that I would I would love. It's funny that like obviously amazing like I for some reason wasn't going span of history in my mind.

[00:26:15] You were doing recently dead. I was doing sort of like dead in memory in memory kind of dead. Yeah, I had a couple of those. Yeah, but fucking I'm picking Gilgamesh just so I can one up you on. Go even further back.

[00:26:31] The other one I thought like who would be very good for this podcast is Mark Twain. Oh, yeah, that'd be amazing. OK, hold on. So it is funny because Homer the constraint I'm finding it hard to get past the deep cultural and historical and linguistic

[00:26:46] constraint and the metaphysical constraint that it might be like several different people over like 400 years or something. Yeah. Yeah. No, there's a lot of issues that would have to get ironed out. If we had a producer, we would have we could deal with that.

[00:27:01] Like was it was that ancient Greek even like the Populopolis kind of Greek that they speak today? Was it like the same? It was almost exactly. Yeah. Yeah, you know, actually Richard Feynman was the last person else mentioned here because he would have been really good on like.

[00:27:15] That's disgusting. So we'll be back to talk about the myth of mental illness. Today's episode is brought to you by Hello Fresh, America's number one meal kit, get fresh pre measured ingredients and mouth watering seasonal recipes delivered right to your door with Hello Fresh.

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[00:34:59] OK, so let's talk about today's topic, the myth of mental illness by Thomas Zaz as we mentioned before, our top Patreon pick by a lot. And I was just going to say a few words by way of introduction of the book and I

[00:35:13] think it's relevance and why people might have chosen it as a topic. So the myth of mental illness was published in 1961 by Thomas Zaz, who is a Hungarian psychiatrist and psychoanalyst who actually was at SUNY upstate until he died in 2012.

[00:35:29] It's considered a classic by his proponents and even by many of his critics. And the main claims that he makes in the book have continued to influence the discourse around mental illness and psychiatry to this day.

[00:35:39] I think there is controversial today as they were when it was published. It still strikes a nerve in many proponents of the so-called disease model of psychological dysfunction, the model that has become the standard view of mental illness among psychiatrists and clinical psychologists.

[00:35:54] And really, there are a few books that can have that sort of impact 70 years after they're published because I think some of the claims that he makes are just as relevant today, even though there are a lot of very dated things that we'll talk about.

[00:36:06] I first read this book. It was recommended to me by one of my professors in college when I was a psych major and I remember actually being completely taken by the sort of humanistic approach to mental illness and the critique of the psychiatric establishment.

[00:36:19] And I'm just going to say some broad things about the argument because we're going to talk plenty about it. But his primary argument is that what we call mental illnesses are not diseases at all, that using the biological model of disease for

[00:36:31] mental problems is just a category error. He's not arguing that psychological problems or disturbances or whatever we call it don't exist. People obviously really do get depressed, have anxiety, they have delusions. Is just that for Zaz, using medical language to describe these is just

[00:36:48] metaphorical and it's a metaphor that gets us in trouble because a lot of people take it as an actual serious fact. So for him, mental illness is just, and this is the part that I think we'll have a lot to talk about.

[00:37:00] Mental illness for him is just sort of part of the struggle and conflict that arises from being a human being. And he believed that it should be treated that way. And he was a psychoanalyst and continued to do therapy throughout his career.

[00:37:12] So it's not, you know, he, he practiced what he preached, but he believed in therapy and in talking therapy to work through these troubles. So he thought that calling this a disease was just the wrong level of analysis.

[00:37:24] And I think this is the part that Tamler will like the most that it probably came from some sort of scientism, like an envy that psychologists and psychiatrists have of the hard sciences and a desire for the same kind of respect that medical scientists and other sciences get.

[00:37:40] And I think that's paired with a sociological claim that for him medicalizing psychological problems by treating mental patients in the same way we treat patients with physical organic disease was for him a step in the direction of coercion.

[00:37:53] He thought so throughout his career, he was a fierce critic of involuntary hospitalization of things like the insanity defense and the use of psychiatric psychotropic medications. And it's unclear what effect he had on modern psychiatry now, but

[00:38:07] there are certainly a ton of people who are still on board with his basic message. I mean, it's interesting to think because in one sense, people are still talking about him, which is remarkable, given that it was in 1961.

[00:38:19] On the other hand, it doesn't seem like he could have lost the debate more than he could have. Like it's hard to find a teenager that isn't diagnosed with some kind of mental illness and taking medication for it.

[00:38:33] And, you know, like the whole DSM five thing, like I probably drove him crazy and he was such a crank. He was the ultimate crank when he wrote the book. Like the tone of the book is already like just defensive.

[00:38:44] And I'm like, wait, he must have been pretty young. I can't imagine I know being that defensive already in the version that I have, he writes like 20 50 years later. So it's 2010. And yeah, and he and it's the same tone.

[00:38:56] Like like you wouldn't know that it's 50 years older than he was before. It's the same fight. Like it's the same fight. It's the same fight. But in some ways it's the same fight. So like I'll just as a way of saying what I thought about it.

[00:39:12] You're totally right that I get hard at the idea that like when, you know, when he says stuff like these are people who are using the prestige of or the illusion of scientific objectivity to promote various and social professional, I eat that stuff up.

[00:39:28] And I actually do think there's a lot of connections between what he's arguing and some of the stuff that, you know, I've been criticizing and we've been talking about. I don't mean to interrupt, but I think it's important for me

[00:39:39] to say right now that I like I just knew I know that some of this stuff is going to go into whatever book comes out of you in the future. Yeah. If that ever happens, which is looking less and less likely. But, but yeah.

[00:39:51] So so in that sense it's it's modern. I think there's just this whole idea, you know, to challenge what's what seems to be happening right now, which is that everyone believes that he's wrong even if, you know, there's still a scholarly debate at the same time.

[00:40:10] Like it is a bit of a relic in the sense of what he is focused on. So one of the things that he is focused on is involuntary hospitalization and a lot of involuntary psychiatric treatment, which is I don't know, like maybe it still goes on.

[00:40:28] But it seems to me more of a relic of like mid 20th century and stuff like one flew over the cuckoo's nest and clockwork orange where people were really worried about the therapeutic state and institutionalizing people for and like lobotomizing them like as a pseudo medical treatment for

[00:40:45] a psychological problem. Exactly right and I just don't it feels like the problem now if you agree with him, the problem is different. It's not a powerful state subjecting people to psychiatric treatment that they don't want. It's more that we've all bought into it and we like are

[00:41:05] medicalizing ourselves and it's definitely true. You know, I talk with my daughter about this. The way they think about it having ADD is like having, you know, like a high fever or the flu or like some kind of physical disease that is that's been ingrained

[00:41:23] in generations of people. Now I think there's also people who are just like, I don't know if it's a thing or not. I just want the drugs or I want the treatment or I want to be able to talk to somebody.

[00:41:32] But then, you know, like his views as far as I could tell it are if the individual wants to seek help for their problems and living, not their disease because that doesn't exist, but their problems and living, then they should be free to do that.

[00:41:46] And it's such a libertarian, there's such a libertarian kind of strain in it that I would almost think if they want to take drugs for it, they can. Yeah. And I don't, you know, I don't know. So one big caveat here is that there is a whole later

[00:42:01] trigger that he produced later on in life and there's a whole bunch of, one of the reasons I said that it's still relevant today is because people continue to write like their criticisms of the arguments and like that. You don't have to look far to find somebody writing

[00:42:14] like 50 years later, like a critique of these arguments. So I don't know what he might have thought later in life about the use of things like antidepressants, but from the text itself, it seems as if he's granting that of course, like one of the things that he's

[00:42:30] saying is it's not as if the brain isn't involved in these psychological problems, obviously, like the brain is involved every time you listen to me talk, like your brain changes. To him, he just thinks it's a mistaken level of analysis.

[00:42:45] But I wonder what he would think about just taking these drugs therapeutically because you don't have to buy into the disease model anymore than I have to, like the cause of my headache might be, you know, sexual repression or it might be a tumor,

[00:42:59] but an aspirin will help. Like in both cases. And so it seems as if you could have that view that drugs, if the drug helps you, then, you know, maybe it's a bandaid, maybe, you know, but. And you choose to take it. And you choose to take it.

[00:43:14] Yeah, and you're willing to. It's not being forced on you. It's not even being, you're not even being pressured to do it by your employer because he does sort of note the bleed between like, okay, maybe a state isn't doing it,

[00:43:27] but maybe your employer is making you do it or your family is incurred. So he does think it's a pernicious myth, not just in the sense that, you know, you can be taken and put in a hospital and lobotomized, but you know, you can be pressured

[00:43:41] in all sorts of ways to do it. And maybe he would think that about children who don't know any better, right? Like we're, yeah, I almost want, and I wanna talk about his argument because I think it's interesting and like why he thinks it's a myth,

[00:43:51] but I would love somebody to do an updated version of this. The other way it's kind of a relic is, it's very focused on the problem of hysteria as a disease. It's really dated in that way. And yes, that does seem a little ridiculous

[00:44:07] the way that was treated. I mean, he has some interesting things to say about it, but the psychiatric establishment has moved on from hysteria. I don't even think they accept that as a mental illness anymore, even a disorder. Well, so it's interesting, we can talk about that

[00:44:22] because it just got labeled differently. Now in the DSM-5, it's called Functional Neurologic Symptom Disorder. I know. Again, like just mystifying it by calling it something technical and that's... Yeah, so you're right. He uses this as the sort of quintessential case of the medicalization of psychological problems,

[00:44:45] which is what Freud built his theories on, which were these primarily women who came in with exhibiting physical symptoms when it was really just psychological problems. And so given that Freud was still huge in the 60s, in some circles he is still today,

[00:45:04] it makes sense that that was a central example and it helps for his argument because it really does put the organic versus the mental like in stark contrast. Are these people faking it? Well, no, they might not be faking it,

[00:45:18] but there's still something else going on that's not... It's not a disease. As he points out, if it was found out that it was because of a tumor, then we wouldn't call it hysteria anymore, right? Like we would actually like say, oh, that's what it was.

[00:45:32] So let's talk about that. So he takes himself to be making a conceptual point that when you wanna talk about disease, we're talking about something that is physical, something that you could presumably find if you did an autopsy or if you took somebody's temperature

[00:45:49] or if there was some like bacterial infection or something like that. There's nothing like that for these mental illnesses. Even today and it's 60 years later, you don't find neurological, biological markers for some of these things that you can find hereditary things,

[00:46:05] but if it's heritable, you don't know why it's heritable. And so I don't know, like what do you think about that argument? First of all, there's just a conceptual mistake to think of disease as something that doesn't have a physiological marker that we're aware of.

[00:46:20] Yeah, I don't know if you got this sense but it bordered sometimes on like what I felt was like a dualistic approach. He backs down from it, but it seems like at times he's saying no, this is mental stuff, not physical stuff.

[00:46:34] And as good materialists that you probably are, you're just like, well, what do you mean? Well, like what do you mean it's mental stuff? Cause certainly there is physical stuff but I think he's not really being a dualist. I think that there is a fair way

[00:46:49] to interpret what he's saying. And the way I think of it is like personality. So take your average individual differences in personality where you say somebody is more extroverted than somebody else, somebody's more introverted. We don't call it a disease because it's not interfering in life

[00:47:06] with like normal functioning to be slightly higher on extroversion and not but it is just as physically caused as depression to be an extrovert. It's the same mechanism working to make you like certain foods or have certain personalities. It's all the same stuff.

[00:47:27] Like for him, psychopathology is just merely an instance of that stuff. Like the stuff that might make you an extrovert being a little off. And it's just because you can see like in an FMRI that the brains of schizophrenics say or like have this kind of activation

[00:47:43] you could probably see the same thing in the brains of extroverts versus introverts. So for him, that's not a piece of data that matters. Is that true though that you can like identify that there are schizophrenics on an FMRI? Because my impression reading a little secondary literature

[00:47:56] is that's not true. It's probably, it's, it's, I'm not an expert in this if it is true, it's cutting edge. It almost doesn't even matter because I think that we could probably identify extroverts at some point if we just read enough like the brain is causing it.

[00:48:12] Right? So as long as we had the enough resolution I think the argument is it's not like, yes the brain is causing it. Of course the brain causes like all of our behavior at both functional and physiological level this is where I think that malingerer.

[00:48:26] So he talks, he devotes a lot of the, a lot of the argument to people who are faking their illnesses and malingering. Like just, I haven't heard that word since I was a kid. And you know, like, so when you malinger like I every once in a while

[00:48:41] if I didn't want to go to school for whatever reason I would pretend I had a temperature and I would do the thing where you put the thermometer to the light bulb and make yourself have a high fever. Like I was faking it.

[00:48:51] And it was clear that I was faking it if my parents were aware of it they could take my temperature again and like look at the thermometer and like there would be a clear demarcation between me having a fever and being really sick and me just faking it.

[00:49:07] But you can't do that with mental illness because there's no independent. So there's two things. There's no independent way of verifying whether the person is faking it or not. And the second thing which seems to frustrate him a lot is that, you know, when Freud would see people

[00:49:23] who were faking it and that's what he thinks hysteria pretty much is as faking of physical illnesses Freud would just say well even if they're consciously doing it that's also a mental illness. So it just collapses the distinction between faking it or having it

[00:49:39] and he thinks that's like conceptually necessary. Like if you have a disease and you're gonna talk about something as a disease there has to be a fact of the matter whether you really have it or not. And there is no fact of the matter with these diseases

[00:49:54] because there's no conceptual distinction between faking it or not faking it. I totally get what you're saying. I think that it starts getting into the possible differences between hysteria and something like schizophrenia that's giving like for real auditory delusions for instance, auditory hallucinations

[00:50:13] where it goes beyond like what people can fake fake and does seem like there's something really different going on with those people. I think even if it is identifiable by some imaging technique I still don't think, I'm still on board with Zaz's argument

[00:50:33] that that's not enough to call it a disease because for him, for Zaz is the wrong level of analysis but like of course the brain is gonna be able. So like it is true that there are like particular genetic markers that make you more likely to have schizophrenia.

[00:50:49] And what like, I don't know if that, what that means either way but we can see some physical difference between people who are more prone to say severe depression or bipolar disorder, schizophrenia but I think that that still doesn't really matter.

[00:51:06] Like I think the argument that Zaz would put forth is yes, like so what? But so then he's vulnerable to the critique which I could maybe be sympathetic to which is well then that's true of all illnesses. If you're not going to accept that a certain disorder

[00:51:23] is really a disease even if you have some sort of physical and functional evidence for it, well then you could say that about like flu's or obesity or like a lot of different kinds of illnesses. And that's, you know, that's a critique

[00:51:40] that I have some sympathy with is he overestimates the objectivity of just medical, like the kinds of medical diagnoses that he seems to think is like, that's what this like medicine really is. He overestimates that like he's constantly using explanations about like, you know, this particular disease

[00:52:00] is caused by this particular virus and like that's it's very easy to know that that's the case and you don't have that in mental illness. There is a quote somewhere where he's talking about like physics and causality and like how that's so clearly causal

[00:52:12] and mental stuff isn't like that at all. And he says something like, all scientists would agree on claims made in the physical sciences. And it's like, wait, no, like there are real debates about like the facts of the matter for causality even amongst physicists.

[00:52:28] So he does a lot of using big medical words to try to convince us that they are really certain about the organic causes of those diseases. But let me try out with like an example that came to mind in reading Zah's arguments.

[00:52:45] And that is there is a viral theory of schizophrenia that says that there is a virus that at some point you're exposed to whether, you know, like when you're a fetus or when you're a child that might give rise to schizophrenic symptoms.

[00:53:04] If we found out that that was true, then Zah would say, well, okay, that's a disease. And there is something that there's something there in the distinction that he's trying to make between the kinds of causes that we call diseases.

[00:53:16] And what he really wants to say, which is, no, like your intentions and desires and your volitional activity is also physically caused and might have a biomarker in the brain, but that's not what we mean by a disease like in the medical sense.

[00:53:35] And I didn't maybe get the sense that he's doing that as like, I thought like it really was a distinction in terms of like biological marker or not for him. And but if he's doing what you're saying, then I think it's not totally clear

[00:53:51] why you would mark off mental illness from physical illness. So what do you think about his like, well, people used to say that homosexuality was a disease. And in fact, his arguments were part of the part of what was used to make people stop treating homosexuality

[00:54:09] like a disease. Like it's clear that there's a genetic component to homosexuality. I think like that's well known enough from twin studies, but to call it a disease means something like there's something going on organically. Well, it's also to make a normative, to have a normative standard, right?

[00:54:27] And I think that is, this is one part of his argument. I was surprised that it wasn't more of his argument, but it is a central part of his argument that, to call something a disease and especially a mental disease is to impose a kind of normative standard.

[00:54:40] And if you say that homosexuality is the disease, then you're saying that it is deviant from like a normal way of living. And he rightly objected to that. That doesn't seem to me to be a problem with whether or not you call it a disease or not.

[00:54:56] It's just a problem of like, just the fact that moral standards have evolved and progressed in a good way. And you might think that about like other things. You might think that about, I don't know, like certain body types or certain,

[00:55:13] if those people, and that would be entirely physical and not mental, but I take the point. And I also think that that's so relevant when you're talking about diagnosing kids with ADD because like they have trouble paying attention in school because they're like third graders

[00:55:32] and they're trying to make them like study first, the standardized tests that couldn't be more boring. And then if you and I tried to do it, like we would probably- No, no, we'd have Adderall. We'd have Adderall, right. But like that's where that seems to be an issue.

[00:55:47] It's like, oh, well you think kids should, instead of wanting to play outside, like fuck around, that they should be able to focus for like eight hours a day on this, these boring tasks that like the standardized test establishment has decided

[00:56:03] is a way that they're going to evaluate the kids' schools. No, well then that's not a disease. That's just something about society. That's in a societal norm that's now being enforced in such a way that it infringes on autonomy. But like it infringes on autonomy because they're kids.

[00:56:19] It seems like it's much more complicated to make that argument about adults. Yeah, that sociological piece of the argument I think is harder to make now. I'm sure there are plenty of people who would still, and there's probably plenty of reasons

[00:56:32] that I'm not aware of about people who are hospitalized because they're in immediate danger to themselves or others and that's probably abused. But I think it's far less of a problem than in Zaz's time. And I think the sociological argument about this being used to control the population

[00:56:49] and to undermine their volition is less interesting to me. I think just because it's not, like you said, it's not of this time as much. Now it's like pharmaceutical companies that are getting people hooked on various kinds of medication, like including you and me sometimes, right? Yeah.

[00:57:06] But it's like we choose it, but do we? It's like more brave new world than 1984. It's more like get people to take Soma and that in some ways diminishes their autonomy, but not in the obvious way of like Jack Nicholson

[00:57:23] getting lobotomized and when flew over the coup d'etat. Right, right. Right. And being like, yeah, unable to escape unless you put through a drinking fountain through the window. There's a part of his argument that where he's making a positive claim which is what mental illness,

[00:57:40] and again in his case he's using conversion disorder hysteria as the primary example. He thinks that it is a form of communication so that like maybe a kid who is acting out, even a kid who like all the other kids aren't

[00:57:57] like they're doing what they ought to be doing and it's not that hard, but this kid is acting out saying that it's ADD is missing the right level of analysis, which is that this kid is trying to tell you something about his living situation,

[00:58:10] but he doesn't have the words to express it and just giving him medicine and treating it like a disease is in fact ignoring the actual root, right? Like the actual causes and maybe not causes in any strict sense,

[00:58:26] but at least the problems that are at the heart of it. I had some quotes that I wanna read from our, like just real quick. So he says, because I'm confused. Okay. And I wanna know what you think. So he says, herein too lies the crucial distinction

[00:58:39] between physical causation and human volition. One is an account of recurrent regularities. The other is an account of an agent making something happen. Like I'm not sure he does sound like a dualist of some sort there. Then he goes on to say,

[00:58:54] in all this we must not lose sight of our criteria for diagnosing illness. They are either certain kinds of demonstrable physiochemical alterations of the body or certain kinds of psychosocial communications about it. This brings us back to our core problem, namely whether the mimicry of neurological illness,

[00:59:11] such as the hysteric exhibits, is to be regarded as physiochemical alteration or as a psychosocial communication. A happening or an action, an occurrence or a strategy. Okay. Let me give this a shot. Cause I, there were, it's definitely one of these things

[00:59:27] where I almost lynched you in where I felt like I had it and then I lost it. Felt like I had it. Then I lost it. And I don't know where I am in that right now. So I think he's very influenced by the positivists.

[00:59:40] This is another way that it's a relic, like the logical positivists. And there's a very clear distinction between certain kinds of claims that are verifiable or factual. They can either be true or false or they're expressive. And those kinds of claims, even if they have the structure,

[01:00:00] you're not making a statement that's either true or false, you're communicating something, you're expressing something. And so I think the category mistake that he thinks is going on is when the hysteric comes in and says, you know, like my face is hurting.

[01:00:17] What they are doing is trying to communicate that they have a problem, that her husband mistreats her or is abusive. And yet what we, we take it as a true false statement like my face hurts, I have this disorder, which could be even true or false,

[01:00:37] but that's not what's going on. What she's doing is not something that can be called true or false. She is communicating something that or expressing her reaction to what is happening to her. And so I think it's like, again,

[01:00:54] I think this is like a kind of a conceptual thing. And it's by analogy, what the logical positivists or expressivists thought about morality when people say that something is wrong, really what they're expressing is their disapproval of it. They're wanting people to not do it anymore,

[01:01:10] but that's not true or false. That's just disapproval. That's just an emotion. And so I think that's what he thinks these things are. And so to treat it as something that is true or false, that is factual, that is a disorder

[01:01:22] is to in some ways kind of ignore what's going on or to like miss whether intentionally or not miss what's going on, which is this person communicating something that's deeply important and this deeply important to them and deeply hurtful to them and that they want you to understand,

[01:01:39] even if they don't even know that that's what they're doing. Right. I think that's a nice way of understanding like the argument because Freud was dealing with and Charcot, his mentor, were dealing with women who came in expressing these bodily symptoms. And in talking to them, right?

[01:01:59] What they called like the talking cure, their symptoms would go away and almost always, at least on their report, it was when they started talking about that what that pain was symbolizing, what that paralysis like that, you know, the non-organic paralysis or the pain,

[01:02:17] it goes away when you talk about like the problem that it was addressing. Because of that, Zaz thinks this is like a proto language. Like these people did not have, and there was a lot, a lot of talk of sexual stuff in these patients.

[01:02:33] People always accused Freud of being like focused on sex, but the patients really were. Like there was some real funky shit going on. So women were obviously sexually repressed and couldn't talk about it. And so in the absence of, you know,

[01:02:46] part of Zaz's book is going through various forms of communication and he categorizes linguistic communication as one level of communication. But this bodily communication is a more basic simple level and it's, you can understand when a little kid doesn't have the language to communicate something

[01:03:03] that's going on, they act differently, they act out. This for Zaz is that communication. So it's expressivism in a language that the body knows, but that might not rise to the awareness of the person. And if it weren't that, it wouldn't go away

[01:03:20] when they started talking about the root cause of the problem. So do you think that's important to his argument? But is that necessary for his argument that it goes away or that something? He hinted at this when he was talking about these,

[01:03:35] when they would talk about like your example about when it turns out that when she started feeling that pain in her face was like when she had been thinking about her husband hitting her. And so he's, I think he's saying that as an example

[01:03:50] of her trying to communicate that this was like distressing her. Without knowing. Without knowing. And that's always like this, he's teetering on this like, well, do they know? Do they not know? Is it malingering? Cause sometimes there's language that he uses in this book

[01:04:04] where he says they're lying. Yeah. Yeah. Just straight up they're lying. And I don't think that that's the right word. No. It's like your body is lying maybe? Sometimes they're lying, but not like, like I think, and especially when you get to the more serious illnesses,

[01:04:21] there's no nobody would want to lie like that. It's just- At some point he says, as the infant's cry galvanizes his parent into suckering action. So the adult's metaphoric cry for help expressed in the verbal or nonverbal claim of illness mobilizes the physician into therapeutic action.

[01:04:38] So he thinks that part of the problem is that we are sort of paternalistically telling people that they are patients, that they are ill. And so what happens is we want the attention of the being the patient. We want to be taken care of.

[01:04:53] And so our bodies will respond in these weird ways. Yeah. And this is where I think the, you don't get such a clear distinction between voluntarily submitting to psychiatric treatment and involuntarily submitting it. It's because if you have a culture, which we arguably have, where all these mental,

[01:05:14] there is a literature on the pathologizing of everyday life and like the problems of everyday life. So if that's your culture, then even if you make the conscious choice to go and seek treatment and get medication or undergo some sort of long stent

[01:05:32] in a center, then you are arguably acting with your own autonomy. But when he talks about like the therapist kind of or the psychiatrist resenting the patient, the people who are not admitting that they have a problem and not agreeing with their diagnosis.

[01:05:52] So now all of a sudden it gets, it sounds for, you know, the way he's talking, it sounds like bullying without being again, like coercion, you know, it's more like subtle way of kind of getting people to think that way. Right. I think you would say like

[01:06:09] the form of control has changed. And maybe coercion isn't the right word anymore, but it is as you say, break new world. Now this is the part where it's hard for me to say that calling something like depression a disease is bad. And I'll give you like,

[01:06:28] I think we all have plenty of experience with mental illness in our families and our friends, but I was raised in a particular, you know, kind of cultural background where it probably just wasn't like, it wasn't the right thing to say that you went to a therapist

[01:06:45] or that you had mental illness. Like it bordered on like in some of the less educated families in the community bordered on just straight up like must be deem, if you're schizophrenic, it must be Satan. And so I remember when a member of my family

[01:07:04] went through heart surgery and when they came out, the doctor said, look a lot of patients undergo like who undergo these like heart surgeries or just major surgeries in general suffer through depression afterwards. And so I'm gonna prescribe antidepressants. And so they took antidepressants

[01:07:26] and honestly man for the first time in their lives they were like they were actually chill and like normal. And they were willing to accept it because it came from a doctor and because it was sold to them as organically caused.

[01:07:40] And it's hard to think that it does that much damage to some of the people who would never take it seriously or some of the people who receive resentment in the Strassonian word for being depressed or having these other psychological problems.

[01:07:57] And like for Zaz, of course, like he says, you know, he talks, he loves the language of language, of this communicative. And he basically says that the therapist is in the job like the good therapist, even at times Freud. Like he's not so anti the kind of treatment

[01:08:15] that Freud would give sometimes. He says that they're in the job of translating the language of the body. Like they're actually well suited to say this is what you're trying to say like your husband is oppressive or you're sexually repressed or whatever.

[01:08:30] And so as I can tell you about this those symptoms will go away. But it seems as if, well, yeah, if we went to therapists to talk about a depression like of course that would help. Right? But the whole point of people thinking

[01:08:44] that it's their fault is that they won't even go to therapists like they're just told like you said to buck up. Yeah, so there's two different issues. There's the issue of like take something like ADD. What was that now? You've taken tests for it.

[01:09:00] We've both taken tests for it. The test is ridiculous, right? It is you fill out answers totally truthfully. Now that you've learned a lot about measurement isn't it kind of funny? Exactly, yeah. Now that I've learned about it, I get it. Like I get the psychometric pathology.

[01:09:18] On a seven point scale Tamler, how often do you think you have trouble concentrating? Do you find yourself browsing like websites when you should be working? It's like yes, cause they're like a person. I mean this is the thing that would drive him crazy.

[01:09:31] Even being who has a computer. Very bad wizards is brought to you by BetterHelp. Tamler with the campus crises and the COVID have you been looking for other work? No, but I probably should be. Well, if you are, I wanted to start off talking

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[01:12:30] dot com slash VBW. Thank you to BetterHelp for sponsoring this episode of Very Bad Wizards. So something like ADD I think, I might be skeptical that that's a real thing and certainly a real thing that you can measure using the tools that they have.

[01:12:47] But at the same time, I also think that there are certain... It's something. It's something. Right? Like it's something. So there's the issue of like, are they just making stuff up, calling something? You know, like yes, people are on a spectrum

[01:13:03] of ability to focus and at some point you can just arbitrarily decide, oh, this is a disorder and start prescribing medication. And that doesn't mean like you've carved nature at the joints, it just means that you've just all of a sudden decided, oh, these kids or these adults

[01:13:20] that have filled out this form in this particular way or who are acting functionally in this particular way that they have a disorder. That's just something that you've invented and constructed. And he's very clear about that he thinks so many disorders are like that.

[01:13:33] It's just, they're just made up by the psychiatric establishment. So like I'm sympathetic to that idea. But I agree with you also that sometimes thinking of it that way is actually really helpful for people to live happier lives. The people you're talking about, people who are depressed,

[01:13:53] people who have severe anxiety, never mind like the serious like again, I don't know about bipolar disorder or schizophrenia or something like that, but like- Those are tough. Those are tough and maybe they are arbitrary things that there's no physiological marker for

[01:14:10] and maybe it is in some ways or maybe in serious significant ways of social construction. But if it gets those people to be willing to accept help and if it gets insurance companies to pay for the medication that will give them help, then it's hard to think that

[01:14:28] that's this is why it's such a complex issue is it's hard to think that that's a bad thing. It's like a, it's probably a good thing. And yet then it bleeds into the cause capitalism, you know, like pharmaceutical companies are now

[01:14:40] like over prescribing medications for all sorts of things. The caveat, right. The big caveat is if the therapy, if the medical therapy like drug therapy help, if it works and there you get into real questions of power and capitalism and like do we even know that SSRIs

[01:15:01] are helping depression or not? It's very hard to determine. Some more than others I'm sure, but there is like all the studies show that like doing actual talk therapy helps just as much. But also weirdly people with severe, severe depression

[01:15:16] who have been unresponsive to drug therapy or like talk therapy, giving them like literally shocking their brains can sometimes help and we don't know why. It's like electro convulsive therapy actually works for them and we have no idea why.

[01:15:34] So if you were gonna be a total radical libertarian you would say let people do what they want but this is the weird thing about libertarianism is your wants are shaped by your society and what your society calls disease and what it doesn't.

[01:15:47] And so like it's very hard to define that even though you're always searching for it that Kantian like uninfluenced by anything numinal self that- The guy behind the veil of ignorance remember? Right, exactly. Yeah and also sometimes we have too much agency

[01:16:08] and I get like he really like he launches us or launches into this in his foundations of a theory for a personal conduct section. He starts saying basically like Christian and Jewish he was a Jew by the way. He starts talking about like sort of this slave psychology

[01:16:25] that is brought about by like this fetishizing of poverty and sickness. And he gets to the point where he sounds like he is not just anti-paternalists. He is like an ex-state like a sarch or like existentialist like everything is a decision.

[01:16:43] Like even your emotional state is a decision that you're making like and sometimes even when I'm like the most dualist about this stuff when I think no it's just your thoughts and your desires and wishes and beliefs it's not like the drugs or whatever.

[01:16:56] I still think sometimes we just really need less agency and we need somebody to tell us like, hey you're sick right? You've made yourself sick from stress like take a break. Yeah and they make you do almost like or pressure you to do it like you need that.

[01:17:12] And it feels nice when somebody tells you you need to take care of yourself like you're and you're like oh yeah. That was a really interesting section that was different than the rest of the book I thought even though the whole book is kind of cranky

[01:17:25] but like then he gets into this kind of Nietzschean thing of like the origins cause he does think like he says Freud was a moralist who is like who is pretending to be like a doctor or a scientist. He's pretending to be a neutral scientist

[01:17:40] while secretly judging people. Yeah I'm like having certain ends that he thought were desirable and then getting patients to those ends but like this part where he talks about you know the way the Bible encourages people to be non resilient, to infantilize people

[01:17:57] and make them helpless and dependent on others and dependent on authority. Like now you sort of get the sense at that point that yeah he really is arguing for a more existential like an idea of autonomy where like even if the patient is voluntarily choosing to

[01:18:19] but this is where I think he's inconsistent a little bit but even if the patient is voluntarily choosing to go to a therapist and accept whatever diagnosis the therapist gives them they are somehow a victim of this slave psychology that has been. Yeah it's weirdly inconsistent because he,

[01:18:39] I guess maybe he's just saying we have enforced this slave psychology on people like through culture and because of that they are actually non less agentric. I have a quote, we're talking about the sort of paternalism and ethics he says it is clear that the foregoing arrangement represents

[01:18:58] the same sort of emotional blackmail in a medical setting as that with which we are familiar in the family. The parent must take care of the child because the child is small and helpless. The physician must take care of the patient because the patient is sick and helpless.

[01:19:13] Therapeutism recapitulates paternalism and there he really make calling it emotional blackmail is really putting a lot of the blame. And I get it if you think that the quote unquote sick person is agentically deciding to have symptoms then it is manipulative and it is seeking care

[01:19:34] but even then I'm sympathetic to those people. Well, yeah this is why it's a really complicated subject. I'm in the camp where we've gone too far in how we medicalize things and I think the younger generation in the way they just unquestionably accept

[01:19:50] that these things are clear objective disorders rather than something that is a social construction to a large degree like yeah, I think that's wrong. I think Zaza's right but whether or not this is a good thing or a bad thing is really hard

[01:20:07] because you have to compare it to where we were before and was that good where people healthy then in the 30s and 40s were all this repressed stuff and all these people who are just deeply unhappy and socially disconnected from their families and like, so I don't know.

[01:20:28] But are they happy now? It's not like people are really happy now because they're on this. But the rise of good therapy of the kind that I think Zaza is okay with the kind that he really is taking care of humans at that same level of analysis

[01:20:41] like you're having a social psychological problem and I am talking to you at that level and we can solve the problem. The rise of that kind of therapy I don't think would have been possible without the cosine from the medical establishment.

[01:20:55] And this is what I've said about psychology when I'm in a good mood about it. It's like, you know, like the Sanford Prison Experiment points to something real that people wouldn't have acknowledged if it didn't have the veneer of scientific objectivity

[01:21:09] even if it was just like a stage play in some ways. Scientism works. Scientism works sometimes. Like in the right hands, scientism works. Here's the quote I wanted to read. The fear of acknowledging satisfaction is a characteristic feature of slave psychology. The well-worked slave is forced to labor

[01:21:28] until he is exhausted. To complete his task does not mean that his duties are finished, that he may rest. On the contrary, it only invites further demands. Conversely, although his task may be unfinished, he might be able to influence his master

[01:21:40] to stop driving him and to let him rest if he exhibits the appropriate signs of imminent collapse, whether genuine or contrived. So he contrasts this kind of mentality and this ethic, this norm, like he really does think it's like a normative ethic of like you're never productive.

[01:21:59] You're never doing what you ought to have done. There's always more that you can do and if you're not doing it then there is a problem. And so given that there's a problem, you now need to seek help. And that's really the only way that you'll get rest

[01:22:11] from the constant work. Yeah, so he says, I submit that the concept of a distinctively human, normal or well-functioning personality is rooted in psychosocial and ethical criteria. It is not biologically given nor are biological determinants especially significant for it.

[01:22:28] I do not deny of course that man is an animal with a genetically determined biological equipment which sets the upper and lower limits within which he must function. I accept the limits or the general range and focus on the development of specific patterns of operation within them.

[01:22:40] Here I eschew biological considerations as explanations and instead try to construct a consistently moral and psychosocial explanatory scheme. And I'm kind of with him about explanation, right? I actually think without, I think without fear of being a dualist that when I wanna explain psychological behavior

[01:23:02] I admit to two things. One, that it's not appropriate for me to bounce down to the level of neurons or whatever because that's not the kind of explanation. Like if I wanna know why you went to the store, you telling me that it's because you wanted to go

[01:23:13] to the store because you were hungry is the level of explanation I'm looking for and that's perfectly fine. And that causality at that level is not like physics. It is probabilistic but that's an epist... I think it's an epistemological problem. And it's true of most diseases

[01:23:32] like most diseases that he accepts as diseases. And I think you're absolutely right to point that his pet examples of disease are very easy. Like you have a virus and you get a fever. There are a lot of syndromes even that medical scientists don't know.

[01:23:49] So this is a second quote, he says, in short, I believe that the aim of psychoanalytic therapy is or should be to maximize the patient's choices in the conduct of his life. And that sounds good but like you were saying your choices are also kind of like part

[01:24:04] of your fucked up and like... Yeah. ...situation. Yeah, and that's where he sounds almost like a naive libertarian where it's like you have this Kantian self that can be free over and above all these influences that are shaping you. And if you reject that, and I'm not saying

[01:24:24] like you might reject it at a physical level but accept it on a methodological or moral level, like you might say, well, this is how... This is the best way to get... And this is an empirical question but the best way to overcome certain psychological obstacles

[01:24:42] or addiction for example, is to take responsibility for it and to make it seem like that this is your choice even if your metaphysical scheme like understands that ultimately these things are a product of your biology and your environment. Maybe that's true.

[01:24:57] And I think he is kind of sympathetic to that view that like we have hammered the resilience out of people with this kind of way of looking at... It's an Eastern block kind of guy. He's like, oh, cry me a fucking river.

[01:25:14] You didn't have an orgasm this week? He grew up in Hungary in like the 30s. He was Jewish, right? Yeah. Yeah, so like... He's seen some shit. He's seen some shit. All right, we should wrap up but I wanted to ask you what you thought

[01:25:28] about this whole thing of like the typecasting. Remind me? Where I was skimming, where I was rapidly skimming. No, I got it. Like I was with you but I hit on this part where there are actors who are typecasted and people and if it's like a TV show

[01:25:47] people associate them with that role but it's very clear there's a distinction between like they know in the end that they are... His example is Ralph Bellamy and not Franklin Delano or Roosevelt but what he accuses the psychiatric establishment of doing

[01:26:04] is kind of telling people that they are that and there is a bleed between the actor and their role, right? Like Julio at Louis Dreyfus if you see her after you've like binged seven seasons of Veep it's hard to think of her not as the character in Veep.

[01:26:21] And like there's a little bit of bleed and actors will sometimes get so wrapped up in a part that they find it hard to distinguish between them but at the end of the day it's like, you know everybody knows oh wait that's the actress, that's the role

[01:26:35] but like I think what he's saying in this section is what psychiatrists are doing is they're treating them as the actual person not the role and that actually ends up in infiltrating the person's mentality to the effect where they now think

[01:26:53] like Ralph Bellamy thinks that he's Franklin Delano or Roosevelt or Julio Louis Dreyfus thinks she's Selena Meyers and so it's like now they're fucked up because of this way of thinking about mental illness. I remember this section now and people said this about Tupac

[01:27:14] that when he took the role in the movie Juice that his personality actually changed that the character's name was Q and that from that point on like he was a different person like as if it had actually infiltrated him

[01:27:28] and I get that like there's a real deep truth in here I think both of us are trying to pin down but it's like one of those slippery toys that you had as a kid that are like a rubber thing with water in it

[01:27:40] like and I'm on, I know I'm on board with some of the stuff I think that what this lacks and I don't blame them it's 1961 is the kind of refined complexity like there are many different kinds of mental problems

[01:27:59] and I think he's right about some of them though I think he's right about and I don't mind his approach as a corrective one to remind us that maybe, I mean for one I think that the taxonomy of mental illness like I'm fascinated by that alone

[01:28:16] like how we come up with the divisions in the DSM is to me like a hilarious and also not transparent from the little research I did and not transparent at all, right? Exactly, exactly. We should act it would be nice to get a clinical psychologist to come on

[01:28:31] and talk about that. So there is something there and like that point about the role like that's deep. But think about it like you tell a like a 12 year old girl you have anxiety you diagnose her as having this condition which they think is like, I don't know

[01:28:47] being like a hard of hearing or blind or something like that. And now how is that not going to like get into their heads to the degree where they start or at least it's possible, possible maybe that that becomes now part of their personality

[01:29:04] that that will become real in the sense. Yeah, it's a self-fulfilling prophecy is the expression I'm looking for. So yeah, so like if that's true and there's a lot of empirical claims made in there that would be a problem that you start diagnosing these people with certain things

[01:29:21] and now they believe that they have it and they act accordingly. Yeah, and it's not hard to see how this might work psychologically. Like I don't know if you've ever experienced this sort of like what, you know when you were sick and stayed home from school

[01:29:35] and like you're really sick but during the day when your parents weren't work it wasn't as bad as when your mom got home and then you're just like, oh, mom like you're crying out for like her care and in some deep way that I don't feel like

[01:29:49] you feel worse because you wanna get taken care of. And if that's the kind of thing that's going on in a lot of these cases which I believe might be really happening with the way that we taxonomize and the way that we apply these labels

[01:30:05] then I think that's why this book is still worth reading even though it spends so much time on weird like conversion disorder, witchcraft and Jesus. Yeah, in a different episode we could talk about the witchcraft analogy which is kind of interesting. It was interesting.

[01:30:25] I don't know what it would be like to be in therapy with Thomas Zaz. I wonder, like I wonder what kinds of stuff he would do and say to like I kind of would be afraid of him. No, no, it'd be intimidating. Yeah.

[01:30:39] Yeah, I don't get the sense he would take my problems like that seriously. Like the fuck out of here? Well thank you to our Patreon. I'm glad I read it. I'm sure I'm gonna think more about it and... And quote it in your book.

[01:30:51] And quote it in this book that I'll never write because I have some sort of disorder that only lets me podcast and not write. That's right. I have insomnia and I'm very much looking forward to popping some pills tonight. Like I... Of your own free will though.

[01:31:04] Fuck Zaz, I want some pills to help me sleep. What I want is somebody to like come in while I'm like lying in bed and I can't sleep and just shove Xanax in my mouth. Against my will, you know? Paternolistically, like oh no,

[01:31:20] please don't with your mouth open. Exactly. All right. Join us next time on Very Bad Wizard. Hey good man, just a very bad wizard.