Szasz, feuchtersleben, and the history of psychiatry

Ernst Von Feuchtersleben is an eminent nineteenth-century Viennese psychiatrist who is almost completely ignored by both modern psychiatrists and historians of psychiatry. However, he has recently been mentioned by Thomas Szasz, who views him as his predecessor and ascribes to him his own thesisnamely, that mental illness is a mere myth (or at best a mere metaphor); Szasz claims it was introduced into psychiatry by Johann C. Heinroth. The present essay examines the question of whether Feuchtersleben can be viewed as Szasz’s/forerunner, and concludes that he cannot. Szasz follows individualistic principles rigorously and argues that all goaldirected individuals are autonomous-regardless of whether they suffer while struggling toward their goals. Hence, Szasz excludes the mentally ill from the realm of medicine and renders immoral the psychiatrists who impose on them psychiatric diagnosis and treatment. For those who endorse at one and the same time both what I shall call “classical individualistic ethics” and the received opinions concerning the limited autonomy of the mentally ill, the paradoxicality of the received opinions, in the light of Szasz’s works, seems unsolvable. Feuchtersleben endorses the Kantian version of individualistic ethics, yet, sensitive to the paradox, at times he rejects Kant’s dogmatic view of human freedom. He thus rejects both poles of the paradox asa myth (á la Lévi-Strauss) and offers an alternative approach instead of the paradoxical one. He recommends that we view mental health and autonomy as regulative principles in the empirical domain. The physician, the educator, the clergyman and the legislator should cooperate in diagnosing and treating gradations of both mental health and human autonomy. Szasz is therefore in error when he claims Feuchtersleben as his predecessor. The views of these two concerning the mentally ill are diametrically opposed. Moreover, I think Feuchtersleben’s view is superior: Szasz succumbs to or explains away the myths which still prevail regarding the mentally ill, but Feuchtersleben’s thinking is helpful in the light of today’s multiple developing explanations of mental illness and proposals for its treatment.