On a Sunday afternoon last spring, Tibor Machan, senior editor of REASON; Marty Zupan, whose critique of The Myth of Mental Illness appeared in the August 1973 issue of REASON; and Al Waterman, Professor of Psychology at Hartwick College, Oneonta, New York; set out to interview Dr. Thomas Szasz at his home in Syracuse. What was intended to be an interview on Dr. Szasz's views of psychiatry turned into a fascinating and far-ranging dialogue—with the result that, rather than reiterating the theses of Dr. Szasz's many publications, we were able to develop some of their implications, especially concerning how our use of language influences the way we think about our personal and social "problems."
For those readers not familiar with Dr. Szasz's often controversial writings, the following brief statement about him should help set the stage for the interview. In 1961, Dr. Szasz published The Myth of Mental Illness—probably his best known work. In this book, Dr. Szasz has argued that the term "mental illness" is only a metaphor; that the belief in and use of this term, as in contemporary psychiatry and psychology, constitutes a myth; and that involuntary mental hospitalization—supported by the literal concept of mental illness—is an unjustifiable offense against individual liberty. With his assault on involuntary mental hospitalization he took a bold step against the professions of psychiatry and psychology, at least in so far as these professions have supported and continue to support what Dr. Szasz terms "institutional psychiatry." In his subsequent books—Law, Liberty and Psychiatry, The Ethics of Psychoanalysis, Psychiatric Justice, Ideology and Insanity, The Manufacture of Madness, The Second Sin, and The Age of Madness (an anthology on the history of involuntary mental hospitalization)—he has amplified and enlarged on these themes. He has also published numerous articles. In his more recent work he has addressed himself to the problems of education, medical care, suicide, and drug use, in each case taking a firm stand for individual liberty and against the professional—often medical and psychiatric—infringements of such liberty. (The interested reader may consult previous interviews with Dr. Szasz in The Humanist, March/April 1973, and in Penthouse, October 1973.)
In this conversation, we first drew out his views on the drug issue, then went on to the theoretical groundwork underlying his view that there is no such thing as mental illness, and finally debated some of his other, less strictly psychiatric ideas. REASON readers will find this an exceptionally spirited and enlightening exchange.
REASON: Dr. Szasz, you have made clear on many occasions your disagreement with all of the laws prohibiting the use and sale of drugs. I would like to know what you think of an argument put forth by Ernest van den Haag. He maintains that the sale of drugs cannot be construed along the same lines as other forms of exchange because by obtaining one sale, the seller obtains a guarantee of future sales. Because of the nature of the substance sold, one obtains a slave so to speak.
SZASZ: I agree with van den Haag in so many ways and on so many issues, and respect him so much, that first I want to make sure he says this; or better, I want to explain why I think this view is mistaken, regardless of who holds it.
REASON: He has said this. Or, if you prefer, assume that someone believes this. Many people do.
SZASZ: Yes, many people do. It's wrong. I hardly know where to begin picking this idea apart. So let me begin with the idea of habituation or addiction which it reflects. That, I assume, is what you mean when you quote whoever says it—that one sale "guarantees" others; that the buyer becomes "enslaved" to the seller?
REASON: You mean you don't believe that heroin is addictive?
SZASZ: Not so fast. It's precisely the word "addictive" that's my quarry, that I want to hunt down. Suppose you give a cigarette to a youngster who has never smoked. He smokes it. Will he enjoy it?
SZASZ: O.K. Suppose you give him a martini. His first martini. Will he enjoy that?
REASON: Probably not.
SZASZ: Well, I think you can see what I am getting at. Drug use—whatever the drug—is like any habit: it must be learned. In my view, drug addiction—that is, the habitual use and craving for a drug—is not something that happens to a person unwittingly, against his will; it's something he does to himself, generally by practicing assiduously how to use—and enjoy—a particular substance. The idea that a single experience with a drug—say heroin—makes one a "slave" to it, makes one unable to exist without it, is simply not true. It's what I call "pharmacomythology"—in contrast to pharmacology, which has to do with the real chemical effects of drugs.
REASON: Of course, that also used to be the argument against masturbation; that if you do it once, you can never stop, you can never again control yourself.
SZASZ: Yes, and also about other forms of sexual activity—homosexual and heterosexual. Now, it's about heroin, and amphetamines, and barbiturates, and so on. The sexual mythology and the pharmacological mythology behind these fantasies is that these acts, drugs, experiences, whatever, somehow "contain" such immense, unbelievable "pleasures" that no ordinary person exposed to them can resist their lure. The Circe and Lorelei legends updated—aren't they?
REASON: So what about the free market question? Do you think heroin and other so-called dangerous drugs could be sold just as—as you yourself have put it—baby food?
SZASZ: Why not? I will be glad to explain why I support the free market approach to drugs—as I do to nearly everything else—but first I want to suggest that the answer to this question is, or seems to me, obvious; it could be obvious to anyone who wants to think about it for a moment.
REASON: To press your critics' points a bit further, wouldn't people abuse it or misuse it?
SZASZ: What do you mean that people would "abuse" drugs? How? By giving themselves pleasure? Should that be forbidden?
REASON: "By killing themselves" is the standard reply here.
SZASZ: Should that be forbidden? Or should the means used for committing suicide be outlawed? How about outlawing tall buildings, then? Or electricity? Or ropes? What is there that you can't kill yourself with? Maybe ping pong balls!
REASON: Again the point is often raised about taking an accidental overdose? That's a risk with heroin, isn't it?
SZASZ: Sure it is. But a free market in heroin doesn't compel anyone to take heroin any more than a free market in alcohol or cigarettes or rat poison compels anyone to use these substances; and insofar as a person wants to use them, he is of course expected to know how to use them. It's no more difficult to learn the proper dose of heroin than it is to learn the proper dose of aspirin or Ex-lax. I just don't believe these are real problems. They are rationalizations, justifications for the prohibitory policies we have. After all, we live in a capitalist country, and yet free trade in gold is prohibited. You certainly can't attribute that to the pharmacological properties of gold.
REASON: Well, then, how do you explain our current drug policies?
SZASZ: I hope you will read my next book, which deals with the subject of why people use and avoid certain drugs, and why people promote and prohibit certain drugs. Its title is Ceremonial Chemistry; its subtitle, "The Ritual Persecution of Drugs, Addicts, and Pushers," explains, I hope, something about what I think the problem is, as against what the politicians and psychiatrists who profit from the war on drugs say it is.
REASON: You mean that people who use illicit drugs are persecuted, like a persecuted minority?
SZASZ: Exactly. There is quite a bit more to it—why we approve of some drugs, like alcohol and nicotine, and disapprove of others, like heroin and marijuana—but the persecution of the illicit drug, drug user, and drug seller is a basic theme.
REASON: Can you explain this further?
SZASZ: I don't know if I can improve on what I have said, and on what you have said. The problem is too complex, too rich for an interview. But I can talk about it a little more.
REASON: All right. Certainly, people who use or sell illegal drugs are not treated very nicely. I assume you have lots to say about that in your book.
SZASZ: Indeed, I do. I compare the current persecution of drug abusers to the former persecution of "self-abusers," or people who masturbated; and, more generally, I compare their mistreatment with the mistreatment of the so-called mentally ill.
REASON: For example?
SZASZ: Well, here is an obvious point. Anyone can confirm it, or refute it, for himself. If someone who has more authority or power than you do wants to pin a nasty label on you, and wants to justify this by what drug you take, there is no use telling him that you are not taking it: he will pin the label on you, and say that you are lying. There is also no use telling him that the drug you take is harmless: he will pin the label on you, and say that you are misguiding the young. Worst of all, there is no use telling him that it's none of his business what drug you take: he will pin the label on you, and say that you are a menace to civilized society. What you must tell a person who wants to stigmatize you because of the drug you take is not that the drug is harmless but that he is harmful. To do that successfully, you must have more prestige or power or both than your would-be stigmatizer has. If you don't, the more "innocent" you and your drug are, and the more valid your arguments are, the more you will inflame your adversary's passion to defame and invalidate you.
REASON: That might be true for marijuana versus tobacco.
SZASZ: It's probably even more true for opium versus alcohol. Opium is one of the safest and most beneficent substances ever discovered by man. Our crusade against opium is a veritable religious war. That this is so, is I hope reasonably plausible to someone who bothers to think about it; why it is so, that is something I would rather not go into now—it's too complicated. I try to explain it in Ceremonial Chemistry.
REASON: In other words, you consider the drug addicts and drug pushers as scapegoats?
SZASZ: Exactly. Did you know what scapegoats were called in ancient Greece? Pharmakoi! That's the root from which words like "pharmacology" and "pharmaceuticals" come from. The original religious-therapeutic act was the sacrifice of scapegoats—of human scapegoats.
REASON: I suppose then that you think the way to regulate drug use is by means of self-control; each person must exercise care and caution about what he uses and how he uses it?
SZASZ: Yes. The issue is not drugs and drug abuse, but temptation and temperance.
REASON: Temperance? That's a nice old-fashioned word.
SZASZ: I am trying to bring it back to life. It's been debauched, like so many words pertaining to moral conduct. Let me tell you a little story about this, as it relates to drugs, and especially alcohol.
Traditionally, until late into the nineteenth century, "temperance" was an admirable human trait; it was a trait which a person possessed and displayed if he practiced certain habits in moderation; typically, if he used liquor in moderation, rather than to excess—which was considered to be harmful and intemperate. The maniacs who have been waging war on alcohol have ruined not only many a good bottle of liquor, but also the word "temperance." How? By calling their zealous efforts to control not just themselves but everyone else they could lay their hands on the "Temperance Movement." Soon after these busybodies started their good works, the word "temperance" ceased to mean moderation and instead came to mean complete abstinence from, or avoidance of, the disapproved habit or substance. By the turn of the century, "temperance" no longer referred to the habits of a person but referred instead to the speaker's self-justification for his intemperate prohibition of all those habits and substances which he or she disliked. It's a fascinating story. I am trying to suggest here—and that's all I can do—why it was that many of the same people who were passionately against slavery were also against smoking and drinking.
REASON: This might be a good point at which to get into your views on psychiatry. You have objected to psychiatry, and the mental health professions generally, because much of what psychiatrists do is "do-gooding"—helping people who don't ask for psychiatric help and don't want psychiatric help. But what about those who do?
SZASZ: I have no objection to voluntary psychiatry or psychotherapy. I myself practice what other people call "psychotherapy" or "psychoanalysis." I think it would be more honest to call it "conversation"; I prefer to call it that.
REASON: Then you would not consider yourself an antipsychiatrist?
SZASZ: Certainly not. I have no control over what other people consider me or call me. I have been called much worse things. Though I think "antipsychiatry" is a pretty stupid term. I emphasize this, because language is important to me, as it must be to anyone who takes human affairs seriously.
REASON: Do you resent the question?
SZASZ: No, not the question. But I do resent being called an antipsychiatrist. Why? For the same reason as a person opposed to rape but not to sexual activities between consenting adults would resent being called an "antisexualist." I oppose involuntary psychiatry, the "rape" of the patient by the psychiatrist; but I do not oppose voluntary psychiatry, psychiatric activities between consenting adults.
Of course, psychiatric activities between consenting adults, just as sexual activities between them, may end disastrously for one or both parties. But that, to my mind, does not justify condemning them in the same breath with psychiatric activities founded on force and fraud; or confusing those who are opposed to force and fraud with those who are opposed to psychiatry and sex.
REASON: Well, this certainly seems like an important distinction. In other words, you analogize rape with involuntary psychiatry, and "making love" with voluntary psychiatry?
SZASZ: Yes. But I try to do, to say, more than that. I try to show how the language of accepted academic—traditional—psychiatry deceives us, because it does not allow us to distinguish between these two antithetical forms of psychiatric interventions. It's as if rapists controlled the language of sexual relations and used the term "making love" both for making love and for rape.
REASON: And how do the antipsychiatrists add to this confusion?
SZASZ: In several ways. First, by assenting to the proposition that all of psychiatry is equally bad: that's implicit in the term "antipsychiatry." Second, by adopting my view that, for example, schizophrenia is not a bona fide disease, and then offering their own form of "therapy" and "cure" for it: that, implicitly, negates the claim that what ails the alleged patient is not a disease. Third, by insisting that although mental patients are not sick, society is: that's merely inverting the despicable psychiatric name-calling.
REASON: With your emphasis on the importance of language, it's not hard to appreciate why you feel these are important distinctions. I take it this, then, is why you are not against mental hospitals or mental hospitalization?
SZASZ: Right. I don't think mental hospitals are nice places to be in. I don't particularly like armies or monasteries, either. However, the issue is not what I, or someone else, likes or dislikes, but the use and avoidance of coercion in areas that are, after all, matters of private morality. If someone wants to retreat to a mental hospital or monastery, why shouldn't he be allowed to do so? The important thing is that those who run such institutions should not have the power to recruit unwilling clients or inmates and should not be able to prevent the departure of persons who have come to them for help.
REASON: But your views against psychiatry go further than merely objecting to involuntary mental health practices.
SZASZ: You are right. My objections to psychiatry—and I shall use this term inclusively to refer to all the so-called mental health professions—are really two-pronged: one has to do with liberty, the other with language. Liberty and language—these are two of the most important things in life, as far as I am concerned.
REASON: Can you elaborate?
SZASZ: We have touched already on my objection to psychiatry stemming from the value I place on individual freedom: involuntary psychiatric interventions are incompatible with the ethic of a free society—and even more incompatible, of course, with the libertarian ethic.
REASON: That's clear enough. Though it's interesting and surprising that libertarians haven't risen up against this enemy sooner. People have been locked up by psychiatrists for a good long time. But there is no need to belabor this. What about your other objection to psychiatry, the one stemming from the importance you attribute to language?
SZASZ: As you know, I have showed, long ago, that the term "mental illness" is a metaphor. If a person has a lousy liver, he has a literal disease—for example, infectious hepatitis. But if he has a lousy love life, then he has a metaphorical disease—for example, impotence. Of course, things like impotence, or an unhappy marriage, or fear of having children, and so forth might make people uncomfortable, sick as it were. But these sorts of sicknesses are metaphorical. I can't really overemphasize this point. We often use the word "sick" metaphorically. When there is a high rate of inflation or unemployment, people say that the economy is sick. But they don't try to cure it by asking for the help of physicians or by taking drugs. But when personal problems are labeled as illnesses—mental illnesses—then the metaphor is taken literally.
REASON: Yes, but what has this to do with your objection to psychiatry?
SZASZ: What? Everything. Psychiatry is defined—just look at Webster's or any textbook of psychiatry—as the study, diagnosis, and treatment of mental diseases. What, then, is psychiatry if there are no mental diseases?
REASON: What you are saying is that the subject matter of psychiatry is not what psychiatrists generally claim it is—that is mental illness and its treatment—but that it is something else. What?
SZASZ: That's obvious: how people live, what troubles them, what they value and don't value, how they gain and lose self-esteem; in general, human conflict. In a sense, the subject matter of psychiatry is the same as that of religion, of what used to be called moral philosophy, of what the great dramatists and novelists of all ages have written about.
REASON: What do you mean that psychiatry is like religion or that it is a religion?
SZASZ: It is like a religion; and it is, in fact, a religion; or perhaps I should say, it is several religions. My objection to psychiatry on the ground of mislabeling—a strategic kind of mislabeling—is similar to the objection one could make against theology. What is theology? Theos is Greek for God, and logos means word or reason. So theology is the study of God, the knowledge of God and His will, and so on. Where does this leave the atheist, or the person who is broadminded and isn't sure which God or gods he is supposed to study—the Greek, the Jewish, the Roman Catholic…? You see my point?
REASON: You mean that theology is ostensibly the study of God, but is actually the justification, in the name of God, of certain religious ideas and rules of conduct?
SZASZ: Exactly. And in the same way, psychiatry is ostensibly the study of mental illness, but is actually the justification, in the name of mental health or psychiatric treatment, of certain psychiatric ideas and rules of conduct.
REASON: Why is this business of mislabeling so important in your view of psychiatry?
SZASZ: Because, in a very fundamental sense, I believe that much of what psychiatry is all about—both in the way of what so-called patients do and what so-called psychiatrists do—has to do with mislabeling, with the misuse of language. Often quite simply with lies.
SZASZ: Yes, lies. You know that I like to think up short statements, aphorisms, the sorts of things I published in The Second Sin. I recently thought of a new "definition"—you must put definition between quotation marks!—of psychiatry. It goes like this.
The subject matter of psychiatry is neither minds nor diseases, but lies—the "patient's" and the "psychiatrist's." These lies begin with the names of the participants in the transaction—the designation of one party as "patient" even though he is not ill, and of the other party as "therapist" even though he is not treating any illness; they continue with the lies that comprise the subject matter of the discipline—the psychiatric "diagnoses," "prognoses," and "treatments"; and they end with the lies that, like shadows, follow the ex-mental patients through the rest of their lives—the records of denigrations called "depression," "schizophrenia," and what not, and of the imprisonments called "hospitalization." Accordingly, if we wished to give psychiatry an honest name, we should call it "mendacitology"—the study of lies.
REASON: How do you refer to what you do? Isn't there anything that psychiatrists and psychologists do that could be considered scientific, or as part of a science?
SZASZ: Let's go slowly. Psychiatrists and psychologists do countless things—from studying Greek myths as Freud and Jung did, to studying molecules and monkeys, as some contemporary workers who consider themselves psychiatrists do. I am not making generalizations or statements about all these activities. I do think, however, that calling all these diverse things—all these heterogeneous ideas and interventions—"psychiatry" is itself a mischievous and misleading way to use language.
REASON: All right. Let's narrow it down. Let me ask you this. There are many people who go to psychiatrists for specific problems. Such a person might say: "Doctor, I am nervous. I get up in the morning and I feel I just can't do my job. I sweat when I meet people. I don't know what to do about it. I am a decent person. I am not trying to evade my responsibilities, but something is wrong. Can you help me?" You call these complaints, these sorts of things, "problems in living," but surely they are not the same kinds of problems in living as one has with one's budget, or what kind of furniture one should buy?
SZASZ: No, they are not the same kinds of problems as one has with one's budget, but they are similar to them. This hypothetical person has some problems, conflicts, difficulties—all these terms may be appropriate—the exact nature of which we don't know yet. Only he does. We have to talk to him and find out what bothers him. Perhaps he doesn't like his wife, or is afraid of getting old, or God knows what. People have, and can dream up, a great variety of things to worry about. I contend that these problems are not diseases—though, of course, they can lead to or "cause" diseases, but that's another matter.
REASON: You say these are moral problems?
SZASZ: I use that term broadly, to distinguish certain human problems from medical problems. I can't help but insist that disagreements are not diseases.
REASON: Would you call these problems "psychological"? What criteria can one use to determine whether a person has such problems? Whether he is living successfully?
SZASZ: I will have to pick at that question. First, I have no objection to calling such personal, human problems "psychological problems." But I am afraid of the positivistic connotations that go with this term; of the idea that the psychologist studies your mind and mental problems, just as the nephrologist studies your kidney and renal problems. I don't like that. Secondly, I don't like the implication or the consequence of this sort of way of looking at the situation: that is, asking for "criteria" of problems in living, rather than asking who complains to whom about what.
REASON: What do you mean?
SZASZ: I mean that when you say that "Jones has a problem in living"—or, for that matter, that "Jones is mentally ill"—I want to know whether Jones thinks so, whether his wife thinks so, whether his psychiatrist thinks so, or just who thinks so—and why. In psychiatry, before we discuss what the problem is and how we should solve it, we should, I think, discuss who defines the problem and why he defines it as he does.
REASON: Don't you think there are people who are not living successfully; who, if you asked them, would say that they are?
SZASZ: You mean people who are not living successfully according to your judgment? or mine? or whose?
REASON: No. Who aren't living successfully as people.
SZASZ: Here we part company. I insist that the statement that someone is not living successfully implies that someone is making a judgment about that person's life style. I want to know who that person is. I will not budge until I know. Because that statement is not just an assertion about the subject, it's also a self-revelation about the speaker.
REASON: You mean no objective statements can be made about people?
SZASZ: Not quite. But not the sort you were talking about. I can say: "This couch is black." Assuming that it's jet black, rather than dark grey, most people will agree. Similarly, I can say: "This man is fat." Assuming that he is very obese, rather than just a little overweight, again most people will agree. But you were talking about how a person should live; what values he should hold; at least that's how I understood the earlier questions.
REASON: Why can't this scientific approach be applied to human beings? There are couches and there are human beings.
SZASZ: Come now. Couches are things. Human beings are persons. Couches don't think, don't have life styles; they don't have any ideas what color they should be—but people get quite excited about what values they should hold.
REASON: But there are some people who still think the world is flat. We don't therefore change our view of the globe. There are a lot of people now who say that the best way to live life is by transcendental meditation. That doesn't suffice as a good reason for thinking that that is the best way to live one's life.
SZASZ: I have no trouble with such questions or problems. It's just a matter of keeping one's language clean. A statement about the world is an assertion. It's like saying: "The door is white." It may be true or false. How we test which it is, and so forth—all that's obvious. And even if a statement is obviously false, people may still want to believe that it's true. That's their privilege. Now, the business about how people should live—whether by transcendental meditation, or psychoanalysis, or Christian Science, or Zionism, or libertarianism—that's a matter of recommendation. It's a prescription, not a description. It's like saying: "Please close the door!" If you say that, I know that you want the door closed. You like it closed. Whether I like it closed is an altogether different matter.
REASON: You say that my question comes down to what people think about themselves; about how they want to live and about how they want others to live. Can't people be wrong when they talk about themselves?
SZASZ: You are using the word "wrong" in a context, in a way, that I wouldn't. If a man tells you: "Please close the door," can you say that he is wrong? Not really. You must say either: "Yes, I will," or "No, I won't." You comply with his request or you reject it. In what sense can he be "wrong"? How can his statement—which is not an assertion!—be wrong?
REASON: But can transcendental meditation be equated with closing a door? What I am getting at is the belief, which many people share, that if human beings abide by some particular doctrine, they will be more successful, have a better existence, as members of that species.
SZASZ: I don't know how to deal with that proposition. It strikes me as a moral tautology. Obviously, if you are going to practice transcendental meditation, you are not going to be a better physicist.
REASON: But we are not talking about being a better physicist, or better whatever, but about being a successful human being in the Aristotelian sense of living one's life.
SZASZ: That's circular. If you want to be a better person in the Aristotelian sense, then clearly you have to do what Aristotle tells you. And further, you would have to convince yourself that Aristotle knows what it means—really means—to be a human being better than anyone else does.
REASON: You seem uncompromisingly opposed to the idea that psychiatry and psychology are sciences. Is this because they are prescriptive and control people? Suppose all that could be eliminated?
SZASZ: You are right. I don't think psychiatry and psychology are sciences basically because they are prescriptive and controlling. I don't see what would be left if you eliminated all that.
REASON: But aren't you going too far? Look, suppose I had a friend who asked me: "I'd like to find someone who could help me with my problems in living." And I'd say: "Hey, I know this butcher, he likes to talk to people, why don't you go and see him." And Marty says: "That's irresponsible. Send him to Dr. Szasz. Dr. Szasz has been delving into these things for years." I say: "That's just a preference. He likes to do that. The butcher also likes to do it. Who cares? Butcher, Dr. Szasz, it makes no difference. Go to the butcher. It's cheaper."
SZASZ: (Laughter) Your question is good—and loaded: it implies that there are no skills in human relations. I didn't say that and I don't believe that. I am better at talking to people with certain kinds of problems; and the butcher is better at chopping meat.
REASON: That sounds very close—that is, on the verge of science. Skill.
SZASZ: It may sound close to you. It sounds far away to me. Bob Hope has a skill. He is good at telling jokes. Even better than you and I. Is telling jokes a science? Skill is the quality of an act; a way of doing things; almost everything that can be done, can be done skillfully or clumsily.
REASON: That's a good point. You say that psychotherapy is a special sort of conversation which can be done well or poorly, skillfully or unskillfully.
SZASZ: Exactly. Psychotherapy—individual psychotherapy—is simply two people listening and talking to each other. For a certain purpose. It's like playing bridge or golf, like swimming or climbing mountains or driving cars. These are all skills that some persons have more of and others have less of.
REASON: It seems to me, however, that where there is skill, one can scratch and find someone who studies the thing with which the skill is concerned. If there is something objective about being skillful with jokes, there needs to be something objective about the subject matter of jokes—humor. It seems that you want to deny that there is such a thing as uniformity, universality about the subject matter of problems in living.
SZASZ: No, I am not denying that. I am drawing a sharper distinction than you between the skill, the exercise of the skill on the one hand—and on the other hand, talking about the skill, speculating about it, making its study into an abstract subject. Driving a car is not a science; knowing how to build one is, or is based on the use of scientific discoveries and principles.
REASON: All right, then as long as you are willing to talk about problems in living as a subject matter about certain skills, you must agree that, as a subject matter, problems in living become a part of science; a field of study in which one can identify principles?
SZASZ: With that I agree. Indeed, I have said that if we agree that the subject matter of psychiatry and psychology is problems in living—of the sorts we have talked about—then psychiatry and psychology become simply aspects or branches of religion and the social sciences.
REASON: Now that we are this far, perhaps we could sound you out on a definition of mental health which seems plausible. One idea is that the standard for mental health or illness is the extent to which the functioning of the person's consciousness is impeded or obstructed, since Man's mind is his unique means to survival.
SZASZ: Here we go again. Whether one should live "consciously" or by blindly submitting to authorities—religious or political or medical—these are moral choices. Why do you want to call what you think is the right way to live "mentally healthy"? Why not just say that you believe it is the right way?
REASON: Because we can show that being one way is worse than being another way.
SZASZ: Worse in what sense?
REASON: In the sense that one will report oneself to be worse off; for example, in feeling more troubled, being in more conflict, more unsatisfied, and so forth, than someone else who does not act on the basis of that outlook on life. It's, as some would put it, an "empirical" view.
SZASZ: You say that "unimpeded" or "unobstructed consciousness" is the criterion for judging mental health, and that living in such a highly conscious—responsive and responsible—way is empirically better than others. Well, I like the value you endorse. You know that. But I don't like calling it "mentally healthy" and I disagree completely that a life-style based on this value can be shown to be empirically superior to others. For one thing, such a view makes all religions into mental illnesses. I just can't countenance anything like that.
REASON: That may be so. A lot of people may be mentally ill as far as I am concerned. I don't find it very strange that I would want to call many people immoral too, and if that means that they are mentally ill, so be it.
SZASZ: Well, here we disagree. You want to call those who live badly, by your standards, mentally ill. The chances are that those who think you live badly, by their standards, will be only too happy to reciprocate and call you mentally ill. I don't like this sort of psychiatric name-calling. I prefer saying these things in plain English.
REASON: I am defending the idea—giving it a run for the money—that there is such a thing as a standard of health pertaining to the use of one's mental faculties. What is different here from health in the other medical areas is that in the conduct of this faculty, one has a volitional role. All the things to which you object are the results of this important difference being ignored. But all that does not suffice to establish that there is no proper and improper functioning of the mental faculties.
SZASZ: We always come back to this issue of the volitional versus the nonvolitional—of an action versus a happening. If you want to emphasize the similarities between these two classes of phenomena; and if you want to metaphorize the volitional as if it were nonvolitional—then you will try to preserve the vocabulary and imagery of mental health and mental illness. Otherwise, you'll want to reject this approach. Let me offer one more example—or analogy—to show what I think the problem is that we keep coming back to.
The central epistemological problem of psychiatry is: What is mental illness? or What is a psychiatric patient? These questions come down to the distinction between playing a role and occupying a role.
A child plays at being father or fireman, detective or doctor; certain adults occupy these roles. A man plays Hamlet or Lear, but occupies the role of actor.
Until the nineteenth century, a person with, say, tabes dorsalis—displaying the limitations of the lesions of advanced neurosyphilis—occupied the role of patient and was called "sick"; whereas a person who pretended to be sick—displaying the limitations of the symptoms of neuromuscular disease—played the role of patient and was called a "malingerer."
Modern psychiatry was born when persons who played the sick role were declared to be occupying it; when, in other words, their medical performances were declared to be mental diseases.
REASON: One of the things about your comparison of mental illness with a performance is the idea of pretense. But mental illness does not pretend to be the same kind of thing, in all respects, as physical illness. It trades on the meaning of illness as something inappropriate to the organism's functioning.
SZASZ: We are still hung up on the analogical use of language. Mental illness cannot pretend to be anything. But people who claim to have mental illness, or who claim that other people have mental illnesses, can and do pretend—if you like—that certain kinds of conduct are like diseases or should be treated like diseases.
REASON: Clearly, the proper use of language and the examination of how language is used are very important in your way of looking at psychiatry and the problems it deals with. Why is that?
SZASZ: For many reasons. One is that psychiatry and psychotherapy are principally about what people say to each other. To me, that's a simple fact which people ignore at their own peril. Another is that I regard the power to define things—especially the nature and quality of human behavior, as good or bad, guilty or not guilty, sane or insane, and so forth—as basic political acts that make use of, and depend on, language.
REASON: And you say that psychiatry and psychology, the languages these disciplines use and foster, are shot through with inappropriate and inexplicit metaphors.
SZASZ: Yes, indeed. That's why I think our first task is to penetrate behind the veil of this psychiatric jargon. Examples are all around us. Even some of the questions you asked me have rested on such metaphorical uses of words. I didn't want to pick at them constantly. Here is an obvious example of the sort of thing that makes me say that we should scrutinize our psychiatric language rather than keep looking for answers to problems framed in this language.
When you say that someone has no guts, you mean that he is a coward. You wouldn't try to treat him for his "gutlessness" with a "gut transplant," would you? Suppose you hear someone say that he or she has had a nervous breakdown. What does that mean? It means that this person, who has had the "nervous breakdown," doesn't accept responsibility for the consequences of his or her ill-chosen or unlucky actions. And yet you may consider it entirely reasonable—certainly most people consider it entirely reasonable—that this person is treated as a "sick patient" with drugs. What are these drugs supposed to do? "Strengthen" his "broken-down nervous system"? We are simply adrift in a sea of literalized metaphors.
REASON: You have said or implied that this metaphoric use of language is something that's fostered by psychiatrists; that they do this because it's to their advantage.
SZASZ: Of course. Why should anybody say anything? I always like to assume, other things being equal, that people say things—and believe things—because, in some way, it's to their advantage. It makes them feel good, or it makes them feel honest, or it enriches them, or something like that.
REASON: Still, analogies or metaphors are usually based on actual similarities. You yourself have pointed out that so-called hysterics resemble people with neurological diseases.
SZASZ: We can't go into this in enough detail here, but let me enlarge on it a little. My main interest now is to explore the linguistic aspects of psychiatry and related fields. I have put much of what I think about these things into The Second Sin.
I believe it's important that we distinguish between two kinds of metaphors. One is based on actual similarity, on similarity in appearance; the other is based on a similarity of intention, on wanting to treat one thing as we do another.
Using metaphor means primarily giving something a name that belongs to something else—for example, calling a remark "cutting" or a person "foxy." This is a metaphor based on observable similarities. But there is another kind of metaphor, one based on a similarity not of appearance but of intention—for example, calling bread and wine the Body and Blood of Jesus, or calling a disagreement a disease. In the latter case, we use metaphor not to identify a similarity seemingly inherent in the objects, but to create a similarity between them for our own strategic purposes: by treating bread as if it were the body of God, we generate certain similarities between it and the deity; by treating certain opinions as if they were the unintended consequences of an illness rather than the intentional products of a decision, we create certain similarities between deviance and disease.
In short, the languages of poetry and science make use of descriptive metaphors, whereas the languages of religion, politics, and psychiatry make use of strategic metaphors.
REASON: This is why you don't like to call psychotherapy "psycho-therapy"?
SZASZ: Right. And it's not "just a matter of words" as some people contemptuously refer to making such distinctions. Individual psychotherapy is, in plain English, a particular kind of conversation between two people. However, if it were called "conversation," one party could not regard himself as ill or deduct his payments for it on his income tax return; and the other party could not regard himself as a physician or prevent others from engaging in such conversation under the pretense that doing so constitutes practicing medicine.
REASON: Psychiatric terms thus guarantee certain privileges.
SZASZ: Yes, privileges for the psychiatrists; and, often, handicaps for the patients. The medical "blessing" of conversation as psychotherapy is like the priestly blessing of water as holy; each transforms something ordinary into something extraordinary, something common and cheap into something uncommon and precious; and it legitimizes those who control this naming—whether they be priests or physicians—as justly in control of the services and the substances to which multitudes want to gain access. We touch here on the linguistic bases of trade-restrictions—of arrangements which are the very opposites of the free market, on which libertarianism so squarely rests.
REASON: Perhaps we should end on this note of freedom and the enemies of freedom. Are you an optimist or pessimist about the prospects for freedom?
SZASZ: Neither. I am impressed by how ambivalent most people are about freedom. They want freedom. But they also want things which are incompatible with it. Perhaps it's the old human weakness of wanting to eat one's cake and wanting to have it too.
REASON: Why, in your view, is there not more support for individual liberty, the free market, libertarian principles in general?
SZASZ: I can give you one reason. There are no doubt others. It seems to me that you can organize against freedom, but that you can't really organize for it. The best you can do is to organize for conditions that make freedom possible. But it's so easy to organize against freedom. In fact, one could almost say that every religion, every ideology, every political system is an organization against freedom. Freedom is opposed in countless guises, for countless reasons: in the name of God—by religion; in the name of the nation—by patriotism; in the name of tradition—by conservatism; in the name of equality—by communism; in the name of the majority—by democracy; in the name of mental health—by psychiatry; in the name of preventing suicide—by suicidology; in the name of controlling drug abuse—by drug abuseology; in the name of all of mankind—by utopianisms of all sorts. There seems to be no end to the reasons that people can find to oppose individual freedom and dignity. Perhaps that's because freedom is such a powerful idea—an idea of still infinite possibilities.
This article originally appeared in print under the headline "Straight Talk from Thomas Szasz".