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. The story of Szasz’s long campaign against psychiatric orthodoxies is nicely told by Jeffrey Oliver in The New Atlantis, a fine journal published by the Ethics and Public Policy Center in Washington. "If mental illnesses truly begin in the brain, no psychiatrist on earth can conclusively say when, where, why, or how. 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years after Eugen Bleuler invented the word ‘schizophrenia’ to describe, among others, the ‘irritable, odd, moody, withdrawn, or exaggeratedly punctual,’ those who ‘vegetate as day laborers, peddlers, even as servants,’ and ‘the wife .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. "For Szasz, the extreme induced by his war against psychiatry was both equal and opposite to that of his profession. When psychiatry failed to shut Szasz up, it went about forgetting him. When Szasz failed to persuade his peers, he seemed to devote his career to enraging them. In 1963, shortly after the crisis at SUNY, Szasz wrote: ‘To maintain that a social institution suffers from certain "abuses" is to imply that it has certain other desirable or good uses . . . . My thesis is quite different: Simply put, it is that there are, and can be, no abuses of Institutional Psychiatry, because Institutional Psychiatry is , itself, an abuse.’ By the 1970s he was comparing psychiatrists to witch hunters. By the 1980s it was slave owners and Nazis. While such extreme rhetoric made Szasz a public figure for a while, his polemical excess eventually ensured his professional obscurity. "Yet we are also right to give the earlier Szasz his due. ‘Quite probably,’ wrote Edwin Schur in The Atlantic Monthly in the 1960s, ‘he has done more than any other man to alert the American public to the potential dangers of an excessively psychiatrized society.’ . . . Perhaps the most remarkable tribute, however, came in 1989, when an ailing Karl Menninger, the long-time patriarch of American psychiatry, wrote Szasz the following: " ‘I am holding your new book, Insanity: The Idea and Its Consequences , in my hands. I read part of it yesterday and I have also read reviews of it. I think I know what it says but I did enjoy hearing it said again. I think I understand better what has disturbed you these years and, in fact, it disturbs me, too, now. We don’t like the situation that prevails whereby a fellow human being is put aside, outcast as it were, ignored, labeled and said to be "sick in his mind." ‘ . . . "Today, Szasz lives alone in a suburb of Syracuse where he continues to write. He has already published one new book this year¯ "My Madness Saved Me": The Madness and Marriage of Virginia Woolf ¯and he recently finished a draft of yet another critical history of his profession. If the trend continues, the books will be read by few and endorsed by almost none. After forty years of comparing psychiatrists to the scum of the earth, Szasz now stands as one of the biggest obstacles to his own ideas. It is simply too easy to dismiss him as an axe-grinding zealot, a ‘musician who does not like music,’ as one critic put it. ‘The atheist who cannot stop speaking about God.’ But perhaps a new generation of critics will arise¯aware of psychiatry’s achievements but also its limits, leading us not to extremes but to a much-needed reformation of psychiatry from within, and a much-needed de-medicalization of human life in the culture as a whole." 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.
The above is in no way intended to lend support to the enemies of Western Civilization who suggest that, in our kind of insane society, the asylum is the refuge of the sane. One thinks of Michel Foucault’s Madness and Civilization
or the 1975 film One Flew Over the Cuckoo’s Nest , based on the Ken Kesey novel of that title. Nor should we sentimentalize the tradition of the "holy fool," in which fools, holy or not, were often left to die in their squalor. The question of how to deal with the intolerably strange is probably one of the truly intractable problems in a world that is far short of the promised Kingdom of God. The contribution of Thomas Szasz is in cautioning us against the delusion of thinking that we have solved the problem or are on the way to solving the problem by telling ourselves that the strangeness is one medical problem among others.
