To the Editor:

In “The Ideology of Homelessness” [March], Joseph Adelson launches an attack on what he calls “anti-psychiatry.” The attack is rife with imprecision, inaccuracies, and straw-man arguments.

Mr. Adelson begins his article by citing the pathetic case of a “deranged man” who shouts incoherently about conspiracy. He claims that his example represents only the tip of the iceberg of homelessness in America, a problem he attributes to the precipitous emptying of mental hospitals, “perhaps the greatest social-policy fiasco of an era which specialized in them.” As a result, Mr. Adelson says, there were “[T]ens of thousands of insane people on the streets.” Leaving aside the use of the word “insane,” which is neither a medical nor (currently) a psychiatric term, it should be noted that Mr. Adelson then creates a strange causal continuum leading to his ultimate bête noire: “anti-psychiatry.” He attributes the “decision to empty the mental hospitals” to “an ideological decision deriving from strong convictions about both the nature of psychosis and the function of the hospital.” This ideology is traced from 1950’s “behaviorist learning theory” to the critics of personality-theory orthodoxy to “situation-ism” and finally to “anti-psychiatry.”

This dubious continuum strangely links situationism, a view which locates the cause of behavior outside the individual and in the environment, with anti-psychiatry which, in the case of Dr. Thomas Szasz, locates the cause within the individual.

There is more than a little confusion here, becauase Mr. Adelson never defines what he means by anti-psychiatry. Whose anti-psychiatry does he mean? That of R.D. Laing, who celebrated the mentally ill as having unique perspectives? Of Timothy Leary, who glorified drug-taking? Or of Thomas Szasz, who never did either? In our opinion, Mr. Adelson should be—but isn’t—addressing Dr. Szasz’s critiques (including, for example, his opposition to the medicalization of deviance). Dr. Szasz is arguably “the premier critic of his profession,” as psychiatrist-turned-columnist Charles Krauthammer, a friendly and well-respected source for Mr. Adelson’s point of view, calls him.

Mr. Adelson cites Madness in the Streets by Rael Jean Isaac and Virginia C. Armat with approval as providing “answers” to what he depicts as anti-psychiatry’s fatuous attacks, but the book, . . . though extensively researched, is very poorly reasoned and argued. The authors never define anti-psychiatry, either, nor, like Mr. Adelson, do they define mental illness, despite using the term repeatedly as if its meaning were self-evident. . . . Their book, termed “dazzling” by Mr. Adelson, is filled with polemics . . . and tautologies. Moreover, it frequently and substantially misrepresents Dr. Szasz’s views. . . . But though it is important to point out the weaknesses of this work, since Mr. Adelson cites it as a major contribution to the debate over the validity of psychiatric practice and as a “devastating book” likely to aid in anti-psychiatry’s “demise,” our main focus here is on Mr. Adelson. . . .

For purposes of discussion we accept that Dr. Szasz is a major player in what is (inaccurately) called the anti-psychiatry movement, though Mr. Adelson never mentions him, much less engages any of his arguments. Further, we will assume that Mr. Adelson is referring to Dr. Szasz when he rails against anti-psychiatry. . . . So let us look at a few of Mr. Adelson’s arguments and implications regarding the homeless and mental illness and see how well they stand up to Dr. Szasz’s anti-psychiatry.

Mr. Adelson argues that anti-psychiatry led to the irresponsible forcing-out into the streets of psychiatrically hospitalized patients. But in fact, Dr. Szasz opposed such forced exits. As he wrote in 1980:

Just as years ago “crazy” people were incarcerated in mental hospitals against their will—now they are evicted from them against their will. . . . In the name of doing something good for mental patients, once more something terrible is being done to them.

More recently he wrote:

Institutionalizing human beings in the name of psychiatric care was, as now nearly everyone admits, a shame. Deinstitutionalizing them in the name of psychiatric progress is a sham.

Mr. Adelson equates “psychosis” and “mental illness,” in one case making them synonymous and often using them interchangeably. This is becoming a rhetorical staple of those who cite the strangest and most likely brain-diseased individuals as the prototype of all the people now presumed to be mentally ill in one sense or another. Yet the nature of the evidence regarding the biological basis for some behaviors labeled as schizophrenia is dramatically different from the almost total absence of such evidence regarding most other types of behavior labeled as mental illness.

In recent years biological psychiatrists believe they have established that schizophrenia is a disease, as evidenced by the structural and chemical abnormalities discovered in the brains of some schizophrenics. The notion that some people labeled schizophrenic have a brain disease is accepted unquestioningly by the public and, we might note, was never excluded as a possibility in any of the writings of Dr. Szasz.

Having provided some interesting evidence and having won acceptance for the view that one type of mental illness may be a bonafide disease, mental-health interests try to transfer the credibility of schizophrenia research to imply that all mental illness constitutes proven brain disease. The hope is that if it is accepted that there is an identifiable brain disease at the root of behaviors labeled as schizophrenic, it will simply be assumed that there is an established brain disease at the root of the tremendous range of behaviors that have at times been labeled as mentally ill. . . .

Mr. Adelson argues that “the disciplines of psychiatry and psychology” have suffered from the difficulty of “science easily overcom[ing] dogma.” This is a strange depiction of antagonists’ roles, since the most compelling attack on those disciplines from Karl Popper to Thomas Szasz is the claim that the disciplines are pseudo-medicine and pseudo-science masquerading as medicine and science.

Dr. Szasz disputes the scientific, as well as the medical, identity of psychiatry, arguing that there is no illness demonstrated in the great preponderance of cases of what is termed mental illness. This is, as Dr. Szasz has now convinced many others, no mere semantic disagreement. Perspectives on deviant behavior profoundly affect public policy. The choice of whether to call or not to call certain behaviors, illnesses will have tremendous consequences in responsibility, sympathy, legal status, and funding currently accorded to those who could be defined as suffering from various medically-based deviant behaviors, from alcoholism to mental illness in general.

Anti-psychiatry may indeed be doomed to “vanish,” as Mr. Adelson predicts, if by anti-psychiatry he means such ludicrous views as some of those that Isaac and Armat cite as prominent in the anti-psychiatry of Timothy Leary and R.D. Laing. However, if Mr. Adelson is referring to the views of Dr. Szasz and others who question the pretentiousness of psychiatry and the medicalization of deviant behavior, his view is contradicted by the many new attacks on the insanity plea, the medical model in general, and the allegedly medical basis of the endless array of behavioral “addictions” from alcoholism to “pathological gambling” (as well as their “treatment” programs).

And, finally, regarding the anti-psychiatry of Dr. Szasz, it is interesting to note the statement of Dr. Thomas Detre, director of the Western Psychiatric Institute and Clinic, who acknowledged several years ago that some of what Thomas Szasz has argued over the years is now psychiatric orthodoxy.

Richard E. Vatz
Towson State University
Towson, Maryland

Lee S. Weinberg
University of Pittsburgh
Pittsburgh, Pennsylvania

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To the Editor:

Although Joseph Adelson complains that “weak, irrelevant, or nonexistent findings” were allowed to triumph over good research in dealing with the mentally ill, this phrase describes Mr. Adelson’s own non-findings in regard to John Locke. Five times Mr. Adelson makes Locke and things Lockean into the butt of criticism. Can he produce from Locke’s own words five quotations (or four, or three) in support of the views that he puts into Locke’s mouth?

In the absence of exact words from Locke, we have only what Mr. Adelson calls “the empiricist tradition deriving from John Locke.” In this supposed tradition, according to Mr. Adelson, one “must concentrate on what was visible and external and measureable, and eschew speculating about such ineffables as ‘the mind.’ ”

Locke’s Essay Concerning Human Understanding gives the lie to Mr. Adelson’s parody. Far from eschewing mind (Book 11, Chapter 11 is called “Of Discerning and Other Operations of the Mind”), Locke gives it central importance in his doctrine of primary and secondary qualities, for the latter are only “in the mind.” Far from concentrating on what is external and measureable, the Essay makes personal identity depend on continuity of internal memory. Far from eschewing ineffables, Locke, as a believing Christian, speculates about God and the soul (Book IV, Chapter 10 is called “Of Our Knowledge of the Existence of God”).

What textual basis does Mr. Adelson have when he says “behaviorism was the heir . . . of Locke”? Among philosophers, Locke is famous for his anti-behaviorist speculation that the soul, representing a personal identity that is psychological rather than bodily, could be interchanged between a rich man and a poor one.

How much of Locke has Mr. Adelson read? He imagines a “Lockean tradition” of “an organism empty, passive, entirely pliable, lacking in will or purpose and without tendency.” Yet although Locke takes the mind as empty of innate ideas, it does not follow that he thinks the mind is passive, since Book II describes the mind’s power to combine “simple ideas” into “complex ideas” and “mixed modes.” Far from thinking that people are lacking in will, Locke affirms freedom of the will.

Mr. Adelson misrepresents Locke’s political philosophy as much as his theory of mind. Mr. Adelson says “the Lockean spirit . . . now become[s] aggressively political,” but aggressiveness has no political basis in the author of A Letter Concerning Toleration, which spoke against the real aggressiveness of religious bigotry in Europe.

Mr. Adelson conjures up a “Lockean formula and its egalitarian extension.” This supposed egalitarianism, however, is debunked by Crawford Macpherson in his The Political Theory of Possessive Individualism, which notes that Locke gives importance to anti-egalitarian property rights, so important in the class system of his time. Far from being “egalitarian,” the Second Treatise of Government explains why white colonists were justified in expropriating Indians’ property in North America.

Greg Lanning
Vancouver, British Columbia

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Joseph Adelson writes:

I long ago learned not to argue with those who believe in lost causes. In high school, I tried to persuade one of my friends that Trotsky was not likely to make a comeback. No luck. More recently, I told a humanities professor that Marxist economics did not have much of a future, except as an oxymoron. No luck again. So I have little heart for one more hopeless debate, this time on anti-psychiatry. In my view, it is dead, history, overtaken by events, specifically by the steady accretion of findings from empirical research. Many psychological disorders do have a biological or genetic component, not just the schizophrenias, but also many of the depressions, and some of the compulsions and eating disorders and panic states and perhaps some of the addictions. And more to come, I would guess. In any case, what I would say about Thomas Szasz’s doctrine has already been said, brilliantly, by Charles Krauthammer in his collection, Cutting Edges.

On Locke: my article borrowed the idea of a Lockean tradition from Gordon Allport, who found it clarified a continuing division in psychology, separating those who emphasize experience and learning from those who posit innate internal dispositions. That is hardly an eccentric idea; if anything it is commonplace. Here is my desk dictionary’s definition of tabula rasa: “The mind before it receives the impressions gained from experience, esp. the unformed featureless mind in the philosophy of Locke.” Here is Bertrand Russell in his history of philosophy:

Locke may be regarded as the founder of empiricism, which is the doctrine that all our knowledge . . . is derived from experience. Accordingly, the first book of the Essay is concerned in arguing, as against Plato, Descartes, and the scholastics, that there are no innate ideas or principles.

Here is John Passmore, another distinguished philosopher, adducing Locke’s belief that humans are intrinsically neither evil nor good, that at birth “their minds are already empty room.” The “educator can move into that empty room and furnish it with habits, thereby bestowing upon the child his moral character.” Hence, “moral education is essentially habit-formation.” Can anyone seriously doubt the connection between that position and behaviorism, past and present? Or its connection to current modes of egalitarianism?

I took pains to say that I was writing about the empiricist tradition Locke (largely) founded and continues to personify, not Locke’s philosophy in toto. I would not dream of doing otherwise. Locke was prolific (ten volumes in the Collected Works), wrote on a great range of topics from epistemology to politics to religion, and was notoriously inconsistent, so much so that most commentators chide him for it, Russell even poking fun at him gently. Above all, there is an ambiguity (or complexity) in Locke’s writing which has invited a startling variety of interpretations. I call Greg Lanning’s attention to the following passage from C. Fred Alford’s book, just published, on the philosophy of the self, which contains a searching discussion of those ambiguities:

One of the most striking things about the secondary literature on Locke is not merely the diversity, but the polarity, of opinions. For Vaughan, Locke is an anarchic individualist, for whom the individual is the only value. For Kendall, on the other hand, Locke is a more thoroughgoing (and hence more dangerous) theorist of the general will than Rousseau. Macpherson sees Locke as a defender of possessive individualism, whereas Dunn sees the key to Locke’s theory in the religious doctrine of the calling. Strauss looks at Locke and sees Hobbes.

He then goes on to comment on Locke’s contradictions, as so many others have done.

One of those contradictions, by the way, is on display in Mr. Lanning’s own letter. On the one hand, Locke is against the aggressiveness of religious bigotry; on the other, he condones aggressiveness against the American Indians. And please don’t tell me there is a higher synthesis where this contradiction vanishes.

In short, there are many Lockes to pick, but no single key.