Szasz’s legacy and current challenges in psychiatry

Szasz’s legacy involves two issues in current psychiatry: First, he criticized the concept of mental illness. The DSM-5 debate shows that psychiatry still suffers from unresolved conceptual problems. The definition of the general concept of mental disorder remains unclear. Specific classificatory entities (e.g., autism spectrum disorder) are notoriously contested. Second, he criticized coercive psychiatric practice. Recent developments suggest an ongoing identity crisis of psychiatry as a medical institution. Psychiatry’s tasks are partly related to societal interests (e.g., dealing with dangerous persons). Two psychiatric forms of intervention are therapeutic coercion and compulsion to prevent harm to others. Whether the latter can be squared with therapeutic purposes is unclear. To justify paternalistic interventions such as therapeutic coercion is difficult. Hence, there is enormous pressure on psychiatry’s medical identity. Szasz asked the right questions, not necessarily providing the most convincing answers. Psychiatry would benefit from a thorough, less prejudiced assessment of his publications.