Thomas Szasz, a Hungarian-American psychiatrist, is the person most associated with the argument that mental illness is a myth. In 1960, he published “The Myth of Mental Illness,” a landmark essay (later expanded into a book) that challenged the very foundation of his own profession. Szasz contended that only physical illnesses are real and that mental diseases are “counterfeit and metaphorical illnesses.” He wasn’t alone in this thinking. A broader intellectual movement in the 1960s and 1970s questioned whether psychiatry was a legitimate branch of medicine or a system of social control.
Szasz’s Core Argument
Szasz drew a sharp line between the body and the mind. A real illness, he argued, involves a deviation from the structural or functional integrity of the body. A broken bone, a tumor, a bacterial infection: these can be observed, measured, and verified. Mental illness, by contrast, involves deviation from a psychosocial and ethical norm, one defined not by biology but by culture and behavior. When psychiatrists label someone “mentally ill,” Szasz believed they were making a moral and social judgment, not a medical one.
He did not deny that people suffer or struggle. He simply rejected the word “illness” as the right frame. Instead, he preferred the term “problems in living,” a phrase that acknowledged human difficulty without medicalizing it. For Szasz, calling emotional distress or unusual behavior a disease was like calling a counterfeit bill real currency. The language of medicine was being borrowed to describe something that wasn’t medical at all. What psychiatrists treated as symptoms, he saw as indirect forms of communication, ways people expressed conflict, unhappiness, or disagreement with the world around them.
Szasz elaborated on these ideas over a writing career that spanned more than 50 years. He was deeply libertarian in his views, opposing involuntary psychiatric commitment and forced treatment. In 1969, he co-founded the Citizens Commission on Human Rights, an organization dedicated to exposing what it called abuses in psychiatry. (The organization was co-founded with the Church of Scientology, though Szasz himself was an atheist and materialist whose philosophical views had little in common with Scientology’s theology.) He remained active in this advocacy until his death in 2012.
The Anti-Psychiatry Movement
Szasz was the most prominent American voice in a broader intellectual current sometimes called the anti-psychiatry movement. Four thinkers are generally considered its foundational figures: Michel Foucault in France, R.D. Laing in Great Britain, Szasz in the United States, and Franco Basaglia in Italy. All four championed the idea that personal reality was independent from any definition of “normalcy” imposed by organized psychiatry.
Foucault approached the question historically. In “Madness and Civilization,” published in the early 1960s, he traced how external economic and cultural interests have always shaped what counts as mental illness. He described psychiatry as functioning like “a jurisdiction without appeal” positioned between the police and the courts, a third order of repression rather than a healing profession.
R.D. Laing took a different angle, focusing on social causality. In “The Divided Self,” a bestseller on college campuses across the U.S. and Britain, Laing proposed that a person experiencing psychosis could be understood in two ways: their behavior could be read as signs of a disease, or it could be seen as expressive of their lived experience. For Laing, paranoid delusions were not symptoms of illness but understandable reactions to an inescapable and persecutory social order. He drew parallels to other work of the era showing how marginalized groups often fulfilled the stereotypes placed upon them, including sociologist Erving Goffman’s research on how psychiatric patients, stripped of normal social responsibilities, developed “institutional behavior” that reinforced the very diagnoses that confined them.
How Psychiatry Responded
The critique landed at an awkward time for mainstream psychiatry. Through the 1960s and 1970s, the field relied on a biopsychosocial model that blended biological, psychological, and social factors. The problem was that this model did not clearly distinguish the mentally well from the mentally ill, and by the 1970s, psychiatry was facing a genuine crisis of legitimacy. If no one could agree on where normal ended and illness began, critics like Szasz had a powerful point.
The profession’s most concrete response came in 1980, with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This represented a deliberate shift from the older clinical model to a research-based medical model. The DSM-III introduced specific, observable diagnostic criteria for each disorder, designed to make psychiatric diagnosis more standardized and scientifically defensible. It was, in many ways, a direct answer to the charge that mental illness was too vague and subjective to qualify as real medicine. While the shift had positive consequences for the field’s credibility, some scholars have noted that it also represented a significant narrowing of psychiatry’s focus, prioritizing measurable symptoms over the broader human context that earlier approaches had tried to capture.
What Szasz Got Right and Wrong
The debate Szasz started is far from settled. His strongest contribution was ethical, not scientific. He forced a reckoning with the power psychiatry holds over individuals, particularly the power to confine and treat people against their will. Many reforms in patients’ rights, informed consent, and the closure of large state psychiatric institutions trace at least partly to the pressure his ideas created.
Where his argument runs into trouble is its rigid insistence that only conditions with identifiable physical pathology count as real illness. Modern neuroscience has documented measurable differences in brain structure, chemistry, and function associated with conditions like schizophrenia, severe depression, and bipolar disorder. These findings don’t fit neatly into Szasz’s framework, which drew a hard boundary between the body (medicine’s domain) and the mind (not medicine’s domain). The brain, of course, is both.
Szasz also struggled to account for the severity of certain conditions. Reframing psychosis as a “problem in living” can feel inadequate when someone is unable to care for themselves or distinguish hallucinations from reality. Critics have argued that while the label “mental illness” is imperfect, abandoning it altogether risks leaving vulnerable people without access to care or legal protections.
Still, the questions Szasz raised in 1960 continue to echo. Who decides what counts as a mental disorder? How much of diagnosis reflects biology, and how much reflects cultural expectations about how people should think, feel, and behave? These remain live questions in psychiatry, even among practitioners who reject Szasz’s most extreme conclusions.