The Baltimore Sun: Szasz turned psychiatry on its head
The Baltimore Sun October 10, 2012
Szasz turned psychiatry on its head
By Jeffrey A. Schaler and Richard E. Vatz
Thomas Stephen Szasz, arguably the world’s foremost psychiatrist, died Sept. 8. 2012. Former psychiatrist and current columnist Charles Krauthammer wrote that “Szasz is the kind of author no one reads but everyone knows about.”
That’s unfortunate. Too many mental health professionals haven’t the foggiest idea who Thomas Szasz was and why he will remain important to fields of science, medicine, ethics, law — and particularly mental health — for centuries to come.
Dr. Szasz, who received an honorary doctorate from Towson University in 1999, adopted the premises of Rudolf Virchow, the Austrian pathologist who defined disease consistent with all serious pathologists. A disease refers to a histological (tissue) lesion. Mental illnesses, therefore, do not exist because the mind (mental component) does not exist except as a construct. Real disease is found in living tissue. Mental illness may refer to bad or destructive behavior, but the behavior is an expression of choice, not brain pathology. (While Dr. Szasz conceded that some cognitively disabled individuals suffered from authentic brain disease, “schizophrenia” was portrayed falsely by psychiatry as prototypical of “mental illness.” Authentic brain disease, he was quick to assert, was, of course, genuine illness.)
This simple truth — that bad, illegal and/or self-destructive behavior is not caused by illness — is one of the most difficult scientific and medical facts for psychiatrists and their cohorts (psychologists, social workers, counselors, etc.) to grasp. It is a particularly inconvenient truth for those who seek to exculpate criminal behavior via the insanity plea, and those Dr. Szasz fought all his life who believe in involuntary incarceration for those who may have offended others but have committed no crime.
While the U.S. Supreme Court has upheld the constitutionality of involuntary commitment, psychologists and psychiatrists who study the ability to accurately predict harm to self and/or others know that we cannot determine which people will harm themselves and/or others with an accuracy much beyond that expected by chance.
A staunch classical liberal in the way of F.A. Hayek and Ludwig Von Mises, Thomas Szasz turned psychiatry on its head when he wrote his first two books: “The Myth of Mental Illness” (1961) and “Law, Liberty and Psychiatry” (1963). Since mental illness referred to behavior, and “involuntary behavior” is a contradiction, the most anyone who called himself a therapist or psychiatrist could do was engage in a game of rhetorical and conversational strategy to try and influence the thinking, consciousness and behavior of a designated patient. Psychiatric drugs, Dr. Szasz argued, may control behavior; they don’t cure a “disease.” Similarly, the word “patient” does not signify the presence of disease or illness; it is the name of a socially assigned role.
Dr. Szasz’s writings were apolitical. His iconoclastic theorizing was the primary reason that homosexuality was declassified from the Diagnostic and Statistical Manual of the Mental Disorders (DSM) and thus no longer considered a mental illness (although “egodystonic homosexuality” remained as a mental illness: homosexuality regretted by a “patient”).
Contrary to the perceptions of many, Dr. Szasz was not responsible for deinstitutionalization, though some still blame him for the “problem of the homeless mentally ill.” Dr. Szasz objected to involuntary commitment on constitutional and civil liberties grounds — and he objected to deinstitutionalization for once again making designated patients suffer for reasons not of their own making.
While Dr. Szasz demystified all consensual therapies as mere conversation, as a strict libertarian he resolutely defended a person’s right to believe in and purchase “therapy.” Schools of therapy, he maintained, are like religions, with all the protections of freedom of religion and freedom of speech. He was errantly depicted as being at peace with “anti-psychiatry” but was in fact virulently opposed to R.D. Laing and others of that persuasion.
The impact of Dr. Szasz’s heroic life — he was consistently the object of relentless personal attacks — will continue to influence the way we think about liberty and responsibility. He claimed that the greatest sin, according to government, is individual autonomy, for autonomy renders government powerless; and the greatest virtue, according to government, is obedience to authority. Dr. Szasz’s life articulated the positive correlation between liberty and responsibility.
Jeffrey A. Schaler, a psychologist, is a professor in the Department of Justice, Law and Society at American University’s School of Public Affairs and the editor of “Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics.” Richard E. Vatz (firstname.lastname@example.org) is professor of political communication at Towson University and is author of “Thomas Szasz: Primary Values and Major Contentions.”