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Thomas Szasz R.I.P.
September 12, 2012 permalink
Psychiatrist, and critic of his own profession, Dr Thomas Szasz, has passed away. The Reason obituary summarizes his work.
I am sorry to report that Thomas Szasz, the great libertarian critic of coercive psychiatry, the "therapeutic state," and the war on drugs, died over the weekend at his home in Manlius, New York. He was 92.
Szasz, a Reason contributing editor and professor emeritus at Upstate Medical University in Syracuse, was driven throughout his long and remarkably productive career by what he called his "passion against coercion," especially the medicalized versions that recast repression as treatment. His radical critique of psychiatry, laid out in the 1960 American Psychologist essay "The Myth of Mental Illness" and then in a book of the same name the following year, may be more relevant today than ever, as the field grows to encompass every sin and foible despite its shaky empirical foundation. Szasz argued tirelessly that psychiatric labels, as nothing more than names attached to sets of behavioral criteria, should not be used to strip people of their freedom or relieve them of their responsibility. Defenders of mental-health orthodoxy dismiss this critique more often than they address it, but even when they engage Szasz's arguments they cannot refute his crucial point about the arbitrariness and subjectivity of psychiatric taxonomy.
In addition to opposing involuntary psychiatric treatment and the insanity defense, Szasz objected to medically sanctioned state interference in what ought to be private decisions, ranging from drug use to suicide. His critique of drug prohibition, which delved into frequently ignored issues such as the nature of addiction and the justification for the mandatory prescription system, went beyond cost-benefit analysis to reveal the essential immorality of using force to stop people from altering their consciousness with politically disfavored chemicals. He brought the same kind of penetrating analysis to the subject of "public health" paternalism, interventions aimed at minimizing morbidity and mortality by discouraging risky behavior. He was a powerful influence on my own work in both of these areas, and I will always be grateful for his courage and insight.
More on Szasz:
Straight Talk From Thomas Szasz (1974 interview)
Thomas Szasz Takes on His Critics (book review essay)
Ill-Treated: The Continuing History of Psychiatric Abuses (book review essay)
You'd Have to Be Crazy (column)
Diagnosing in the Dark (book review essay)
Szasz in One Lesson (essay by Sheldon Richman)
Mental Health and the Law (Cato Unbound debate)
Thomas Szasz on Freedom and Psychotherapy (interview)
The Myth of Thomas Szasz (essay in The New Atlantis)
Amazon has his books here.
Addendum: A second obituary.
The Man Versus the Therapeutic State
Thomas Szasz's courageous defense of freedom and responsibility
The New York Times obituary for Thomas Szasz, who died this month at the age of 92, says his critique of psychiatry "had some merit in the 1950s…but not later on, when the field began developing more scientific approaches." That's a paraphrase of historian Edward Shorter, whose judgment reflects the conventional wisdom: Szasz called much-needed attention to psychiatric abuses early in his career but went too far by insisting on a fundamental distinction between actual, biological diseases and metaphorical diseases of the mind.
In fact, however, Szasz's radicalism, which he combined with a sharp wit, a keen eye for obfuscating rhetoric, and an uncompromising dedication to individual freedom and responsibility, was one of his greatest strengths. Beginning with The Myth of Mental Illness in 1961 and continuing through 35 more books and hundreds of articles, the maverick psychiatrist, driven by a "passion against coercion," zeroed in on the foundational fallacies underlying all manner of medicalized tyranny.
The idea that psychiatry became scientifically rigorous soon after Szasz first likened it to alchemy and astrology is hard to take seriously. After all, it was not until 1973 that the American Psychiatric Association (APA) stopped calling homosexuality a mental disorder.
More often, psychiatry has expanded its domain. Today it encompasses myriad sins and foibles, including smoking, overeating, gambling, shoplifting, sexual promiscuity, pederasty, rambunctiousness, inattentiveness, social awkwardness, anxiety, sadness, and political extremism. If it can be described, it can be diagnosed, but only if the APA says so. Asperger's, for instance, will cease to exist when the fifth edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM) comes out next year.
As Marcia Angell, former editor of The New England Journal of Medicine, observed last year in The New York Review of Books, "there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses in ways that would be impossible, say, in a field like cardiology." In other words, mental illnesses are whatever psychiatrists say they are.
How "scientific" is that? Not very. In a 2010 Wired interview, Allen Frances, lead editor of the current DSM, despaired that defining mental disorders is "bullshit." In an online debate last month, he declared that "mental disorders most certainly are not diseases."
Then what exactly are they? For more than half a century, Szasz stubbornly highlighted the hazards of joining such a fuzzy, subjective concept with the force of law through involuntary treatment, the insanity defense, and other psychiatrically informed policies.
Consider "sexually violent predators," who are convicted and imprisoned based on the premise that they could have restrained themselves but failed to do so, then committed to mental hospitals after completing their sentences based on the premise that they suffer from irresistible urges and therefore pose an intolerable threat to public safety. From a Szaszian perspective, this incoherent theory is a cover for what is really going on: the retroactive enhancement of duly imposed sentences by politicians who decided certain criminals were getting off too lightly—a policy so plainly contrary to due process and the rule of law that it had to be dressed up in quasi-medical, pseudoscientific justifications.
Szasz specialized in puncturing such pretensions. He relentlessly attacked the "therapeutic state," the unhealthy alliance of medicine and government that blesses all sorts of unjustified limits on liberty, ranging from the mandatory prescription system to laws against suicide. My own work has been powerfully influenced by Szasz's arguments against drug prohibition, especially his discussion of its symbolism and its reliance on a mistaken understanding of addiction, and his criticism of paternalistic interventions, such as New York Mayor Michael Bloomberg's recently approved soda serving ceiling, that conflate private and public health.
I will always be grateful for Szasz's courage and insight, and so should anyone who shares his passion against coercion.