Thursday, 13 September 2012

The Passing of Dr. Thomas Szasz

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Practitioners in the field of psychiatry can rest a little easier now that their key antagonist, Dr. Thomas Szasz, has passed. The obituary in the New York Times noted that Szasz “questioned the legitimacy of his field” (he was trained as a psychiatrist) and so enraged the true believers in the efficacy of enforced psychiatric diagnosis and treatment that he successfully made “enemies of many fellow doctors.” He died at his home on Saturday after a fall at age 92.

His first book, The Myth of Mental Illness (the first of 36 published during his lifetime, along with hundreds of articles), was seminal. It laid the groundwork — some would say charted the battleground — for the rest of his life’s work: the exposure of psychiatry as chicanery and a fraud, calling it “in the company of alchemy and astrology.”

He argued for freedom from the very first, which meant he opposed coercive treatments, involuntary confinement, and the use of psychiatric diagnoses in the court system, calling them unscientific and unethical. New York State prohibited him from teaching at a state hospital despite his position as a professor of psychiatry at the State University of New York Heath Science Center located in Syracuse, New York.

His position was that a diagnosis of mental illness "is not something a person has, but is something he does or is. There is no medical, moral or legal justification for involuntary psychiatric interventions. They are crimes against humanity."

His point of view was based on natural law and classical liberalism, which claims that each person owns his own body and as a result enjoys — or should enjoy — the right to be free from violence imposed by others. Specifically he believed that the practice of medicine and the sale and use of drugs should be private, contractual, and outside the realm of any state or federal jurisdiction.

The more he studied psychiatry the more persuaded he became of the fictitious character of “mental disorders” and “mental illness” and the resulting damage done by so-called psychiatric “treatments.” Early on he set himself the task of delegitimizing the agencies and authorities promoting psychiatric legitimacy, including psychiatrists and other mental health professionals.

He had the gift of simplifying the complex and of expressing his outrage in terms that defenders of the faith couldn't rebut. He described psychiatry’s definition of “mental illness” as a metaphor for behavior that others considered to be outrageous and offensive. Wrote Szasz:

If you talk to God, you are praying. If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist. If you talk to the dead, you are a schizophrenic.

Szasz demanded that the profession define a disease as it is defined in medicine: “malfunctions of the human body, of the heart, the liver, the kidney, the brain.” It must be confirmed by being able to be measured or tested in some scientific fashion and must demonstrate the disease at the cellular or molecular level. If it can’t be confirmed that way, according to Szasz, then it can’t be called a disease. Accordingly, “no behavior or misbehavior is a disease or can be a disease. That’s not what diseases are.”

Szasz pointed to the difference between “heart break” and “heart attack” and between “spring fever” and “typhoid fever” as belonging to two completely different logical categories, saying that treating them the same way constitutes the promotion of a myth. Diagnoses of “mental illness,” according to Szasz, are merely judgments that are used to support the use of coercion and force by psychiatric authorities.

His logic in exposing the myth was breath-taking and devastating.

In his review of Szasz’ book Our Right to Drugs: The Case for a Free Market, Daniel Klein noted that Szasz’s compendium of intellectual expression “represents one of history’s most passionate and penetrating explorations of the moral constitution of the libertarian idea. Here he is in the company of [Wilhelm] von Humboldt, [John Stewart] Mill, [Herbert] Spencer and [H.L.] Mencken.”

In this volume, Szasz reminded his readers that in 1906, “although virtually all of the drugs of which we are now deathly afraid were freely available, there was nothing even remotely resembling a ‘drug problem.’” Klein summarized Szasz’s stand against the War on Drugs trenchantly:

The Drug War [stands] against the presumption of individual choice and for the presumption of the state as forbidding father and succoring mother.

The American people are correspondingly degraded. They knuckle under to belligerent paternalistic dictates, they acquiesce in the face of draconian police measures, they learn to fear and respect medical experts who enjoy state power….

They willingly imbibe the indoctrination of so-called drug education programs, and they mouth the intolerant dogma of the [anti-drug] crusade.

Szasz took advantage of every opportunity given him to express his point of view. As a regular columnist at The Freeman, he offered blistering insights and lobbed verbal grenades at the psychiatric establishment. In March 2011, at age 91, he wrote a column entitled “The Shame of Medicine: Celebrating Coercion” in which he likened psychiatric treatment to slavery:

The State-sanctioned forcible control of one group of innocent persons by another group of persons authorized to control them is, of course, as old as civilization. We call its prototype “slavery.” Justified by religious and philosophical authorities, the supporters of such systems of institutionalized domination-submission always felt morally superior to those who rejected their reasoning and opposed their power. Today, the system based on the same age-old rationalizations is called “psychiatry.” I have renamed it “psychiatric slavery.”

“If slavery is not wrong,” declared Abraham Lincoln, “nothing is wrong. I cannot remember when I did not so think, and feel.” Slavery is wrong because it empowers one group of persons to deprive another group of liberty on the ground of who they are, not of what they do.

I knew very little about Lincoln when I grew up in post-World War I Hungary. But I did recognize, as a gut feeling, that if the domination of the mental patient by the psychiatrist is not wrong, then nothing is wrong. I cannot remember when I did not so think and feel.

He ended his article by noting the change in the psychiatric profession over the years:

Sixty years ago, when I was young, the psychiatrist was embarrassed by his role as coercer. Now, when I am old, he is proud of it. That, in my opinion, is the sum total of the “progress” achieved by modern, “scientific psychiatry.”

Thomas Szasz was a libertarian warrior laboring in a field unfamiliar to many involved in the freedom fight. But he knew, almost from the beginning, that it was a battle he was called to wage. Happily his legacy lives on.