Letters

From the August/September 2005 issue

(Page 2 of 2)

Indeed, the notion of competence is fundamentally a legal, not a psychiatric one. Surely a diagnosis of delirium, rendered by an emergency room physician, carries a much higher connotation of mental incompetence and also presents the "threat" of involuntary treatment. Yet we do not find many screeds condemning the motives or practices of such emergency room physicians.

Ronald Pies, M.D.
Clinical Professor of Psychiatry
Tufts University School of Medicine
Boston, MA

It is not accurate to say that I was "once a Szasz admirer," as Reason's review of Szasz Under Fire suggests. I continue to admire him for his outspoken criticism of many psychiatric practices. These include "diagnosis creep," whereby increasing numbers of undesirable human behaviors are given official diagnostic labels in order to qualify practitioners for insurance claims, and the potential for the political abuse of psychiatric labels, such as occurred in the former Soviet Union.

On the subject of schizophrenia, however, I am indeed "one of his most vocal critics." Szasz ignores a vast amount of evidence, much of which became available in the last decade, that schizophrenia is a disease of the brain in exactly the same sense that Parkinson's and multiple sclerosis are diseases of the brain. By continuing to hold to his 1961 view that schizophrenia is a "myth," Szasz is increasingly viewed as anachronistic. This allows critics to discredit him on other issues on which he has much to contribute. Dr. Szasz thus risks being confused with Dr. Seuss, which would be a loss to the psychiatric profession.

E. Fuller Torrey, M.D.
Bethesda, MD

Jacob Sullum's rich review of Szasz Under Fire is an unusually sophisticated piece, but there are some subtle points that deserve a little elaboration.

Sullum repeats the now accepted empirical observation that "insanity pleas are offered only in about 1 percent of criminal cases." He might have added that they are successful in only about 25 percent of those cases. This misleading fact, which has been utilized tendentiously to indicate that because of its rare use the insanity plea is not invalid, hides the tremendous involvement of psychiatry in the criminal justice system, from mitigated sentences to incompetence to stand trial.

The most difficult issue in evaluating Szasz and his critics is this: What about schizophrenia, which Szasz calls "The Sacred Symbol of Psychiatry"? The early E. Fuller Torrey seems more reasonable that the later Torrey on this matter, but one dilemma remains the issue of whether there is a discrete somatic illness called schizophrenia, and how much its morbidity constitutes an exception to Szaszian theory, since there are psychiatrists who diagnose schizophrenia falsely and promiscuously.

Richard E. Vatz, Ph.D.
Professor of Rhetoric and Communication
Towson University
Towson, MD

CORRECTION: An article about the drug war in Colombia ("Legalization Now!," June) quoted Sandro Calvani of the United Nations Office on Drugs and Crime as saying "we're spending around $5,000 per hectare fumigated." The figure refers to spending by the international community (not the U.N.) per hectare eliminated from coca production, not merely fumigated.

Reason News

This is our annual double issue. The next issue subscribers receive will be dated October.

We're happy to report that the June 2004 Reason has won the Western Publication Association's "Maggie" award in the "politics and social issues" category.

We're also pleased to announce the publication of The Agony of an American Wilderness, by Samuel A. MacDonald, our former Washington editor. Sam's book examines the continuing struggle over the Allegheny National Forest among environmentalists, industry, and the locals who have lived and worked there for generations.