I made up this rule for living in my early days of dealing with those patients we call Borderline [because of their propensity to achieve outlier status no matter how you approach them]. As it turned out, it was a better rule than I knew – one with a surprisingly wide range of applications [usually discovered in retrospect when you realize where something went very wrong]. I was thinking about my rule when I was remembering those days in the 1970s when I first came into psychiatry [like old men often do…] and I found myself reading through the Google Books pages from Thomas Szasz’s 1960 book, The Myth of Mental Illness. That was long ago, but I still remember how I first heard of Dr. Szasz.
It was from a fellow resident in my first year residency. He was an aloof and somewhat argumentative guy, who asked odd philosophical questions in rounds. Not long after we started, I noticed something – he never had any patients. We were at Grady hospital in downtown Atlanta. In rounds, we got a census sheet and his list was very short. Then I noticed that in morning rounds after he worked, we never had new patients to discuss. If you don’t know what Grady hospital is, maybe you can’t really appreciate how extremely unlikely it is to have no new psychiatric patients on any day – a finding that transcends statistical possibility. One day at lunch, he started explaining to us about his hero, Dr. Szasz, and about the Myth of Mental Illness – how "these people" just needed to learn to take responsibility for their lives. I took the bait and asked him why he was in a psychiatry residency. I can’t recall what he said [because it made little sense], but I remember thinking it reminded me of Ayn Rand. Not long afterwards, the chief resident, having noticed the same thing on the census sheet, showed up early one morning after he worked, reviewed the charts from the night before, marched the resident and the charts to the Chairman’s office, and said that either he or this resident would be leaving on that very day. The chief resident stayed.
The chief resident wouldn’t talk about it back then, but years later I ran into him at a meeting where he told me about the desperately ill patients this resident had sent home after lecturing to them about personal responsibility. He was still upset about it, near tears, so many years later. The resident tried to transfer to S.U.N.Y. where Dr. Szasz held court, but was turned down. He ended up finishing in Psychiatry in the north somewhere. I found him on the Internet in practice – just a bunch of those doctor rating sites with no data. One did say, "ease of scheduling an appointment: excellent."
I later read one of Dr. Szasz’s books [or as much of it as I could tolerate]. I certainly am not going to try to summarize Szasz’s views because I couldn’t do it without arguing, a futile endeavor [following rule #1]. There’s a cogent Wikipedia summary and enough to get his point in Google Books if you’ve never encountered him before. In 1969, Szasz partnered with the Scientologists to form the Citizen’s Commission on Human Rights. The CCHR web site tirelessly keeps up with the controversy and mis-behavior in Psychiatry, actually covering many of the same thing I write about. There’s a difference in intent that’s obvious, but much of their information is accurate. The same might be said of Szasz. A lot of what he says is true, or at least in the range of truth, but his conclusions all roll to the same place – a system populated with demons. The patients are demons getting away with bad or irresponsible behavior disguised as mental illness. The psychiatrists are demons, controlling the patients with laws, diagnoses, medicines. Freud and Charcot created a system of lies to explain the lies of the patients. With Szasz, disease is reserved for things you can see at an autopsy.
Back in my day, psychiatrists were targeted for psychoanalysis, involuntary hospitalization, not guilty by reason of insanity. Szasz preaches that mix of libertarianism that sides with unlimited freedom, but stands strong on the side of criminal justice. Suicide is a choice in a free society, Schizophrenia too. He’s a moving target … [whoops! almost broke rule #1]. Now, he’s in the anti-drug set [though he’s also on the side of unlimited access to drugs]. I’m mentioning him because he’s had a much more powerful impact on psychiatry than most of us would care to admit, more as symbol than anything else. Psychiatry is very easy to criticize and hard to defend, and Thomas Szasz has offered a safe haven for critics of multiple persuasions for over forty years. At times he’s like the court fool in a Shakespearean play – speaking the truth on the side. At other times, he’s an Elmer Gantry who can lead anyone anywhere any time. Here he is, after all these years, in the flesh:
[Full Disclosure: I’ve read all his books and have dined with Dr. Szasz]
It’s unfortunate that Szasz has become more symbol than substance. The substance of his message has remained remarkably consistent over 50 years (he is 91 and his next book will be released in October). Although Wikipedia is an excellent source of information, and Dr. Szasz would agree (though his nationality is US, not Hungarian), it’s not the best short course on Szasz. I commend his introduction to “Szasz Under Fire”, that provides autobiographical material not available elsewhere, and explains, succinctly, where he’s coming from.
He’s anything but a moving target. Almost unlimited freedom? Not exactly. He believes in ordered freedom, as in the freedom to swing your fist ends at the tip of my nose. Anti-medication but pro-drug? Again, not exactly. Szasz would say you should be able to take any drug you want to. You just should be lied to about the medication you’re taking, forced to take it, or otherwise defrauded.
Suicide is a choice, not a disease. Schizophrenia is not a choice, but neither is it a disease. But don’t take my word for it: read “Schizophrenia”, by T.S. Szasz.
Hi Rob,
I headed my post with rule #1 for a reason. To speak of Szasz is to engage in the vicissitudes of his arguments, so I knew what I was doing to even bring him up. I’ve never heard him mentioned without an argument about what he does or does not mean coming closely behind. He is uncriticizable and undefendable simultaneously. I think of him as an acquired taste for one side of an argument and a bitter pill for the other.
My reason for mentioning him is not to argue with, for, or against him or people who follow him. It’s to highlight his place in the attitudes of, for, and against psychiatry – particularly in the time I came on the scene.
Full Disclosure: I made my own peace with Dr. Szasz years ago. Brilliant guy. Good points. His ideas extrapolate to motivations in psychiatrists as a group that should be watched for, but are hardly universal, and not often found in my head. It’s not his arguments that bother me. It’s their inevitable conclusions. I find him stigmatizing…
“An acquired taste for one side of an argument and a bitter pill for the other.” It’s a brilliant way to put it. I first heard of Szasz in medical school, and at that time he was referred to only in hushed tones as “that guy who doesn’t believe there’s any such thing as mental illness!”
But uncriticizable and undefendable? I don’t know what you mean? The book I referenced in my first comment is a full-length series of parries and thrusts by Szasz and his critics (although I admit that some of the essays have nothing to do with Szasz’s thought at all – they are usefully skipped)
We agree on one point: Szasz has an extremely dim view of his colleagues that borders on viciousness. I can see how that could be a turn-off…
Side note for interest sake, he will be speaking along with Robert Whitaker and others http://bipolarsoupkitchen-stephany.blogspot.com/2011/08/alternatives-to-psychiatry-conference.html Alternatives to Psychiatry Conference 2011 ISEPP Conference October 28-29, 2011 Los Angeles, CA
Well, thanks for the youtube link. To give the devil his due, he does make some excellent points. I don’t agree with a lot of what he says, especially the government coercion crap (but who cares what I think?). Still, Szasz may be a necessary corrective to mindless biological psychiatry, especially regarding children. Let’s face facts: There are NO biological markers for the “diseases” we treat. Maybe there will be some in the future. Lord knows schizophrenia and bipolar I cry out for such markers. But Szasz should make us a bit more reluctant to label and throw pills at everyone and everybody who walks into our clinics and our hospitals.
Rob,
What I mean by “uncriticizable and undefendable” is easy. If you make a criticism, he has an immediate response – well formed and logical. If you try to defend his ideas, it’s met with an immediate retort. Arguing for or against Szasz is breaking rule #1.
Tom,
I attached that video because in person, he’s magnetic. He’s quick-minded even in advanced age. I showed it to the lady that lives here who would disagree with him on many points – particularly ADHD. But she watched with a smile and said, “he’s a good speaker, makes good points, he’s cute.” He has certainly been a powerful force as a Professor of Psychiatry who writes books like Psychiatry: The Science of Lies. That’s pretty impressive…
I am glad you brought him up and hope you will continue to post your perspective on his views. I like what Tom posted: he may be a necessary corrective to mindless biological psychiatry.
I am glad you brought him up and hope you will continue to post your perspective on his views. I like what Tom posted: he may be a necessary corrective.
so, given the comments I had to go back and actually watch the video instead of just reading what you had written; I have read his book the Myth of Mental Illness. Your neighbor is right: he IS cute. And surprisingly charismatic. I had no idea. Thanks for posting it.
“Arguing for or against Szasz is breaking rule #1.” Or, you could “do the unmentionable” and be persuaded by the force and logic of the arguments. I was.
It looks like you drew some Scientology trolls in with your post.
His arguments are the worst kind of intellectual dishonesty. On the surface, one can easily agree with the observations. But attempts to argue the merit of the conclusions are an exercise in futility as there is no discussion. Just disagreement.
It’s the worst kind of abuse of the scientific method.
Lucky for psychiatry that Szasz joined up with the Scientologists to form the Citizens Commission on Human Rights. It provided a cadge to beat critics, and, apparently, an easy source of ad hominem attacks.
I plead guilty to “troll”, but innocent to Scientology. And I do mean innocent: I honestly have no idea what they stand for apart from that they are anti-psychiatry.
The ad hominems I can handle. What I can’t abide are accusations of abuses done to the scientific method without mention of a single example!
I disagree that there can be no discussion, unless by “discussion” you mean an argument that you win. Are we not discussing?
I sense in Mickey’s post, and in jueesus’s comment, some frustration (or something) at the quality of Szasz’s arguments.
One quick response to Mickey regarding Szasz’s “conclusions”. I don’t believe he calls for the abolition of psychiatry full-stop. To the contrary, he preaches (and practiced) voluntary psychiatry – that is to say non-coercive, contractual therapeutic relationships paid for by the client.
Meant “cudgel”, not “cadge”. Call me crazy…
“he preaches (and practiced) voluntary psychiatry – that is to say non-coercive, contractual therapeutic relationships paid for by the client.”
me too – preaching and practicing…
The frustration with Szasz isn’t in the quality of his arguments or his logic – he’s a master of both. The frustration is in the digital nature of things Szasz. I agree with some of what he says and some of what he concludes and disagree with some of what he says and some of what he concludes. That’s true of my reactions to many people, partial agreement and partial disagreement. I don’t feel obligated to defend my areas of disagreement with him any more than with any other person. That’s my “liberty.”
My experience with discussions about matters Szasz is that that never seems to be okay. It’s digital – either total agreement, or total disagreement. Neither work for me. He’s categorically opposed to involuntary confinement of psychotic or “lethal” patients. I’m not, though I hated doing it and have avoided situations where that was an issue. He sees medication of children with ADHD as poisoning. I do not, though I wouldn’t do that involuntarily. He sees child psychiatrists as one of the most dangerous forces on the planet. I see some child psychiatrists that way [Joseph Biederman as an example], others I see as valued colleagues and a force for good on the planet. I practiced psychotherapy of the voluntary kind and am not in love with medications, but give/gave them in situations where they helped – and stop/stopped them if they don’t/didn’t. I agree that involuntary hospitalization has been horribly abused in the past. I hope I never did that. I remain haunted by the times I didn’t hospitalize when I should’ve. In the modern world, it is not much abused. If anything, it’s underutilized because there are no services to back it up, particularly for the uninsured.
So I find Dr. Szasz interesting, but unwilling to address the gray areas in the spaces between his rhetoric and the abuses of the past/present we all abhor. As a person who has been in those spaces frequently during periods in my life, his arguments and conclusions didn’t fit the real-life dilemma of either the patients there or myself. And if I was working for the government, I sure didn’t know it.
And like Dr. Szasz, I gravitated to the world that he describes:“he preaches (and practiced) voluntary psychiatry – that is to say non-coercive, contractual therapeutic relationships paid for by the client.”
But that doesn’t mean that the impossible dilemmas of those afflicted with intense psychosis and the people who care for them evaporated. And it doesn’t address the fact that the resident I mentioned in this post was on a trajectory to kill some people who really didn’t need to die, in my opinion [then and now]…
To Juheesus!
As a Christian, I resent your choice of names and the manner in which you presented it. As a human being, I am offended by your use of “Scientologist trolls” Adolph Hitler taught me all I need to know about that kind of venom leveled on someone on the basis of their religion. It has no place in this debate.