Welcome to From Insults To Respect. I’m 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
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”. 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
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.
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.
The following year, Dr Szasz published a best selling book by the same name. Some loved it while others writhed in anger. One reviewer, for example, gave it five stars out of five, and wrote:
Here is my curse on you, Thomas: May you suffer ten minutes of acute clinical depression. Ten minutes in that “over-heated room”, that “bell-jar”, that “bed of nails” which we sufferers know oh too well.
I was initially puzzled about the anger that appears to come from many who genuinely believe, and demand others believe as well, that without any doubt mental illness is an illness like any other illness. My puzzlement stemmed from my experience that oftentimes when someone proposes a different way to describe something, it doesn’t create great uproars. The proposal is either met with feelings that the new way to describe something is either helpful, or not.
William James, in his book, Pragmatism, tells us the following story. 
This human witness tries to get sight of the squirrel by moving rapidly round the tree, but no matter how fast he goes, the squirrel moves as fast in the opposite direction, and always keeps the tree between himself and the man, so that never a glimpse of him is caught. (p. 43)
“Which party is right,” I said, “depends on what you practically mean by ‘going round’ the squirrel. If you mean passing from north of him to the east, then to the south, then to the west, and then to the north again, obviously the man does go round him, for he occupies these successive positions. But if on the contrary you mean being first in front of him, then on the right of him, then behind him, then on his left, and finally in front again, it is quite obvious that the man fails to go round him, for by the compensating movement the squirrel makes, he keeps his belly turned towards the man all the time, and his back turned away. (p. 44)
Once the process of comparing and contrasting two or more descriptive approaches gets underway, it can lead to an understanding of just how vague some of the descriptions were, and they can be abandoned for more precise descriptions. Of course, the new description may also be so terribly vague as well, and nothing positive occurs. In such cases, a little time was wasted, and people get on with their lives without furious reactions.
Let me begin here by asking you to note that in the squirrel anecdote, those who discussed whether or not the squirrel went around the tree were not going to lose their job, money, freedom, or any other highly significant valued thing depending on who ended up being proved correct. Once everyone declared their positions, each might have had a little sense of prestige that might be derived if they could convince others that they came up with the most respected answer. But for people who like to discuss issues, learning from the discussion is typically the most important reward for them, and they can well handle their emotions that come from having taken a position that ends up being faulty.
The pharmaceutical companies make billions of dollars convincing people that their experiences are illnesses like any other illnesses. Thus, they claim that taking a pill to manage their illness is not any different than taking insulin for diabetes. Psychiatrists and other doctors who prescribe these drugs have an enormous financial interest in keeping this position unchallenged.
The facts are that there are numerous examples of people who could have easily been classified as having a mental illness who come to a state of enormous improvement either through a religious experience, a philosophy such as Buddhism, a delightful romantic love, an exciting new job, a support group such as AA, counseling, etc., You don’t see diabetes being “cured” by changes in relationships, work settings, religious beliefs, and thinking patterns. The fear of those invested in pharmaceutical company profits and the prescribing of their pills leads to great resistance to any descriptive changes that are not in line with the illness approach.
The second consequence that I think people fear is that people who now have access to mental health services might lose them if people stop thinking that the patterns now viewed as real illnesses are really not illnesses. Dr. Szasz’s “problems in living” alternative and my “mental health concerns” approach, they fear, will trivialize these experiences.
Some argue that if everyone could go to a mental health professional merely to have their concerns addressed, then the system would soon be overloaded with clients, and insurance policy costs would soar. Because insurance companies only cover people with more serious conditions known as mental disorders, so the argument goes, this limits the number of people who can get to see a mental health professional. However, I believe that third-party-payer executives would readily come to understand, with a little explaining, that mental health service providers now using the current mental illness approach do not turn anyone away who has mental health insurance coverage and comes to their office expressing what my approach refers to as a mental health concern. Professionals are in the business of increasing their clients. The current relevant definitions are so vague that with little imagination, anyone can be “diagnosed” as having 
Similarly, people who seriously hurt others while drinking alcohol or in some furious fit might be blamed for their actions. Thinking that they have an illness, somehow makes them blameless.
This process involves learning that there is a dramatic difference between taking some responsibility for what has occurred and blaming oneself for what has occurred. Blame suggest that you should be punished for your actions. Taking some responsibility for your actions allows one to realize that there may indeed be some very strong conditions that are out of your control regardless of whether or not you have an illness. Blaming yourself for these is not helpful, but allowing yourself to experience deeply the dissatisfied feelings about whatever control you do have can spur you to make valued changes.
Okay, so those are the three feared consequences that I have come to believe ignite anger whenever there is a discussion about conceptualizing the set of concerns now called mental illnesses. In my view, “mental health concerns” are a more apt way to conceptualize these concerns than “illnesses.” However, I fully support that for those who prefer the illness approach, that they be free to access services using that model. At the same time, I believe that ending the monopoly of the illness approach could very well stir up some valuable competition that will improve services for all.