Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum

Thomas Szasz on the medicalization of American life.

Jacob Sullum from the July 2000 issue

(Page 6 of 7)

Reason: In the area of drug policy, you've criticized the idea of shifting from a criminal justice approach to a "medical" or "public health" model, which you say would only reinforce the therapeutic state. But if a drug offender who might otherwise go to jail can instead undergo "treatment"--which is now the case in Arizona, for example--isn't he better off, even if the treatment is bogus?

Szasz: He may be better off in the sense in which a Jew in 15th-century Spain may have been better off converting to Christianity than being tortured. But I reject the dilemma. One of these so-called treatment options may be less punitive for the subject. But the side effect is that it reinforces the legitimacy of this kind of medical autocracy.

Reason: Another reform pushed by advocates of a "public health" approach is needle exchange programs. What do you think of them?

Szasz: I am unqualifiedly opposed to this kind of piecemeal reform. I keep falling back on the slavery analogy. You cannot prettify the plantation. You either have slaves as a legal arrangement or you don't. Either you have access to empty syringes just like you have access to guns, or you don't have access.

Reason: A simple way of addressing that issue would be to make the needles available without prescription and to stop penalizing people for possessing them. That's not exactly a fundamental reform in terms of drug policy, but is that the kind of reform you could support?

Szasz: I think that would be fundamental, because the message it would send is that this is a problem only because the government has made it a problem. The American people don't realize that a very large proportion of the AIDS cases in America are government-manufactured, in the sense that the government has prohibited needles. People talk about iatrogenic--doctor-caused--diseases. People never talk about government-caused diseases. There is no Latin word for that.

Reason: Another so-called harm reduction reform is to make methadone more readily available to current opiate users or to make heroin available by prescription. Do either of those suggestions make any sense to you?

Szasz: They make a great deal of sense, in the sense that they strengthen the establishment which is causing the problem. I am bitterly opposed to all of these autocratic medicalizations. All of these glorify the punitive state and the punitive doctor and debase the citizen for exercising his free choice. It's as simple as that.

Reason: You take a similar view when it comes to medical marijuana, that it reinforces the therapeutic state, since the doctor gets to say whether you can have it or not. But from the point of view of somebody who is sick and who finds that marijuana relieves his pain, his nausea, or his muscle spasms, a measure like California's Proposition 215 means that he's less likely to be arrested and prosecuted. Isn't that an improvement?

Szasz: I see this as analogous to leaving Soviet Russia. You could appeal to Stalin and say, "My father is living in America, and he is 80 years old. Won't you let me out?" And then Stalin might say, "OK. I'll let you out, because that really would be a good thing for you, because of your father." The patient is getting a special exception from a general rule, which I find totally unacceptable.

Reason: The general rule or the exception?

Szasz: I find the general rule unacceptable, and the exception is simply doing one particular favor to one particular person or group of persons.

Reason: But the people to whom the exception applies are better off. Is equal enforcement of a bad law better than making exceptions?

Szasz: This is one of those classic problems where if you leave the bad law in place long enough, then maybe it will be repealed, whereas making exceptions prolongs its life expectancy. I am not opposed to being nice to particular groups of people as a humanitarian gesture, obviously. If somebody who is undergoing anti-cancer treatment has nausea and benefits from marijuana, it would be a nice thing for this person to have it. How can I be opposed to that? But that's like smuggling Jews out of Nazi Germany with the help of a Gestapo agent. Wouldn't it be better not to persecute them in the first place?

Reason: The question of whether people may use marijuana to treat various kinds of symptoms seems to be a small part of the drug policy debate. Yet the medical marijuana movement has drawn a very strong response from the federal government. Why do you think people like the drug czar, Barry McCaffrey, get so upset about attempts to legalize the medicinal use of marijuana? Does that reaction suggest that maybe the medical marijuana activists are on to something, that they've found an effective way of undermining prohibition?

Comments

|4.23.10 @ 4:01PM|#

To me Dr Szasz is the most humanitarian person on this planet. I hope there are many like him everywhere but who are not expressing their views as well or at this time. To Dr Szasz: Thank you for your wonderful books as they will live on to perpetuate your exquiste understanding of the human conditions. I am nearing my 80's so will wish us both many more years to enjoy the time of our lives. Warm Regards Always.

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