Nassir Ghaemi, M.D., M.P.H., is Professor of Psychiatry at Tufts University and Lecturer in Psychiatry at Harvard Medical School. Szasz presents mental health professionals with two stark alternatives: he must choose between serving the interests of the client, as the client defines them; or serving the interests of the clients family or employer or insurance company, or the interests of his profession, religion, community, or the state, as they define them. The prospect of being a double agent, as Szasz calls it, and therefore, presumably, of betraying the clients trust and confidence isnt very appealing, of course. a-symptomatic) individuals, who are called upon to diagnose and treat such cases, very highly, urging his readers to ponder their social and cultural surroundings more carefully before they did until this point. In the end, Szasz life and work reflect the vagaries of the psychiatric profession itself, as it has lunged from error to error, to the glee of its critics. Likewise, women who did not bend to a man's will were said to have hysteria. 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 baros, for "weight"), was created to deal with those who erred from the medical norms concerning the weight the body should have. Homosexuality was not a perversion. Too often we err in the opposite direction, speaking well of the dead out of respect. The most famous proponent of this view was undoubtedly the late Dr. Thomas Szasz. I think not. 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. and somatic sensations (like pain, tiredness, etc. Szasz traces psychiatry's origins to the widespread use of private madhouses in England, where relatives would send their unwanted family members (see Parry-Jones's ( The Trade in Lunacy ). His main arguments can be summarized as follows: "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, as an "illness" or "disease". In sum, one can be quite humanistic in ones approach to psychiatry without verging into the anti-psychiatric judgments, and extreme libertarianism, that characterized Szasz work. [4] Psychiatrists are the successors of "soul doctors", priests who dealt and deal with the spiritual conundrums, dilemmas, and vexations the "problems in living" that have troubled people forever. Szasz is part of a larger postmodernist tradition, which one can accept or reject, but which is independent of him. [31] The association provided legal help to psychiatric patients and published a journal, The Abolitionist. Why? Thomas Stephen Szasz (/ss/ SAHSS; Hungarian: Szsz Tams Istvn [sas]; 15 April 1920 8 September 2012) was a Hungarian-American academic and psychiatrist. Our approach will be more phenomenological if we begin with a substantial quotation, as a precaution against quoting isolated phrases or sentences out of context. Szasz was a biological libertarian in psychiatry. Life-enhancing anxiety is the invigorating degree of anxiety needed to become passionately engaged, ethically attuned, and creatively enriched. The falsehoods of Freud were replaced by the falsehoods of DSM-III in 1980. This statement warrants our enthusiastic and unqualified assent. "Throughout his long life, he did not simply fight the good fight, he . The question then emerges: why does Szasz dredge up these sad tales of familial discord, and harp about Laings drinking, and other outbursts or excesses? Oxford University Press is a department of the University of Oxford. [citation needed]. [26]:496, Civil libertarians warn that the marriage of the state with psychiatry could have catastrophic consequences for civilization. This item is part of a JSTOR Collection. Rather, it is his rigid adherence to abstract ethical principles that admit of no exceptions, and that preclude the possibility of doubt or regret. When you take these mundane matters into account, Szaszs lofty appeal to principles, and his claim that Laing approved of involuntary hospitalization seems opportunistic or obtuse, to say the least. In short, I think Szasz was right in many ways for his time, and for the right reasons; he is right partially today, but for the wrong reasons; and he is wrong if his views are used, as many of his extreme supporters use them, to deny any reality to any psychiatric disease, like schizophrenia or manic-depressive illness. It has become familiar to millions through a diverse publishing program that includes scholarly works in all academic disciplines, bibles, music, school and college textbooks, business books, dictionaries and reference books, and academic journals. . a person professing to help a fellow human being in distress cannot be a double agent; he must choose between serving the interests of the client, as the client defines them; or serving the interests of the clients family or employer or insurance company, or the interests of his profession, religion, community, or the state, as they define them. . 1950s-60s US psychiatry was to the profession as 1950s-60s Soviet orthodoxy was to communism. In any case, reading Szaszs reflections on liberty and confidentiality, one sometimes gets the impressions that his clear-cut, crystalline ethical principles are designed to spare us the agonizing and often inconclusive reflections that many clinicians face frequently in the course of their work. As Mead's model resembles existentialism in several ways, Szasz used both perspectives to overcome aporia in each. Where it draws that line goes far in defining the kinds of laws its citizens live under, the kinds of medical care they receive, and the kinds of lives they are allowed to live. Confidentiality has limits, and the priest/confession analogy, which Szasz cites repeatedly, does too. Moreover, and more importantly, in terms of general principles for clinical practice, it is quite possible to be compassionate and respectful toward the client, and to put their interests first, while still trying to be helpful to the clients significant others. 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. Therapists must wrestle with the same ethical questions their clients face, but also call attention to those they avoid facing. In addition to contemporaries R D Laing in the UK, the Canadian sociologist Erving Goffman, and the French philosopher Michel Foucault, Szasz provided much of the high octane intellectual fuel for the genesis of the . Pop culture's most prominent depiction of OCD was among its worst. cme . [9], Szasz first presented his attack on "mental illness" as a legal term in 1958 in the Columbia Law Review. Having said that, Szasz is not an existentialist when it comes to the mind/body issue. And since my early twenties, I have researched the marital and family lives of Freud, Jung, Klein, Erikson and others research which confirms my initial impressions a hundred fold. This collection of impassioned essays, published between 1973 and 2006, chronicles Thomas Szaszs long campaign against the orthodoxies of pharmacracy, that is, the alliance of medicine and the state. Thus, he underscores that in 1970, the American Society of Bariatric Physicians had 30 members, and already 450 two years later. And from 1953 till 1956, he held civilian psychiatric posts at the Royal Gartnavel Hospital and Southern General Hospital, where he was called upon to certify people insane from time to time. One could still use psychological concepts even though one realizes that such notions are based in the brain. The iconic figures behind psychiatry's most consequential ideas. [13]:64, 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 poison gas namely, that the persecuted persons are not human beings, but 'vermin. Admittedly, despite the sound and fury of their previous exchanges, the published work of Szasz and Laing discloses far more points of convergence and intellectual kinship than Dr. Szasz is presently willing or able to admit (Burston, 1996, chapter 8). Patients should be allowed to do whatever they want; they shouldnt be forced by society to do anything. 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. Szasz argued throughout his career that mental illness is a metaphor 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."[5]. I know there are many pro-Szasz ideologues out there, especially among some strident anti-psychiatry groups. My view of Szasz' ideas is not that he is simply wrong, but that when right, he is right for the wrong reasons; and when wrong, he is simply wrong. He is seen by his supporters, mostly citizens who are critical of the psychiatric system, as a courageous man who spoke out against the errors and excesses of his profession. His books The Myth of Mental Illness (1961) and The Manufacture of Madness (1970) set out some of the arguments most associated with him. because the greatest obstacle to success may be success. This does not mean that we should jettison our critical faculties, or blunt our ethical sensibilities in the process. The Center for Independent Thought established the Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties. These anatomic findings, along with strong genetic evidence of almost complete genetic heritability of these diseases (and clear genes associated with them in the human genome project), would meet some of Szaszs requirements for claiming that one is dealing with a bona-fide medical disease. This action is uncommon for an invited essay, but I probably shouldn't have been surprised. 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). If a public figure claims to have a psychiatric condition, then clinicians can discuss the topic. To sum up his description of the political influence of medicine in modern societies imbued by faith in science, 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. If existentialism has been used as a pretext to violate human dignity, we can (and should) protest. It remains mired in falsehoods, and this is why some of Szaszs critiques will remain relevant today. For more than half a century, Thomas Szasz has devoted much of his career to a radical critique of psychiatry. That's not what diseases are." cme icme icmes . In that line of thinking, schizophrenia becomes not the name of a disease entity but a judgment of extreme psychiatric and social disapprobation. 1980 Oxford University Press In a long lifetime, as with most human beings, he never changed his mind on this matter or any other major aspect of his psychiatric beliefs. A collection of essays by one of the most influential and original thinkers of our generation. pt. He had previously suffered a fall and would have had to live in chronic pain otherwise. If so, that cannot be helped. Naval Reserve.[7]. According to Szasz, despite their scientific appearance, the diets imposed were a moral substitute to the former fasts, and the social injunction not to be overweight is to be considered as a moral order, not as a scientific advice as it claims to be. . Recommended Article Julie Falk of SHP has conversations with six psychologists who represent a broad range of humanistic flavors, including (but not limited to) existential-humanistic, phenomenological, human science, constructivist, and transpersonal. Sociologist Erving Goffman, who wrote Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates, was skeptical about psychiatric practices. Whether he would want to call them mental illnesses or not is a linguistic and conceptual matter, as Pies again describes. 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. For decades, Thomas Szasz has publicly challenged the excesses that obscure reason. 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. Other groups among anti-psychiatrists have motivations which Szasz may not have shared (he wasnt a Scientologist), but he shared their goals. But on reflection, we really neednt even go that far. Strange as it may sound, on the face of it, suicide in such circumstances can be an act of freedom, of transcendence over the blind cruelty of circumstances, a resounding affirmation, an existential statement: I am!. Laing, however, consciously decided not reply to Szasz, a task taken up instead by Leon Redler on behalf of the Philadelphia Association (PA). Existential perspectives in psychology are often associated with the humanistic movement and provide somewhat of a philosophical ground for it. He served for most of his career as professor of psychiatry at the State University of New York Upstate Medical University in Syracuse, New York. The Medicalization of Everyday Life offers . Szasz motivation was libertarian, which has some value, just as an anarchists skepticism about government has value. For decades, Thomas Szasz has publicly challenged the excesses that obscure reason. Disorder of Openness: Authoritarian Personality Disorder aka OCPD. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. He has writ- ten extensively on many subjects including the history of medicine and the symbolic nature of communication. Indeed, in the preface to the Pelican edition of The Divided Self, Laing went so far as to say In the context of our present pervasive madness that we call normality, sanity, freedom, all our frames of reference are ambiguous and equivocal. In his IFPE address of November 2, 2002, Szasz stated: Psychoanalysis possesses a valuable moral core that has never been properly identified and is now virtually unrecognized: it is, or ought to be, a wholly voluntary and reliably confidential human service, initiated and controlled largely by the client who pays for it (p.2). To keep this ethical relationship intact, says Szasz, the practitioner must confine his or her role to conversing with the client in the privacy of a professional office, and to completely refrain from meddling in their life outside it. He accepted the existence of medical disease; he just denied such status to psychiatric diagnoses. In the 1970s, Szasz was claimed by existentialist psychotherapists as a fellow traveller, if not a full member of the clan (Hoeller, 1997, 2012; Stadlen, 2014). And clearly, he meant it at the time. He arrived in the US as an adult, whose whole character must have been stamped by his experience of totalitarianism. To argue the contrary is to assume, in effect, if not in quite so many words, that the client is always so deeply embroiled in conflict that he or she shares no common or important interests with his or her family, friends, employers, etc., or none deep or potent enough to mitigate the severity of the clients difficulty. Because that conclusion would not be warranted by the evidence. Lithium is proven to prevent suicide based on double-blind placebo-controlled studies; it is the only drug proven to do so in our highest level of scientific research. Though Laing did little to extract Fiona from Gartnavel after her hospitalization, or to prevent her from receiving ECT, as Adrian Laing points out, it was probably because he deemed any effort to intervene on her behalf doomed from the start. 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. . [8], Szasz was convinced there was a metaphorical character to mental disorders, and its uses in psychiatry were frequently injurious. Szasz's inconsistencies and nonsociological underpinnings lead to a clear political bias in his own work, as well as provide a rationale for regressive social policies. But from 1956 till 1987, when his medical license was finally revoked, Laing hospitalized no one, to my knowledge, and worked diligently to create therapeutic communities that would function as viable alternatives to mental hospitals. It would be to easy to say that both perspectives are partly correct, though they likely are. Contributions are invited in areas of philosophical and psychological . But as Erich Fromm was apt to point out, inner and interpersonal conflicts can also be symptomatic of health the manifest expressions of an intact and vibrant social conscience, of a desire for rational self-assertion, or a need to puncture the pretences and illusions that more complacent or conformist souls habitually mistake for truth (Burston, 1991). [27] In the same vein as the separation of church and state, Szasz believes that a solid wall must exist between psychiatry and the state. That line reads: When I certify someone insane, I am not equivocating when I write that he is of unsound mind, and may be dangerous to himself and others, and requires care and attention in a mental hospital. [17][18], Szasz believed that testimony about the mental competence of a defendant should not be admissible in trials. Meanwhile, framing the whole issue in such starkly adversarial terms, as Szasz does, is quite revealing, and there are many reasonable people who would shun the services of a mental health professional whose ostensible zeal on behalf of the clients interests pits them in adversarial struggle with others from the outset, as a matter of course. From "Diagnoses Are Not Diseases" to "The Existential Identity Thief," "Fatal Temptation," and "Killing as Therapy," the book delves into the complex evolution of medicalization, concluding with "Pharmacracy: The New Despotism." . His libertarian approach to life must have grown out of this painful personal experience with the Nazism which displaced him from his homeland in 1938, and the Stalinism which famously repressed his nation of origin in 1956. Szaszs problem is not that he suffers from an excess of conviction as Hugh Heatherington remarked. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic. Practice Improves the Potential for Future Plasticity, Questionnaires Give Us Data; They Do Not Tell Your Story, Why You Should Change Your Life Every Decade, Questions About Herschel Walker's Self-Reported Mental Illness. This would be like a surgeon who claims that cutting into bodies is wrong. Wherever Jews tried to kill themselves in their homes, in hospitals, on the deportation trains, in the concentration camps the Nazi authorities would invariably intervene in order to save the Jews' lives, wait for them to recover, and then send them to their prescribed deaths. 7, The Person as Moral Agent. And even if he hadnt resorted to such base rhetoric, his overarching agenda using Laings personal failings and family woes to discredit his work and ideas is intellectually bankrupt. For instance, as some authors note, Szasz held a humanistic approach to work with patients. When Laing left his post at Gartnavel, in 1956, he was a highly respected psychiatrist who was on very friendly terms with Dr. Angus McNiven and Dr. Ferguson Rodger, who jointly ran the facility. In this passage from his 1960 essay (later, . That said the fact that Szasz is not an existentialist does not deprive him or anyone else of the right to criticize existential psychotherapists who have trampled on the liberties of others in the past. Psychology Today 2023 Sussex Publishers, LLC. Thomas Szasz. One of the most respected and widely read professional journals in today's social sciences, Social Problems presents accessible, relevant, and innovative articles that maintain critical perspectives of the highest quality. So for the sake of clarity and emphasis, let me re-state my argument in the following, hypothetical terms. 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. Szasz maintained throughout his career that he was not anti-psychiatry but rather that he opposed coercive psychiatry. 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 or "body language", which psychiatrists and psychologists have misguidedly interpreted as the signs/symptoms of real illness. In fairness to Szasz, of course, there are indeed many instances when an individuals right of self-determination cuts against the grain of collective common sense. The state, searching for a way to exclude nonconformists and dissidents, legitimized psychiatry's coercive practices. Dr. Thomas Szasz 19202012. Szasz lives in an imaginary world where one and the same ethical principle the right to suicide, or to absolute confidentiality in all imaginable circumstances applies equally to all people, regardless of age, background and condition. We now speak of having a drug-abuse problem. [6] Szasz completed his residency requirement at the Cincinnati General Hospital, then worked at the Chicago Institute for Psychoanalysis from 195156, and then for the next five years was a member of its staff taking 24 months out for duty with the U.S. All claims to science and disease and an external source of truth are false pretensions. Let us say that you have a colleague who divorced and re-married, whose first family lives in a city several hundred miles from him. [12][pageneeded]. Request Permissions. 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. "[25] The "nanny state" has turned into the "therapeutic state" where nanny has given way to counselor. This is the standard perspective of the anti-psychiatry movement, and Szasz participated in it, collaborating closely with Scientology-funded groups, and smiling broadly in pictures with the likes of Tom Cruise. Judging from the testimony of Dr. Richard Gelfer, whom I interviewed in 1992, and who roomed with Laing and his family from 1957 to 1961, Laing probably composed these lines sometime in 1958 perhaps as late as 1959.