Psychology/Psychiatry

Thomas Szasz: How and Why the Great Libertarian Psychiatrist Thought What He Did

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Jacob Sullum and Jesse Walker have both done great jobs summing up the importance of Szasz; I have always found his own thoughts and expressions the best way to understand him. He was, in my judgement, one of the smartest and most thorough defenders of autonomy and liberty of our time, fighting against both his profession, most of the world, and often his own fellow libertarians, and succeding at a higher level than most (Szasz was actually a public intellectual of mass popularity in the 1960s/early 1970s.)

Herewith, a sampling from some of my own previous writings about Szasz, mostly quoting him.

From a 1999 review essay for Feed magazine:

Szasz says that most so-called mental illnesses are not what the psychiatric profession maintains, and that fact is of great socio-political and ethical importance….

Szasz says the category of "mental illness" turns willed behavior into a disease, taking away both rights and responsibilities from the actor just because his actions strikes a doctor, family member, or judge as inexplicably bizarre and strange. In pragmatic terms, Szasz avers, "incarcerating innocent persons in mental hospitals and freeing guilty persons from prison… continue to be the psychiatrist's two most important social functions." He takes a cui bono? approach, asking what the psychiatric profession gains from the idea of mental illness (prestige, power, money) and what the patient gains (exculpation for bad actions or crime, relief from responsibility). Szasz is politically appalled by the coercion inherent in the modern psychiatric enterprise, and always credits even the most seemingly mad with humanity and intentionality. On the contrary, psychiatrists rarely credit the lunatic with having any sense or rationality behind his actions—even when it's clear that there is some rational goal in mind. "A berserk lunatic may claim to be Jesus or kill his wife," Szasz writes. "The point of such a person's behavior, I dare say, is to be revered like Jesus or be rid of his wife. (Why a person chooses such ends and means is another question, the answer to which is often easily obtained by asking him.)"

From my 2007 book Radicals for Capitalism:

The innovation—or semantic trick, as Szasz would have it—of classical psychoanalysis was turning faking an illness into an illness in and of itself. The human capacity for deception is central to Szasz's intellectual program. Human beings lie; and many a so-called insane delusion, such as voices in the head advising one to commit heinous acts, are, Szasz maintained, best understood as lies—often strategic ones….

Szasz…recalls that "I was not about to tell him that the persons he called 'seriously ill patients' I regarded as persons deprived of liberty by psychiatrists."…He later wrote that "psychiatric training is, above all else, a ritualized indoctrination into the theory and practice of psychiatric violence. The disastrous effects of this process on the patients are obvious enough; though less evident, its consequences for the physician are often equally tragic."

….To Szasz, psychoanalysis proper had nothing to do with medicine. It was conversation, with one person paying the other. "The psychiatrist has only one duty: to keep his mouth shut outside the room and maintain total confidentiality. It has nothing to do with disease. It has to do with human problems."…

Szasz fought for the specific liberty of specific patients:

"When I began to publish on the civil rights of mental patients, some of this hit the papers, The New York Times. I began to get invitations from patients and lawyers—'I have this client locked up for 10 years and he hasn't done anything. He's been in long enough. Can you get him out?'" Szasz began testifying on behalf of imprisoned mental patients—some alternately hilarious and harrowing transcripts from those court cases are in his book Psychiatric Justice (1965)—though he rarely succeeded in winning anyone's freedom. He'd find himself, he recalled, "in the courtroom in front of some very nice judge who said something like, 'Szasz, how can you say that he should be out when six of his doctors say he should be in?' I said, 'Your honor, those are not his doctors. Those are his adversaries. He wants his freedom. I am the one that he calls his doctor.'"….

Szasz thought he saw the underlying truth of psychiatry others missed, or wanted to miss:

[Szasz] considers his heterodox positions pure common sense, a common sense marred by the power-grabbing pretensions of psychiatrists and the government-psychiatric establishment. Those pretensions have been embraced by a credulous populace all too ready to believe that people should be relieved of both responsibility and liberty whenever it became convenient for either the state or any relative or caretaker troubled by the so-called mentally ill. From the very beginning, Szasz recognized that psychiatry wasn't really about what it purported to be about.

"What is the thing itself that psychiatrists describe, debate, diagnose, and treat?" Szasz asked. "The psychiatrist says it is mental illness, which, he now quickly adds, is the name of neurochemical lesions of the brain. I say it is conflict and coercion and the rules that regulate the psychiatrist's power and privileges and the patient's rights and responsibilities. The former perspective leads to an analysis of psychiatry in terms of illness and treatment, medical theory and therapeutic practice, while [my] perspective leads to an analysis in terms of coercion and contract, the exercise of power and the efforts to limit it, in short, political theory and legal practice." He believed that psychiatry was more properly conceived as an ethical and political field—the arena of human troubles, communication, and conflict—than as a medical science. Psychiatry was rife with "hidden agendas of domination and submission concealed by a rhetoric of disease and treatment."….

Szasz was anti-coercive-psychiatry, but not a cliched "anti-psychiatrist."

While defending the rights of mental patients not to be treated or imprisoned against their will, Szasz was dismissive of the "anti-psychiatry" movement and its figurehead R.D. Laing, with whom Szasz was often mistakenly conflated in the late '60s and early '70s. Szasz had little sympathy with the Laingian view that saw the so-called insane as in fact victims of an insane society—or going through an understandable reaction to that insane society—or visionaries taking a valuable "journey through madness."

"I insist," Szasz wrote, "that schizophrenia is no more a journey through madness than it is a disease of the brain. Both of these statements assert literalized metaphors. Of course schizophrenia may be said to be like a journey or like a disease; but it is also like many other conditions or situations; for example, being childish, aimless, useless, and homeless, or being angry, obstreperous, conceited, or selfish."

Laingian assessments of the so-called insane, then, were in most cases higher than Szasz's, who is above all a moralist, and not a groovy admirer of alternative lifestyles. (A student skit at his university joked about the "Szasz Diagnostic Manual" which had two categories: "crook" and "bum.") The antipsychiatrists, to Szasz, were just as paternalistic and anti-individualist as their opponents, merely in the opposite direction…

Szasz is perplexed that any part of the psychiatric industry sees him as anything other than a bitter enemy. He speculates that those of his colleagues who accept him as a friendly and welcome addition to the scholarly debate "just don't give serious enough thought to this to either agree or dismiss it and dismiss me as completely wrong. They just write me off as 'interesting.'"

Szasz had unique things to say to libertarians:

He has analogized a sane human life to a statue carved out of marble. Although we may all metaphorically have a chunk of marble at birth, we don't all automatically have the statue, as standard mental health professionals seem to think we ought; nor does the lack of a statue mean a repressive culture has smashed ours. It means we haven't done the work to sculpt it. Szasz is the libertarian movement's most stoic exponent, hoping for a fully free and responsible culture but painfully mindful that it may be impossible—for reasons that don't necessarily have to do with the outward tyranny of the state.

Szasz was also very personally gracious to this young reporter and fan, giving me time and attention above the call of duty when we interacted professionally. He was a model public intellectual and a decent and brave man.