Thomas Szasz, Epicurean psychiatrist?

Mad in America

"The opposition of these two approaches [i.e., shamanism v. medicalism] is well known, and figures in every history of psychiatry. What is less familiar today is that in 4th-century BC Greece, yet another view was on offer—the Epicurean model, which attributed mental abnormality, as inferred from behavioral deviance or self-report, to spiritual anguish. The Epicurean model held that man’s universal fear of death was responsible for his mental anguish, which caused and resulted from his poor choices and failure to understand the relationship between his appetites and his responsibility. The sacred symbol of the Epicurean view is its emblematic treatment, talk therapy or exercise, both mental and physical.

The competition among three different models of mental anguish—the shamanic, the medical, and the Epicurean—is hard to map onto today’s context. In part this is because the Epicurean model runs counter to modern scientific thinking. It interpreted the spirit or mind (psyche, soul), not as something immortal and God-given, but as a purely mortal and material product of natural evolution; so it may seem counterintuitive. Since most people today, and especially non-Christians, believe either that the soul does not really exist, or that the mind is just a function of the brain, they have a hard time understanding this approach. For an atheist to say we have a spirit, and to refer to "spiritual well being" (as Szasz does), may strike you as funny. Most unreligious people today would deny that human beings have a spirit. For them, humans are organic compounds of atoms, molecules, electrochemical processes, and no more. There is no room in this picture for a spirit, a word that smacks of religion, superstition, or supernaturalism. Furthermore, today psychoanalysis (talk therapy) and pharmacophysical treatment (lobotomy, electroshock, drugs) are both subsumed under the name psychiatry; whereas in antiquity, the two were in direct competition. The medical model was the province of the Hippocratic healers, or doctors. The Epicurean model was the province of the philosophers and their students. Each group explained distress differently. The philosophers, like psychoanalysts, thought the patient’s psyche was disturbed; whereas the psychiatrists, like the Hippocratics, thought the brain's chemistry (or humors) were out of balance. (In antiquity, the shamanic model was only believed in by the lower classes and because it is obsolete today, it does not interest us here.)

It is the Epicurean model, I suggest, that Szasz himself hit upon and developed independently—though he was apparently unaware that he was reactivating a view that was not only ancient, but that had once been massively influential on civilized man, and for seven centuries."

The entire paper is well worth reading.