Dr. Thomas Szasz, Psychiatrist Who Led Movement Against His Field, Dies at 92
New York Times
by BENEDICT CAREY
September 11, 2012
Thomas Szasz, a psychiatrist whose 1961 book “The Myth of Mental Illness” questioned the legitimacy of his field and provided the intellectual grounding for generations of critics, patient advocates and antipsychiatry activists, making enemies of many fellow doctors, died Saturday at his home in Manlius, N.Y. He was 92. He died after a fall, his daughter Dr. Margot Szasz Peters said.
Dr. Szasz published his critique at a particularly vulnerable moment for psychiatry. With Freudian theorizing just beginning to fall out of favor, the field was trying to become more medically oriented and empirically based. Fresh from Freudian training himself, Dr. Szasz saw psychiatry’s medical foundation as shaky at best, and his book hammered away, placing the discipline “in the company of alchemy and astrology.” The book became a sensation in mental health circles, as well as a bible for those who felt misused by the mental health system.Dr. Szasz argued against coercive treatments, like involuntary confinement, and the use of psychiatric diagnoses in the courts, calling both practices unscientific and unethical. He was soon placed in the company of other prominent critics of psychiatry, including the Canadian sociologist Erving Goffman and the French philosopher Michel Foucault
Edward Shorter, the author of “A History of Psychiatry: From the Era of the Asylum to the Age of Prozac” [1997], called Dr. Szasz “the biggest of the antipsychiatry intellectuals.” “Together,” he added, “they tried their hardest to keep people away from psychiatric treatment on the grounds that if patients did not have actual brain disease, their only real difficulties were ‘problems in living.’ ” This attack had some merit in the 1950s, Dr. Shorter said, but not later on, when the field began developing more scientific approaches.
To those skeptical of modern psychiatry, however, Dr. Szasz was a foundational figure…
As those early weeks went on, there was something else odd. We were on the Grady Hospital In-Patient Unit, and every morning, we got a sheet with all of the residents and their patients. He had very few. We worked every fourth night, and our patients were mostly people we admitted on call. The daytime admissions admitted by staff were rotated among us. The only patients he had were from those daytime admissions. One morning, I got to work and saw the Chief Resident carrying a stack of charts followed by this resident getting on the elevator, and neither showed up for morning rounds. Later that day, the Chief Resident called a meeting, told us that the resident in question was gone, divvied up his patients, and left the room. I never saw that resident again. The Chief Resident remained silent for the rest of the year.
Some years later, I ran into my former chief resident at a meeting, and he told me the story. When he realized that there were essentially no admissions on this resident’s call nights, he started reviewing the charts of the patients seen. On the morning I described, he had confronted the resident and gone over the cases one by one. After that meeting, he drove him to the Chairman’s Office across town with the charts in hand and announced that one of them had to leave the Department immediately. After going over the charts, it wasn’t the Chief Resident that got fired. It was our resident Szaszian. Grady Hospital in downtown Atlanta is not for the faint-hearted. The patients brought there are often violent, psychotic people completely out of control. It seems that this resident would lecture to the patients that they were responsible for their behavior, talk to them about life being made up of choices, and send them on their way. Apparently, on his nights on call, the staff had been surreptitiously holding the patients over that they were uncomfortable about releasing for the regular ER staff psychiatrists to see the next day. I heard that he later applied to SUNY where Szasz was on faculty, but was turned down. The Internet says he finished a residency in a small program in the mid-west and practices in a town near where he trained.
After that episode, I got curious and read some Szasz – the Myth of Mental Illness and something else. It seemed monotonous. I decided that Szasz was more ideologue than psychiatrist. Something of an Ayn Rand like figure. Someone to read and think about, but nothing more. The flagrantly psychotic people brought to the Grady Emergency Room should either be left alone to be free, or held responsible for their actions. If a crime were committed, Mental Illness was not a mitigating factor. So our resident was, indeed, practicing Szasz as it was written. I think Dr. Szasz made me think more deeply about the commitment laws, testamentary capacity, criminal responsibility, the arrogance of some psychiatrists, but I found his view of human beings as living in a world of voluntary choices an untenable way of looking at the desperately ill people I was learning about in that period of my training, and later. As time passed, I saw some videos of him speaking. He filled any room he entered. He was an impish, quick-witted, charismatic contrarian. I bet he never lost an argument. He took on psychoanalysts, behaviorists, psychiatrists, psychopharmacologists, legal scholars, and sometimes mental patients with equal relish. We were all off the mark.
‘It seemed monotonous.’
I have to disagree with you on this one.
‘his view of human beings as living in a world of voluntary choices an untenable way of looking at the desperately ill people….’
Interesting philosophical position you take here. May be worth rereading Szasz and I for one would enjoy reading an extended blog on this.
cheers.
The damage is done,15 plus years of the lie of biochemical imbalance as the sole cause to mental illness has made the majority of patients I see in community and private practice settings just focus on meds, meds, meds. I am not a fan of Szasz not a fan of any extremist view, but I am tired of biology run amok among all the mental health “brethren” that goes on now.
Szasz had a point of view, but once again not applicable to all. I just wonder what the antipsychiatry supporters have to say when someone close to them commits suicide, gets floridly psychotic, or is just struggling with much psychosocial stress that such antipsychiatry attitude is not helping.
Moderation is life, folks.
Szasz was not antipsychiatry. He pointed out that for over 100 years the biological disease model of ‘mental illness’ was short of any scientific validity and emphasised that psychosocial stress, or ‘problems in living’ were not necessarily the domain of medical science. His much maligned and misunderstood views have stood the test of time. The fact that psychiatry has totally ignored his criticisms, rather than address them, has caused most of the problems we see today.
Dr. Hassman,
This article by one of your colleagues may address some of the issues you raised:
http://www.madinamerica.com/2012/09/finland-the-pre-seminar/
AA
I find it interesting that you appear to dismiss Szasz’s basic criticism of Psychiatry; when this blog is a running evidenced commentary that tends (more often than not) to support his conclusions & position.
Psychiatry is historically rooted in subjectivity (fallibility). More recently psychiatry has laid claims to power that is not supported in actual medicine, science, or functional practice. Psychiatry has little foundation to make claim to a higher ground, or to stand in overseeing judgement of society; while subverting our individual personal liberties & basic behavioral responsibilities.
Maybe the best analogy of modern psychiatry, is that it is a profession living in a glass house throwing stones at the world.
How about a profession living in a cave interpreting shadows and throwing its feces at the world?
As a person driven to extreme distress by community-based psychiatric abuse leading to my more or less willingly accepting brief breaks in the storm through commitment to psychiatric wards only there to be branded psychotic, out of control and lacking insight into my illness…sans autocritique…I assure you the cure for mental illness is understanding it is psycho-iatrogenically induced mass, intense trauma. Only openly accepting the insight of the brilliant, good, warm, humorous, challenging, fiercely independent and no less respectful man who was Thomas Szasz – “whether physicians like it or not, the stubborn fact remains that psychiatric training is, above all else, a ritualized indoctrination into the theory and practice of psychiatric violence” – exposes psychiatrists for who they are: boring brutes who blunder and maim.
re: ‘At one point, I asked our resident the question that must’ve been asked of Dr. Szasz repeatedly. “Why are you here?”
Contrary to your adamant assertion, Doctor, Dr. Szasz, who graduated at the top of his class from the University of Cincinnati medical school in 1944, most probably never encountered any such question.
Respectfully, I refer you to comments he contributed in 2010 to the Bulletin of the Association for the Advancement of Philosophy and Psychiatry (Volume 17, Number 2):
‘In Psychiatry: The Science of Lies, I cite the warning of John Selden, the celebrated seventeenth–century English jurist and scholar: “The reason of a thing is not to be inquired after, till you are sure the thing itself be so. We commonly are at, what’s the reason for it? before we are sure of the thing.” In psychiatry it is usually impossible to be sure of “what a thing itself really is,” because “the thing itself” is prejudged by social convention couched in ordinary language and then translated into pseudo-medical jargon. Seventy-five years ago, in my teens, I suspected that mental illness was a bogus entity and kept my mouth shut. Twenty-five years later, more secure in my identity, I said so in print. Fifty years later, in the tenth decade of my life, I am pleased to read Dr. Allen Frances candidly acknowledging: “Alas, I have read dozens of definitions of mental disorder (and helped to write one) and I can’t say that any have the slightest value whatever. Historically, conditions have become mental disorders by accretion and practical necessity, not because they met some independent set of operationalized definitional criteria. Indeed, the concept of mental disorder is so amorphous, protean, and heterogeneous that it inherently defies definition. This is a hole at the center of psychiatric classification.” This is as good as saying, “Mental illness, there ain’t no such thing,” and still remain loyal to one’s profession.’