Szasz Under Friendly Fire: Damned With Faint Praise

This essay is a critical review of recent collections of articles by friends and colleagues of Thomas Szasz. Apart from the usual misunderstandings and wilful misinterpretations of Szasz's social psychology generally and critique of mental illness specifically, his friends and colleagues add a new dimension to Szaszian criticism by damning him with faint praise. Ignoring his indebtedness to social psychologist, George Herbert Mead, they interpret his work as an ideological defence of libertarianism, rather than as a logical critique of mental illness. A defence is, therefore, especially indicated.

The Boundaries of Medicine

A valid concern regarding medicine in society is the medicalization of social deviance as a form of social control. Peter Conrad writes about this concern as we become more dependent on physician judgement of what is and isn’t illness. We are faced with determining what is inside and outside the realm of medicine, and what the limits of medical involvement should be. I explore two instances that reveal that medicine should be involved in cases of human suffering, though should never carry all the societal burdens of alleviating suffering. Whether or not medicine should be involved in mental illness is a view contested by Thomas Szasz in an argument that aims to establish that mental illness is outside the realm of medicine. His argument relies on the clear separation between somatic and mental illnesses, which I show are not clearly separated at all. Ultimately, I argue that as complex—and undoubtedly human—as the practice of medicine is, it is a discipline with a wide array of applications that are critically important for treating mental illness.

The clinical wisdom of Thomas Szasz

Besides Szasz’s controversial views are brilliant contributions to clinical practice, including the following examples: (1) He elaborated the physician-patient relationship with three models—“activity-passivity,” “guidance-cooperation,” and “mutual participation.” (2) In The Ethics of Psychoanalysis (1965), he promoted “autonomous psychotherapy,” which involved noncoercive dialogue between therapist and patient that would lead to education and growth for the latter. (3) He argued that transference is part of the analyst’s judgment and the patient’s experience, and that there is a relationship between transference and learning. (4) He used principles of “object relations” theory to explicate deeply the signs and symptoms of schizophrenia. Contrary to popular belief, he was not “antipsychiatry” simpliciter. As a theorist, he clarified language and tried to understand pain. As a practicing clinician, he advocated ways to help people in distress, urged embracing the freedom and autonomy of patients, and treated them as persons with abilities to help themselves.

Myths, projections, and overextensions: The conceptual landscape of Thomas Szasz

This chapter distinguishes among myths, projections, and overextensions as they occur within the practice of psychiatry—adding to the conceptual complexity of Szasz’s own analyses and reflecting on how his focal concept of autonomy may itself fall prey to myth, projection, or overextension. Szasz offers detailed explications of his use of the term “myth,” yet many questions remain regarding his application of that term and its relevance to psychiatry. How is a metaphor “literalized,” and when is this problematic? What terms, in addition to the term “mental illness,” serve to support the myths of psychiatry? How do myths relate to the projections and overextensions that can also be found in the language and practice of psychiatry? With these distinctions in mind, it is appropriate to ask whether Szasz’s own reliance on the notion of autonomous agency might itself qualify as a myth, a projection, or an overextension.

Philosophical influences on Thomas Szasz

We would naturally expect Szasz, a libertarian conservative, to have been influenced by, for example, Rousseau, Burke, Hayek, von Mises, Thoreau, Socrates, Camus, Sartre, Mill, Mencken, Seneca, Nietzsche, Stirner, and individualism in general. But this is not entirely the case. As somewhat of a philosophical rogue, his influences were subterranean, selective, and so eclectic that we could almost accuse him of cherry-picking. He could not use many philosophers to his advantage since they mostly accepted the reality of mental illness. Yet in Szasz’s works we detect Popper’s rejection of historicism and social determinism, Russell’s linguistic analysis, Reichenbach’s logical empiricism, Bridgman’s operationalism, Langer’s and Cassirer’s systematic understanding of non-linguistic expressions such as symbols, Kierkegaard’s indirect communication, and Hobbes’s idea that government may not legitimately take away any individual’s rights unless the individual has first freely empowered the government to do so.

Thomas Szasz and the insanity defense

Szasz stoutly opposed the use of the insanity defense. This chapter considers the persuasiveness of Szasz’s arguments against it, which fall into three broad categories: (1) arguments that the insanity defense is immoral; (2) arguments that it relies on a nonexistent entity, namely mental illness; and (3) arguments that the sciences of psychiatry offer no grounds for supporting it. Each category of argument is explored in its various forms. The most persuasive type of argument is found to be the third. Unlike the other two, it does not require us to buy into strong and broad beliefs which are indeed characteristically Szaszian (such as that mental illness is a myth), but which lack widespread acceptance. In contrast, Szasz’s argument that the sciences associated with psychiatry (such as psychology) do not offer grounds for the existence of the insanity defense appeals to a commonly held and highly plausible multifactorial account of the causes of human behavior. In short, analysed carefully, Szasz’s writing provides more persuasive grounds for taking exception to the insanity defense than his own best-known views offer.

Thomas Szasz

This anthology takes a multidisciplinary approach to examining the legacy of the controversial psychiatrist and libertarian philosopher Thomas Szasz (1920-2012), whose mordant criticism of psychiatry challenged the very concept of mental illness and the practice of coercive psychiatric treatment and some tenets of psychoanalysis and psychotherapy. The international spectrum of contributors represents a wide variety of viewpoints in psychiatry, philosophy, and the history of ideas. They discuss the viability of interpretations of mental illness, especially with reference to specific conditions such as schizophrenia; the legal and ethical implications of Szasz’s thought, particularly for the insanity defense; several aspects of the suicide debate; questions of accountability, responsibility, and psychopathy; thinkers who influenced him; and his influences on others.

Thomas Szasz and the language of mental illness

Szasz famously declared mental illness a “myth” and a “metaphor,” arguing that psychiatry’s diagnostic categories are only temporary stops on the road to “real” and “legitimate” bodily diseases. He argued that conditions once regarded as “mental illnesses” would rightly be reclassified as “brain diseases,” insofar as scientific investigations would uncover their neuropathology. Based on a critique of six foundational claims in Szasz’s writings, the author of this chapter argues that psychopathology and neuropathology are complementary rather than contradictory or disjunctive. Just as some mental illnesses may be considered brain diseases, some brain diseases may manifest as “mental illness.” The locution, “mental illness,” remains useful, albeit imperfect, shorthand to describe a particular kind of suffering and incapacity, usually affecting cognition, emotion, reasoning, or behavior. Even if all mental illnesses were conclusively and causally linked to specific brain abnormalities, we would still need “mental language” in both ordinary discourse and the vocabulary of clinical work.