Sunday, 16 September 2012

Thomas Szasz has left the building

 Posted September 12, 2012 at 4:22 pm | Permalink

No matter what else one may think about Dr. Thomas Szasz and his views, if one is at all familiar with his writings — and capable of a modicum of intellectual charity and honesty (as opposed to mindlessly regurgitating the opinions of his critics) — one will agree that we have lost one of the twentieth century’s great, and most underappreciated, minds. Even those unpersuaded by his arguments, and those who hold that his influence has hurt, rather than assisted, the interests of the mentally ill, ought to be able to admit that Szasz often remained brilliant even when he was wrong. He was a master rhetorician, a riveting author, and one of the last century’s pre-eminent moral thinkers and psychiatry’s most original, articulate and cogent critic.

Until the 1980s, Szasz’s ideas (even when presented in an unsympathetic light) were a standard part of the psychology, social work and psychiatry curriculum in universities in the West. The fact that since then nearly all traces of Szasz’s influential ideas have been erased from textbooks is less a result of his views having been refuted (as his critics would have it) than it is a testimony to the supremacy of ideology over intellectual honesty. It takes rare courage, persistence and strength of character to withstand the tsunami of — often unfair and dishonest — vitriolic criticism, personal attacks and professional ostracism that Szasz had to endure in the second half of his life. The barrage of hostility and ridicule never succeeded in shutting him up.

It is true that some of Szasz’s stances (e.g. his categorical rejection of any form of socialized healthcare) stand or fall with his political values. Still, even those who (like myself) don’t share his libertarian premises can identify with his relentless defence of the humanistic and personalistic conception of human beings as (at least partly) free and responsible agents, as against the dominant, and demeaning, notion of humans as biological machines entirely described, and determined, by the laws of physics. (As Szasz himself noted, in spite his atheism, many of his views resonate more closely with those of theologians than with the crude reductivistic materialism of his colleagues.) Even today, more than five decades after “The Myth of Mental Illness”, few psychiatrists, and members of the lay public, would openly object to Szasz’s insistence on viewing and treating the people we label (for the lack of a better term) mentally ill as, first and foremost, human beings, who deserve the same respect and dignity as everyone else. Yet, in the case of Szasz’s colleagues this is usually mere lip service. Modern psychiatry, with its scientistic and nihilistic thrust, trivializes and degrades its patients’ existential struggles, moral dilemmas, and emotional, social and economic difficulties by ascribing them to (yet undetectable) physiological malfunctions of the brain.

Many of Szasz’s early critics have over the years quietly come around to some of his basic views. (Karl Menninger was one of his colleagues who acknowledged his change of heart.) The notion that the great majority of people with mental illness should never be hospitalized against their will (even when they are troublesome to those around them) has become common sense. It remains one of the great injustices of history that the psychiatric establishment continues to refuse to credit Szasz with being the first member of his profession who, in the mid 1960s, stated on record — against the unanimous opinion of his colleagues — the revolutionary contention that homosexuality was not a disease, and that it didn’t warrant “treatment” of any kind.

The classical liberal notion of “live and let live” resonates closely with the “first, do no harm” of the Hippocratic Oath that Thomas Szasz took as a young medical doctor. For better or worse, Szasz remained consistently faithful to these principles of negative freedom his whole life. Those, however, who believe that, as individuals and as a society, we have a moral obligation to (somehow) assist the mentally ill even when they don’t reach out for support, would regard Szasz’s characterization of psychiatric paternalism as “cruel compassion” as equally descriptive of his own apparent lack of concern for the welfare of those labelled mentally ill. Szasz tirelessly defended the autonomy of even the most severely disturbed mental patients (so long as they didn’t violate the law), yet seemed to care little whether they live or die if no one infringed on their sacred negative rights. Although Szasz dedicated a period of his life (and a single book) to practicing his brand of psychotherapy, it was a very modest effort in comparison to the amount of time and energy he spent attacking his profession. Clearly, his hatred of institutional psychiatry dwarfed his love of its oppressed victims. (Szasz’s writings contain a number of harsh value judgments vis-a-vis the mentally ill, such as “unproductive”, “idle”, “lawless” and “bums”. Even when accurate, these are hardly dispassionately descriptive terms.) If his colleagues’ sin was overzealousness, Szasz’s was relative indifference.

Despite some common values and goals, Szasz distanced himself from the anti-psychiatry movement of the 1960s and 1970s. Unlike Ronald Laing and his associates, who stressed praxis and made efforts to understand and personally assist the mentally ill (with various degrees of success), Szasz remained a staunch theoretician, content with making attempts at changing the law in the direction of enlarging the scope of personal liberty and responsibility for the mentally ill. Whereas Laing attempted to engage with his patients’ messy humanness (with mixed results), Szasz rarely left the ivory tower from which he pontificated about his rigid absolutist principles and abstract arguments with cold, iron-clad logic (the fascinating and illuminating nature of these diatribes notwithstanding). When Szasz finally committed his thoughts on the anti-psychiatry to paper, their harshness and unfairness easily equalled that with which his own ideas had been met by the mainstream psychiatry.

It is impossible to overstate Szasz’s impact on the origin and development of the psychiatric survivor movement. Practically all the pioneers of the movement (Leonard Frank, Judy Chamberlin, David Oaks, Don Weitz, et al), regardless of their political stripes, freely acknowledge their debt to Szasz for providing them with intellectual ammunition against coercive psychiatry and spurring them to activism. Szasz was the first prominent intellectual who stressed that eccentricity and harmless social deviance were neither diseases nor crimes, and should never be treated coercively. His writings helped empower millions of readers around the world to view themselves as fully human — instead of helpless victims brain pathology — and deserving of the same basic rights as everyone else, regardless of their personal challenges. Unfortunately, some readers used Szasz’s books to rationalize their refusal to recognize that they can’t solve their problems on their own and need to seek help. Others (however few) may have tragically mistaken his unflinching notion of suicide as “a fundamental human right” for a permission to end their lives before they had exhausted all other potential options.

As he readily admitted, Szasz didn’t have superior answers as to how to best assist those overwhelmed by life’s many challenges. But he cautioned that medicalizing human existential, moral, emotional, social and economic problems only mystifies and further compounds these difficulties, leading to the “psychiatric dehumanization” of the sufferers. Today this warning is considerably more relevant then it was when Szasz articulated it half a century ago. The merger between psychiatry and the pharmaceutical industry is now nearly complete, and the arrangement is more profitable for both parties than ever before. According to the former president of the American Psychiatric Association, Dr. Stephen Sharfstein, his profession has “allowed the biopsychosocial model to become the bio-bio-bio model”. Pharmacracy is now a literal reality.

Szasz explicitly stated that his main aim has always been merely to try to think clearly. He has examined his profession’s stated values, assumptions, methods and goals with a keenly skeptical eye and peered beneath their veneer. His thought-provoking criticisms have forced his colleagues to confront their complacency: make an attempt to clarify the nature of their work, defend its scientific legitimacy and re-evaluate the ethics of their interventions. This has been a very healthy, if not particularly fruitful, exercise.

Szasz’s views have been repeatedly misunderstood by the lazy-minded and deliberately mischaracterized by opponents. It is a shame that because of systematic blacklisting his ideas are not nearly as well known as they deserve to be. Despite his critics’ charge that his arguments amount to nothing more than semantic trickery, and have been refuted decades ago, the neuropathology of mental disorders remains largely a mystery in spite of a century and half of research. The question of the ultimate nature of the experiences and behaviours classified as mental illnesses, and the best way to deal with them, is yet to be satisfactorily settled.

Dr. Thomas Szasz was one of the most brilliant, original and controversial thinkers of modern times. His iconoclastic influence on psychiatry during the latter half of the twentieth century, whether acknowledged or not, is unequalled. His intellectual legacy is a testimony to the power of healthy skepticism, fiercely independent thought and common sense. One doesn’t need to agree with any of the Hungarian-American moralist’s premises or conclusions to appreciate the depth of his analysis, the clarity of his argumentation, his riveting polemical and rhetorical skills, and his obvious passion for liberty. Szasz’s numerous books and articles will doubtless continue to inspire new generations of young people to think deeply and critically not only about psychiatry and human nature, but about all of society’s, and their own, fundamental assumptions and deeply held beliefs as well.
Tracy Harms
 Posted September 15, 2012 at 2:40 pm | Permalink

Thank you, Aporeticist, for that overview. You’ve noted the significance of his work more effectively than any other commentator I have seen since his death. I intend to help keep the insights, criticisms, and courage of Thomas Szasz alive by applying what I have learned from him, and speaking openly. It’s gratifying to see I am not the only one who will be doing so

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