No Excuses: The Reality Cure of Thomas Szasz

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by Thomas Szasz: Fifty
Years After TheMythofMentalIllness



And you
thought Tom Szasz was yesterday’s hero? This paper brings us
up to date.

Future historians
may well cast Thomas Szasz as
an intrepid campaigner for the blindingly obvious: people do not
have "mental illnesses" but experience a wide range
of moral, interpersonal, social and political "problems in
living." All such problems concern, or have an impact on, our
sense of who and what we are and could just as easily be called
spiritual crises. However, despite his prodigious scholarly
output, Szasz might well be written out of history, as punishment
for his single-handed and persistent exposure of the greatest hoax
of the modern age – the construction of the "myth of mental
illness" and psychiatry’s ludicrous attempts to "treat"

In the best
Socratic tradition Szasz has been, for over 50 years, the gadfly
of psychiatry. In his classic book, The
Myth of Mental Illness: Foundations of a Theory of Personal Conduct

(Szasz, 1961), he contended that, contrary to the professional
and public opinion of the time (the late 1950s) the mind
– an abstract concept – could only be considered "sick"
in the same sense that a joke or a building might similarly be described.
This mind metaphor functions as a powerful myth, like many fictions,
offering comfort to all who embrace the idea as a way of explaining
the "inexplicable."

At the end
of the 20th century religion, especially Christianity, was furiously
debunked by radical secularists like Richard Dawkins, Daniel Dennett
and Christopher Hitchens. They exposed not just its mythical nature
but the harm and injustice associated with its practice down the
ages. Ironically, their glaring sin of omission was to ignore psychiatry
– by far the most potent and influential religion of the past
two hundred years.

might feign offense at their portrayal as "high priests,"
believing that they offer a complex and compassionate form of psychological
medicine, worshipping at the same altar as scientists like Dawkins.
Historically, the facts tell a very different story, as Szasz’s
works have vividly illustrated.

religions can hold sway over large sections of any population, and
may be considered a force for good or evil. However, such "myths"
are, at the very least, embraced by the faithful; who gain
socially, culturally or spiritually from their allegiance; and are
free to rejoin secular society whenever they wish. The same could
never be said of "psychiatric patients." The open secret
of the 20th century was that modern psychiatry became a "church"
founded on hocus-pocus masquerading as science, and promoted a range
of means of detaining and restraining its "patient" flock.
Today, as psychiatry rebrands itself as a branch of neuroscience,
it seeks to colonize "developing nations," despite its
near-bankrupt status in its Western world of origin. Parallels with
the Christian missionaries seem wholly apposite.

Over the past
60 years Thomas Szasz has published over 30 books and around 700
papers and articles, all focused on exposing the logical weaknesses
of psychiatric thought, and the moral bankruptcy of its practice.
Heidegger proposed that every great thinker thinks but one thought.
Szasz’s singular, original thought concerns the moral bankruptcy
of expecting (far less forcing) people to see psychiatrists;
to be admitted to so-called "mental hospitals"; to take
psychiatric drugs; and otherwise to comply with the capricious fashions
of psychiatric religion. His diverse and remarkably accessible writings
around this single proposition have led many to view him as the
foremost, contemporary moral and existential philosopher of psychiatry
and psychotherapy: the psychiatric equivalent of the boy obligated
to point out the Emperor’s nakedness. In his 90th year, the uncompromising
fury of Szasz’s scholarship shows no sign of waning as three of
his latest books attest.

as Cure
(Szasz 2007) has a "classic" feel providing,
as its subtitle makes clear, a much-needed "critical history
of psychiatry." Szasz acknowledges that, from his first
day in medical school in the early 1940s, his understanding of the
physician’s role was to try to relieve the suffering of individuals
who asked for, and accepted, medical help. He quickly
formed the view that psychiatrists were committing a grave moral
wrong by imprisoning and coercing people who neither sought nor
wanted their "help." This simple, yet profoundly humanist
view became, and remains, his raison d’être.

Szasz opens
with his assertion that "the typical relationship between doctor
and patients rests, and has always rested, on consent,"
returning to this moral imperative in his conclusion. Between these
moral bookends he lodges a highly original thesis, which frequently
makes for painful reading. His intentions, like his writing style,
are clear from the outset:

In the days
of the insane asylum, the nature of psychiatry was clear: the
madhouse was a snake pit and snake pits could be found only in
insane asylums. Today…. "snake pits" are everywhere,
from the kindergarten to the hospice and the reality of psychiatric
coercion and dehumanization is camouflaged by a façade
of fake diagnoses, outpatient commitment, the renaming of insane
asylums as "health care facilities" and a lexicon of
euphemisms concealing the exploitation and injury of so-called
mental patients as "treatments."

Szasz’s critics
argue that, today, involuntary commitment is rare. Szasz disagrees.
The use of force has simply become, for the most part, covert; as
shown by the proliferation of "community treatment orders"
and the lingering threat of involuntary treatment, should people
refuse to "volunteer." That said, in many countries, like
the UK, "commitment" is again on the rise.

The comparison
with religion is obvious. Psychiatry "is a belief-system impregnated
with rules and values, permissions and prohibitions." The theory
and practice of psychiatry is irrefutable and inviolable "not
because they are true or good, but because it is taboo to deny or
reject them." St. Augustine said that "religion binds
us to the one Almighty God." It is no accident that the most
popular diagnostic manual – the DSM – is commonly referred
to as the "psychiatric bible." It binds psychiatrists,
other "mental health" practitioners and even the "patient"
to the spurious ideology of the psychiatric faith.

Sadly, most
"mental health professionals" have little knowledge of
the scandalous history of their discipline; insulated from the warts
of their history by a cavalcade of hagiographers. Those with any
awareness, either blindfold themselves with the psychiatric flag,
or reframe coercion as compassion: "in the patient’s best interests."

history is riddled with charlatans and megalomaniacs, who peddled
bogus remedies either in the name of medical treatment or scientific
progress. All were welcomed as messiahs, if not by patients, then
certainly by the families fed up with the patient’s behavior. Szasz’s
critical history follows this messianic pathway: tracing the development
of the asylum system, with its various pretenses towards "humane
treatment"; adding a wealth of detail to established accounts
of "shock treatment" (iatrogenic epilepsy); the "cerebral
spaying" of lobotomy; and the ethical disingenuousness of "moral
treatment." He reminds us that "neuroleptic drugs"
were not developed to "treat" any lesion but were, in
the words of Laborit – "inventor" of chlorpromazine
– "a veritable medicinal lobotomy." All "side
effects" associated with such drugs are – in truth –
"intended effects." Today’s "new generation"
of psychoactive drugs perform much the same function. There is no
disease to treat, only persons to be managed and muted.

Szasz’s detailed
account of the career of Walter Freeman, the serial lobotomist,
is one of the many high (or low) spots in this remarkable book.
Freeman heralded, unwittingly, the era of the "celebrity patient."
Operating brutally on thousands of patients, once he completed 228
"operations" in 12 days, often without gown, mask or gloves,
turning his operating theater into a circus performance. Called
on by the serial womanizer, Joseph Kennedy to "treat"
his gregarious, free-spirited daughter, Rose, Freeman’s lobotomy
rendered her so passive that the family had to pass her off as "mentally
retarded," and she spent the next 63 years in the care of nuns.
In an attempt to hide the disgraceful butchery of his daughter,
Kennedy and his family "donned the mantle of protectors of
the mentally ill and mentally retarded, as if the two terms referred
to similar conditions."

Today, many
psychiatrists claim a neurological basis for mental illness –
especially the "psychoses." Szasz has addressed such claims
for decades, noting that if a "mental illness" emanates
from some disease or disorder of the brain, then the patient needs
a neurologist, not a psychiatrist. The difference is critical, as
he notes at the end of Coercion as Cure. Over a century ago,
the fledgling American Psychiatric Association invited S.
Weir Mitchell, founder of the American Neurological Association
to address their 50th anniversary meeting. With grave misgivings,
Mitchell agreed. Szasz notes that Mitchell’s scathing address has
been remarkably neglected by psychiatric historians:

You quietly
submit to having hospitals called asylums; you are labeled as
medical superintendents … You should urge in every report the
stupid folly of this. You … conduct a huge boarding house –
what has been called a monastery of the mad…. I presume that
you have, through habit, lost the sense of jail and jailer which
troubles me when I walk behind one of you and he unlocks door
after door…. You have for too long maintained the fiction that
there is some mysterious therapeutic influence to be found behind
your walls and locked doors. We hold the reverse opinion … Your
hospitals are not our hospitals; your ways are not our ways.

Plus a
change! Contemporary neurologists do not coerce people with
manifest brain disorders – such as Parkinson’s disease or epilepsy
– to accept treatment. Neither do they show any interest in
pursuing people with hypothetical "brain disorders" –
such as schizophrenia. Szasz concludes: "More than ever, the
ways of psychiatry are not the ways of medicine."

In Psychiatry:
The Science of Lies
Szasz summarizes, pithily, the thesis
he has been illustrating so vividly for five decades. His erudite
and highly readable account underlines the scientific folly of talking
of "illness" in the absence of physical pathology; bringing
the sheer mendacity of both professional and political perspectives
on "mental illness" to life through the duplicitous accounts
of those like Tipper Gore, Kay Redfield Jamison and Lauren Slater,
all of whom "built successful careers as celebrity experts
on madness." Szasz views them all as "impostors…."
"Being an expert about mental illness is like being an expert
on ghosts or unicorns."

However, the
best examples of impostors are to be found among the parcel of rogues
called "antipsychiatry," especially its "guru"
Ronnie Laing. Although he tried to distance himself from such an
affiliation, Szasz’s documentary account reveals how Laing created
this "movement" with the South African psychiatrist, David
Cooper, who later proposed that having sex with female patients
would be "therapeutic." Szasz has frequently been associated
with this grouping, so it is unsurprising that he should want, so
vigorously, to explode its mythical nature; showing how "antipsychiatry"
was merely a thinly veiled attempt to redirect power from the mainstream
into the hands of Cooper, Laing and others.

In Antipsychiatry:
Quackery Squared
, Szasz begins by pointing out the foolishness
of the title – who would call an obstetrician opposed to abortion,
an "anti-abortionist"? More importantly, he reminds readers
of his libertarian belief that people should be free to believe
in "mental illness," just as they are free to believe
in God, voodoo, alien abduction, or anything else about which he
might be skeptical. People should also be free to consult psychiatrists;
to accept or reject their diagnoses; to take drugs; to accept electro-convulsive
therapy, or even submit to psychosurgery. His main concern has always
been with the abuse of psychiatric power: where people are
coerced, or otherwise manipulated, into accepting bogus "treatments"
for their metaphorical "illnesses." All those associated
with "antipsychiatry" – from Cooper and Laing, to
Lacan, Basaglia and their various "disciples — never sought
to challenge this abuse of power. Instead, they tried to wrest power
from orthodox psychiatry, in pursuit of their own ideological prejudices.

Szasz begins
his conclusion by quoting GK Chesteron who "wisely warned –
do not free a camel of the burden of his hump, you may be freeing
him from being a camel." In Chekhov’s novella, Ward No 6, he
reminded us that "what the inmates of psychiatric confinement
need is freedom, not another set of careers." Szasz concludes
with the reminiscence of Lenin’s younger sister, who recalled that
when the "great dictator" read Ward
No. 6
"he felt like going out of his room and taking
a breath of fresh air: it seemed to him that he had himself been
locked up in Ward No. 6."

organizations and government departments alike now employ the ludicrous
double-talk of "mental health problems/issues/difficulties";
acknowledging, however grudgingly, that the only "fact"
is that people experience problems, in relation to themselves or
others. In that sense, Szasz’s original premise has been accepted.
The outstanding problem lies in the consequences of such a worldview.
When people experience problems they may or may not ask for help
to deal with them. Nowhere is it written (except in the psychiatric
canon) that people are obliged to accept "help" far less
be penalized should they decide to ride out their fate.

None of this
is "rocket science." Indeed, future scholars might wonder
how Szasz managed to create such a fuss in the late 20th century,
when the social significance of science and its inherent rationalism
was being brought to widespread public attention; and support for
mythology and faith-based ideologies teetered on the brink of collapse.
Szasz’s thesis has been simple and straightforward. If people have
a genuine (i.e., biological) illness, then they may be offered
appropriate medical help. However, as persons, they have the right
not only to choose from various "treatment" alternatives,
but can refuse them all, if they wish.

Szasz’s emphasis
on persons was and remains the critical stumbling point of
Szasz’s thesis: a veritable sin of commission. In The
Myth of Mental Illness he stressed the centrality of "personal
conduct" and ever since has written and talked only of
persons. 40 years ago he wrote:

Modern psychiatry
dehumanizes man by denying …the existence, or even the possibility,
of personal; responsibility of man as a moral agent…(The psychiatric
mandate) is precisely to obscure, and indeed deny, the ethical
dilemmas of life, and to transform these into medicalized and
technicalized problems susceptible to "professional solutions"
(Szasz, 1973. p. 11).

There are no
"patients, clients, survivors or service-users," only
persons. This stubborn defense of personhood is ignored,
not because it is flawed, but because of its implications.

Szasz’s concerns
are unashamedly political. Szasz has often quoted Lord Acton’s dictum:
"Power tends to corrupt and absolute power corrupts absolutely."
In Psychiatry: The Science of Lies he recaps the story of
its origin, in Acton’s critique – as a Catholic – of Vatican-sponsored

It cannot
be faith in the true sense, which a man defends by immoral means…
[B]elief is not sincere when the believer is not sincere. …I
have never found that people go wrong from ignorance, but from
want of consciousness, Even the ignorant are ignorant because
they wish to be ignorant in bad faith. (Acton cited by Szasz,
2008: p114–5)

Acton concluded:
"I find that I am alone…I cannot obey any conscience but
my own." The parallels with Szasz are all too apparent. He
too realizes how marginal is the position he has created for himself:

of psychiatry) who call themselves "antipsychiatrists,"
"critical psychiatrists," "ethical psychiatrists,"
"postpsychiatrists," "ex-mental patients,"
"voice hearers" and so on – oppose one or another
psychiatric "diagnosis" or "treatment"; sometimes
even psychiatric coercion. But they draw back from defending an
ethic based on nonviolence, personal responsibility for public
actions (as distinct from private actions called "thoughts"),
and every person’s inalienable right to his or her
life and death – lest they appear uncompassionate and, perish
the thought, unscientific and illiberal (in the modern, statist
sense of "liberal").

A popular tactic
employed by many of Szasz’s critics is to dismiss both the man and
his ideas on the basis that he eschewed the practice of mainstream
psychiatry: refusing especially to work with so-called "non-compliant
psychotics." Szasz reminds us that obstetricians are free to
choose not to perform abortions and neurologists are not obliged
to conduct so-called "psychosurgery." Indeed, despite
its emergence as a response to the traumatic casualties of the Great
War, most "plastic surgeons" are celebrated today for
treating "patients" whose primary complaint is overweening
vanity. Szasz chose to work only with those who asked for
his help and who were willing to enter into a contract with him.
The legal analogy, which Szasz first employed in Ideology
and Insanity
, is apposite.

In the practice
of law…the objects of classification are not the attorney’s
clients, but the nature of his work. We thus have attorneys who
specialize in corporation law, criminal law, divorce law, labour
law, tax law and so forth (Szasz 1973, p. 238).

Szasz chose
to be a "psychiatric defense lawyer." The hostile opposition
to any similar "division of labour" within its ranks "is
a measure of the extent to which psychiatry has abandoned the liberal-rationalist
values of science and the open society (committing itself) to their
counterrevolutionary antithesis, the illiberal and irrational values
of scientism and the closed society (Szasz, 1973:238)."

Much of today’s
radical thinking in mental health amounts to little more than footnotes
to Szasz. From the "political correctness" of "mental
health problems" to the emergence of "advance statements,"
most of our contemporary "radical thinking" is borrowed
from Szasz. It may well become the historian’s duty to make repay
the debt.

from The Journal of Critical Psychology, Counselling and Psychotherapy.

4, 2010

Phil Barker
is Honorary Professor, University of Dundee, Scotland. Poppy Buchanan-Barker
is Director, Clan Unity International, Fife, Scotland. Thomas
Szasz is professor of Psychiatry Emeritus at the State University
of New York Health Science Center in Syracuse, New York. Visit
his website.

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