???????? What would it mean to say that schizophrenia is a problem of living rather than a disease? What would be the implications for treatment? In what way does society respond to people who behave in unusual ways? In 1961, the psychiatrist Thomas Szasz (1920–2012) shocked the psychiatric establishment by making a bold claim that mental illness does not exist. In his controversial book, The Myth of Mental Illness, Szasz, a long-time critic of the psychiatric establishment, argued that mental illness is a myth, a convenient fiction society uses to stigmatize and subjugate people whose behavior it finds to be deviant, odd, or bizarre (Szasz, 1961, 2008, 2011). To Szasz, the so-called mental illnesses are really “problems in living,” not diseases in the same sense that influenza, hypertension, and cancer are diseases. Szasz did not dispute that the behavior of people diagnosed with schizophrenia or other mental disorders is peculiar or disturbed. Nor does he deny that these individuals suffer emotional problems or have difficulties adjusting to society. But he challenged the conventional view that strange or eccentric behavior is a product of an underlying disease. Szasz argued that treating problems as

“diseases” empowers psychiatrists to put socially deviant people away in medical facilities. To Szasz, involuntary hospitalization is a form of tyranny disguised as therapy. It deprives people of human dignity and strips them of the most essential human right—liberty.

Are the myriad problems of people with schizophrenia—the deluded thoughts and hallucinations and incoherent speech—

merely “problems in living,” or are they symptoms of an underlying disease process? The belief that mental illness is a myth or a social construction is difficult to reconcile with a large body of evidence showing structural and functional differences in the brains of schizophrenia patients and of genetic factors that increase the risk of developing the disorder.