Was Thomas Szasz a Conservative?

In an interesting but puzzling Aeon essay, Cornell historian Holly Case notes the resemblance between contemporary doubts about the scientific foundation of psychiatry and the critique first laid out by Thomas Szasz half a century ago. "It might be that the world has only recently come around to his way of thinking," Case suggests. Yet she misconstrues an important aspect of Szasz's thinking by portraying him as "a staunch Republican" and a "conservative," apparently unaware of his self-proclaimed libertarianism. Szasz, who died last year at the age of 92, was a Reason contributing editor for decades. He described the main motivation for his intellectual career as "my passion against coercion," which he opposed (outside of situations involving the defense of rights) no matter who was advocating it, left, right, or center. Hence he opposed forced psychiatric treatment, but he also opposed interference in consensual transactions between psychiatrists and voluntary patients. Here he parted company with some left-wing critics of psychiatry. As he explained in a 2000 interview with Reason:

[R.D.] Laing in particular was completely inattentive to the legal aspects, so he never really distinguished between involuntary and voluntary psychiatry. Here my classical liberal convictions are crucial, in that I firmly believe that there should be no interference in voluntary relationships between psychiatrists and patients. If the patient wants a drug, fine. If the patient wants electric shock, fine. If the patient wants a lobotomy, fine. Now that doesn't mean that I like it, any more than I would if the patient wants to have an abortion just because it's inconvenient to have a baby. I don't think that's a good idea either. But I don't think the law should interfere with it.

Where a classical liberal would see consistent application of a nonaggression principle, Case sees a kind of pigheaded perversity:

Being contrarian was [Szasz's] way of being right. Throughout his career, even friendly co-optation irked him. When scholars started associating him with the anti-psychiatry movement, he wrote a book entitled Antipsychiatry: Quackery Squared (2009).

But Case focuses mainly on common ground between what she views as right-wing and left-wing critics of psychiatry. Beginning in the 1960s, she writes, "Right and left sought to eliminate insanity in order to lionise dissent, legitimise the marginal and condemn the new normal. Few other issues show a convergence of right and left so far-reaching, while still allowing both sides to adhere to their politics and maintain a sense of total opposition." At the same time, she says "Szasz was conspicuously alone in mounting the barricades from the right," so she really needs him to be a right-winger. Bending the facts to fit her thesis, she ascribes to Szasz a "distinctively conservative perspective." That label does not jibe with his opposition to drug prohibition and his forthright defense of the right to suicide, two major themes of his career that Case tellingly ignores. Szasz's position on physician-assisted suicide combined both of these themes and demonstrated that his perspective was in fact distinctively libertarian. He opposed Oregon's Death With Dignity Act (later imitated by Washington) because it medicalized a moral decision and required people to meet government-dictated criteria before they could legally end their lives. If the drug laws did not make it difficult for people to obtain substances useful for suicide (such as barbiturates), he said, there would be no need for physician-assisted suicide.

Case fitfully recognizes that conservatism is not an adequate description of Szasz's political philosophy. "In seeking to discredit the insanity defence in order to preserve morality," she writes, "perhaps Szasz and [Hannah] Arendt both came unmoored from the traditional political spectrum altogether." She notes that Szasz criticized attempts to pathologize the ideologies of Barry Goldwater and Maj. Gen. Edwin Walker, who in 1962 was charged with incitement for urging resistance to desgregation in Mississippi. Yet "when Szasz chronicled the history of ideological quarantine, his own earliest examples tended to feature conservative henchmen." Even in his criticism of those who portrayed Walker's racism and communist conspiracy theories as symptoms of mental illness, Szasz does not sound like a conservative. "Before the Civil War," he wrote in 2009, "proslavery physicians in the South diagnosed black slaves who tried to escape to the North as mentally ill, 'suffering from drapetomania.' In the Walker case, pro-integration psychiatrists in the North diagnosed white segregationists as mentally ill, 'suffering from racism.'"

Szasz's consistent condemnation of the tendency to portray political opponents as mentally ill is of a piece with his consistent condemnation of unjustified coercion. As Case herself puts it, Szasz believed "right and left needn't bear any relation to right and wrong." In that gloss there is the seed of a more perceptive essay on the relationship between Szasz's political views and his critique of psychiatry.