Welcome to From Insults To Respect. I’m Dr. Jeffrey Rubin.

Dr. Jeffrey Rubin

Typically, here on this blog I aim to write posts that suggest how we might deal with various intrapersonal and interpersonal conflicts in a manner that will enhance the respect that we have for ourselves, and others have for us. But today we will look at a set of circumstances that is a bit more complicated.

It just so happens that during the last 20 years of Dr. Thomas Szasz’s life I got to know and respect him. He passed away in 2012. During the period of time that I got to know him, I found that some people respected him as I did, but others didn’t. So, throughout this period, I had the following quandaries: If I let the people who didn’t respect him know I did, would that end up weakening the respect they have for me? Should I remain silent about my respect for him until I find out how the others I am with view him? Would I respect myself more if I spoke up about why I respect him even if I risked losing the respect of some? These are the questions that today I invite you to explore.

Learning About Dr. Szasz

Dr. Thomas Szasz

I first came to hear of Dr. Szasz back in 1971when I was taking an undergraduate Abnormal Psychology course at Brooklyn College. One of the assigned readings was Dr. Szasz’s article, published in the American Psychologist, titled, “The Myth of Mental Illness” (see HERE for free access to that article).  Dr. Szasz also wrote a popular book with the same title, which I read a few years later.

In the article, Dr. Szasz put forth his belief that the behaviors and experiences that are considered “mental illnesses” are more accurately construed as problems in living. As someone whose family narrowly escaped the violent, inhumane actions of Hitler in 1938, he expressed a concern about society giving psychiatrists the authority to convert these problems into a language of illness. As he saw it, his own profession has a financial interest in converting more and more problems in living into illnesses that require its services to reach some vague harmonious state thought of as mental health. However, according to Szasz,

…it seems to me that—at least in our scientific theories of behavior—we have failed to accept the simple fact that human relations are inherently fraught with difficulties and that to make them even relatively harmonious requires much patience and hard work. I submit that the idea of mental illness is now being put to work to obscure certain difficulties which at present may be inherent—not that they need be unmodifiable—in the social intercourse of persons. If this is true, the concept functions as a disguise; for instead of calling attention to conflicting human needs, aspirations, and values, the notion of mental illness provides an amoral and impersonal “thing” (an “illness”) as an explanation for problems in living.

Of particular interest to my fellow students was Szasz’s argument that by converting these problems into something that sounds like a real illness, it creates a situation in which psychosocial, ethical, and/or legal deviations are claimed to be correctible by (so-called) medical action only doctors are licensed to provide, such as the prescribing of drugs. To Dr. Szasz, it is logically absurd to expect that it will help solve these types of problems by prescribing tranquilizers and other drugs as if they were like a bacterial infection, or the growth of a tumor. To be sure, people on their own have tried to deal with these problems by taking a wide range of drugs, such as alcohol, tobacco products, stimulants, and heroin. Such approaches, rather than promoting healthy outcomes, tend to lead to less healthy outcomes. To Szasz, changing to the drugs doctors prescribe to deal with these problems in living is like changing seats on the Titanic.

Upon reading the American Psychologist article, it seemed to me that Szasz made some valid, thought provoking points, and during the class discussions, although not everyone agreed with everything Dr. Szasz had written, none of the students, nor did the professor, seem upset with the author’s position.

As several years rolled by, I read several of Dr. Szasz’s books. The role of psychiatrists in social control, promoting conformity, lobotomizing, administering electrical currents to brains to cause convulsions, prescribing harmful drugs to children for behavior problems, stigmatizing adversaries, disqualifying citizens of their right to stand trial, and creating confusion by calling both voluntary medical interventions and coercive practices “treatment,” are the issues Dr. Szasz incisively analyzed.

Many of Dr. Szasz’s books received enormous praise. For example, a reviewer in The Atlantic wrote of his Myth of Mental Illness:

It is no exaggeration to state that Szasz’s work raises major social issues which deserve the attention of policy-makers and indeed of all informed and socially conscious Americans….Quite probably he has done more than any other man to alert the American public to the potential dangers of an excessively psychiatrized society.

Dr. Szasz’s book, Law, Liberty, and Psychiatry, also was met with high praise. In a review published in the New York Times, Edward de Grazia wrote;

This bold and iconoclastic work takes up most of the faults committed in the name of mental illness, and lays down short-run and long-run solutions.

Charles D. Aring, M.D., Professor of Neurology, University of Cincinnati, wrote:

It is likely to rank among the classics of psychiatry.

How We Met

Corning, NY

So, by the time I graduated from the University of Minnesota’s PhD program, and obtained a position as a psychologist in the Corning, New York school system, I was quite familiar with Dr. Szasz’s writings, but I had never met him. But then I began to notice that during my time in graduate school, there was an explosion in the number of students who were being prescribed psychiatric drugs. This began to alarm me more and more because of several of the cases referred to me.

One boy had recently become depressed. When I asked him why he thought he was depressed, he said that his mother was making him take Ritalin to treat his ADHD. The boy didn’t believe he had ADHD, and when the drug’s stimulant effects began to wear off each evening, he was left feeling awful, with waves of sadness, stomach aches, and difficulty falling asleep.

I checked his school record and found he had been consistently on the honor roll prior to taking Ritalin. His teacher reports never expressed any concerns about his having any trouble paying attention or being hyperactive. Instead, he was viewed as an excellent student.

When I asked the boy’s mother why he had begun to take the drug, she explained that he appeared to her to be having trouble paying attention to his homework. When she brought him to her doctor, he diagnosed him as having ADHD based on her concern about the homework issue and then prescribed the drug. When I informed her that the boy attributed his depression to the side effects of Ritalin, she got defensive, and told me  she had faith in her son’s doctor, and she didn’t want my advice about what drugs her doctor was prescribing. I was, according to her, to keep my mouth shut about the drug and just treat her son’s depression.

I found this a very challenging situation.

At the same time, I had become concerned that so many of the kids referred to me who were in foster care were on drugs typically prescribed for people diagnosed as psychotic. These students typically were dealing with serious emotional challenges involving being taken from their parents’ home. A couple of these cases involved parental child abuse, others involved parents being sent to prison, and I had another case of a boy dealing with his parents dying in a car accident. My efforts to help these grieving kids became ever more difficult because of the side effects of the psychiatric drugs prescribed to them. Some of the side effects were known to be life threatening.

And then, in the spring of 1989, a 21-year-old man was found dead at a nearby psychiatric facility within 24 hours of being forcibly injected with the same type of drug these foster children were taking.

Prior to this incident, members in my community were already hotly debating the use of psychiatric drugs within schools. The death broadened and intensified the issues.

Lincoln-Douglas Debates

As a psychologist, my views were sought. Although forthright about my position, in my PhD program I had learned that when confronted with a controversial issue my primary obligation is not to propagandize but to teach; not to indoctrinate but to provide opportunities for citizens to hear a free exchange of opposing views.

To this end, I organized a full day debate in my community on this issue titled, “Psychiatric Drugs: Wonderful Revolution Or Ongoing Catastrophe?” There were two psychiatrists and a patient in favor of the current drug approach, and two psychiatrists and a former patient who were on the other side of the issue. Dr. Szasz was one of those psychiatrists. I served as the debate moderator.

The debate was so popular that people from other communities began to ask me to organize a similar event in their community. Consequently, I set them up in Washington, D.C., Binghamton University, Niagara Falls, and Baltimore, all of which were very well attended. As I went about planning these events, I started to hear from people who were vehemently opposed to them. For example, one woman wrote to one of the sponsors of the debate:

Regarding the October 3rd Binghamton Conference, I am writing in great dismay and utter incredulity that so much mental health money would be spent in this fashion. The money for the needed basic services has been so sharply reduced for our ill family members; plus with the number of mentally ill homeless ever increasing, then to see the large number of participants in such a program was definitely upsetting to me.

I am a member of the Finger Lakes Alliance for the Mentally Ill and have been involved with mental health issues at close range for many years. Firsthand, I can attest to the grief and destruction of lives which mental illness causes. To waste funds and not direct them toward research into the root causes is in my opinion, the wrong direction. To present fallacious viewpoints so flagrantly as was done October 3rd., can only cause more heartbreak to those least deserving of any more heartbreak.

No wonder so many health professionals are stumbling along trying to help our loved ones, but getting nowhere. This is not to say their motives are not right but such attitudes as Dr. Szasz, etc., expound upon cannot help but cloud their thinking.

It is my hope no such conferences will occur. However, if there are any other similar ones, family members should also be on the panel. Dr. Major and Dr. Feinstein were great, but there should be representation from the families who watch and suffer.

So, here we see that the person writing the letter acknowledges that some on the panel did a great job presenting her views but she objects to views with which she disagrees being expressed. Dr. Szasz is specifically named as among those who should be silenced.

By the way, the objection expressed by the critic of the debates, “that so much mental health money would be spent in this fashion” is very misleading. Those who attended came voluntarily and payed a fee for coming. There were some scholarships for those who wanted to attend but said they couldn’t afford the fee, but because so many attended, there were no substantial cost to mental health funded programs. The one exception was that one mental health department in New York State volunteered to print the brochure and send it out to all members of the state’s mental health workers. The cost to the department represented a pittance to their overall budget.

Shortly after receiving this letter, I was contacted by the Executive Director of the Mental Health Association in Niagra County, who asked me to work with her group, and several others in her area, to put on a similar debate for her community. This time I did add to the panel a family member who belonged to the local chapter of the National Alliance On Mental Illness. Despite that, I received a letter from the president of that organization’s New York State chapter asking that the debate be cancelled. In his letter, he specifically objects to Dr. Szasz expressing his views.

I am pleased to report that the debate in Niagra County went ahead as planned. Moreover, the Niagra New York chapter of the Alliance On Mental Illness formally welcomed the conference.

My involvement in the project led to Dr. Szasz and I becoming friends. I would go visit him at his home from time to time, and we would have lunch while discussing his views. At such times when I disagreed with him, I found his delightful sense of humor and cogent counter arguments were done in a manner that I deeply enjoyed and respected.

Over the years, I found his love for his two daughters particularly heartwarming. I could easily relate to his feelings toward them because I have two dear sons.

Whenever I visited him, he normally didn’t interrupt our conversation even when the phone rang, but if the answering machine indicated the call was from one of his daughters, the delight on his face was something to behold. And then he would quickly apologize to me and, like a little boy being invited to have some chocolate cake, he would rush over to take the call.

I remember being invited to his eightieth birthday party. Over a hundred people attended, and the enormous respect they all had for him was amazing.

How Best To Handle A Situation In Which It Becomes Apparent Someone Doesn’t Respect Your Friend?

So, what do you do in a situation like this, that is, a situation in which some people highly respect your friend, while others don’t? As for me, when I meet someone saying negative things about Dr. Szasz, I take some time to listen carefully, and I respectfully summarize the person’s position. I then gently say a few supportive things about Dr. Szasz, while bracing myself to deal with the person’s reaction. As the other person replies, I again listen, seeking to be as empathic as possible.

I recognize that I may lose a certain amount of respect from that person, but I hope, and seek, to win them back as time goes by with my other actions.

What are your thoughts about such challenging situations?

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence.  To begin at the very first post you can click HERE.

Dr. Thomas Szaszmental illnessRadical Psychiatry