On this blog, one of the main topics of discussion is name calling.  And, from time to time, some people have asked me what I think of the types of names psychiatrists use to talk about their patients.

In response, I wrote a post titled Name Calling by Psychiatrists: Is it Time to Put a Stop to it?  It stirred up a great deal of interest, and the various comments led me to write several follow-up posts.  While all of this was going on, several people asked what I thought of the psychiatrist, Thomas Szasz.  And so, today’s post at least begins my reply.

It was 45 years ago when I first heard of Dr. Szasz.  I was about 19 years old, it was the late 1960s, and I was taking an Abnormal Psychology course as an undergraduate student at Brooklyn College. Professor Meyers presented a whole class on Dr. Szasz’s recent book, The Myth of Mental Illness.  It was a time when many of us were raging against the Vietnam War.  Questioning all authority went right along with that, and so Szasz’s position, for me, fell right into that general mindset.

After the course had ended, I really didn’t think much about Szasz’s ideas again until about 15 years later.  I was working with youth in the Corning, New York area, when I began to notice a dramatic increase in the number of young children and teenagers being prescribed psychiatric drugs.  At one point, five straight foster children that were brought to me for counseling not only were taking a psychiatric drug, but were taking several of them. Those students typically were unhappy about this, complained about serious side effects, and when I went to the library to check out the various risks associated with their use, I became very concerned.

To address my concern, I began to organize a debate on the use of these drugs, and the first person I thought to call was Dr. Szasz.  He was very helpful, agreed to debate the topic, and the debate created so much interest that other people began to ask me to help organize similar debates in their communities.  In the end, that single debate turned into a series of seven debates.

I learned a great deal from all of the participants, but it was Dr. Szasz who most challenged my thinking.  Although I disagree with some of his ideas, I admire his guts for standing up for what he believed, his humor, and his extraordinary intelligence.

Thomas Szasz passed away a couple of years ago at the age of 92.

A great deal of Szasz’s writings and ideas are readily available on line (see for example the article on Wikipedia). Nevertheless, to give my readers a little sense of his ideas, I am providing below a little snippet of his opening remarks from one of the debates that I helped to organize. It is slightly edited because he was not the first speaker during the debate and some of his comments alluded to remarks that someone else had said earlier during the proceedings.  Without having heard these other remarks, Szasz’s comments would be hard to follow, so I edited them out. This gives his comments a slight disconnected feel at times, so I ask that you not blame him for that.

And so, without any further ado, I give you, Dr. Thomas Szasz:

Ladies and gentlemen…. I would like to take this time to present my views of psychiatry ….

I believe…ideas have consequences.  Words only mean what we do about them.  They do not have abstract meaning.  So the question is what do we mean when we say something is a disease?

Now to me, psychiatry doesn’t have to do with diseases at all.  Just like, to me, communism doesn’t have to do with ideas. 

Communism was symbolized by a bunch of stones called the Berlin Wall.  But what it actually meant is that if you lived in a communist country, you can come in, everything was fine and you were told everything was wonderful for you, but if you tried to leave you found that they shot you, that you couldn’t get out. This is what happens in a mental hospital.  You can get in, but you can’t get out….

Psychiatry is a branch of the law, it has alway been, and always will be…  To me, psychiatry is coercion.  I have always said, I support psychiatry between consenting adults…  I am only interested in involuntary aspects of psychiatry.

For the sake of the argument, I don’t believe this, but for the sake of the argument, to make my argument clear, let’s say schizophrenia is a brain disease, just like cirrhosis is a disease of the liver.  If we accept this and treat it like other diseases, then psychiatry disappears.  It would then be treated by a brain doctor.  The insanity defense disappears.  Involuntary psychiatry disappears.  If somebody kills somebody they are tried like everyone else.  There are no psychiatrists lining up to testify to say Prozac causes murder, or mental illness causes murder, or everything causes murder except free will.

Ok,… let me give you two English sentences. The statement Jones is bleeding, is a statement about his body.  The statement  that Jones is boasting is a statement about Jones.  They sound like the same type of statement, but they are not. The question, what do we mean by schizophrenia.  Do we mean that they are a type of lesion, or do we mean, behavior.  How does someone first diagnose someone with schizophrenia—from his body, or his behavior?

Let’s assume the person has a disease.  The person is still behaving, the person is still a moral agent.  Patients, from a moral, legal point of view, are exactly like non-patients. If I have asthma, Parkinson, etc., I can still behave.  When people have Parkinson and they shoot somebody, they are responsible, if they are nice to their wives, they get along, if they are not so nice they get a divorce and so on.

Now we come to some more issues.  Supposing someone claims that someone has a disease. On whose authority do we take this?  In my lifetime, great authorities have maintained homosexuality was a disease.  When I was in the US Navy 30 years ago, that was one of the major ideas of the service was to single out homosexuals, who were then given diagnoses by psychiatrists.  This was viewed as a serious disease.  Now, on the cover of Time we find that they are entitled to civil rights.  What happened to their disease?

Not only was homosexuality a disease, so was being black according to an early psychiatrist, Benjamin Rush. According to him, blacks were blacks because they had a form of leprosy.  On whose authority did he claim this?  On the authority that he is a doctor?

Now we are shown pictures of brains and told that they prove that schizophrenia is a disease.  On whose authority?  The fact is that no pathologists diagnose anyone as schizophrenic based on any pictures of someone’s brain, or any other medical test.  Even on postmortem, when the patient said to be schizophrenic dies the pathologist says no disease was found.  The same thing with depression…

The discussion of who has a mental  illness is based on judgements of a person’s behavior.  So this idea that you can have a brain disease, like schizophrenia, is a little  strange.  Let me just give you a few questions to stimulate you.  What would asymptomatic depression look like.  Now we know what asymptomatic hypertension is, or asymptomatic leukemia,… but what is asyptomatic depression?  Better yet, what is asyptomatic schizophrenia? What would that be.  Or asymptomatic Judaism, or Christianity.  These are behaviors.  If the behavior is not there it is not here….

My time is nearly up, so let me leave you with a couple of questions.  Please listen carefully because this is a question and a joke.  If somebody has a delusion of having cancer, then he has a mental illness, right, because he doesn’t have cancer?  What would it mean if he has a delusion of being mentally ill?

Okay, now to the issue of saying someone has a mental illness which is due to some biological basis. This is nonsense because everything we do has a biological basis… The most ordinary things are biological bases, namely eating and sex, called hunger and lust.  These are not diseases.  And just because they have a biological basis that doesn’t mean that you have to act.  Urination and defecation have a biological basis. These are powerful impulses that have a biological basis but that doesn’t mean we have to do it in the middle of the living room…. Life begins with responsibility and ends with responsibility….  Psychiatry is a discipline that undermines responsibility.  Thank you.

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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 intelligence.  To begin at the very first post you can click HERE.