Misunderstanding Thomas Szasz

It's hard to think of a writer who expressed himself as clearly as the late Thomas Szasz did, or who argued his points with such precision. You might fault his logic or disagree with his premises, but it ought to be hard to misunderstand what exactly he was saying. And yet he was constantly misunderstood. How many times, for example, has someone suggested that Szasz's argument against the idea of mental illness has been refuted by research on the biological basis of schizophrenia? The implications of that research are routinely overstated, but set that aside: Even if the most breathless pop-science coverage of those investigations were accurate, they wouldn't affect Szasz's distinction between metaphorical mental diseases and actual physical lesions. They would simply move schizophrenia from the first category to the second one. Far from being unable to process such scientific developments, Szasz wrote thoughtfully about something similar that had happened in the past, when the treatment of epilepsy moved from the dominion of the psychiatrists to the dominion of the neurologists.

Meanwhile, there seems to be no limit to the medicalization of our lives. So while Szasz's critics tout those schizophrenia studies as evidence that their target is no longer relevant, I read stories like this CNN report and conclude that he's more relevant than ever:

A federal court judge on Tuesday ordered Massachusetts officials to provide sex-reassignment surgery for a transsexual prison inmate, after determining that it was the only adequate treatment for the inmate's mental illness.

The state's Department of Correction said Michelle Kosilek, previously known as Robert, who is serving a life sentence without parole for murdering his wife in 1990, has a gender identity disorder....

Chief Judge Mark L. Wolf ruled that sex reassignment surgery is the "only adequate treatment" for Kosilek, and "that there is no less intrusive means to correct the prolonged violation of Kosilek's Eighth Amendment right to adequate medical care."

In the old days, "gender identity disorder" or some similar label would have been a license to coerce Kosilek back into a male identity. Now it's a license to coerce taxpayers into subsidizing a sex-change operation. Szasz would have said it's absurd to think of the sexual roles people adopt in terms of a disorder.

The medicalization mindset has taken hold even among the people you'd expect to like it the least. While many transsexual activists object, on understandable grounds, to the idea that they're sick, reporters haven't had trouble finding others willing to say things like "It's great to see a judge recognize that transition-related health care is medically necessary health care." In 2012, there are social advantages as well as social disadvantages to acquiring a psychiatric label -- and not just when it comes to a headline-grabbing subject like sex-change surgery behind bars. The Diagnostic and Statistical Manual of Mental Disorders is filled with diagnoses designed to describe ordinary life problems, some of which might be solved or made more manageable by talking to a counsellor or by taking a mood-altering chemical. Once upon a time, a label from its pages would have been a stigma; now it's a way to get an insurance company to cover the costs of those talks or those drugs. (The flow of money from insurance companies has, in turn, become an incentive encouraging psychiatric coercion, a process Joe Sharkey described in his muckraking book Bedlam. Circle of life!)

It was bad enough when readers misunderstood Szasz's own ideas. It was worse when they misattributed other figures' ideas to his work. Forty years ago, when people heard that Szasz was a critic of psychiatry, they often assumed he must be a countercultural "antipsychiatrist" like R.D. Laing. In fact, while Szasz saw some of the antipsychiatrists as allies early on -- he recommended one of Laing's books in a footnote to The Manufacture of Madness -- he concluded quickly that they were no more opposed to coercion than the psychiatric establishment was. Eventually he grew so aggravated at being conflated with them that he wrote a book-long critique of their worldview. By then, with Laing forgotten, people were more likely to insinuate that Szasz was some sort of Scientologist. L. Ron Hubbard's weird church denounces psychiatry all the time, after all, and it was Szasz's ally in the political fight against electroshock and other involuntary treatments. But no, he wasn't a Scientologist, and no, they aren't the master manipulators behind every challenge to psychiatric authority.

I had my disagreements with Szasz, but I can't think of anyone who wrote with as much bracing clarity about the ways psychiatric ideology distorts our understanding of issues ranging from religion to the drug war. (Did I say "ranging from"? Szasz's best book -- Ceremonial Chemistry -- makes a strong case that the drug war and religion are closely linked.) He had the ability to look at claims that are presented as objective science and to see the cultural assumptions lurking behind the curtain. Just as important, he could see the ways it served our social hierarchies to pretend those cultural contingencies weren't there.

I met Szasz just once, at a conference sponsored by Liberty magazine. I asked him about Gregory Bateson's theory of schizophrenia in Steps to an Ecology of Mind, which paralleled Szasz's writing in several significant ways but stopped short of Szasz's full critique of the idea of mental illness. "It seemed like he got halfway to your position," I told him. "No, he got all the way there," Szasz replied, "but he wasn't brave enough to say it." Whether or not it was fair to charge Bateson with cowardice, it's difficult to imagine anyone levying such an accusation at Szasz: Here was a man with the courage of his convictions. And here was a man with the literary skill to express those convictions clearly, no matter how hard some might find it to decipher his plainly stated arguments.

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  • ||

    Psychology for some people hits the same crazy buttons as circumcision or abortion do for others. They go FULL RETARD about it and cannot react rationally to it, and therefore are completely unable to comprehend what is actually criticism or praise (or neither) about it.

  • $park¥||

    I see what you did there.

  • ||

    Look, dude, I'm trying.

  • ||

    Paging John, please come to the white courtesy phone.

  • o3||

    let john contemplate this on the tree of woe...

    "Wolf was nominated by President Ronald Reagan on March 8, 1985..."

    http://en.wikipedia.org/wiki/Mark_Lawrence_Wolf

  • ||

    There aren't enough "tree of woe" references on the internet. +1.

  • Brutus||

    We need to hear the weeping and lamentations of Orrin's women.

  • Pi||

    No, the WHITE phone.

  • Randian||

    "Listen Betty, don't start up with your white zone shit again."

  • Hugh Akston||

    Szasz would have said it's absurd to think of the sexual roles people adopt in terms of a disorder.

    What about Warty?

  • ||

    Warty hasn't adopted rapeosexual, he was born that way.

  • Killazontherun||

    born that way

    I had no problem with that phrase until this person who calls herself Lady Gaga used it, and now it just rubs me the wrong way. Like a 'masseuse' use to giving handjobs on much bigger penises.

  • $park¥||

    Aw, don't let the giggling hurt your feelings. Just lay back and enjoy.

  • Killazontherun||

    It's not the giggling that hurts my feelings, it's the baby talk they coo it with. It's not a baby pecker, it's a big boy pecker!

  • Heroic Mulatto||

    People with paraphilic infantilism might think that's hot.

    Jus' sayin'

  • ||

    I guess you can't read their poker face.

  • Randian||

    ah ma ma ma...

  • ||

    I liked it. Well, the actual song part, anyway. The terrible thing about some of her videos (besides the weird imagery, which isn't to my taste) is the long, long lead-in to the actual song. Once it's there, I can just let it run while looking at something else.

  • Killazontherun||

    I know the titles, I have never heard the songs. It might be decent, but there is really no reason for me to find out. Sorting through what sucks and doesn't suck in pop music is not worth the effort. Most of my listening material of late had been song tracks from movies, and I'm beginning to enjoy song tracks from games after the ones for Human Revolution and Max Payne 3 turned out so well.

  • Brett L||

    Didn't Jesse point out the part about lesions?

  • Hugh Akston||

    So you're saying it's brain herpes?

  • $park¥||

    I've never read anything by him, but can I assume that he wouldn't consider hero worship a mental illness?

  • nicole||

    Szasz's distinction between metaphorical mental diseases and actual physical lesions

    In fact, Szasz's very problem in being understood is that he was so clear, in a world where the real and the metaphorical are treated interchangeably much of the time. It's much too easy for your interlocutors to constantly move the goalposts, and without remotely realizing they are doing so, because their whole problem is that they're not thinking clearly about what you're talking about.

  • $park¥||

    Are you trying to say that the people who didn't understand him were ... crazy?

  • ||

    NEEDS MOAR L RON HUBBARD

  • $park¥||

    If you can't understand Thomas Szasz's points...

    *sunglasses*

    You must be out of your mind.

    YEEEAAAAHHH!!!

    /CSI

  • tarran||

    L. Ron Hubbard's Beef with the psychiatrists was that they wouldn't tell the U.S. Navy to give him a lifetime pension for being so anxiety-ridden that he could only perform his duties under close supervision.

    Being a crappy naval officer in now way entitles someone to disability.

  • tarran||

    Although, I do think L Ron Hubbard ordering his men to fire on Mexican territory is on some level brilliantly Eristic.

  • ||

    THIS IS WHAT TARRAN ACTUALLY BELIEVES

  • Heroic Mulatto||

    I think you're being way too kind to the Hub.

    His anti-psychiatric schtick was cynically designed. If you are making money through brainwashing, of course you want to demonize the one discipline that could combat your techniques.

  • ||

    Yeah, it was a competition thing. "You say depression, I say thetans. Fuck you!" Also, Xenu.

  • Heroic Mulatto||

    Let's not forget, though, he was absolutely correct concerning the Marcab Confederacy.

    Hubbard said that the Marcab Confederacy invented income tax as a means of punishment, with the death penalty imposed for making even the slightest mistake in returns — "one comma wrong and it's 'dead forever'." The Marcabians also appear to have been distinctly socialistic, having "had plan balanced economies" (presumably some form of planned economy). ...
    Hubbard stated that the Marcab Confederacy was now using Earth as a "prison planet". When a person dies or "drops the body", as Scientologists put it, his thetan is pulled into a Marcab-established "implant station" or "report station".
  • ||

    Hubbard stated that the Marcab Confederacy was now using Earth as a "prison planet". When a person dies or "drops the body", as Scientologists put it, his thetan is pulled into a Marcab-established "implant station" or "report station".

    So THAT'S where our trolls come from.

  • Killazontherun||

    Giving the Freudian and Jungian mysticism prevalent in the field at the time, it was ripe for easy pickings from a grift artist of Hubbard's caliber.

  • Killazontherun||

    Given the F and J . . .

  • BakedPenguin||

    ...a grift artist of Hubbard's caliber.

    "My game is the long con, baby."

  • Brett L||

    Yes. I still remember going to see the "intro to Scientology" movie in Austin after a friend and I dropped acid and flipped through Dianetics. They had some setup interview of LRon while he was living on his boat and dodging taxes. He was pretty down on psychiatry and psychology for someone whose entire bag seemed to be spoonfeeding people pop psychology for prices that would make degreed psychologists jealous.

  • BakedPenguin||

    Unfortunately, a lot of critics of psychiatry get painted as Scientologist nut jobs because of Scientology's attacks on the field.

  • ||

    my taxpayer funded coverage... covers sex reassignment surgery. i know this because one of my coworkers has used it. complete breast removal because their gender identity didn't conform with (female) breasts.

    no genitalia action yet... as far as i know... and i;m not askin'

  • Heroic Mulatto||

    complete breast removal because their gender identity didn't conform with (female) breasts.

    Balderdash! "Moobs" are a thing.

  • ||

    Schizophrenia most definitely has a biological basis, as do a number of other mental illnesses. But you are right that way too many poorly defined "disorders" out there. There's a lot of bleed-through from the mushy world of psychotheraphy, where anything that keeps you from living a "normal" life (or the life you want) is a disorder, to the world of psychiatry, where psychoactive medications get applied to treat these disorders.

    Although, really, if people want to take anti-psychotic medication to treat their dysfunctional family childhood trauma who is really in a position to judge them ? It's only really an issue to the extent that children are getting medicated unnecessarily or people are being manipulated or coerced into believing there is something wrong with them.

  • nicole||

    To the point of your last paragraph, I completely agree. However, one point that Szasz makes very well in The Myth of Mental Illness is that structuring this system as we do also creates bad outcomes for patients (or "patients") by disincentivizing honest, open relationships with doctors/practitioners. The unique ability to coerce based on "mental illness" (whereas patients can refuse treatment for physical disease) makes the whole structure vulnerable to abuse on both sides.

  • ||

    back in the day a lot of treatment could be coerced for mental illness

    nowadays, it doesn't matter WHAT the alleged mental illness is, people are free to be crazy as fuck, and the state can only step in when they are determined to be an imminent danger to self or others. it's a pretty high standard. walk around the downtown of any major city and you will see mental illness galore. the only ones gettting taking in are those that are doing stuff like cutting their wrists, or lying down in traffic. and i've invol'd many myself this year

    so, it's less "bothersome" because it's not as coercive as it used to be

    mental illness is neither sufficient nor necessary for coercive state action. what is necessary is that the person behave in a manner that evidences imminent danger to self or others.

  • nicole||

    the state can only step in when they are determined to be an imminent danger to self or others. it's a pretty high standard.

    Well, standards vary as to what actually rises to this level, and it's inherently subjective because someone has to determine when you're a danger to yourself or others, but the point still stands: what kind of quality of care do you think is available to a person who is suicidal but does not want to be locked up (and knows he will be if he tells the truth to his doctor) and have many of his rights permanently abrogated? (And the flip side, of course, is that it's easy to get locked up if you want to but aren't actually "that sick.")

  • $park¥||

    Why can't we just let suicidal people kill themselves?

  • Heroic Mulatto||

    Because, God. Or something.

  • ||

    NOBODY is stopping them

    it's incredibly easy to do so. if you REALLY want to do so, you don't call up yer ex-gf, 911, etc. before you start your (often half assed) attempt, which is usually more a cry for help than a bona fide attempt

    i 100% support the right to die, and nobody can stop any ambulatory individual who wants to do so

    it's easy and people do it all the time.

  • $park¥||

    NOBODY is stopping them

    If this is true then why are suicidal people receiving treatment? More importantly, why are life-with-no-parole prisoners receiving sex change operations on the taxpayers dime because they'll kill themselves if they don't?

  • ||

    for a host of reasons. like they made their attempt while they were incarcerated for a crime, and thus it was intervened.

    OR, as i said, they call 911, or their gf, or make a big SHOW of their "attempt" (which many times isn't a bona fide attempt, but a cry for help) which is why law enforcement/medics etc. are there in the first place TO intervene

    again, if you WANt to commit suicide and you are, as i am trying to explain, an average joe (ambulatory, not in custody, etc.) it's EASY to do. and NOBODY can stop you.

    there is a reaosn why women have many X the "attempt" rate of males, but males COMMIT suicide far more often than women

    (see: bona fide attempts)

    you take a bunch of sleeping pills, or other such bullshit. you are almost certainly not going to die. and intervention will start.

    you want to actually kill yourself? go to any isolated high as fuck location and jump. or go to the woods and hang yourself. or go to the drugstore, buy some over the counter insulin e.g. humulin-r and some over the counter syringes (at least in my state), get a sleeping bag, and go into the woods and shoot yourself up with metric assloads of insulin. drink some wine too!

    or shoot yourself

    or...

    it's not friggin' rocket science.

  • ||

    where i work, the level is pretty high. it's a totality of the circs thing, like everything else, but i get lots of cases where the guy is crazy as fuck, scaring the hell out of the family, they want us to take them away for help, and i simply don't have 'enough' to do so.

    and around here, suicidal or not, they are usually out of the hospital within 8 hrs (AT MOST) of being taken in

    maybe

  • nicole||

    Sure. Maybe. And you can't know. You can't know if what you say will be enough to get you locked up, and if so, for how long, and what you might need to say to get back out again. Or what will happen while you are incarcerated.

    And I know some people say that incarceration helped them. But I think it's generally a bad thing to create a situation where you are discouraging people from being honest with someone they need to be honest with if they are actually going to receive meaningful treatment. There is plenty of talk about what we need to do to end the stigma of mental illness so people will seek the help they need. But there is much more than just stigma to be worried about.

  • ||

    yea, i have to agree. not speaking from training/education here (which i have in psychology, and i think psychology on the whole is no more a SCIENCE than Intelligent Design theory is), but from experience

    i've just dealt with too many schizophrenics to doubt that it is not a very real thing. and i think the research supports a biological basis for it.

    but szasz' underlying point about the medicalization of everything is correct. his points in general are. and the DSM has to be the most arbitrary joke of a "scientific" text that ever existed.

    as for the children being medicated, i was pretty shocked when i started taking cases at a local high school (kids selling their script drugs, etc.) HOW MANY high school kids were on psychiatric meds. it's pretty amazing.

  • o3||

    wonder why they dont play sports and drink beers like we did?

  • Heroic Mulatto||

    OT Kinda: Modern medicine: Lab-grown genitals, spray-on skin

    Soon, we will all be able to customize our genitals. I'm going for something with the flexibility of an elephant's trunk and can sustain 3600 rpm.

  • ||

    That reminds me of a very odd short story I read a year or two ago. I couldn't possibly look it up right now though.

  • nicole||

    You want it to...rotate?

  • nicole||

    Or by "sustain" did you mean someone else would be doing the revolving?

  • ||

    Are you familiar with the term "spinner"?

  • ||

    HM doesn't thrust, he spins. Don't ask me why.

  • Heroic Mulatto||

    Of course...you've never heard of my life's dream to become a human Sybian?

  • nicole||

    Well...all I'll say is that's an awful lot of RsPM.

  • Heroic Mulatto||

    That's just the upper limit. Newbies to the HM-experience can start at around 60 to 120 rpm.

    Jus' sayin'

  • $park¥||

    I take it you're going for bionic arms too?

  • ||

    Read John Varley's Steel Beach or various Iain Banks novels; they've already thought of it.

  • SugarFree||

    He tried to count the number of times he'd had to listen to people - usually from third- or low fourth-level societies, usually fairly human-basic, and more often than not male talking in hushed, enviously admiring tones about how It's More Fun in the Culture. Perversely coy for once, the Culture played down the extent to which those born into it inherited such altered genitalia.

    Naturally, such modesty only increased everybody else's interest, and Horza occasionally became angry with humans who exhibited the sort of fawning respect the Culture's quasi-technological sexuality so often engendered. Coming from Kraiklyn, it didn't surprise him a bit. He wondered if the Man had had some cheap, Culture-imitative surgery himself. It wasn't uncommon. It wasn't safe either. Too often such alterations were simply plumbing jobs, especially on males, and made no attempt to uprate the heart and the rest of the circulatory system - at least - to cope with the increased strain. (In the Culture, of course, that high performance was genofixed in.) Such mimicking of this symptom of the Culture's decadence had, quite literally, caused a lot of broken hearts.
  • $park¥||

    "A reality is just what we tell each other it is. Sane and insane could easily switch places... if the insane were to become the majority. You would find yourself locked in a padded cell... wondering what happened to the world."

    "No, that wouldn't happen to me."

    "It would if you realized... everything you ever knew was gone. It'd be pretty lonely being the last one left."

  • Trespassers W||

    Horrible movie. It retroactively ruined every other John Carpenter movie for me. I'm becoming enraged just thinking about it.

  • $park¥||

    Well you deserve no less for being such a movie snob. Why don't you run along and join Epi's Movie Snob Club for Movie Snobs.

  • Trespassers W||

    Epi's Movie Snob Club for Movie Snobs snubbed me.

    *runs away in tears*

  • Heroic Mulatto||

    Man, it's been an hour and half since this article was posted.

    Do I have to do everything around here?

  • Francisco||

    Wolf ruled that sex reassignment surgery is the "only adequate treatment" for Kosilek, and "that there is no less intrusive means to correct the prolonged violation of Kosilek's Eighth Amendment right to adequate medical care."

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