Thomas Szasz

Thomas Stephen Szasz ( ; ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate Medical University. A distinguished lifetime fellow of the American Psychiatric Association and a life member of the American Psychoanalytic Association, he was best known as a social critic of the moral and scientific foundations of psychiatry, as what he saw as the social control aims of medicine in modern society, as well as scientism.

Szasz maintained throughout his career that he was not anti-psychiatry but rather that he opposed coercive psychiatry. He was a staunch opponent of civil commitment and involuntary psychiatric treatment, but he believed in and practiced psychiatry and psychotherapy between consenting adults.

Life and death

Szasz was born on April 15, 1920, in Budapest, Hungary, the second son of Jewish parents Gyula and Lily Szász. In 1938, the family moved to the United States, where he attended the University of Cincinnati for his Bachelor of Science in physics, followed by an MD.

Szasz completed his residency requirement at the Cincinnati General Hospital, then trained as a psychoanalyst at Chicago Institute for Psychoanalysis from 1951 to 1956. He took a position as a professor at SUNY in 1956 and received tenure in 1962, taking 24 months out for duty as a practicing psychiatrist with the U.S. Naval Reserve.

Szasz had two daughters. His wife, Rosine, died in 1971. Szasz's colleague Jeff Schaler described her death as a suicide.

Thomas Szasz ended his own life on September 8, 2012, after suffering a painful spinal-compression fracture from a recent fall. Szasz had previously argued for the right to die in his writings.

Career

Thomas Szasz was a strong critic of institutional psychiatry and was a prolific writer. According to psychiatrist Tony B. Benning, there were "three major themes in Szasz's writings: his contention that there is no such thing as mental illness, his contention that individual responsibility is never compromised in those suffering from what is generally considered as mental illness, and his perennial interest in calling attention to the political nature of psychiatric diagnosis". According to Williams and Caplan, Szasz is "best known for his view that without a diagnosis of neurological disease or damage, a psychiatric diagnosis was meaningless". Though his ideas had little influence on mainstream psychiatry, many were supported by some behavioral and social scientists.

Szasz first presented his attack on "mental illness" as a legal term in 1958 in the '' Columbia Law Review''. In his article he argued that mental illness was no more a fact bearing on a suspect's guilt than is possession by the devil.

His books '' The Myth of Mental Illness'' (1961) and ''The Manufacture of Madness'' (1970) set out some of the arguments most associated with him.
In 1961, Szasz testified before a United States Senate committee, arguing that using mental hospitals to incarcerate people defined as insane violated the general assumptions of the patient–doctor relationship, and turned the doctor into a warden and keeper of a prison.

Szasz was convinced there was a metaphorical character to mental disorders, and its uses in psychiatry were frequently injurious. He set himself a task to delegitimize legitimating agencies and authorities, and what he saw as their vast powers, enforced by psychiatrists and other mental health professionals, mental health laws, mental health courts, and mental health sentences.

Szasz was a critic of the influence of modern medicine on society, which he considered to be the secularization of religion's hold on humankind. Criticizing scientism, he targeted psychiatry in particular, underscoring its campaigns against masturbation at the end of the 19th century, its use of medical imagery and language to describe misbehavior, its reliance on involuntary mental hospitalization to protect society, and the use of lobotomy and other interventions to treat psychosis.
Szasz consistently paid attention to the power of language in the establishment and maintenance of the social order, both in small interpersonal and in wider social, economic, and/or political spheres.

Positions

Mental illness is a myth

In Szasz's view, people who are said to have a mental illness only have "problems in living". Diagnoses of "mental illness" or "mental disorder" are passed off as scientific but are judgments (of disdain) to support certain uses of power by authorities. In that line of thinking, schizophrenia becomes not the name of a disease entity but a judgment of extreme psychiatric and social disapprobation. Szasz called schizophrenia "the sacred symbol of psychiatry" because those so labeled have long provided and continue to provide justification for psychiatric theories, treatments, abuses, and reforms.

He argued that psychiatry is a pseudoscience that parodies medicine by using medical-sounding words and that, supported by the state through various Mental Health Acts, it has become a modern secular state religion. As a vastly elaborate social control system which disguises itself under the claims of being rational, systematic and therefore scientific, it constitutes a fundamental threat to freedom and dignity.

In ''The Myth of Mental Illness'' he argued that people can only play "the mental illness game" if their partner and those around them play a complementary role - a situation that would later be described as codependency.

Separate psychiatry and the state

Szasz believed that if we accept that "mental illness" is a euphemism for behaviors 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, for example, "insane" or as a "drug addict".

In ''Ceremonial Chemistry'' (1974), he argued that the same persecution that targeted witches, Jews, gypsies, and 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 an 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 scientific advice as it claims to be. As with those thought bad (insane people), and those who took the wrong drugs (drug addicts), medicine created a category for those who had the wrong weight (obesity).

Szasz argued that psychiatrics were created in the 17th century to study and control those who erred from the medical norms of social behavior; a new specialization, "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 (from the Greek βάρος ''baros,'' for "weight"), was created to deal with those who erred from the medical norms concerning the weight the body should have. Thus, he underscores that in 1970 the American Society of Bariatric Physicians had 30 members, and already 450 two years later.

The therapeutic state

The "therapeutic state" is a phrase coined by Szasz in 1963. The collaboration between psychiatry and government leads to what Szasz calls the ''therapeutic state'', a system in which disapproved actions, thoughts, and emotions are repressed ("cured") through pseudomedical interventions. Thus suicide, unconventional religious beliefs, racial bigotry, unhappiness, anxiety, shyness, sexual promiscuity, shoplifting, gambling, overeating, smoking, and illegal drug use are all considered symptoms or illnesses that need to be cured. When faced with demands for measures to curtail smoking in public, binge-drinking, gambling or obesity, ministers say that "we must guard against charges of nanny statism." The " nanny state" has turned into the "therapeutic state" where nanny has given way to counselor. Nanny just told people what to do; counselors also tell them what to think and what to feel. The "nanny state" was punitive, austere, and authoritarian, the therapeutic state is touchy-feely, supportive – and even more authoritarian.

According to Szasz, "the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion." Faced with the problem of "madness", Western individualism proved to be ill-prepared to defend the rights of the individual: modern man has no more right to be a madman than medieval man had a right to be a heretic because if once people agree that they have identified the one true God, or Good, it brings about that they have to guard members and nonmembers of the group from the temptation to worship false gods or goods. A secularization of God and the medicalization of good resulted in the post- Enlightenment version of this view: once people agree that they have identified the one true reason, it brings about that they have to guard against the temptation to worship unreason – that is, madness.

Civil libertarians warn that the marriage of the state with psychiatry could have catastrophic consequences for civilization. In the same vein as the separation of church and state, Szasz believes that a solid wall must exist between psychiatry and the state.

Abolish involuntary commitment

Szasz made efforts to abolish involuntary psychiatric hospitalization for over two decades, and in 1970 took a part in founding the American Association for the Abolition of Involuntary Mental Hospitalization (AAAIMH). Its founding was announced by Szasz in 1971 in the '' American Journal of Psychiatry'' and '' American Journal of Public Health''. Until it was dissolved in 1980, the association provided legal help to psychiatric patients and published a journal, ''The Abolitionist''.

According to Williams and Caplan, "Szasz's philosophical activism was not intended to improve the treatment of people affected by mental illness as much as to block involuntary treatment." Citing Szasz's writings, legal reforms were enacted, and all 50 US states narrowed their criteria for involuntary commitment from the prior standard of "need for treatment"—causing the number of patients in public psychiatric hospitals to plummet, and the homeless population to balloon. It also exponentially increased the prison population with an estimate of 40%–80% inmates with mental illness by 2006.

Three legal decisions were key:
* ''Lessard v. Schmidt'' (1972) required states to narrow their vague commitment statutes,
* '' O'Connor v. Donaldson'' (1975) limited commitment to imminently dangerous mentally ill persons, and
* '' Rennie v. Klein'' (1978) established the right of patients to refuse mental treatment.

Abolish insanity defense

Szasz advocated for the removal of the insanity defense. 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.

Szasz believed that testimony about the mental competence of a defendant should not be admissible in trials. Szasz compared psychiatric testimony in court to religious testimony, suggesting that both lack empirical grounding. Szasz argued that the insanity defense 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, often leaving widows and orphans destitute. Only an insane person would do such a thing to his widow and children, it was successfully argued. This is legal mercy masquerading as medicine, according to Szasz.

Right to drugs

According to Szasz, drug addiction is not a "disease" to be cured through legal drugs but a social habit. Szasz also argued in favor of a free market for drugs. He criticized the war on drugs, arguing that using drugs is in fact a victimless crime. Prohibition itself constituted the crime. He argued that the war on drugs leads 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 was skeptical about the merits of psychotropic medications, he favored the repeal of drug prohibition.

Szasz also drew analogies between the persecution of the drug-using minority and the persecution of Jewish and homosexual minorities.

Szasz cites former U.S. Representative James M. Hanley's reference to drug users as "vermin", using "the same metaphor for condemning persons who use or sell illegal drugs that the Nazis used to justify murdering Jews by poisoned gas—namely, that the persecuted persons are not human beings, but "vermin."

Right to die

In an analogy to birth control, Szasz argued 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 considered suicide and the right to die to be among the most fundamental rights, but he opposed state-sanctioned euthanasia. In his 2006 book about Virginia Woolf, Szasz stated that Woolf put an end to her life by a conscious and deliberate act, her suicide being an expression of her freedom of choice.

Citizens Commission on Human Rights

In 1969, Szasz and the Church of Scientology co-founded the Citizens Commission on Human Rights (CCHR) to oppose involuntary psychiatric treatments. Szasz served on CCHR's Board of Advisors as Founding Commissioner. 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." In a 2009 interview aired by the Australian Broadcasting Corporation, Szasz explained that he was an atheist and collaborated with Scientology only out of convenience, as an organization with money who were active in this cause.

Reception

In the summer of 2001, Szasz took part in a Russell Tribunal on human rights in psychiatry held in Berlin between June 30 and July 2, 2001, and was part of the majority verdict which claimed that there was "serious abuse of human rights in psychiatry" and that psychiatry was "guilty of the combination of force and unaccountability".

In 2005, Robert Evan Kendell presented a critique of Szasz's conception of disease and the contention that mental illness is "mythical" as presented in ''The Myth of Mental Illness''. Kendell argued that Szasz's conception of disease exclusively in terms of "lesion", i.e. morphological abnormality, is arbitrary and unsound, and his argument that "disease or illness can only affect the body" was based on Cartesian dualism which is already known to be medically inaccurate.

In 2011, Szasz published an essay in recognition of the 50th anniversary of ''The Myth of Mental Illness'', which had been delivered as a plenary address at the 2010 International Congress of the Royal College of Psychiatrists in Edinburgh. In the same issue, a response from Edward Shorter echoed Kendell's criticism and dismissed Szasz as largely premised on a conception of mind drawn from the psychiatry of the early-mid 20th century – namely psychoanalytic psychiatry – which does not exist in the current disciplines of psychiatry or medicine. Modern psychiatry has ''de facto'' dispensed with the idea of ''mental illness'', i.e. the notion that psychiatric disease is mainly or entirely psychogenic and is not a part of biological psychiatry. To this extent, he said, Szasz's critique does not address contemporary biologically-oriented psychiatry, and is irrelevant.

According to Williams and Caplan (2012), Szasz mostly influenced libertarians and the anti-psychiatry movement, with resultant devastating effects on those with severe mental illness, by promoting his "non-evidence based, philosophical foundation for the practice of mental health that prioritised the views and preferences of individuals with serious mental disorders above the true interests of a person not in the grip of mental illness". Considering that mental illness greatly contributes to homelessness and incarceration in the USA, they challenge whether "people with serious mental disorders who are confined to these settings reany better off than their pre-Szaszian predecessors who once filled asylums?"

Awards

Szasz received significant public recognition for his work, including:
* American Humanist Association Humanist of the Year (1973)
* Award for Greatest Public Service Benefiting the Disadvantaged, an award given out annually by Jefferson Awards (1974)
* an honorary doctorate in behavioral science at Universidad Francisco Marroquín (1979)
* American Psychological Association division of Humanistic Psychology ''Rollo May Award'' (1998)
* The Center for Independent Thought established the Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties

Writings

Books

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* (First published in 1976 under the name: Karl Kraus and the Soul-Doctors: A Pioneer Critic and His Criticism of Psychiatry and Psychoanalysis – Louisiana State University Press, 1976.)
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Selected scholarly papers

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See also

* Controversies about psychiatry
* Wrongful involuntary commitment
* Scientology front groups

References

Further reading

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External links

Bibliography of Szasz's writings

Thomas Szasz Knowledge Finder





Thomas S. Szasz Cybercenter for Liberty and Responsibility
* 1970 video
Concepts and Controversies in Modern Medicine: Psychiatry and Law: How are They Related? pt. 1pt. 2
Two-part video discussion of forensic psychiatry by Szasz and Bernard L. Diamond.

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