Thomas Szasz: A Life in Error
Dr. Thomas Stephen Szasz has died at the age of 92 at his home in upstate New York. Born in Hungary in 1929, he came to the United States at the age of nine, trained as a psychiatrist, and served -- after a stint in the military during which he was stationed at the Naval Medical Center in Bethesda -- as professor of psychiatry at the Upstate Medical Center in New York from 1956 until he retired in 1990.
Szasz serves as a powerful testament to the proposition that ideas have consequences -- and that terrible ideas, no matter how demonstrably false and even absurd, can not only survive, but shape our institutions, in the process doing untold damage to human lives and the social fabric.
The bizarre idea that Szasz propagated for upwards of fifty years was that mental illness does not exist. The vast majority of Szasz's 35 books and over four hundred articles are devoted to this claim. As Charles Krauthammer has observed, "Like the atheist who can't stop talking about God, Szasz cannot stop talking about psychiatry." Szasz disposes of mental illness by rhetorical sleight of hand: "Mental illnesses do not exist; indeed they cannot exist, because the mind is not a bodily part or bodily organ." But of course what is diseased in "mental illness" is the brain, which is as susceptible to malfunction as any other bodily organ.
Szasz rejected mental illness on ideological grounds. An unsparing libertarian, Szasz insisted that each man was responsible for his actions. "Autonomy is my religion," he wrote. It is thus ironic that his notion that mental illness does not exist owed its impact to being taken up by the political radicals and counterculture of the 1960s, which Szasz despised. The mentally ill became a group to be "liberated" along with blacks, Hispanics, and third-world peoples. Some countercultural intellectuals went so far as to claim the sane were mad and the mad sane, for it was the latter who rejected the irrational reality of a rotten social system.
Szasz's idée fixe of mental illness as merely an invention of power-hungry psychiatrists came to be the foundation of public policy through its impact on a cohort of radical young attorneys who would make "liberation" of the mentally ill their lifework. Bruce Ennis, the single most influential member of this group, admits he knew nothing about mental illness until he stumbled on the works of Thomas Szasz while working on a new project on the rights of "the mentally handicapped" for the New York Civil Liberties Union. Within a year, the NYC Civil Liberties Union had passed a resolution denouncing involuntary hospitalization as incompatible with the principles of a free society. Szasz would write the preface to Ennis's 1972 book Prisoners of Psychiatry, praising Ennis for recognizing "that individuals incriminated as mentally ill do not need guarantees of 'treatment' but protection against their enemies--the legislators, judges, and psychiatrists who persecute them in the name of mental health."
Anti-psychiatric doctrine in its Szaszian formulation (Szasz's veneer of logical reasoning was especially appealing to lawyers) soon made its way into articles on mental illness in legal journals. Entire issues of law journals were devoted to demolishing all psychiatric claims. In one such issue, the May 1974 University of California Law Review, Ennis and Thomas Litwack argued that relying on psychiatric expertise was worse than relying on chance, and so psychiatrists should not be allowed to testify as expert witnesses in commitment hearings. Indeed, anti-psychiatry so dominated discussions on mental illness in law journals in the 1970s that it was rare to find an article with a different perspective. And these articles became the acknowledged underpinning for judicial decisions in the flood of law cases brought by the new mental health bar.
If mental illness was a myth, there was nothing to treat, and so psychiatric treatments, and above all the psychoactive drugs that were psychiatry's proudest achievement, became the next targets. Law journal articles painstakingly described their every possible unpleasant side-effect, with no hint of their benefits. Yet it was these medications which could restore the individual's ability to make choices in any meaningful sense -- in other words, restore the autonomy that Szasz claimed to value above all else.
The upshot was that as a result of judicial decisions and actions of state legislators in response to them, state mental hospitals were emptied, and involuntary commitment became contingent on imminent dangerousness -- and even then, treatment was uncertain because the law instituted a right to refuse it, which could be exercised even after commitment. All this had a devastating effect on families, who were forced to watch helplessly as someone they loved deteriorated, and on the lives of the mentally ill themselves. This did not trouble Szasz. For all his emphasis on the alleged brutality of psychiatry (many of his volumes are extended comparisons of psychiatry to the persecution of witches and Jews, the Inquisition, and slavery), it is Szasz's ideology that is truly inhumane. In a 1975 speech in California, he declared that he did not give psychotropic drugs and did not promise patients he could make them better: "They can go home and blow their brains out."
Nor did the broader society escape the effects of Szasz's reasoning. The mentally ill became the hard core of "the homeless" on America's streets and swelled the population of her jails and prisons. Headlines reporting deaths of innocents at the hands of mentally disturbed individuals became routine. (Usually, in the small print, there's a history of families striving in vain to obtain treatment for them.)
In fairness to Szasz, he was right to condemn what he called imperialist trends in psychiatry. Influenced by the notion that mental illness and mental health formed a continuum, psychiatric overreach was at its peak when Szasz began writing in the late 1950s. Psychiatrists included in their provenance everything from juvenile delinquency to the resolution of international conflicts. And just about everyone was in need of their services. The famous Midtown Manhattan Study of 1962 claimed that 80% of the population was psychiatrically impaired. While psychiatrists have largely sobered up, those wildly inflated surveys are still with us: the National Institute for Mental Health currently claims that one in four Americans has a mental disorder and one in 17 has a serious illness such as schizophrenia or manic depression.
Had Szasz called on psychiatry to define mental illness more narrowly and its own expertise more modestly, he would deserve to be celebrated for puncturing psychiatric pretensions. Instead, he launched an absurd and destructive attack. He portrayed psychiatrists as key agents in a government plot to insinuate a totalitarian system of coercion through a therapeutic state. He thus reinforced the countercultural "anti-psychiatry" he professed to disdain and attracted to its core untruth -- that there is no distinction between sanity and insanity -- a credulous new audience among conservatives and libertarians. That audience is still here. Just last month the Cato Institute devoted an issue of its online journal Cato Unbound to Szasz acolyte Thomas Schaler, who regurgitates the same "there is no such thing as mental illness" nonsense.
Szasz is gone. His destructive legacy lives on.
Rael Jean Isaac is co-author (with Virginia Armat) of Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill (The Free Press, 1990).