Realism and anti-realism in the philosophy of psychiatry

This paper invalidates the anti-realist point of view on the existence of mental illness by reviewing the anti-psychiatry challenge to official psychiatry. We present the anti-realist ideas of Thomas Szasz as the most radical anti-psychiatric author followed by the more moderate thoughts of Cooper and Laing. We then present the criticism of all these authors, most notably by the Canadian philosopher of psychiatry L. Reznek. We argue that some forms of schizophrenic experience can be non-pathological and emancipatory, but that this does not negate the existence of schizophrenia as a mental illness. After the invalidation of the anti-psychiatric point of view that insanity is just a political construct, mental illness is defined as not only a biomedical, but also a semiotic reality. Finally, we differentiate the object-level and the meta-level of the problem of anti-realism in psychiatry and conclude that anti-realism is only acceptable on the former level, as a characterization of the lack of reality testing by psychiatric patients.