The Man vs. the Therapeutic State

A remembrance of Thomas Szasz, courageous defender of freedom and responsibility

The New York Times obituary for Thomas Szasz, who died in September at the age of 92, said his critique of psychiatry “had some merit in the 1950s…but not later on, when the field began developing more scientific approaches.” That paraphrase of historian Edward Shorter reflects the conventional wisdom: Szasz called much-needed attention to psychiatric abuses early in his career but went too far by insisting on a fundamental distinction between actual, biological diseases and metaphorical diseases of the mind.

In fact, however, Szasz’s radicalism, which he combined with a sharp wit, a keen eye for obfuscating rhetoric, and an uncompromising dedication to individual freedom and responsibility, was one of his greatest strengths. Beginning with The Myth of Mental Illness in 1961 and continuing through 35 more books and hundreds of articles, the maverick psychiatrist, driven by a “passion against coercion,” zeroed in on the foundational fallacies underlying all manner of medicalized tyranny.

The idea that psychiatry became scientifically rigorous soon after Szasz first likened it to alchemy and astrology is hard to take seriously. After all, it was not until 1973 that the American Psychiatric Association (APA) stopped calling homosexuality a mental disorder. 

More often, psychiatry has expanded its domain. Today it encompasses myriad sins and foibles, including smoking, overeating, gambling, shoplifting, sexual promiscuity, pederasty, rambunctiousness, inattentiveness, social awkwardness, anxiety, sadness, and political extremism. If it can be described, it can be diagnosed, but only if the APA says so. 

As Marcia Angell, former editor of The New England Journal of Medicine, observed last year in The New York Review of Books, “there are no objective signs or tests for mental illness…and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses in ways that would be impossible, say, in a field like cardiology.” In other words, mental illnesses are whatever psychiatrists say they are. 

How “scientific” is that? Not very. In a 2010 Wired interview, Allen Frances, lead editor of the APA’s current diagnostic guidebook, despaired that defining mental disorders is “bullshit.” In a recent online debate, he declared that “mental disorders most certainly are not diseases.”

Then what exactly are they? For more than half a century, Szasz stubbornly highlighted the hazards of joining such a fuzzy, subjective concept with the force of law through involuntary treatment, the insanity defense, and other psychiatrically informed policies.

Consider “sexually violent predators,” who are convicted and imprisoned based on the premise that they could have restrained themselves but failed to do so, then committed to mental hospitals after completing their sentences based on the premise that they suffer from irresistible urges. From a Szaszian perspective, this incoherent theory is a cover for the retroactive enhancement of duly imposed sentences by politicians who decided certain criminals were getting off too lightly—a policy so plainly contrary to due process and the rule of law that it had to be dressed up in quasi-medical, pseudoscientific justifications.

Szasz, a longtime Reason contributing editor, specialized in puncturing such pretensions. He relentlessly attacked the “therapeutic state,” the unhealthy alliance of medicine and government that blesses all sorts of unjustified limits on liberty, ranging from the mandatory prescription system to laws against suicide. My own work has been powerfully influenced by Szasz’s arguments against drug prohibition, especially his discussion of its symbolism and its reliance on a misunderstanding of addiction, and his criticism of paternalistic interventions that conflate private and public health.

I will always be grateful for Szasz’s courage and insight, and so should anyone who shares his passion against coercion.  

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  • Pound. Head. On. Desk.||

    including smoking, overeating, gambling, shoplifting, sexual promiscuity, pederasty, rambunctiousness, inattentiveness, social awkwardness, anxiety, sadness, and political extremism.

    Yes, yes, yes, no, yes, no, yes, yes, yes, yes, yes, and yes. I've done most of these things.

  • Pi Guy||

    There's an 83% chance that you're one sick puppy, then, Desk.

  • Pound. Head. On. Desk.||

    Oh, yeah, the chances are much better than that, PG. Family history. I'd be completely convinced if the voices didn't tell me I'm absolutely, perfectly, textbook sane.

  • ||

    You do know what pederasty is correct?

  • Pound. Head. On. Desk.||

    Actually looked it up. Pederasty is a "no."

  • ||

    No take-backsies. It's in your permanent chart now. -)))

  • Pound. Head. On. Desk.||

    1 smoking, 2 overeating, 3 gambling, 4 shoplifting, 5 sexual promiscuity, 6 pederasty,
    1 Yes, 2 yes, 3 yes, 4 no, 5 yes, 6 no, 7 yes

    Nice job! You had me convinced I had screwed up the count.
    The idea of sex without a woman seems to me like eating a vegan meal. It might take care of the immediate problem if you're really that desperate, but otherwise why bother?

  • Ted S.||

    The idea of sex without a woman seems to me like eating a vegan meal.

    Surely you masturbated at some point of your life! ;-)

  • ||

    If you masturbated as a young boy, doesn't that make you a pederast?

  • Pound. Head. On. Desk.||

    The idea of sex without a woman seems to me like eating a vegan meal.
    Surely you masturbated at some point of your life! ;-)

    I was an extremely lucky teenager, so events conspired toward making me skillful talking with women. And with the exception of the way things turned out with first woman I truly loved, I have had no cause for complaints on this topic. I've always been confident there would be an eager volunteer turning up at any time.

    Sometimes a bit overconfident...

  • Humason||

    I always get pederasts and pediatricians mixed up.

  • Archduke Pantsfan||

    Donny: What's a... pederast, Walter?
    Walter: Shut the fuck up, Donny.

  • Humason||

    Eight year olds, dude.

  • ||

    Is this your stated or revealed preference?

  • Paul.||

    All of these things listed are normally thought of as Neuroses, not Psychoses. There's a pretty wide gap between someone who feels anxious when they enter awkward social situations, or feels compelled to wash a glass out four times before putting it back on the shelf, and someone who's lost complete grasp of reality.

  • ReformRealist||

    More from Allen Frances:

    "I have enormous respect for intellectual reach and depth of Dr Szasz’ critique of psychiatric diagnosis and for the moral power of his lifelong efforts to prevent its misuse. He skillfully undercut the pretentions of the Umpire I position at a time when its biological proponents were at their triumphalist peak, loudly trumpeting that they were close to finding the gene for schizophrenia and to elucidating its brain lesions. He anticipated and exposed the naivete of these overly ambitious and misleading claims. He has fought the good fight to protect the rights, dignity, and personal responsibility of those deemed to be “mentally ill”. My argument with Dr Szasz is that he goes too far and draws bright lines where there are shades of gray. Surely, he is right that schizophrenia is no “disease”, but that does not mean it is a “myth”. Surely, he is right that psychiatric diagnosis can be misused and misunderstood, but that doesn’t mean it is useless or can be dispensed with. Dr Szasz is correct in defining the many of problems with psychiatric diagnosis, but doesn’t have alternative solutions. There is a baby in there with the bath water he is so eager to discard."

    http://www.peh-med.com/content.....41-7-3.pdf

  • TheSpiteHouse||

    I agree with Frances' take there.

  • C. Anacreon||

    Dr. Szasz can be credited with a great thing -- being a leader in the movement against coercion in psychiatry, which today is pretty much a standard of treatment. Some may even argue that the pendulum has swung too far in the patients rights direction; one need only walk downtown in any major city to see seriously mentally ill people, living on the streets, who reject have rejected care that would allow them housing and food.

    Szasz did a great injustice to patients with severe brain disorders, such as schizophrenia, by asserting that they are always competent enough to choose or deny treatment, possibly because he did this during the early state of neurobiology research 50 years ago when the neurotoxic effects of psychosis were still undiscovered. Unlike persons with healthy brains and prefrontal executive functions that enable sound decision-making, schizophrenia patients can have anosognosia—the neurologic term for lack of insight and self-monitoring—severe cognitive deficits in processing information and decision-making, and reality distortion, and in such cases they can lack the capacity to determine that they urgently need treatment. (cont)

  • C. Anacreon||

    (cont)
    Witness the death of thousands of schizophrenia patients who were abruptly released from Italy's asylums in the 1980s because they lacked the basic brain functions needed to survive. It was a tragic mistake to leave them to their own devices in the name of freedom, conceptualized by lay legislators who had no idea how impaired the brain is in many schizophrenia patients.

    Dr. Szasz practiced long before research demonstrated that the longer psychosis went untreated, the worse the deterioration and functional outcome. Thus, his stance to let patients with psychosis refuse medications significantly harmed those patients, worsened their symptoms, and reduced their chance for remission.

  • SIV||

    So you don't believe patients have the right to ignore a doctor's advice?

    Fuck Off, Slaver.

  • C. Anacreon||

    Not always. Sometimes a patient's "right to treatment" supercedes their right to refuse treatment -- if they are putting themselves in a situation where they are dangerous to themselves or others. Otherwise, people can and do refuse treatment every day, and the law is (appropriately) on their side. We discharge many patients daily from the ER "against medical advice".

    At times a person's mental state can be so impaired, though, that they are not able to judge the risks vs benefits of a treatment. Let's say you were just hit by a car and were dazed, and are actively bleeding. You will bleed to death if the bleeding is not stopped; but because you are so confused from your head trauma you are refusing treatment. Should we just let you lie there and bleed to death, because we want to preserve your right to ignore a doctors' advice?

  • Humason||

    I don't care if someone is dangerous to himself. That's his right. And there are plenty of perfectly sane people out there who are dangerous to others.

    Also, unlike schizo, head trauma is blaringly obvious. There's no danger of a slippery slope for treating people with head trauma... and the duration of the confusion of a person who is treated for head trauma is a matter of hours, not years as is common for psych treatment.

  • C. Anacreon||

    I don't necessarily disagree with you about a clear-thinking person's right to suicide. And a mafia hit man can certainly be a danger to others. But there is a difference when the dangerousness to self or others is due to psychosis, and yes, it is only for a matter of hours, not years, that involuntary medication is typically needed (it is different from state-to-state, but anything beyond emergency psychiatric medications against a patient's will needs a judge's order, which can be very difficult to obtain).

    I saw a patient not long ago who had paranoid delusions and auditory hallucinations telling him his eyes were plotting against him. So he tore his eyeballs out. Completely out of his face, just two holes left. Please tell me that you think this an example of behavior that is OK and medical professionals should stand by permitting. I think it is very similar to the bleeding head trauma example.

    There are medications that can make those kinds of symptoms go away in a matter of hours. Very frequently, it only takes one involuntary dose before a patient improves to the point that they take the meds voluntary from that point on. They are very often quite thankful as they improve and want to work with the staff after that.

  • Humason||

    Who is to say that the patient after the drug is administered is the real patient, while the one who didn't want the drug before it was administered was not?

  • SweatingGin||

    Where we're going, we won't need eyes.

  • Ice Nine||

    And it takes all of five minutes to bleed to death. Way to snag his point.

    Also, how do you feel then about people interfering with a four-year-old's right to play in the street? (Any answer that denies rough equivalency in reasoning power between 4y/olds and acute schizos will only demonstrate lack of experience with acute schizos .)

  • Ice Nine||

    for Humason

  • Humason||

    Young children are easily verified to be young children. Schizophrenics not so much.

    The problem with mental illness being used as an excuse for coercion is that there is such a huge gray area. it's too easy to abuse.

  • Ice Nine||

    I see. So then you are saying that it's because the deficient reasoning ability of a 4y/o is easily verified that he gets yanked out of the street, presumably with your blessing. I can assure you that acute decompensated schizophrenics are "easily verified" and it's acute decompensated schizos that get yanked off the street - and are the ones Anacreon was talking about. I'm afraid you've tied yourself up on this one.

  • ||

    unless you own that street, your kid does not have a right to play in it. He/she does not belong there.

  • Andy Triboletti||

    I don't think the pendulum has swung too far in the patient's rights direction. I was involuntary committed in 2010 and at my commitment hearing I wasn't allowed to use my own lawyer and was held for 20 days against my will. I was committed by two people at the hospital which are anonymous to me and my insurance company had to pay the bill. I don't know the name of my public defender or the judge. I was driven to the hospital by my family and once I read the contract I refused to sign it, so they put me in restraints and carried me to a bed and tied me down. Here's some more information: http://www.quora.com/Legal-Iss.....e-violated

  • ShagNasty||

    Dude can you provide some more information about this incident? I'm really curious about this subject and i'd love some firsthand info, but you left pretty much all the details out of the story you poasted on that site

  • Andy Triboletti||

    Here's some more details:

    http://surroundedbyspies1.tumblr.com/
    http://twitter.com/andytriboletti (check out my tumblr blog in my bio too, I can only have 2 links here)

    If you've read all of that and still have questions post them or email me at andy.triboletti@gmail.com

  • ReformRealist||

    Cato Unbound did an issue on Mental Health and the Law back in August with contributions from Allen Frances and Sullum among others. It goes into more of the fine details: http://www.cato-unbound.org/archives/august-2012/

    Rael Jean Isaac also presents an alternative Libertarian perspective on mental illness: http://www.cato-unbound.org/20.....mas-szasz/

  • mtrueman||

    'How “scientific” is that? Not very.'

    Not all those infected with HIV have AIDS and not all those with AIDS have HIV. How scientific is that?

    Not very, but let's keep in mind it's medicine we are talking about, not science. Confusing the two does no favour to Szasz's argument. The NYT only muddies the water by claiming that better medicine is more scientific medicine, a claim that nobody seems to have any trouble with. I have trouble with this notion, and I think dismissing approaches to problems like depression because they are "quasi-medical and pseudo-scientific" is ill-conceived and imperialistic.

  • ||

    I'd imagine that the problem with distinction between medicine and science is where systematic diagnoses occur. Without a scientific process of being able to tell WHO needs medicine and for WHAT reason, the label "disease" can be thrown on anybody.

  • mtrueman||

    You're probably right, though I don't think we'll soon have this scientific process, and perhaps never will. For the meanwhile, we're stuck with common sense and good will toward men.

  • ||

    "For the meanwhile, we're stuck with common sense and good will toward men."
    Good luck reconciling that with a profit- and interest- motive put forth by the state. Given the speed at which medicine and technology has been advancing in these areas, I'd say we're going to find out how incredibly complex the human mind is and that any recognizable symptoms we find are going to be arbitrary as hell.
    I've no doubt many psychiatrists sincerely want to help their patients get better, but wanting to help someone doesn't negate the other person's wishes to live with their own problems.

  • Humason||

    Not all those infected with HIV have AIDS and not all those with AIDS have HIV. How scientific is that?

    First, everyone with AIDS does in fact have HIV.

    Getting beyond that head-scratch-inducing quote, I don't think you understand what scientific means. HIV and AIDS are very well-defined concepts, and each of these things can be objectively tested for. Not so with schizo.

  • mtrueman||

    I thought there were cases of AIDS where no HIV was found. There was some controversy some years back. Sorry if I led anyone down the garden path.

    I completely agree that there is no objective tests for schizophrenia. But here's my point. Insistence on objectivity in testing is mistaken.

    Dig this: two doctors giving a sugar pill to the same patient can result in wildly different effects. Doctors know this and work to bend it to the patient's (and their own) advantage.

  • ||

    The placebo affect isn't used as often as you seem to think. Maybe you have a newsletter I could subscribe to?

  • ||

    Placebos are also only permitted concurrent a clinical drug trial.

    The Placebo Effect, though demonstrable, is hardly a reliable course of therapy and any practitioner that relies on them should be shot.

    I know if I was in killer pain and I asked for a scheduled drug and found out I got a sugar pill, at the very least the prescribing physician would get a punch in the face, not to mention a nice little serving for fraud.

  • Humason||

    It's not fraud unless you pay for it.

  • ||

    C6-H12-O6 is a scheduled drug? Morphine SO4 is a scheduled drug, and if I requested it, was granted the request orally and in writing, but was not given it in lieu of something that was not Morphine SO4, absent a known contraindication, that would be fraud.

    Or theft if the nurse is filching drugs after a draw up, which unfortunately does happen sometimes.

    Moreover, somebody is paying the bill. TANSTAAFL.

  • yonemoto||

    Hey, y'all this is an amazing blog:

    http://thelastpsychiatrist.com/

    Especially like the teardown of the Gerry Mak situation.

  • TheSpiteHouse||

    That is an excellent read.

  • Thane of Whiterun||

    "Amazing"? The writing is incomprehensible.

  • Rich||

    "there are no objective signs or tests for mental illness"

    Hence there are no objective signs or tests for mental *health*. You can take down that shingle now.

  • mtrueman||

    You mean because the signs are not objective? So? You need a little more time under your thinking cap, my friend.

  • Rich||

    Mental illness/health is like pornography: you know it when you see feel it.

  • mtrueman||

    Or sound mental health is like good taste. There are no objective tests to help us here, but that doesn't mean that the notion of good taste is meaningless or non-existent. Again, objectivity is a standard to judge scientific claims. You're barking up the wrong tree when you apply them to medicine, or art for that matter.

  • ||

    But notice how there is no science of good taste? Yeah, I think you're the one who's missed the point here...

  • ||

    And medicine is a science.

  • ||

    But notice how there is no science of good taste?

    Philistine.

    Behold.

    Some related chemistry.

  • mtrueman||

    "there is no science of good taste"

    That, my friend, is exactly my point. Or to be even more exact, my point is that science will only take us so far in understanding mental health. You appear to have totally misconstrued the comments I've posted here. For clarity: there's science, and there's art. Medicine lies somewhere in the middle, and shares features of both.

  • ||

    I think you're confusing "art" with applied science. Medicine is an applied science, which is why most people don't see it as similar to "pure" sciences.

  • Ted S.||

    Some sciences are more pure than others.

  • ||

    Ah yes. That sums up why I had such a struggle in college deciding whether to major in math or biology. Intellectually, I was more interested in mathematics but it has very little in the way of career opportunities relative to biology. I ended up minoring in math, but it's still #1 in my heart.

  • ||

    I think you're confusing "art" with applied science. Medicine is an applied science, which is why most people don't see it as similar to "pure" sciences.

    This mostly true heller; however, the interpersonal dynamic, or rapport, established b'twixt patient and physician is learned skill, and does require a certain intuition for both formulating a DX/DDX and relaying that DX and subsequent TX communicated to the patient in the best way possible to ensure the best possible outcome and resolution of what ails.

    Encouraging compliance with a given TX regimen, depending on the personality archetype of both the patient and the physician (and arguably Nursing and Allied Health support staff), can be something of a trick as well.

  • ||

    Yes, but the same could be said for many sciences. There's always a certain amount of intuition and experience that goes into deciding what you're going to research and how you're going to do it.

  • ||

    Yes, but the same could be said for many sciences. There's always a certain amount of intuition and experience that goes into deciding what you're going to research and how you're going to do it.

    Also true, but the art (or creative, if prefer) aspect deals with the human emotive element, probably something, you as a biologist, with which you are not likely going to be dealing. A physician may know their given discipline backwards, forwards, slantways, and sideways, but if they can't communicate effectively to the patient, their utility is arguably impaired and can mean the difference between a mediocre outcome and a superior outcome, as no two patients, even if they have the same DX, are exactly alike. The course of TX may differ based on those differences, be they either anatomical/histological or psychiatric.

  • ||

    I agree. That is basically what makes medicine an applied science in my mind.

    Although I will say that connecting with people and communication skills are ALOT more important in research sciences then most people realize. It's likely that I owe my career equally to dumb luck and knowing the right people as well as any innate ability.

  • Humason||

    Modern medicine is science based. Period. There's no art component.

    If you want to subject yourself to leeches, herbalists, faith healers, psychiatrists, and alternative medicine, go ahead. Just don't use it to justify coercing me.

  • C. Anacreon||

    I never understand the hate some have for psychiatrists. These are people who spent years in medical school and residency to become full-fledged physicians, and are usually very devoted and caring individuals, helping patients that are shunned by many in society. While I have met plenty I do not like, I don't think any of them are evil or want anything but the best for their patients. They also have a lot more basis in science than leeches and faith healers, thanks.

  • Humason||

    Probably because psychiatrists charge ridiculous fees and, once their power to prescribe drugs is removed from the equation, are not provably any more effective at "making people better" than talking to a priest or a minister or a bank teller is.

  • C. Anacreon||

    If you take away the power to prescribe medicine from any non-surgical physician they can't help people much more than a bank teller. What do you think physicians do? It is called the practice of medicine.

    Most of the psychiatrists I work with do not do psychotherapy, which is what I think you are getting at. They diagnose patients and prescribe appropriate medications, just like internal medicine docs, oncologists, etc.

    And psychiatrists are below the median on physician salaries, so their fees can't be any more ridiculous than other physicians.

  • Alan||

    The whole psychiatry/psychology crowd has just pathologized too many normal and healthy behaviors to trust their opinions about things. There are a few who are doing some incredible work, but the vast majority are quacks at best.

    Plus, my psychiatrist sister tortured me when I was a child.

  • mtrueman||

    You ever actually seen a doctor at work? White lab coat, stethoscope, and all the rest? In show business, this is called a costume. In the performing arts, it's long been recognized that actors wearing costumes do a better job at "suspending disbelief" in their audience than those wearing their street clothes.

    Now I doubt the Newton found he could more reliably get rays of light to refract through glass by donning a lab coat and slipping a slide rule in his pocket because Newton was a scientist. If Newton were practicing medicine things would be different.

    As for the importance of objectivity in medicine, I advise you to turn off your computer, put some clothes on, and head off to your local library and research the placebo effect.

  • ||

    Actually my father was an ED physician. He never wore a lab coat or a stethoscope, just scrubs.

    "Witchcraft to the ignorant, simple science to the learned"

  • ||

    The reason doctors wear coats or scrubs is because it's quite awkward to be seen going home with blood, vomit, mucus, and various other fluids on your street clothes. And stethoscopes do have a medical use. So far you haven't really shown me that you know anything about medicine.

  • mtrueman||

    "So far you haven't really shown me that you know anything about medicine."

    Heller, so far I've not been interested in showing you what I know of medicine. I'm commenting here again and again, to dispute the notion that because there are no objective methods to identify mental disorders, mental disorder is meaningless or nonexistent. If you were to apply the same criteria across the board, other well recognized medical phenomenon would have to be consigned to non existence. The placebo effect, for one, the importance of establishing a sound doctor/patient relationship, for another.

    You needn't insist that "stethoscopes do have a medical use." I never claimed otherwise. Aside from listening, they establish authority and instill confidence - not something objectively measurable by scientists, but still unquestionably part of medical practice.

  • Humason||

    not something objectively measurable by scientists

    Hogwash. There are loads of experiments where such things were objectively measured, from before the 1960s when rigorous experimentation on human subjects became essentially impossible to do because of quote-unquote ethical concerns.

  • ||

    The placebo effect isn't used in doctoring, it's used in drug design. And the doctor-patient relationship doesn't shed light either way on whether medicine is a science. No one has ever claimed that the bedside manner is scientific, so your analogy to psychiatry is completely baseless.

  • ||

    Modern medicine is science based. Period. There's no art component.

    Really? That would be news to plastic surgeons the world over (especially cosmetic surgeons), as would PX management specialists (correctly identifying what type of, etiology thereof, and most effective TX for PX is definitely an art), and so would orthopedic surgeons, since they craft both form and function to a particular joint(s) while aesthetics in mind. Even I have to worry about WX TX and have to use the appropriate surgical approach, meaning incision site, which sutures I will use to close, and post-op closing TX and orders in minimize scarring as much as possible, particularly the abdomen, breasts, and neck. Body alteration can be pretty shocking, Tulpa, and in good many of my patients (women in particular), resolution of scarring was just as, if not more, important than the actual surgery itself.

    You're definitely no doctor Tulpa, that's for sure, and stick to attempting to parse addresses better than Episiarch.

    Most of your posting in this thread, and in medical threads in general, is a swirling cauldron of FAIL, but I couldn't let this little gem go unanswered.

    PS

    Leeches are used routinely post op in limb re-attachments/grafting.

  • ||

    But any plastic surgeon worth his handsome face would argue that the function of the face is its aesthetics, but I'm not going to play devil's advocate with that one.

  • Humason||

    Oh come on, GM. There may be some "creative" aspect to surgery but it's all science based.

    As usual, you bring to the table a flurry of details and jargon and I'm-the-doctor-and-you're-not posturing that pops like a soap bubble once one actually considers whether it's relevant.

    Even I have to worry about WX TX and have to use the appropriate surgical approach, meaning incision site, which sutures I will use to close, and post-op closing TX and orders in minimize scarring as much as possible, particularly the abdomen, breasts, and neck.

    I hope you're using sutures that have been scientifically proven not to be harmful to the tissue they're butting up against, and incision tools that have been scientifically proven not to damage the tissue it incises beyond repair, etc. And I hope you can point after the fact to scientific reasons why the creative choices you made were the right ones.

    What mtrueman is talking about is bringing a totally unscientific, unfalsifiable component into psychology. I hope to god that's not what you're doing in medicine.

  • ||

    There may be some "creative" aspect to surgery but it's all science based.

    Please tell me where I said it was not science based? You made the erroneous assertion that there was no artistic component to medicine. This is demonstrably false.

    Boob jobs, specifically breast augmentation. Are they medically necessary to live? Nope, I don't know of a case where someone died from a lack of boobage improvement. However, the requested size may or may not be flattering and proportionate, and it's the surgeon's job and artistic ability to craft a bosom that will be pleasing to the patient first and anyone else with whom she (or he) wishes to share. The science would be selecting one with saline as opposed to silicon, the art is making it look natural and without nipples shooting in weird directions.

    As usual, you bring to the table a flurry of details and jargon and I'm-the-doctor-and-you're-not posturing that pops like a soap bubble once one actually considers whether it's relevant.

    Strawman, thy name is Projection. There may even be a bogus entry for that in the Book of Voodoo AKA the DSM. The colour green is probably a symptom.

    As for the rest of your breathless diatribe, yes to all of the above, though I fail to see anything totally unscientific here, and I certainly don't use Magic 8-balls, crystals, or other hokum to DX maladies, rest assured.

    You may now lie down on the fainting couch if you so choose. -)))

  • Humason||

    People don't get locked up, have their assets taken away, and lose constitutional rights because of bad taste.

  • Heroic Mulatto||

    People don't get locked up, have their assets taken away, and lose constitutional rights because of bad taste.

    They should. And women who wear the tights/Ugg boots combo should be summarily executed.

  • ||

    What?! No "In a sane and just world..."? You're slipping, HM. If there was ever a need for karmic justice, tights/yoga pants and UGGS combined is it.

  • C. Anacreon||

    The DSM is mostly a joke, with too much influence in its creation by psychotherapists who want a billable diagnosis for every eccentricity. It would be nice to have a real diagnostic manual for psychiatrists with only the severe mental illnesses such as schizophrenia and mania, and then have some other manual for the psychologists and therapists with all the neuroses. Putting them all in the same book cheapens the serious and debilitating psychiatric diseases and makes them seem less "real" than, say, diabetes or asthma.

  • The Late P Brooks||

    Speaking of the mentally ill-

    We live in an anti-political moment, when many people — young people especially — think politics is a low, nasty, corrupt and usually fruitless business. It’s much nobler to do community service or just avoid all that putrid noise.

    I hope everybody who shares this anti-political mood will go out to see “Lincoln,” directed by Steven Spielberg and written by Tony Kushner. The movie portrays the nobility of politics in exactly the right way.

    It shows that you can do more good in politics than in any other sphere. You can end slavery, open opportunity and fight poverty. But you can achieve these things only if you are willing to stain your own character in order to serve others — if you are willing to bamboozle, trim, compromise and be slippery and hypocritical.

    The ends justify the means. Might makes right.

    WE DON' NEED NO STEENKING PRINCIPLES.

  • An0nB0t||

    Forget it, Brooks. It's NYT town.

  • Rhywun||

    the nobility of politics

    Barf.

  • The Late P Brooks||

    More:

    The movie also illustrates another thing: that politics is the best place to develop the highest virtues. Politics involves such a perilous stream of character tests: how low can you stoop to conquer without destroying yourself; when should you be loyal to your team and when should you break from it; how do you wrestle with the temptations of fame — that the people who can practice it and remain intact, like Lincoln, Washington or Churchill, are incredibly impressive.

    The truly great man will stop at nothing to impose his enlightened will on the ignorant smelly rabble.

  • Anonymous Coward||

    The challenge of politics lies precisely in the marriage of high vision and low cunning. Spielberg’s “Lincoln” gets this point. The hero has a high moral vision, but he also has the courage to take morally hazardous action in order to make that vision a reality.

    Glad to see David Brooks didn't gorge himself at Thanksgiving. He left himself plenty of room of stuff his face with statist cock.

  • iggy||

    I don't see what the point in mocking the Times is anymore. They're literally fascist authoritarians at this point, so mocking a single article from the Times has become like attacking a Stalin speech because he split an infinitive.

  • PapayaSF||

    Oh, wonderful! "Morally hazardous action" in the service of "a high moral vision." Too bad that history is filled with catastrophes caused by just that sort of "the ends justify the means" reasoning.

  • A Serious Man||

    Like when Pol Pot courageous took the morally hazardous actions needed to bring about Year Zero. At least he tried, damnit!

  • anarch||

    “The educated classes are possessed by the idea that in the social domain anything can be accomplished if only one applies enough force and is sufficiently resolute.”~ Ludwig von Mises, Epistemological Problems of Economics, p. 200

  • anarch||

    Socialist squirrels, seeking to level all hypotaxis, displaced the above comment.

  • Humason||

    David Brooks actually has an (unintentional I'm sure) point. We do need good people to not flee from politics, because for better or worse it's always going to be around. The government isn't going away, and community service isn't going to make it less powerful. If everyone with principles stays away from politics, everyone in politics is going to be unprincipled.

    Of course, the system's rigged that way already, since to reach high office you normally have to spend years or decades carrying water for and sharing in the unscrupulous deeds of the politicians who came before you. Even the few exceptions to this rule, like the Pauls for instance, are overwhelmed by those who aren't exceptions and won't be able to get much done.

    Also, I agree with Brooks that if you reach high office and serve in that office, and maintain your integrity on some level, it is impressive. Unfortunately, politics is also the best place to develop the lowest vices, and that's far more common. For every Winston Churchilll there are 1000 disgusting Bohners and Reids.

  • Archduke Pantsfan||

    I know why the egyptians are pissed. From radio reports it sounds like Morrissey has made himself dictator.

  • A Serious Man||

    From radio reports it sounds like Morrissey has made himself dictator.

    Springtime for Morsi and Egypt...

    Winter for Coptics and Jews!

  • Rhywun||

    Heaven knows they're miserable now.

  • Humason||

    From radio reports it sounds like Morrissey has made himself dictator.

    It's about damn time.

    This is the coastal town
    That they forgot to close down
    Armageddon - come Armageddon!
    Come Armageddon! Come!
  • Archduke Pantsfan||

  • Frank_Carbonni||

    You don't need to go to one extreme or the other. I think it is fair to have commit people with serious mental illness if they are threat to themselves and others. I am talking about people who show virtually no reasoning ability and suffer from delusions.

    The reason why I think that libertarians (and many liberals and conservatives as well) are skeptical and distrusting of involuntary mental healthcare is that it is field that has a less than stellar record when it comes to human rights, remaining politically unbiased, and being right about what is or should be considered a mental illness.

    Keep in mind that homosexuality and feminism used to be considered mental illnesses. An early psychologist once classified the desire of slaves to run away as a mental illness. The Soviet Union classified those who were critical of the socialist system as suffering from "Sluggishly Progressing Schizophrenia". I won't get into lobotomies which made the majority of recipients worse off and only cured a small percentage.

    Also, I don't think a lot of mental health professionals have learned their lesson. Even nowadays I have read articles where some psychologist is proposing a new Personality Disorder or condition that sounds suspiciously like they are trying to classify every trait as a disorder.

    That being said, I don't think the homeless man throwing his own feces at passing cars because the mailbox told him to do so is as mentally competent as someone who isn't.

  • Frank_Carbonni||

    You don't need to go to one extreme or the other. I think it is fair to have commit people with serious mental illness if they are threat to themselves and others. I am talking about people who show virtually no reasoning ability and suffer from delusions.

    The reason why I think that libertarians (and many liberals and conservatives as well) are skeptical and distrusting of involuntary mental healthcare is that it is field that has a less than stellar record when it comes to human rights, remaining politically unbiased, and being right about what is or should be considered a mental illness.

    Keep in mind that homosexuality and feminism used to be considered mental illnesses. An early psychologist once classified the desire of slaves to run away as a mental illness. The Soviet Union classified those who were critical of the socialist system as suffering from "Sluggishly Progressing Schizophrenia". I won't get into lobotomies which made the majority of recipients worse off and only cured a small percentage.

    Also, I don't think a lot of mental health professionals have learned their lesson. Even nowadays I have read articles where some psychologist is proposing a new Personality Disorder or condition that sounds suspiciously like they are trying to classify every trait as a disorder.

    That being said, I don't think the homeless man throwing his own feces at passing cars because the mailbox told him to do so is as mentally competent as someone who isn't.

  • Archduke Pantsfan||

    Meanwhile in Russia

  • ||

    The drivers in UKR may actually be worse than Russia, if you can believe that.

  • ||

    it's a rare week when i do not get a call involving a situation where i , or my partner will involuntarily commit somebody for observation (72 hrs max w/o a hearing. usually out within a couple of hours). that being said, many family members are amazed at how fucked up a person must be before we can involuntary commit them.and often pissed off that we can't commit them, when the person is clearly out of their gourd, but we don't have evidence they are an IMMINENT danger to self.

    the pendulum has swung pretty darn far.

  • waaminn||

    I thin kits pretty pathetic dude, seriously.

    www.Max-Privacy.tk

  • Humason||

    Speaking of things that aren't science...

    During a year with a monster storm and scorching heat waves, Americans have experienced the kind of freakish weather that many scientists say will occur more often on a warming planet.

    And as a re-elected president talks about global warming again, climate activists are cautiously optimistic that the U.S. will be more than a disinterested bystander when the U.N. climate talks resume Monday with a two-week conference in Qatar.

    Basically, any weather other than exactly seasonal temperature with exactly average rainfall totals is evidence for global warming. Freezing our asses off in Pgh in early November was global warming too, of course.

  • sohbet||

    very super blogos thanks admin sohbet & sohbet odaları

  • cinsel chat||

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