Thomas Szasz
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Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American
academic An academy (Attic Greek: Ἀκαδήμεια; Koine Greek Ἀκαδημία) is an institution of secondary or tertiary higher learning (and generally also research or honorary membership). The name traces back to Plato's school of philosophy, ...
and
psychiatrist A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
. He served for most of his career as professor of psychiatry at the
State University of New York Upstate Medical University The State University of New York Upstate Medical University (SUNY Upstate) is a public medical school in Syracuse, New York. Founded in 1834, Upstate is the 15th oldest medical school in the United States and is the only medical school in Centra ...
in
Syracuse, New York Syracuse ( ) is a city in and the county seat of Onondaga County, New York, United States. It is the fifth-most populous city in the state of New York following New York City, Buffalo, Yonkers, and Rochester. At the 2020 census, the city' ...
. A distinguished lifetime fellow of the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are invo ...
and a life member of the
American Psychoanalytic Association The American Psychoanalytic Association (APsaA) is an association of psychoanalysts in the United States. APsaA serves as a scientific and professional organization with a focus on education, research, and membership development. APsaA comprises ...
, he was best known as a social critic of the moral and scientific foundations of
psychiatry Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry. Initial p ...
, as what he saw as the social control aims of
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
in modern society, as well as
scientism Scientism is the opinion that science and the scientific method are the best or only way to render truth about the world and reality. While the term was defined originally to mean "methods and attitudes typical of or attributed to natural scientis ...
. His books ''
The Myth of Mental Illness ''The Myth of Mental Illness: Foundations of a Theory of Personal Conduct'' is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, ...
'' (1961) and ''The Manufacture of Madness'' (1970) set out some of the arguments most associated with him. Szasz argued throughout his career that
mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitt ...
is a
metaphor A metaphor is a figure of speech that, for rhetorical effect, directly refers to one thing by mentioning another. It may provide (or obscure) clarity or identify hidden similarities between two different ideas. Metaphors are often compared wi ...
for human problems in living, and that mental illnesses are not "illnesses" in the sense that physical illnesses are, and that except for a few identifiable brain diseases, there are "neither biological or chemical tests nor biopsy or necropsy findings for verifying DSM diagnoses." Szasz maintained throughout his career that he was not
anti-psychiatry Anti-psychiatry is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionabl ...
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

Szasz was born to
Jewish Jews ( he, יְהוּדִים, , ) or Jewish people are an ethnoreligious group and nation originating from the Israelites Israelite origins and kingdom: "The first act in the long drama of Jewish history is the age of the Israelites""The ...
parents Gyula and Lily Szász on April 15, 1920, in
Budapest Budapest (, ; ) is the capital and most populous city of Hungary. It is the ninth-largest city in the European Union by population within city limits and the second-largest city on the Danube river; the city has an estimated population o ...
, Hungary. In 1938, Szasz moved to the United States, where he attended the
University of Cincinnati The University of Cincinnati (UC or Cincinnati) is a public research university in Cincinnati, Ohio. Founded in 1819 as Cincinnati College, it is the oldest institution of higher education in Cincinnati and has an annual enrollment of over 44,0 ...
for his Bachelor of Science in physics, and received his M.D. from the same university in 1944. Szasz completed his residency requirement at the Cincinnati General Hospital, then worked at the Chicago Institute for Psychoanalysis from 1951–56, and then for the next five years was a member of its staff – taking 24 months out for duty with the U.S. Naval Reserve. In 1962 Szasz received a tenured position in medicine at the
State University of New York The State University of New York (SUNY, , ) is a system of public colleges and universities in the State of New York. It is one of the largest comprehensive system of universities, colleges, and community colleges in the United States. Led by ...
. Szasz had first joined SUNY in 1956. Szasz had two daughters. His wife, Rosine, died in 1971. Szasz's colleague Jeff Schaler described her death as a suicide. Szasz's views of psychiatry were influenced by the writings of
Frigyes Karinthy Frigyes Karinthy (; 25 June 1887 – 29 August 1938) was a Hungarian author, playwright, poet, journalist, and translator. He was the first proponent of the six degrees of separation concept, in his 1929 short story, ''Chains'' (''Láncszemek'') ...
.


Death

Thomas Szasz ended his own life on September 8, 2012. He had previously suffered a fall and would have had to live in chronic pain otherwise. Szasz argued for the right to suicide in his writings.


Rise of Szasz's arguments

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. In 1961 Szasz testified before a
United States Senate The United States Senate is the upper chamber of the United States Congress, with the House of Representatives being the lower chamber. Together they compose the national bicameral legislature of the United States. The composition and po ...
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's main arguments

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 Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
on society, which he considered to be the
secularization In sociology, secularization (or secularisation) is the transformation of a society from close identification with religious values and institutions toward non-religious values and secular institutions. The ''secularization thesis'' expresses ...
of religion's hold on humankind. Criticizing
scientism Scientism is the opinion that science and the scientific method are the best or only way to render truth about the world and reality. While the term was defined originally to mean "methods and attitudes typical of or attributed to natural scientis ...
, he targeted psychiatry in particular, underscoring its campaigns against
masturbation Masturbation is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrators, or combinat ...
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 A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections t ...
and other interventions to treat
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavi ...
. To sum up his description of the political influence of medicine in modern societies imbued by faith in
science Science is a systematic endeavor that builds and organizes knowledge in the form of testable explanations and predictions about the universe. Science may be as old as the human species, and some of the earliest archeological evidence ...
, 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.
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:
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?...
he one He or HE may refer to: Language * He (pronoun), an English pronoun * He (kana), the romanization of the Japanese kana へ * He (letter), the fifth letter of many Semitic alphabets * He (Cyrillic), a letter of the Cyrillic script called ''He'' in ...
who first seizes the word imposes reality on the other;
he one He or HE may refer to: Language * He (pronoun), an English pronoun * He (kana), the romanization of the Japanese kana へ * He (letter), the fifth letter of many Semitic alphabets * He (Cyrillic), a letter of the Cyrillic script called ''He'' in ...
who defines thus dominates and lives; and
he one He or HE may refer to: Language * He (pronoun), an English pronoun * He (kana), the romanization of the Japanese kana へ * He (letter), the fifth letter of many Semitic alphabets * He (Cyrillic), a letter of the Cyrillic script called ''He'' in ...
who is defined is subjugated and may be killed.
His main arguments can be summarized as follows:


"Myth of mental illness"

"Mental illness" is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behavior, such as packaged under the wide-ranging term
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
, 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 Spiritualism is the metaphysical school of thought opposing physicalism and also is the category of all spiritual beliefs/views (in monism and dualism) from ancient to modern. In the long nineteenth century, Spiritualism (when not lowercase) ...
; If you talk to the dead, you are a schizophrenic." He maintained that, while people behave and think in disturbing ways, and those ways may resemble a disease process (pain, deterioration, response to various interventions), this does not mean they actually have a disease. To Szasz, disease can only mean something people "have", while behavior is what people "do". Diseases are "malfunctions of the human body, of the heart, the liver, the kidney, the brain" while "no behavior or misbehavior is a disease or can be a disease. That's not what diseases are." Szasz cited drapetomania as an example of a behavior that many in society did not approve of, being labeled and widely cited as a disease. Likewise, women who did not bend to a man's will were said to have
hysteria Hysteria is a term used colloquially to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, hysteria was considered a diagnosable physical illness in women. It is assumed that ...
. He thought that psychiatry actively obscures the difference between behavior and disease in its quest to help or harm parties in conflicts. He maintained that, by calling people diseased, psychiatry attempts to deny them responsibility as moral agents in order to better control them. In Szasz's view, people who are said by themselves or others to have a mental illness can only have, at best, "problems in living". Diagnoses of "mental illness" or "mental disorder" (the latter expression called by Szasz a " weasel term" for mental illness) are passed off as "scientific categories" but they remain merely judgments (judgments of disdain) to support certain uses of power by psychiatric 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. The figure of the psychotic or schizophrenic person to psychiatric experts and authorities, according to Szasz, is analogous with the figure of the heretic or blasphemer to theological experts and authorities. According to Szasz, to understand the metaphorical nature of the term "disease" in psychiatry, one must first understand its literal meaning in the rest of medicine. To be a true disease, the entity must first somehow be capable of being approached, measured, or tested in scientific fashion. Second, to be confirmed as a disease, a condition must demonstrate pathology at the cellular or molecular level. A genuine disease must also be found on the autopsy table (not merely in the living person) and meet pathological definition instead of being voted into existence by members of the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are invo ...
. "Mental illnesses" are really problems in living. They are often "like a" disease, argued Szasz, which makes the medical metaphor understandable, but in no way validates it as an accurate description or explanation. Psychiatry is a
pseudoscience Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable claim ...
that parodies medicine by using medical-sounding words invented especially over the last one hundred years. To be clear,
heart break ''Heart Break'' is the fifth studio album by American R&B quintet New Edition, released June 20, 1988 by MCA Records. It is the first album to return the Boston-reared band as a quintet after the public exit of original member Bobby Brown, and t ...
and
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which ma ...
, or spring fever and
typhoid fever Typhoid fever, also known as typhoid, is a disease caused by '' Salmonella'' serotype Typhi bacteria. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often there is a gradual onset of a high fever over severa ...
belong to two completely different logical categories, and treating one as the other constitutes a
category error A category mistake, or category error, or categorical mistake, or mistake of category, is a semantic or ontological error in which things belonging to a particular category are presented as if they belong to a different category, or, alternative ...
. Psychiatrists are the successors of "soul doctors",
priest A priest is a religious leader authorized to perform the sacred rituals of a religion, especially as a mediatory agent between humans and one or more deities. They also have the authority or power to administer religious rites; in partic ...
s who dealt and deal with the spiritual conundrums, dilemmas, and vexations – the "problems in living" – that have troubled people forever. Psychiatry's main methods are assessment, medication, conversation or rhetoric and incarceration. To the extent that psychiatry presents these problems as "medical diseases", its methods as "medical treatments", and its clients – especially involuntary – as medically ill patients, it embodies a lie and therefore constitutes a fundamental threat to freedom and dignity. Psychiatry, supported by the state through various Mental Health Acts, has become a modern secular
state religion A state religion (also called religious state or official religion) is a religion or creed officially endorsed by a sovereign state. A state with an official religion (also known as confessional state), while not secular, is not necessarily a t ...
according to Szasz. It is a vastly elaborate social control system, using both brute force and subtle indoctrination, which disguises itself under the claims of being rational, systematic and therefore scientific.


"Patient" as malingerer

According to Szasz, many people fake their presentation of mental illness, i.e., they are malingering. They do so for gain, for example, in order to escape a burden like evading the draft, or to gain access to drugs or financial support, or for some other personally meaningful reason. By definition, the malingerer is knowingly deceitful (although malingering itself has also been called a mental illness or disorder). Szasz mentions malingering in many of his works, but it is not what he has in mind to explain many other manifestations of so-called "mental illness". In those cases, so-called "patients" have something personally significant to communicate – their "problems in living" – but unable to express this via conventional means they resort to illness-imitation behaviour, a somatic
protolanguage In the tree model of historical linguistics, a proto-language is a postulated ancestral language from which a number of attested languages are believed to have descended by evolution, forming a language family. Proto-languages are usually unatt ...
or "body language", which psychiatrists and psychologists have misguidedly interpreted as the signs/symptoms of real illness. So, for example, "analyzing the origin of the hysterical protolanguage Szasz states that it has a double origin: – the first root is in the somatic structure of human being. The human body is subject to illnesses and disabilities expressed through somatic signs (like paralysis, convulsions, etc.) and somatic sensations (like pain, tiredness, etc.); – the second root can be found into cultural factors."


Separation of psychiatry and the state

Szasz believed that if we accept that "
mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitt ...
" 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 drug A psychoactive drug, psychopharmaceutical, psychoactive agent or psychotropic drug is a chemical substance, that changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behavior. Th ...
s 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'' (1973), he argued that the same
persecution Persecution is the systematic mistreatment of an individual or group by another individual or group. The most common forms are religious persecution, racism, and political persecution, though there is naturally some overlap between these ter ...
that targeted
witches Witchcraft traditionally means the use of magic or supernatural powers to harm others. A practitioner is a witch. In medieval and early modern Europe, where the term originated, accused witches were usually women who were believed to have us ...
,
Jews Jews ( he, יְהוּדִים, , ) or Jewish people are an ethnoreligious group and nation originating from the Israelites Israelite origins and kingdom: "The first act in the long drama of Jewish history is the age of the Israelites""The ...
, gypsies, and homosexuals now targets "drug addicts" and "insane" people. Szasz argued that all these categories of people were taken as
scapegoat In the Bible, a scapegoat is one of a pair of kid goats that is released into the wilderness, taking with it all sins and impurities, while the other is sacrificed. The concept first appears in the Book of Leviticus, in which a goat is designate ...
s of the community in
ritual A ritual is a sequence of activities involving gestures, words, actions, or objects, performed according to a set sequence. Rituals may be prescribed by the traditions of a community, including a religious community. Rituals are characterized ...
ceremonies A ceremony (, ) is a unified ritualistic event with a purpose, usually consisting of a number of artistic components, performed on a special occasion. The word may be of Etruscan origin, via the Latin '' caerimonia''. Church and civil (secula ...
. To underscore this continuation of religion through medicine, he even takes as an example
obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...
: instead of concentrating on
junk food "Junk food" is a term used to describe food that is high in calories from sugar and/or fat, and possibly also sodium, but with little dietary fiber, protein, vitamins, minerals, or other important forms of nutritional value. It is also known ...
(ill-nutrition), physicians denounced hypernutrition. According to Szasz, despite their scientific appearance, the
diets The Low Countries comprise the coastal Rhine–Meuse–Scheldt delta region in Western Europe, whose definition usually includes the modern countries of Luxembourg, Belgium and the Netherlands. Both Belgium and the Netherlands derived their ...
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. 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.


Presumption of competence and death control

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. In an analogy to
birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
, 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 Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
to be among the most fundamental rights, but he opposed state-sanctioned
euthanasia Euthanasia (from el, εὐθανασία 'good death': εὖ, ''eu'' 'well, good' + θάνατος, ''thanatos'' 'death') is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different eut ...
. In his 2006 book about
Virginia Woolf Adeline Virginia Woolf (; ; 25 January 1882 28 March 1941) was an English writer, considered one of the most important modernist 20th-century authors and a pioneer in the use of stream of consciousness as a narrative device. Woolf was born ...
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 and involuntary hospitalization

Szasz believed that testimony about the mental competence of a defendant should not be admissible in trials. Psychiatrists 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 Insanity, madness, lunacy, and craziness are behaviors performed by certain abnormal mental or behavioral patterns. Insanity can be manifest as violations of societal norms, including a person or persons becoming a danger to themselves or t ...
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. 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.


The right to drugs

Drug addiction Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences. Repetitive drug use oft ...
is not a "disease" to be cured through legal drugs but a social
habit A habit (or wont as a humorous and formal term) is a routine of behavior that is repeated regularly and tends to occur subconsciously.
. Szasz also argues in favor of a free market for drugs. He criticized the
war on drugs The war on drugs is a global campaign, led by the United States federal government, of drug prohibition, military aid, and military intervention, with the aim of reducing the illegal drug trade in the United States.Cockburn and St. Clair, 1 ...
, arguing that using drugs is in fact a
victimless crime A victimless crime is an illegal act that typically either directly involves only the perpetrator or occurs between consenting adults. Because it is consensual in nature, whether there involves a victim is a matter of debate. Definitions of vi ...
. 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 Opium (or poppy tears, scientific name: ''Lachryma papaveris'') is dried latex obtained from the seed capsules of the opium poppy '' Papaver somniferum''. Approximately 12 percent of opium is made up of the analgesic alkaloid morphine, which ...
; both are traditional plants opposed by the
Western world The Western world, also known as the West, primarily refers to the various nations and states in the regions of Europe, North America, and Oceania.
. 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.
The Nazis spoke of having a "Jewish problem". We now speak of having a drug-abuse problem. Actually, "Jewish problem" was the name the Germans gave to their persecution of the Jews; "drug-abuse problem" is the name we give to the persecution of people who use certain drugs.
Szasz cites former U.S. Representative
James M. Hanley James Michael Hanley (July 19, 1920 – October 16, 2003) was an American businessman, World War II veteran, and politician who represented New York in the House of Representatives for eight terms from 1965 to 1981. Biography 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 poison gas – namely, that the persecuted persons are not human beings, but 'vermin.'"


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 A civilization (or civilisation) is any complex society characterized by the development of a state, social stratification, urbanization, and symbolic systems of communication beyond natural spoken language (namely, a writing system). ...
. In the same vein as the
separation of church and state The separation of church and state is a philosophical and jurisprudential concept for defining political distance in the relationship between religious organizations and the state. Conceptually, the term refers to the creation of a secular s ...
, Szasz believes that a solid wall must exist between psychiatry and the state.


American Association for the Abolition of Involuntary Mental Hospitalization

Believing that psychiatric hospitals are like prisons not hospitals and that psychiatrists who subject others to coercion function as judges and jailers not physicians, 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''. The association provided legal help to psychiatric patients and published a journal, '' The Abolitionist''.


Relationship to Citizens Commission on Human Rights

In 1969, Szasz and the
Church of Scientology The Church of Scientology is a group of interconnected corporate entities and other organizations devoted to the practice, administration and dissemination of Scientology, which is variously defined as a cult, a business, or a new religious ...
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 The Australian Broadcasting Corporation (ABC) is the national broadcaster of Australia. It is principally funded by direct grants from the Australian Government and is administered by a government-appointed board. The ABC is a publicly-owne ...
, Szasz explained his reason for collaborating with CCHR and lack of involvement with Scientology:
Well I got affiliated with an organisation long after I was established as a critic of psychiatry, called Citizens Commission for Human Rights, because they were then the only organisation and they still are the only organisation who had money and had some access to lawyers and were active in trying to free mental patients who were incarcerated in mental hospitals with whom there was nothing wrong, who had committed no crimes, who wanted to get out of the hospital. And that to me was a very worthwhile cause; it's still a very worthwhile cause. I no more believe in their religion or their beliefs than I believe in the beliefs of any other religion. I am an atheist, I don't believe in Christianity, in Judaism, in Islam, in Buddhism and I don't believe in Scientology. I have nothing to do with Scientology.


Russell Tribunal

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. The tribunal brought in the two following verdicts: the majority verdict claimed that there was "serious abuse of human rights in psychiatry" and that psychiatry was "guilty of the combination of force and unaccountability"; the minority verdict, signed by the Israeli Law Professor Alon Harel and Brazilian novelist Paulo Coelho, called for "public critical examination of the role of psychiatry".


Responses and reactions

Szasz was a strong critic of institutional psychiatry and his publications were very widely read. He argued that so-called mental illnesses had no underlying physiological basis, but were unwanted and unpleasant behaviors. Mental illness, he said, was only a metaphor that described problems that people faced in their daily lives, labeled as if they were medical diseases. Szasz's ideas had little influence on mainstream psychiatry, but were supported by some behavioral and social scientists. Sociologist
Erving Goffman Erving Goffman (11 June 1922 – 19 November 1982) was a Canadian-born sociologist, social psychologist, and writer, considered by some "the most influential American sociologist of the twentieth century". In 2007 '' The Times Higher Ed ...
, who wrote '' Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates'', was skeptical about psychiatric practices. He was concerned that the stigma and social rejection associated with psychiatric treatment might harm people. Thomas Scheff, also a sociologist, had similar reservations.


Kendell's views

Robert Evan Kendell presents (in Schaler, 2005) a critique of Szasz's conception of disease and the contention that mental illness is "mythical" as presented in ''
The Myth of Mental Illness ''The Myth of Mental Illness: Foundations of a Theory of Personal Conduct'' is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, ...
''. Kendell's arguments include the following: # Szasz's conception of disease exclusively in terms of "lesion", i.e. morphological abnormality, is arbitrary and his conclusions based on this idea represent special pleading. There are non-psychiatric conditions that remain defined solely in terms of ''
syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...
'', e.g.
migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
, torticollis,
essential tremor Essential tremor (ET), also called benign tremor, familial tremor, and idiopathic tremor, is a medical condition characterized by involuntary rhythmic contractions and relaxations ( oscillations or twitching movements) of certain muscle groups in ...
,
blepharospasm Blepharospasm is any abnormal contraction of the orbicularis oculi muscle. The condition should be distinguished from the more common, and milder, involuntary quivering of an eyelid, known as myokymia, or fasciculation. In most cases, blepharosp ...
, torsion dystonia. Szasz's scepticism regarding syndromally defined diseases – only in relation to psychiatry – is entirely arbitrary. Many diseases that are outside the purview of psychiatry are defined purely in terms of the constellation of the symptoms, signs and natural history they present yet Szasz has not expressed any doubt regarding their existence. Is syndrome-based diagnosis only problematic for psychiatry but without issue for the remaining branches of medicine? If syndrome-based diagnosis is unsound on account of its absence of
objectivity Objectivity can refer to: * Objectivity (philosophy), the property of being independent from perception ** Objectivity (science), the goal of eliminating personal biases in the practice of science ** Journalistic objectivity, encompassing fai ...
then it must be generally unsound and not only for psychiatry. # Szasz's ''ostensibly'' exclusive criterion of disease as morphological abnormality – i.e., a lesion made evident "by post-mortem examination of organs and tissues" – is unsound because it inadvertently ''includes'' many conditions that are not considered to be diseases by virtue of the fact that they don't produce suffering or disability, e.g., functionally inconsequential
chromosomal translocation In genetics, chromosome translocation is a phenomenon that results in unusual rearrangement of chromosomes. This includes balanced and unbalanced translocation, with two main types: reciprocal-, and Robertsonian translocation. Reciprocal transl ...
s and deletions, fused second and third toes, dextrocardia. Szasz's conception of disease does not distinguish between ''necessary'' versus ''sufficient'' conditions in relation to diagnostic criteria. In branches of medicine other than psychiatry, morphological abnormality ''per se'' is not considered sufficient cause to make a diagnosis of disease; functional abnormality is the ''necessary'' condition. # Szasz's criticism of syndrome-based diagnoses is divorced from a consideration of the
history of medicine The history of medicine is both a study of medicine throughout history as well as a multidisciplinary field of study that seeks to explore and understand medical practices, both past and present, throughout human societies. More than just histo ...
. In medicine (in general) diseases are defined in terms of a multitude of criteria, these include: (a) ''morbid anatomy'', e.g., mitral stenosis,
cholecystitis Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pai ...
; (b) ''histologically'', e.g., most
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
s,
Alzheimer's disease Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As ...
; (c) ''infective organism'', e.g.
Tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...
,
Measles Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
; (d) ''physiologically'', e.g.
myasthenia gravis Myasthenia gravis (MG) is a long-term neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, ...
; (e) ''biochemically'', e.g. aminoaciduria; (e) ''chromosomally'', e.g. trisomy 21, Turner's syndrome; (f) ''molecularly'', e.g.
thalassemia Thalassemias are inherited blood disorders characterized by decreased hemoglobin production. Symptoms depend on the type and can vary from none to severe. Often there is mild to severe anemia (low red blood cells or hemoglobin). Anemia can resul ...
; (g) ''genetically'', e.g.
Huntington's disease Huntington's disease (HD), also known as Huntington's chorea, is a neurodegenerative disease that is mostly inherited. The earliest symptoms are often subtle problems with mood or mental abilities. A general lack of coordination and an uns ...
,
cystic fibrosis Cystic fibrosis (CF) is a rare genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. Ot ...
; and (h) ''
syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...
'', e.g.
migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
, torticollis,
essential tremor Essential tremor (ET), also called benign tremor, familial tremor, and idiopathic tremor, is a medical condition characterized by involuntary rhythmic contractions and relaxations ( oscillations or twitching movements) of certain muscle groups in ...
,
blepharospasm Blepharospasm is any abnormal contraction of the orbicularis oculi muscle. The condition should be distinguished from the more common, and milder, involuntary quivering of an eyelid, known as myokymia, or fasciculation. In most cases, blepharosp ...
, torsion dystonia and most (so-called) mental disorders. The more objective definitions of disease – specified as (a) through (g) – became possible through the accumulation of scientific knowledge and the development of relevant technology. Initially the underlying pathology of some diseases was unknown and they were diagnosed ''only'' in terms of syndrome – no lesion could be demonstrated "by post-mortem examination of organs and tissues" (as Szasz requires) until later in history, e.g.
malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. ...
was diagnosed solely on the basis of syndrome until the advent of
microbiology Microbiology () is the scientific study of microorganisms, those being unicellular (single cell), multicellular (cell colony), or acellular (lacking cells). Microbiology encompasses numerous sub-disciplines including virology, bacteriology, ...
. A strict application of Szasz's criterion necessitates the conclusion that diseases such as malaria were "mythical" until
medical microbiology Medical microbiology, the large subset of microbiology that is applied to medicine, is a branch of medical science concerned with the prevention, diagnosis and treatment of infectious diseases. In addition, this field of science studies vario ...
arrived, at which point they became "real". In this regard Szasz's criterion of disease is unsound by virtue of its contradictory results. # Szasz's contention that mental illness is not associated with any morphological abnormality is uninformed by genetics, biochemistry, and current research results on the
etiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, ...
of mental illness.
Gene In biology, the word gene (from , ; "...Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a b ...
s are essentially instructions for the synthesis of proteins. Hence, any condition that is even partly
hereditary Heredity, also called inheritance or biological inheritance, is the passing on of traits from parents to their offspring; either through asexual reproduction or sexual reproduction, the offspring cells or organisms acquire the genetic informa ...
''necessarily'' manifests structural abnormality at the molecular level. Regardless of whether the actual morphological abnormality can be identified, if a condition has a hereditary component then it has a biological basis. Twin and adoption studies have strongly demonstrated that heredity is a major factor in the etiology of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
; thus there ''must'' be some biological difference between schizophrenics and non-schizophrenics. In relation to
major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Intro ...
a difference of response between euthymic and depressed individuals to
antidepressant Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common Side effect, side-effects of antidepressants include Xerostomia, dry mouth, weig ...
drugs and to
tryptophan Tryptophan (symbol Trp or W) is an α-amino acid that is used in the biosynthesis of proteins. Tryptophan contains an α-amino group, an α-carboxylic acid group, and a side chain indole, making it a polar molecule with a non-polar aromatic ...
depletion has been demonstrated. These results in addition to twin and adoption studies provide evidence of an underlying molecular – hence structural – abnormality to depression. # Szasz contends that, "Strictly speaking, disease or illness can affect only the body; hence, there can be no mental illness" and this idea is foundational to Szasz's position. In actuality, there are no physical or mental illnesses ''per se''; there are only diseases of
organism In biology, an organism () is any living system that functions as an individual entity. All organisms are composed of cells ( cell theory). Organisms are classified by taxonomy into groups such as multicellular animals, plants, and fu ...
s, of persons. The bifurcation of organisms into minds and bodies is the product of the Cartesian dualism that became dominant in the late 18th century and it was at this time that the notion of insanity as something ''qualitatively'' different from other illnesses became entrenched. In actuality, brain and body comprise one integrated and indivisible system and no illness "respects" the abstraction of mind vs. body upon which Szasz's argument rests. There are no illnesses that are purely mental or purely physical. Somatic pain is itself a mental phenomenon as is the subjective distress produced by the
acute phase response Acute-phase proteins (APPs) are a class of proteins whose concentrations in blood plasma either increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation. This response is called the ''acute- ...
at the onset of illness or immediately after trauma. Similarly, conditions such as schizophrenia and major depressive disorder produce somatic symptoms. Any illness lies somewhere ''within'' a continuum between the poles of mind and body; the ''extrema'' are purely theoretical abstractions and are unoccupied by any real affliction. The mind/body division persists purely for pragmatic reasons and forms no real part of modern biomedical science.


Shorter's views

Shorter replied to Szasz's essay "The myth of mental illness: 50 years later", which was published in the journal ''The Psychiatrist'' (and delivered as a plenary address at the International Congress of the Royal College of Psychiatrists in Edinburgh on 24 June 2010) – in recognition of the 50th anniversary of ''
The Myth of Mental Illness ''The Myth of Mental Illness: Foundations of a Theory of Personal Conduct'' is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, ...
'' – with the following principal criticisms: # Szasz's critique is implicitly premised on a conception of
mind The mind is the set of faculties responsible for all mental phenomena. Often the term is also identified with the phenomena themselves. These faculties include thought, imagination, memory, will, and sensation. They are responsible for various m ...
drawn from the psychiatry of the early-mid 20th century – namely psychoanalytic psychiatry – and Szasz has not updated his critique in light of later developments in psychiatry. The referent of Szasz's critique – Freud's mind – is to be found only in the historical record and some isolated islands of psychoanalytic practice. To this extent, Szasz's critique does not address contemporary biologically-oriented psychiatry and is irrelevant. Certainly the phrase ''mental illness'' occurs in the contemporary psychiatric lexicon, but that is merely a legacy of the earlier psychoanalytic influence upon psychiatry; the term does not reflect a ''real'' belief that ''psychiatric disease'' – Shorter's preferred term – originates in the ''mind'', an abstraction as Szasz rightly explains. # Szasz concedes that some so-called mental illnesses may have a neurological basis – but adds that were such a biological basis discovered for these so-called mental illnesses, they would have to be reclassified from ''mental illnesses'' to ''
brain disease Central nervous system diseases, also known as central nervous system disorders, are a group of neurological disorders that affect the structure or function of the brain or spinal cord, which collectively form the central nervous system (CNS). T ...
s'', which would vindicate his position. Shorter explains that the problem with Szasz's argument here is that ''it is'' the contention of
biological psychiatry Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscie ...
that so-called mental illnesses are ''actually brain diseases''. Modern psychiatry has ''de facto'' dispensed with the idea of ''mental illness'', i.e. the notion that psychiatric disease is mainly or entirely psychogenic is not a part of biological psychiatry. # There exists at least ''prima facie'' evidence that psychiatric illness has a biological basis and Szasz either ignores this evidence or attempts to insulate his argument from such evidence by effectively claiming that "no ''
true True most commonly refers to truth, the state of being in congruence with fact or reality. True may also refer to: Places * True, West Virginia, an unincorporated community in the United States * True, Wisconsin, a town in the United States * ...
'' mental illness has a biological basis." Shorter cites hypothalamic–pituitary–adrenal axis (HPA) dysregulation, a positive dexamethasone suppression test result, and shortened
rapid eye movement sleep Rapid eye movement sleep (REM sleep or REMS) is a unique phase of sleep in mammals and birds, characterized by random rapid movement of the eyes, accompanied by low muscle tone throughout the body, and the propensity of the sleeper to dream ...
latency in those with melancholic depression as examples of this evidence. Further examples cited by Shorter include the responsiveness of catatonia to
barbiturate Barbiturates are a class of depressant drugs that are chemically derived from barbituric acid. They are effective when used medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological addiction potential a ...
s and
benzodiazepine Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...
s.


Awards

Szasz was honored with over fifty awards including: *
American Humanist Association The American Humanist Association (AHA) is a non-profit organization in the United States that advances secular humanism. The American Humanist Association was founded in 1941 and currently provides legal assistance to defend the constituti ...
named him Humanist of the Year (1973) * Award for Greatest Public Service Benefiting the Disadvantaged, an award given out annually by Jefferson Awards (1974) * ''Martin Buber Award'' (1974) * He was honored with an honorary doctorate in behavioral science at Universidad Francisco Marroquín (1979) * ''Humanist Laureate Award'' (1995) * Great Lake Association of Clinical Medicine ''Patients' Rights Advocate Award'' (1995) * American Psychological Association ''Rollo May Award'' (1998)


Thomas S. Szasz Award

The Center for Independent Thought established the Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties.


Notable recipients

* Giorgio Antonucci * Vladimir Bukovsky *
Henry Zvi Lothane Henry Zvi Lothane, M.D., is a Polish-born American psychiatrist, psychoanalyst, educator and author. Lothane is currently Clinical Professor at Icahn School of Medicine at Mount Sinai, New York City, specializing in the area of psychotherapy. He ...
* Jeffrey Schaler *
Edward Snowden Edward Joseph Snowden (born June 21, 1983) is an American and naturalized Russian former computer intelligence consultant who leaked highly classified information from the National Security Agency (NSA) in 2013, when he was an employee and su ...
* Jacob Sullum *
Phil Zimmermann Philip R. Zimmermann (born 1954) is an American computer scientist and cryptographer. He is the creator of Pretty Good Privacy (PGP), the most widely used email encryption software in the world. He is also known for his work in VoIP encryption ...


See also

* Wrongful involuntary commitment


Writings


Books

* * * * * * * * * * * * (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.) * * * * * * * * * * * * * * * * * * * * * * * *


Selected scholarly papers

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *


References


Further reading

* * * * * * The book in full is available online b
click
* * * * * * * *


External links



of Szasz's writings.

at Syracuse University
The Thomas S. Szasz Cybercenter for Liberty and Responsibility

Concepts and Controversies in Modern Medicine: Psychiatry and Law: How are They Related? pt. 1
Video discussion of forensic psychiatry by Szasz and Bernard Diamond.
Concepts and Controversies in Modern Medicine: Psychiatry and Law: How are They Related? pt. 2
{{DEFAULTSORT:Szasz, Thomas 1920 births 2012 deaths Activists from Syracuse, New York Jewish American atheists American human rights activists American humanists American libertarians American people of Hungarian-Jewish descent American psychiatrists American psychoanalysts Anti-psychiatry History of psychiatry Hungarian emigrants to the United States Hungarian Jews Hungarian libertarians Jewish American writers Jewish psychoanalysts People from Manlius, New York Psychiatry academics Scientology and psychiatry Social critics Soviet psychiatric abuse whistleblowers State University of New York faculty State University of New York Upstate Medical University faculty Theorists in psychiatry University of Cincinnati alumni Writers from Budapest 2012 suicides Suicides in New York (state) Member of the Mont Pelerin Society