Thomas Szasz

Thomas Stephen Szasz (pronounced /sas/; born April 15, 1920 in Budapest, Hungary) is a psychiatrist and academic. He is Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He is a prominent figure in the antipsychiatry movement, a well-known social critic of the moral and scientific foundations of psychiatry, and of the social control aims of medicine in modern society, as well as of scientism. He is well known for his books, The Myth of Mental Illness (1960) and The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement which set out some of the arguments with which he is most associated.

His views on special treatment follow from classical liberal roots which are based on the principles that each person has the right to bodily and mental self-ownership and the right to be free from violence from others, although he criticized the "free world" as well as the Communist states for its use of psychiatry and "drogophobia". He believes that suicide, the practice of medicine, use and sale of drugs and sexual relations should be private, contractual, and outside of state jurisdiction.

Szasz's main arguments
Szasz is a critic of the influence of modern medicine on society, which he considers to be the secularisation of religion's hold on human kind. Criticizing scientism, he targets in particular psychiatry, underscoring its campaigns against masturbation at the end of the 19th century or the use of lobotomy to treat schizophrenia. To sum up his conception of medicine, he declared: "Since theocracy is the rule of God or its priests, and democracy the rule of the people or of the majority, pharmacracy is therefore the rule of medicine or of doctors."

He considers that: "'The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed.'" His main arguments can be summarised as follows:


 * The myth of mental illness: It is a medical metaphor to describe a behavioral disorder, such as schizophrenia, as an "illness" or "disease". Szasz wrote: "If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic." While people behave and think in ways that are very disturbing, this does not mean they have a disease. To Szasz, people with mental illness have a "fake disease," and these "scientific categories" are in fact used for power controls. Schizophrenia is "the sacred symbol of psychiatry". To be a true disease, the entity must somehow be capable of being approached, measured, or tested in scientific fashion. According to Szasz, disease must be found on the autopsy table and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. Mental illnesses are "like a" disease, argues Szasz, putting mental illness in a semantic metaphorical language arts category. Psychiatry is a pseudo-science that parodies medicine by using medical sounding words invented over the last 100 years. To be clear, heart break and heart attack belong to two completely different categories. Psychiatrists are but "soul doctors", the successors of priests, who deal with the spiritual "problems in living" that have troubled people forever. Psychiatry, through various Mental Health Acts has become the secular state religion according to Thomas Szasz. It is a social control system, which disguises itself under the claims of scientificity. The notion that biological psychiatry is a real science or a genuine branch of medicine has been challenged by other critics as well, such as Michel Foucault in Madness and Civilization (1961).


 * Separation of psychiatry and the state: If we accept that "mental illness" is a euphemism for behaviours that are disapproved of, then the state has no right to force psychiatric "treatment" on these individuals. Similarly, the state should not be able to interfere in mental health practices between consenting adults (for example, by legally controlling the supply of psychotropic drugs or psychiatric medication). The medicalization of government produces a "therapeutic state," designating someone as "insane" or as a "drug addict". In Ceremonial Chemistry (1973), he argued that the same persecution which has targeted witches, Jews, Gypsies or homosexuals now targets "drug addicts" and "insane" people. Szasz argued that all these categories of people were taken as scapegoats of the community in ritual ceremonies. To underscore this continuation of religion through medicine, he even takes as example obesity: instead of concentrating on junk food (ill-nutrition), physicians denounced hypernutrition. According to Szasz, despite their scientific appearance, the diets imposed were a moral substitute to the former fasts, and the social injunction not to be overweight is to be considered as a moral order, not as a scientific advice as it claims to be. "Health" is a moral concept, argues Szasz. As with those thought bad (insane people), those who took the wrong drugs (drug-addicts), medicine created a category for those who had the wrong weight (obeses). Szasz argued that psychiatrics was created in the 17th century to study and control those who erred from the medical norms of social behavior; a new specialisation, "drogophobia", was created in the 20th century to study and control those who erred from the medical norms of drug consumption; and then, in the 1960s, another specialization, "bariatrics", was created to deal with those who erred from the medical norms concerning the weight which the body should have. Thus, he underscores that in 1970, the American Society of Bariatic Physicians (from the Greek baros, weight) had 30 members, and already 450 two years later.


 * Presumption of competence: Just as legal systems work on the presumption that a person is innocent until proven guilty, individuals accused of crimes should not be presumed incompetent simply because a doctor or psychiatrist labels them as such. Mental incompetence should be assessed like any other form of incompetence, i.e., by purely legal and judicial means with the right of representation and appeal by the accused.


 * Death control: In an analogy to birth control, Szasz argues that individuals should be able to choose when to die without interference from medicine or the state, just as they are able to choose when to conceive without outside interference. He considers suicide to be among the most fundamental rights, but he opposes state-sanctioned euthanasia. In his 2006 book about Virginia Woolf he stated that she put an end to her life by a conscious and deliberate act, her suicide being an expression of her freedom of choice.


 * Abolition of the insanity defense: Szasz believes that testimony about the mental competence of a defendant should not be admissible in trials. Psychiatrist testifying about the mental state of an accused person's mind have about as much business as a priest testifying about the religious state of a person's soul in our courts.  Insanity was a legal tactic invented to circumvent the punishments of the Church, which, at the time included confiscation of the property of those who committed suicide, which often left widows and orphans destitute.  Only an insane person would do such a thing to his widow and children, it was successfully argued.  Legal mercy masquerading as medicine, said Szasz.


 * Abolition of involuntary hospitalization: No one should be deprived of liberty unless he is found guilty of a criminal offense. Depriving a person of liberty for what is said to be his own good is immoral. Just as a person suffering from terminal cancer may refuse treatment, so should a person be able to refuse psychiatric treatment.


 * Our right to drugs: Drug addiction is not a "disease" to be cured through legal drugs (Methadone instead of heroin; which forgets that heroin was created in the first place to be a substitute to opium), but a social "habit". Szasz also argues in favor of a drugs free-market. He criticized the "war on drugs", arguing that using drugs was in fact a victimless crime, or a crime without a victim. Prohibition itself constituted the crime. He shows how the "war on drugs" lead states to do things that would have never been considered half a century before, such as prohibiting a person from ingesting certain substances or interfering in other countries to impede the production of certain plants (e.g. coca eradication plans, or the campaigns against opium; both are traditional plants opposed by the Western world). Although Szasz is skeptical about the merits of psychotropic medications, he favors the repeal of drug prohibition. "Because we have a free market in food, we can buy all the bacon, eggs, and ice cream we want and can afford. If we had a free market in drugs, we could similarly buy all the barbiturates, chloral hydrate, and morphine we want and could afford." Szasz argued that the prohibition and other legal restrictions on drugs are enforced not because of their lethality, but in a ritualistic aim (he quotes Mary Douglas's studies of rituals). He also recalls that pharmakos, the Greek root of pharmacology, originally meant "scapegoat". Szasz dubbed pharmacology "pharmacomythology" because of its inclusion of social practices in its studies, in particular through the inclusion of the category of "addictiveness" in its programs. "Addictiveness" is a social category, argued Szasz, and the use of drugs should be apprehended as a social ritual rather than exclusively as the act of ingesting a chemical substance. There are many ways of ingesting a chemical substance, or "drug" (which comes from pharmakos), just as there are many different cultural ways of eating or drinking. Thus, some cultures prohibit certain types of substances, which they call "taboo", while they make use of others in various types of ceremonies.

Szasz has been associated with the anti-psychiatry movement of the 1960s and 1970s, although he has resisted being identified as an anti-psychiatrist. He is not opposed to the practice of psychiatry if it is non-coercive. He maintains that psychiatry should be a contractual service between consenting adults with no state involvement. He favors the abolition of involuntary hospitalization for mental illness. In a 2006 documentary film called Psychiatry: An Industry of Death released on DVD Szasz stated that involuntary mental hospitalization is a crime against humanity. Szasz also believes that, if unopposed, involuntary hospitalization will expand into "pharmacratic" dictatorship.

Szasz's work has influenced thinkers as diverse as Karl Popper, Milton Friedman, and Michel Foucault.

Relationship to Citizens Commission on Human Rights
Together with the Church of Scientology, Szasz co-founded the Citizens Commission on Human Rights (CCHR), in 1969, to fight the human rights crimes committed by psychiatrists and other mental health professionals. He remains on CCHR's Board of Advisors as Founding Commissioner. and continues to provide content for the CCHR. In the keynote address at the 25th anniversary of CCHR, Szasz stated: "We should all honor CCHR because it is really the organization that for the first time in human history has organized a politically, socially, internationally significant voice to combat psychiatry. This has never been done in human history before.” Szasz, himself, is an atheist, without any membership or involvement in Scientology. In 2003, the following statement, authorized by Szasz, was posted to the official Szasz web site by its owner, Jeffrey Schaler, explaining Szasz's relationship to CCHR:

"Dr. Szasz co-founded CCHR in the same spirit as he had co-founded -- with sociologist Erving Goffman and law professor George Alexander -- The American Association for the Abolition for Involuntary Mental Hospitalization... Scientologists have joined Szasz's battle against institutional psychiatry. Dr. Szasz welcomes the support of Jews, Christians, Muslims, and any other religious or atheist group committed to the struggle against the Therapeutic State. Sharing this battle does not mean that Dr. Szasz supports the unrelated principles and causes of any religious or non-religious organization. This is explicit and implicit in Dr. Szasz's work. Everyone and anyone is welcome to join in the struggle for individual liberty and personal responsibility -- especially as these values are threatened by psychiatric ideas and interventions."

Criticism
While teaching at SUNY, Szasz offered private psychotherapy to individuals with "problems in living," consistent with his belief that mental illness is a myth and that drugs do not solve emotional conflicts. He did not apply psychiatric disease labels to his patients because he believes that such diseases are fictional. Szasz's critics maintain that, contrary to his views, such illnesses are now regularly "approached, measured, or tested in scientific fashion." The list of groups that reject his opinion that mental illness is a myth include the American Psychiatric Association (APA) and the National Institute of Mental Health (NIMH).

Analysis of criticism
The journalist Jacob Sullum, who received a 2004 Thomas S. Szasz Award, summarized some specific criticisms of Szasz's views when he noted that critics "offer various alternatives to the Szaszian perspective, which insists upon an objectively measurable bodily defect as the sine qua non of a true disease".

If mental illness is a myth, so is physical illness, because both categories have fuzzy boundaries and are to a large extent culturally determined. Viewing mental illness as a myth, they assert, is a fiction that is necessary to maintain the integrity of psychotherapy as a moral enterprise. Critics, Sullum notes, also contend that the distinction between mental and physical disease is misleading, since, as the American Psychiatric Association puts it:

There is much that is "physical" in mental disorders and much "mental" in "physical" disorders.

Writings by Szasz
Bibliography of Szasz's writings.

Books
SUP = Syracuse University Press.
 * 1973. The Second Sin. Doubleday.
 * 1973 (editor). The Age of Madness: A History of Involuntary Mental Hospitalization Presented in Selected Texts. Doubleday Anchor.
 * 1974 (1960). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper & Row.
 * 1976. Heresies. Doubleday Anchor.
 * 1984. The Therapeutic State: Psychiatry in the Mirror of Current Events. Buffalo NY: Prometheus Books.
 * 1985 (1976). Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers. Holmes Beach FL: Learning Publications.
 * 1987 (1963). Law, Liberty, and Psychiatry: An Inquiry into the Social Uses of Mental Health Practices. SUP.
 * 1988 (1965). Psychiatric Justice. SUP.
 * 1988 (1965). The Ethics of Psychoanalysis: The Theory and Method of Autonomous Psychotherapy. SUP.
 * 1988 (1957). Pain and Pleasure: A Study of Bodily Feelings. SUP.
 * 1988 (1976). Schizophrenia: The Sacred Symbol of Psychiatry. SUP.
 * 1988 (1977). The Theology of Medicine: The Political-Philosophical Foundations of Medical Ethics. SUP.
 * 1988 (1978). The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric, and Repression. SUP.
 * 1990 (1980). Sex by Prescription. SUP.
 * 1990. The Untamed Tongue: A Dissenting Dictionary. Lasalle IL: Open Court.
 * 1990. Anti-Freud: Karl Kraus and His Criticism of Psychoanalysis and Psychiatry. SUP. First printed in 1976 as Karl Kraus and the Soul-Doctors: A Pioneer Critic and His Criticism of Psychiatry and Psychoanalysis. Louisiana State University Press.
 * 1991 (1970. Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man. SUP.
 * 1993. A Lexicon of Lunacy: Metaphoric Malady, Responsibility, and Psychiatry. New Brunswick NJ: Transaction Books.
 * 1996 (1992). Our Right to Drugs: The Case for a Free Market. SUP.
 * 1996. Cruel Compassion: Psychiatric Control of Society's Unwanted. SUP.
 * 1996. The Meaning of Mind: Language, Morality, and Neuroscience. SUP.
 * 1997. Insanity: The Idea and Its Consequences. SUP.
 * 1997 (1977). Psychiatric Slavery: When Confinement and Coercion Masquerade as Cure. SUP.
 * 1997 (1970). The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. SUP.
 * 1999 (1996). Fatal Freedom: The Ethics and Politics of Suicide. Westport CT: Praeger.
 * 2001 (1996). Pharmacracy: Medicine and Politics in America. Westport CT: Praeger.
 * 2002. Liberation By Oppression: A Comparative Study of Slavery and Psychiatry. New Brunswick NJ: Transaction Books.
 * 2004. Words to the Wise: A Medical-Philosophical Dictionary. New Brunswick NJ: Transaction Books.
 * 2004. Faith in Freedom: Libertarian Principles and Psychiatric Practices. New Brunswick NJ: Transaction Books.
 * 2006. My Madness Saved Me: The Madness and Marriage of Virginia Woolf. Somerset NJ: Transactions Publishers.

Secondary literature

 * Burston, Daniel, 2003, "Szasz, Laing and Existential Psychotherapy." Existential-Humanist Institute.
 * Powell, Jim, 2000. The Triumph of Liberty: A 2,000 Year History Told Through the Lives of Freedom's Greatest Champions. Free Press.
 * Schaler, J. A., ed., 2004. Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court Publishers.
 * Vatz, R. E., and Weinberg, L. S., eds., 1983. Thomas Szasz: Primary Values and Major Contentions. Prometheus Books.