Jacob Sullum reports that Thomas Szasz, one of the most vigorous critics of the psychiatric profession, died over the weekend. Jeffrey Oliver explained the importance of Szasz career in the New Atlantis:
Nearly one hundred years after Eugen Bleuler invented the word “schizophrenia” to describe, among others, the “irritable, odd, moody, withdrawn, or exaggeratedly punctual,” those who “vegetate as day laborers, peddlers, even as servants,” and “the wife . . . who is unbearable, constantly scolding, nagging, always making demands but never recognizing duties,” the only way to diagnose this “disease,” or any other mental illness, remains the observation of behavior. Given the complexity of the human psyche, this makes sense: we can hardly expect the many moods and miseries of human life, even the most extreme, to have simple neurological explanations. But given the grand ambitions of modern psychiatry—to explain the human condition, to heal every broken soul—the reliance on behavioral observation has led to the medicalization of an ever-growing range of human behaviors. It treats life’s difficulties and oddities as clinical conditions rather than humanity in its fullness.
Richard John Neuhaus was an appreciative reader of Szasz, and praised him in his “Public Square” column:
When, as a young Lutheran pastor, I first came to the inner city of Brooklyn, the parish of St. John the Evangelist was too poor to offer a salary. So, on the side, I served as chaplain at Kings County Hospital, which then claimed to be the largest medical facility in the world. It was a city hospital serving mainly the blacks of the Bedford Stuyvesant section of Brooklyn who could not afford to go anywhere else.
Part of the chaplain’s forty-eight-hour shift was spent in the huge ward for the mentally ill. It was then that I first came across the writings of Dr. Thomas Szasz, whose arguments about “the myth of medical illness” rang true to me. It was obvious that the psychiatrists at Kings County were making up fancy words to “medicalize” the conditions of some people who had simply decided not to live by society’s rules. Some of the psychiatrists admitted as much. The diagnosis of medical illness was, at least in many cases, another way to imprison people without going to the trouble of charging or convicting them of any crime. [ . . . ]
Back in my chaplaincy days, the Kings County psychiatric ward was pretty much the “snakepit” of horror stories about the “nuthouse.” In the 1970s, the movement for “deinstitutionalization” had pretty well emptied the big mental hospitals, putting thousands of people out on the streets. These street people were euphemistically called the homeless, as though the problem was a shortage of low-income housing.
I still have occasion to visit psychiatric wards from time to time. They are generally much smaller and quieter places now, since most of the patients/inmates are heavily drugged. Pharmacotherapy is now the treatment of choice. It is too bad that Thomas Szasz’s frustrations drove him over the top. His argument is still pertinent in a society that doesn’t know what to do with people who, for whatever reason, refuse to live by its rules. Most of them are not criminal and they are not sick in any medical sense of the term. They are intolerably eccentric. Over the centuries, societies have been perplexed about what to do with such people. They have been locked up and warehoused. The Nazis preferred euthanasia. Given some alternatives, drugging them may seem more humane. There is, however, another long tradition, also in Christian history, of respect, even reverence, for the “holy fool.”
Do not get me wrong. I don’t claim to know what the answer is. But I’m indebted to Dr. Thomas Szasz, who many years ago alerted a young hospital chaplain to the “scientific” ways in which we deceive ourselves about people for whose strangeness we have no room.
Szasz enjoyed a brief day in the national spotlight, but outlived his own influence. After enjoying publication in outlets like Harpers and National Review, he became more and more shrill (psychiatrists were soon enough compared to Nazis), and lost the public ear.
That’s a shame. If anything, the tendency to diagnose any kind of disagreement or eccentricity as a mental illness has gained ground, especially in popular culture. Exhibit A is Jon Stewart and Stephen Colbert’s “Rally to Restore Sanity,” which drew some 200,000 people to the national mall. The implication of the event—and of much of Stewart and Colbert’s comedy—is that one’s political opponents are not merely in possession of what is politely called a different “perspective”—they are somehow insane. They do not have bad reasons, they have no reason whatsoever.
This is a supremely smug perspective, and a deeply undemocratic one. It denies the possibility of legitimate political debate and instead suggests that anyone who seems to disagree is not merely wrong (or possibly right!) but is instead either crazy or a bigot (and, as William Brafford points out, bigotry is reduced to “phobia”). Either way, we receive permission to stop taking seriously our democratic disagreements.
September 11th, 2012 | 2:18 pm
I’m a bit confused by this appreciation or critique. I haven’t read Szasz, though I knew he was a critic of psychiatry.
Whatever the original meaning of schizophrenia, I’m pretty sure the modern clinical meaning is a bit more precise than “vegating day laborer.”
Surely there’s a difference between odd, even very odd, behavior, and pathological behavior, even granting Sallum’s contention about the trend to categorize oddities as clinical [mental] conditions.
Your use of Stewart/Colbert’s “Rally to Restore Sanity” as an example of…something, seems like a stretch, to me. Describing someone’s opinion as “crazy” isn’t usually understood as a medical diagnosis. The point is. the Rally and its name was a joke.
It seems…well, crazy to suggest otherwise.
September 11th, 2012 | 2:26 pm
This is a supremely smug perspective, and a deeply undemocratic one.
I would think it is better than what we see so often (including sometimes here), which is not that one’s political opponents are irrational or insane, but that they are evil. I’ll try to be nonpartisan here and point out that both the Republicans and the Democrats, or both liberals and conservatives generally aren’t “taking seriously our democratic disagreements.” They are accusing those they disagree with of wrongdoing. For example, from the liberal side, the conservatives are oppressors who are seen to be waging a “war on women” and are homophobic bigots, whereas from the conservative side, the liberals are still pushing the sexual revolution, undermining family values, encouraging the “normalization” of homosexuality, and plotting the overthrow of the Catholic Church.
Exhibit A is Jon Stewart and Stephen Colbert’s “Rally to Restore Sanity,”
Here are more exhibits: We get books from people like Ann Coulter with titles like Slander: Liberal Lies About the American Right, Treason: Liberal Treachery from the Cold War to the War on Terrorism, Godless: The Church of Liberalism,and Demonic: How the Liberal Mob Is Endangering America, and she gets invited to appear on Meet the Press to represent the conservative viewpoint. And then of course there is Arguing with Idiots: How to Stop Small Minds and Big Government by Glenn Beck, The Roots of Obama’s Rage by Dinesh D’Souza, Culture of Corruption: Obama and His Team of Tax Cheats, Crooks, and Cronies by
Michelle Malkin, and so on, and so on. Is this really talking seriously about our political disagreements?
At least Jon Stewart and Stephen Colbert are comedians!
September 11th, 2012 | 2:31 pm
The Rally to Restore Sanity was not directed against just any opponent, it was directed against Glenn Beck. Unfortunately, while Beck is just a kook and a crazy uncle, featured at this rally was someone who had called for the murder of a novelist who had written something he didn’t like, to sing “Peace Train”, no less. So this rally was orders of magnitude worse than anything Beck has ever said.
September 11th, 2012 | 2:57 pm
Relativists can not, by definition, argue that other people are wrong. Therefore, to exclude their notions, they must label them as crazy.
September 11th, 2012 | 3:01 pm
His argument is still pertinent in a society that doesn’t know what to do with people who, for whatever reason, refuse to live by its rules. Most of them are not criminal and they are not sick in any medical sense of the term. They are intolerably eccentric.
I disagree that people with schizophrenia, bipolar disorder, and major depressive disorder “are not sick in any medical sense of the term.” Watch this TED Talk by Elyn Sacks if you don’t think people with schizophrenia have a disease rather than an intolerable eccentricity. You may not be able to diagnose these three disorders by a blood test, or discover them in an autopsy, but I think someday we will discover the physical causes.
Of course, it is a fascinating question, and one very difficult to answer, what “really” constitutes a mental disease or disorder. Who is to say that someone whose brain chemistry results in severe depression, or alternating states of mania and depression, is not “normal” for them. It is their brain chemistry, after all. If they are “sick,” then what about people who remain cheerful and optimistic in the face of severe trials. Might they not be judged to have too much of what depressed people have too little of? And I rather suspect that Father Neuhaus disagreed with psychiatrists (including Szasz) that homosexuality was not a mental disorder but just a normal variant or perhaps an eccentricity.
September 11th, 2012 | 3:16 pm
One notes, BTW, that all mental illness are defined by behavior, because once we find their physical causes, we stop calling them mental illnesses.
Are epileptics merely suffering from a world that does not make room for them? But as long as they were defined by a person who abruptly thrashed about, it was considered mental illness.
September 11th, 2012 | 4:18 pm
Thomas Szasz defined what we call mental illness as a choice, and Neuhaus apparently agreed: ” It was obvious that the psychiatrists at Kings County were making up fancy words to “medicalize” the conditions of some people who had simply decided not to live by society’s rules.”
Perhaps that’s true of some conditions, but I can’t imagine anyone who has worked with a schizophrenic believing he has chosen to be that way. Similarly, if you have known someone in the depths of a clinical depression, you would not doubt that this is not a decision not to live by society’s rules. (It is also not a failure to pull oneself together and cheer up.)
The medicalization of non-medical conditions is a real problem, but defining all mental problems as chosen differences in lifestyles trivializes real suffering.
September 11th, 2012 | 4:53 pm
Szasz has been frequently misinterpreted, e.g., he does not say that conditions of suffering the culture calls “mental illness” do not exist, or that psychoactive drugs cannot or should not help people. He simply objects to any and all coercion, which too frequently psychiatry employs, and he expects precise physical lesions when talking about “mental illnesses” as real “diseases”. When such lesions are actually found in medicine, the symptoms cease being called “mental illnesses” and stop being handled by psychiatrists, which almost proves his point. He also rails against the illogic that since a drug helped someone, it necessarily proves a disease or chemical imbalance existed. No, it simply means a drug helped someone, just like caffeine does — is coffee drinking proof of caffeine deficiency disease? Prescribing psychiatric drugs is an art just as much as there’s any science involved in it. Why then should this be state-regulated, with monopoly power to prescribe psychoactive drugs being given only to state-licensed psychiatrists, who no doubt serve state interests as much if not more than patient interests? And since they serve state interests, does this not inevitably lead to coercion, such as the recent case of Brandon Raub being forcibly hospitalized by the state for his political Facebook postings ( http://tinyurl.com/8ch9gm5 )?
Never in my life have I read or seen a more stronger advocate against coercion in general, than Thomas S. Szasz.
September 11th, 2012 | 7:13 pm
Lee Killough –
“No doubt”? I confess to a doubt. I think that’d at least have to be established, and not merely asserted.
September 11th, 2012 | 9:59 pm
I always have, and will continue to have, to greatest respect for the late founder of my favorite magazine FIRST THINGS. Fr. Neuhaus was brilliant, and often right; but he missed the mark on Dr. Szasz. Mental illness is no myth. The good doctor Szasz should have known better. The brain, which is the generator of all thoughts and emotions, like the kidneys, liver, or any other part of the body, can malfunction, resulting in what we call collectively “mental illness.” It’s curious that we don’t hear about the “myth” of kidney illnesses, or the “myth” of spleen illnesses, etc.
Clearly those who suffer from so-called “mental illness” have real illnesses, originating in the brain, and can often be helped. But the only way they can be helped, is by recognizing that their illnesses are real.
September 11th, 2012 | 11:49 pm
I would suggest you read “The Myth of Mental Illness” and pay special attention to the second half of the book on the protolanguage of the body. What he calls ‘bodily signs’ do not result from a ‘biological disease’ but is a result of problems in communication and problems is living.
Our body changes with experiences in living. These changes are not caused by a biological disease. Example: Neglected orphans have enlarged ventricles. This does not translate into them having a biological illness..they had experienced problems in living, stress, neglect and paucity of healthy human communication.
Anybody who argues that a brain change translates into biologically based mental illness is either exceptionally simple minded or have alternative dishonest intentions and goals that cloud clear-thinking.
September 12th, 2012 | 4:36 am
Michel Foucault’s 1961 classic « Folie et déraison: Histoire de la folie à l’âge classique » argues along very much the same lines, particularly that the conceptual distinction between the mad and the reasonable was, in a sense, a product of their physical separation through confinement
“…modern man no longer communicates with the madman [...] There is no common language: or rather, it no longer exists; the constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange between madness and reason was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence.”
September 12th, 2012 | 6:32 am
I seem to recall that Dr. Paul McHugh –an occasional contributor to these pages– had a rather different take on the career and opinions of Dr. Szasz, and the consequences and his work.
September 12th, 2012 | 7:22 am
“Who is to say that someone whose brain chemistry results in severe depression, or alternating states of mania and depression, is not “normal” for them. It is their brain chemistry, after all. ”
Of course, by the same token, would that take in any disease not caused by a pathogen? Severe allergic reactions — it’s their immune system, who’s to say its ferocious attack on some harmless substance is not normal?
September 12th, 2012 | 11:07 am
Of course, by the same token, would that take in any disease not caused by a pathogen? Severe allergic reactions — it’s their immune system, who’s to say its ferocious attack on some harmless substance is not normal?
Mary,
It seems to me, from one perspective at least, what is a pathogen and what is a disease are judgment calls, just as it is not all that easy to decide whether some people with atypical behavior should be called mentally ill. A lot of attention is being paid recently to the “human biome”—the 10 trillion microorganisms that live on and in the human body and outnumber human cells 10 to 1. The human body is massively “infected” with microorganisms, some of which may be partly beneficial and partly detrimental. How do we decided which “infections” constitute “diseases”? Some microorganisms may be entirely beneficial, some may be entirely harmful, but some may have both beneficial and harmful effects.
It also depends on whose perspective you take. A cold is miserable for you, but it is a great opportunity for the cold virus to reproduce and thrive, which is what it’s “supposed” to do.
As for mental illness, who is to say that someone who is mildly bipolar and extremely productive in the manic phase has a “disease”? Or who would say that someone who is extraordinarily cheerful and optimistic in bad times is diseased even if it turns out their brain chemistry is the opposite of that of a depressed person?
September 12th, 2012 | 6:57 pm
The best ‘psychiatrist’ after our Lord Himself , is His Mother – whose Holy Name , The Church venerates today ..
In her apparitions before the genocide that was to bring bloodbath to Rwanda , She warned her children , to put aside hatred ..to meditate in her sufferings ..the country did heed so to that invitation after the massacres ..and inturn , has been blessed with peace ..
She has given the rosary of the Seven Sorrows , as remedy for personaliy disorders , which are considered as rather incurable ..yet , the sense of oneness brough on through such mediations help human hearts to heal , from the sense of abandonment and hatreds that linger ..to know that a Mother was allowed to go through such, for our sake – to know that She understands and is there , in the strenght of The Spirit , to pour out that Spirit , into our hearts ..
True, when it comes to major psychiatric disprders where the person is a risk to self or others , meds can be helpful ..
yet , the better collaboration of faith based treatments , such as esp. readings of the word ..may be the Lamenations , pslams book of Job .. holy chants , exorcism prayers ..hopefully an area that would continue to evolve , to bring the Peace that The Lord promised as His gift !
September 13th, 2012 | 11:29 am
Mary,
You ask a very common question, which many find themselves confused about.
A pathogen or injury is very different from a disease. What change happens to the person with a pathogen or injury is not a result of that person being faulty or abnormal. Rather the person has a response to an attack by a pathogen or an injury. And the way we work with that is keep the person safe from further injury and allow the body heal itself or well kill the pathogen. We do not say the person is abnormal or has bad chemistry.
I hope this helps clear that up a bit for you.
September 13th, 2012 | 12:14 pm
And the idea of an analogy to pathogen or injury is helpful but an over simplified metaphor.
A persons behavior also involves choice, will, responsibility, relationship, desire, love, hate..etc..etc… That is one reason Szasz did not like to make his point from the bio stance…
It is like concentrating on the size of a solders muscle to explain world war II. Sure stronger solders were helpful but were not the reason for the complexity of nations fighting.
September 13th, 2012 | 1:46 pm
“We do not say the person is abnormal or has bad chemistry.”
Oh yes we do. We call it an illness.
I hope this helps clear that up a bit for you.
September 13th, 2012 | 2:00 pm
War is not a biological illness. Neither are other behaviors.
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