Ross Levatter, MD., Spring 1983
Mental illness is not a disease; it is a myth. Madness is not diagnosed; it is manufactured. Psychiatry is not the science of "the unconscious"; it is the theology of medicine. Psychiatrists—from Sigmund Freud to Karl Menninger—are not beneficent healers who treat patients; they are base rhetoricians who trample rights, stigmatizing others by placing them in a position of institutionalized helplessness.
These are just some of the pioneering points psychiatrist Thomas Szasz has made over the last three decades, as he has diagnosed institutional psychiatry as practicing social control disguised as medical treatment. This diagnosis, while casting him as a pariah among the psychiatric community, has earned him great and deserved admiration among friends of liberty everywhere.
The best introduction to Szasz is the recently released Thomas Szasz: Primary Values and Major Contentions. Through a well-chosen selection of Szasz's writings, culled from a broad range of books, journal articles, magazine pieces, and newspaper columns, editors Richard E. Vatz and Lee S. Weinberg highlight Szasz's commitment to freedom and autonomy, dignity and self-responsibility, tolerance and truth. For Szasz, the book shows, these values are best promoted by a laissez-faire approach, with the respect for person and property that it presumes, and is most easily undermined by psychiatry, with its flouting of the rule of law.
For Szasz, it would be hard to understate psychiatry's contribution to Power in its struggle over Liberty in the 20th century. As he put it in an exclusive Laissez-Faire interview:
Psychiatry's contribution to Power today is very similar to the Church's contribution to Power in the Age of Faith. Psychiatry is one of the major justifiers and implementers of Power in our so-called secular age . . . it is one of the major supporters—perhaps the major supporter—of the power of the State.
If modern psychiatric concepts have been developed as justifications to deprive people of their liberty, Szasz's Law, Liberty, and Psychiatry shows the culmination of this development. Szasz explains how psychiatry subverts the rule of law, justifies abridgement of constitutional rights, and reverses the normal historical trend in Western societies from status to contract. Discussions of criminal responsibility and the insanity defense are included. This book, and Szasz's strong advocacy of universal human rights, are in large part responsible for the relative ease with which the civilly committed person can free himself today.
Szasz ridicules psychiatry's practice of "medicalizing morals" and points out that mental illness acts as a myth. His book, The Myth of Mental Illness, dissects the flaws in the "medical" model of mental illness, and offers three alternative models: the "language" or "communicative" model; the "rule-following" model; and the "game-playing" model. It is interesting to note that although Szasz makes his points here with considerable restraint, and with less rhetorical flourish than in later works, organized psychiatry—how shall we say—took it badly. Szasz's expose of the psychiatric establishment did not win him friends in the profession. As he describes it, "I did not quite expect the really enormously hostile reaction—and that's putting it mildly. All Hell broke loose . . . absolutely colossal harassment ensued as soon as I finished the book."
That sort of thing doesn't stop Thomas Szasz, it seems. Instead, it drives him on to logical conclusions. If mental illness is a myth, Szasz reasoned, psychotherapy must be a myth too. After all, only non-existent treatments exist for non-existent diseases. Or, to put it another way, if the "patient" has no disease, what the doctor does may be helpful or harmful, but it's not treatment.
If psychotherapy is a myth, you can imagine what Szasz might say, in Sex By Prescription, about sex therapy. Here Szasz decries the ultimate end of medicalizing morals, of believing that everything bad is illness and everything good is treatment. In the Theologic State, you went to a priest with your sex problems (usually lust) and were told you were sinful. In the Therapeutic State, you go to a psychiatrist with your sex problems (usually lack of lust) and are told you are dysfunctional.
Szasz, of course, is not the first to highlight psychiatric inanities and oppose psychiatric injustices. Karl Kraus, the early 20th century Viennese satirist and contemporary of Freud's, walked this road before him. Szasz pays tribute to Kraus, the path-breaker, in Karl Kraus and the Soul Doctors, which offers Szasz's biographical sketch of Kraus, a summary of Kraus's criticisms of psychiatry and psychoanalysis, and a selection of Kraus's best writings.
Kraus saw what Szasz sees today, perhaps more clearly than any other modern observer. As Szasz told Laissez Faire:
In our society, if enough people want to use medical ideas and medical interventions to fix everything, then everything—from poverty, to beating children, to sexual deviance, to taking drugs the government doesn't want you to take, to international relations, to political assassinations—everything unpleasant will look like a disease, especially a mental disease, and everything pleasant will look like a treatment.
This attempt to transform bad men into bad molecules is morally bankrupt, a demonstration of our need for an individualist-oriented medical ethic. Szasz provides this in The Theology of Medicine: The Politico-Philosophical Foundations of Medical Ethics, a compilation of numerous difficult-to-obtain journal articles.
Readers who have come to know Dr Szasz's views may wonder why one who has spent so much effort attacking the organized psychiatric establishment ever chose a career in psychiatry. Laissez Faire asked him that question, and received this characteristically straightforward response:
I did not go to medical school in order to go into psychiatry. I was interested in going into internal medicine . . . I feel that I went into psychiatry in order to say something about what seemed to me—really, from my childhood on—the fallacy of mental illness; it seemed to me like the Emperor's Clothes, that really everyone knows there is no mental illness, but no one has the guts to say it.
Reading Thomas Szasz is a joy and a pleasure; an exploration and an enrichment; a stimulating and rewarding experience. Medicine's loss is liberty's gain.
(Dr. Levatter, a co-alumnus with Dr Szasz of the University Of Cincinnati Medical School, is a long-time libertarian writer and activist. He currently practices medicine in Phoenix, Arizona.)
THE MANUFACTURE OF MADNESS (reviewed by Ross Levatter)
Were the "witches" of Inquisition times possessed by the devil? Many great minds apparently once believed so. Current psychiatric
histories argue that witches were mentally ill. But Thomas Szasz counters that calling people witches and depriving them of their rights is
the equivalent of calling people mentally ill and depriving them of their rights.
In this classic work, Szasz lays out the history of the religious scapegoating of witches, then the psychiatric scapegoating of homosexuals
and masturbators. It's the same history in a different guise. (As Szasz himself notes in his new preface, the discussion of homosexuality is
now dated, but I believe it remains an important historical analysis.) The upshot is that the actions of a socially dominant elite - once
religious, now secular and psychiatric - remain self-serving and coercive.
Those who haven't read Szasz are in for a treat. Those exposed only to his more recent, polemical works will enjoy seeing him in a
different light. The master polemicist is also a brilliant historian and analyst.
INSANITY The Idea & Its Consequences (Syracuse University Press, 1997)
In this provocative book, Dr. Thomas Szasz, one of the most celebrated and controversial psychiatric thinkers of our time, presents a
carefully crafted, systematic analysis of the precise character and practical consequences of the idea of mental illness.
"Szasz is a brilliant debater. …. He can turn a topic as somber as insanity and its social context into a book that is extraordinarily
entertaining. He is as likely to quote Shakespeare or Moliere as Freud and Jung, and when it suits him, he quotes Ann Landers and
Dear Abby, too. His irreverence and moral outrage fairly sizzle on the page." The New York Times Book Review
A LEXICON OF LUNACY Metaphoric Malady, Moral Responsibility, and Psychiatry
Szasz has challenged the legitimacy of "mental illness" throughout most of his 21 books. It's a behavior, he insists, not a medical
condition like cancer. Here, Szasz comes at the subject from a somewhat different, more amusing angle. He focuses on a remarkable
variety of words over 2,000 altogether used as excuses for evading individual responsibility.
Thomas Szasz reveals how politically-correct people evade individual responsibility (Review by Jim Powell, January 1993)
"Although well-known for his writings on psychiatry, Thomas Szasz has established himself as a preeminent philosopher of individualism.
He shows why individuals can and must be held morally responsible for their actions, even in the most difficult test
case—politically-correct "mental illness."
Szasz has challenged the legitimacy of "mental illness" throughout most of his 21 books. It's a behavior, he insists, not a medical
condition like cancer. He tags psychiatry as largely a pseudo-science which uses fancy words to describe different kinds of behavior but
rarely ever identifies specific causes or cures. Now in his new book, Lexicon of Lunacy, Szasz comes at the subject from a somewhat
different, more amusing angle. He focuses on the remarkable variety of words used to describe human behavior. Some are clinical, some
are insulting, but none amount to a believable excuse for evading individual responsibility.
Szasz tells how psychiatry has become perhaps the ultimate refuge for the politically correct. "Unlike regular physicians, who have no
need to rename diabetes or hypertension," he says, "psychiatrists labor under the unremitting pressure of cultural forces to slap approving
or disapproving labels on certain behaviors. With women's liberation, nymphomania, formerly a 'sexual perversion,' has become normal
behavior; whereas smoking, formerly de rigueur among psychiatrists, is now a disreputable mental disorder called 'tobacco dependence.'"
The politically correct way of referring to drunkedness now is alcohol abuse, something which can't be considered anyone's
fault—except, in this litigious age, for the other person who served the drink. Szasz recalls many politically incorrect expressions for
drunkedness which mostly reflect disapproval, such as stewed, boiled, zozzled, squiffy, potted, pickled, blotto, cock-eyed, half-cocked, lit
up, heeby-jeebies, have the shakes, loaded for bear, out like a light, stewed to the gills, passed out cold.
Szasz cites the Americans With Disabilities Act, which became effective last year, as a landmark of political correctness. Congress, in its
infinite wisdom, saw fit to prohibit discrimination against people with a wide array of "mental illnesses." For example, "frotteurism" which
is officially defined as "recurrent, intense, sexual urges and sexually arousing fantasies, of at least six months' duration, involving touching
and rubbing against a nonconsenting person." On the other hand, "hypoactive sexual desire disorder" is also protected by Congress. This
is defined as "persistently or recurrently deficient or absent sexual fantasies and desire for sexual activity."
Lexicon of Lunacy includes seven previously published papers which illustrate how psychiatrists use language in an effort to manipulate
people by undermining individual responsibility. No one is doing a better job defending individual responsibility than Thomas Szasz.
To underscore his view that psychiatry is a pseudo-science, Szasz' new book Lexicon on Lunacy includes a long, amusing list of
politically correct words together with slang words, all of which do the same thing—describe unusual behavior. Here's a sampling:
Abalienation, Abnormal, Acid head, Acromania, Addlepated, Airhead, Alcohol abuse, All worked up, Anorgasmia, Asinine,
Autoeroticism, Babbler, Bag of nuts, Balloonatic, Balmy, Bananas, Basket case, Batty, Bee in his head, Benighted, Berserk,
Bipolar illness, Block head, Blooming idiot, Blue funk, Bozo "
"Szasz reminds us again of the absurdity, and the dangers, of using literal medicine to treat
metaphorical diseases. He argues that to call something mental illness and equate it with
physical illness gives too much power to mental health professionals and to the governments
they serve and strips people of their responsibility for their own behavior."
—Mitchell Handelsman, in Contemporary Psychology
THE UNTAMED TONGUE A Dissenting Dictionary
"As usual, Szasz takes on the tough issues that other people tend to skirt: children and parents, disease, drugs, the insanity defense,
mental illness, psychiatry, punishment, religion, sex, suicide, and the therapeutic state, among others... Sacred cows are slaughtered,
treasured beliefs overthrown, cliches crushed, and enemies of liberty unmasked."
(reviewed by Roy A Child Jr, May 1990)
Where are today's real masters of language, the Voltaires, the Nietzsche's, the H. L. Menckens? I mean the serious thinkers who use a
mastery of language to goad or provoke us into thought, who undermine conventions and passive, habitual ways of thinking and behaving
through, paradoxically, satire and other inventive uses of humor. Tom Wolfe comes to mind, but beyond that it often looks like a barren
Barren, that is, until you pick up the work of Thomas Szasz. Has there ever been a thinker so outrageous in tone and yet so serious of
purpose? Has there ever been a finer scholar so at ease with naked exaggeration for effect? Is there another contemporary thinker who
has forced people to take his point of view seriously—and many to adopt it—through sheer penetrating, rhetorical power? Who has
turned the tables on an entire professional establishment with nothing but his own wit, intelligence, courage, and legendary productivity to
serve his cause? Thomas Szasz is unique!
The Untamed Tounge is Szasz's latest book, and it is scintillating, outrageous, incandescent, provocative, biting, iconoclastic, and
The Untamed Tounge is a collection of stinging, often caustic, aphorisms, ribald definitions, wise reflections, and provocative metaphors
on some thirty topics. As usual, Szasz takes on the tough issues that other people tend to skirt: children and parents, disease, drugs, the
insanity defense, mental illness, psychiatry, punishment, religion, sex, suicide, and the therapeutic state, among others. His perspective is
really never that of anyone else's; Szasz is nobody's copy, but rather an original, par excellence. And he is a satirist without
peer—satirizing people, beliefs and practices that desperately need it.
Szasz uses humor to puncture the pomposity of his targets, beginning of course with the psychiatric professional establishment and its
medical model of insanity, but extending pretty much to everything else in society, too. Like a standup comic, his use of humor gives an
audience a totally new perspective on what is going on—a view that wouldn't have been obtained any other way. In The Act of Creation,
Arthur Koestler pointed out that humor, like discovery and art, is a creative process whose purpose is to discover hidden similarities by
operating on more than one plane at once. Humorists juxtapose two totally different things and discover a connection between them—a
connection that is not usually made. And that is Szasz's leitmotif. As Szasz himself writes, "Aphorism is to description as caricature is to
The Untamed Tounge runs the gamut from simple, one-sentence aphorisms to meditations several paragraphs long. A few items are
reprinted from his long out-of-print collections The Second Sin and Heresies, but the vast majority are new here. It would be impossible
to give a sample of some of the longer, more substantive entries, but here is a tiny sample of what is waiting for you between these
precious, provocative covers:
"In the United States today there is a pervasive tendency to treat children as adults, and adults as children. The options of
children are thus steadily expanded, while those of adults are progressively constricted. The result is unruly children and
"Treating addiction to heroin with methadone is like trading addiction to scotch with bourbon."
"Giving oneself addictive drugs is a crime. Accepting addictive drugs from a 'maintenance program' is a treatment."
"The Nazis had a Jewish problem. We have a drug abuse problem. Actually, "Jewish problem" was the name the Germans
gave to their persecution of the Jews; "drug abuse problem" is the name we give to our persecution of people who use certain
"Clear thinking requires courage rather than intelligence."
"The proverb warns that 'You should not bite the hand that feeds you.' But perhaps you should, if it prevents you from
"Sooner or later, every person must ask himself: What should I make of my life? Which is the same thing as asking: What
shall I make in it? One can make money, or machines, or food, or works of art, or children, or many other things. The person
who feels or finds that he doesn't want to, or can't, make anything at all, can always fall back on making trouble—the product
in which psychotics, psychiatrists, and politicians specialize."
"The plague of mankind is the fear and rejection of diversity: monotheism, monarchy, monogamy—and, in our age,
monomedicine. The belief that there is only one right way to live—only one right way to regulate religious, political, sexual,
medical affairs—is the root cause of the greatest threat to man: members of his own species, bent on ensuring his salvation,
security, and sanity."
"A person cannot make another happy, but he can make him unhappy. This is the main reason why there is more unhappiness
than happiness in the world."
"Mysticism joins and unites; reason divides and separates. People crave belonging more than understanding. Hence the
prominent role of mysticism, and the limited role of reason, in human affairs."
"Beware of the person who never says 'I am sorry.' He is weak and frightened and will, sometimes at the slightest
provocation, fight with the desperate ferocity of a cornered animal."
"'Homosexuality' is the name we give to the preference for sexual intercourse with members of one's own sex. Would calling
preference for marriage with members of one's own race and religion 'homoraciality' and 'homoreligiosity' make them mental
diseases? Would the members of the American Psychiatric Association vote on whether or not they are mental diseases?"
"Freedom is what many people want for themselves and few want for others."
These are, of course, but a tiny sample of what is contained in The Untamed Tonge. Sacred cows are slaughtered, treasured beliefs
overthrown, cliches crushed, and enemies of liberty unmasked. While he has an adult's seriousness of purpose, he has a child's sense of
delight—and he sees naked Emperors everywhere. This is Szasz at his best.
OUR RIGHT TO DRUGS The Case for a Free Market
Szasz makes a strongly moral case for a free market in drugs. He goes beyond many other advocates of legalization by calling for a
complete return to the 19th century policy full free trade, where anything from cocaine to morphine could be purchased at the corner
grocery store, or even through mail order. Szasz also calls for the abolition of our current prescription laws, arguing that physicians are
better in the role of guiding experts than in that of withholding parents. Szasz proves that our right to drugs is actually just a part of the
right to our own bodies, and that the War on Drugs is the health of the state!
CRUEL COMPASSION Psychiatric Control of Society's Unwanted
Giving some people power over others is commonly justified in the name of "compassion." Yet as Dr. Szasz demonstrates, "compassion"
is a cover for oppression. This is a fresh attack on psychiatrists who drug and incarcerate millions of Americans for noncriminal behavior.
The Inhumanity of "Compassionate" Compulsion (Review by Jim Powell, Novemeber 1995)
Giving some people power over others is commonly justified in the name of "compassion." Yet as Dr. Szasz demonstrates, "compassion"
is a cover for oppression.
More than three decades ago, Dr. Szasz first attacked the practice of taking away the rights of people labelled "mentally ill." Now he
unleashes a fresh attack on psychiatrists who drug and incarcerate millions of Americans for noncriminal behavior.
Dr. Szasz provides shocking historical perspective on the inhumanity of compulsion. He tells how 18th century English "reformers" like
Jeremy Bentham promoted rounding up indigent people in "poor houses," so they would be out of sight and under control. Dr. Szasz
talks about supposedly benevolent 19th century psychiatrists who urged that epileptics be forced into "therapeutic communities."
Although 20th century psychiatrists never had objective criteria for diagnosing schizophrenia, Dr. Szasz explains, they forcibly inflicted
dangerous treatments on people labelled schizophrenic. He reveals how psychiatrists, backed by the federal government, promote
Dr. Szasz expresses outrage at the long history of "compassionate" compulsion applied to children. He covers madhouses of the past. He
explains why, during the 1980s, the number of teenagers locked in madhouses soared almost 50%. He shows why hundreds of thousands
of children are incarcerated unnecessarily—and how even the New York State Commission on Quality Care for the Mentally Disabled
reports that three-quarters of children in the state's psychiatric facilities don't show any psychotic symptoms.
Dr. Szasz makes clear how psychiatrists possess more power than ever to subvert individual rights, with adults kept against their will in
state mental hospitals, Veterans Administration hospitals, community hospitals, general hospitals, private mental hospitals, children's
psychiatric units, nursing homes, alcohol and drug rehabilitation centers, forensic psychiatric facilities, jails and prisons, among other
Dr. Szasz articulates the refreshingly radical view that everyone, even people controlled by psychiatrists, should be treated as human
beings responsible for their actions and entitled to life, liberty and the pursuit of happiness.
"Dr. Szasz is a brilliant debater...his formidable writing talent is extraordinarily entertaining."
—New York Times Book Review
"This book will delight the lawyer by its brief-like style, and the non-lawyer will be attracted by the use of trial transcripts which
lend both the suspense and tension of courtroom drama." National Review
(reviewed by Roy A Childs, Jnr, November 1989
Over the past few months, in preparation for writing on some of the major libertarian figures of our times, I have been reading or
rereading the most significant works of many of them, including Thomas Szasz. In the process, I have become something of a Szasz
fanatic, and have been waging a minor crusade to get people to come to grips with this most remarkable thinker.
Champion of Freedom
Szasz has the courage of Patrick Henry, the audacity of Lysander Spooner, and the passion for clarity and for justice of Ayn Rand. He
has been as tenacious in his dedication to his life's work—he will turn seventy this year—as Ludwig von Mises and as concerned with the
subtleties of argument as F. A. Hayek.
He is, moreover, an uncompromising crusader for individual liberty, and the foremost advocate in this century for the importance of
pressing the rule of law against the claims of the therapeutic state. On issue after contemporary issue, his has been a lone voice, fighting
in the cultural darkness for the illumination of reason.
Why, then, isn't he as lionized and appreciated today by libertarians as, say, Milton Friedman or Thomas Sowell?
The answer, clearly, is that some people are made uncomfortable by his subject matter: mental illness. Involuntary mental hospitalization.
Commitment without trial. Drugs. Madness. Insanity. The therapeutic state. Most people hope that the principles he defends and the
issues he raises will never apply to them. They fear that if they do, they may never be heard from again.
And with some justice! But what they should realize, also, is that if it does happen to them and they are heard from again, it will probably
be because of Szasz's work.
Statism run amok
Psychiatric Justice is a perfect example of this sort of work. It combines a treatise on law and psychiatry with case histories,
recommendations for reform, and a bitter polemic against statism run amok. The specific subject matter is the use of psychiatry as a
means of denying a person a constitutional right: the right to stand trial. I hadn't realized how common—and how outrageous—this
practice was until I read Szasz's book.
One of the four case histories will summarize what is going on—it's like reading a hair-raising short story, with Szasz as the hero, but with
a tragic ending. It is the case of "Louis Perroni." A simple man, a gas station owner, his lease was up and the owners of the property
refused to extend it because they wanted to erect a shopping mall. He gave the owners trouble because they tried to "push him around,"
and he was arrested. But he was never brought to trial. As the courtroom scene—reproduced through an edited transcript—opens,
Perroni has been held for seven years because of this scuffle, without trial, because two pathetic psychiatrists, having apparently taken a
dislike to him (his shoes were untied; he had a day's growth of beard; he refused to answer certain questions about the charges on the
advice of his attorney), decided he was unfit to stand trial.
Seven years without a trial. But the outrage will really build up as you read the transcript, and witness the flimsy grounds upon which
psychiatrists are allowed to advise such treatment. Szasz then appears on the scene and sifts ruthlessly through the evidence, making the
case that in any normal use of the terms, Perroni is obviously fit to stand trial and to assist with his own defense.
But to no avail! As the transcript ends, he is once again confined to custody in a mental jail, on the flimsiest of evidence of an obviously
Szasz defends the right to stand trial as a fundamental constitutional right, dissects the heinous role of psychiatry in routinely violating this
right, and looks at the legal perspective behind the whole shameful mess. His case histories—three of the cases involved his own
participation; the fourth was that of the late Gen. Edwin Walker—are riveting and eye-opening, his analysis splendidly lucid, his passion
for justice evident in every paragraph.
Before I picked up Psychiatric Justice I had heard little about it, and assumed it was one of his minor works. Not so! It is a fine example
of Szasz at his best, analytically, rhetorically, and in every other way. Syracuse University is doing a wonderful job issuing this series of
The Collected Works of Thomas Szasz, and it makes collecting Szasz a pleasure that everyone can afford. Contains a new afterword by
IDEOLOGY AND INSANITY Essays on the Psychiatric Dehumanization of Man
(reviewed by Roy A Childs, Jr, February 1991)
Ideology and Insanity is the tenth book in the handsomely-bound uniform paperback edition of the Collected Works of Thomas Szasz
now being published, each with a new preface by Szasz. For me, at least, this is a real thrill—it is the first time the works of a major
libertarian thinker have been brought together in a single, convenient, uniform edition.
Ideology and Insanity sticks more with psychiatry and insanity proper—his chosen fields, to which these essays provide outstanding
introductions and surveys.
Now, please DON'T TURN THE PAGE! One of the things that continually puzzles me is that when Szasz writes on these areas, he
makes people uncomfortable, and they tend to avoid him. Translation: they make jokes, and don't buy or read many of these books.
Why? Are they afraid of the murky issues surrounding insanity and mental illness? Do they think they are secretly nuts?
The paradox is that Szasz has spent his entire professional life trying to demystify, clarify, and explain these issues. He is the solution, not
the problem. I have found that the more I read of Szasz, the more sense he makes, and the less these issues "bother" me, on one
level—i.e. make me uncomfortable—and the more I grasp their importance in the wider scheme of things, as well.
What we have to understand is that in today's world, psychiatry and its central concepts of insanity and mental illness are key concepts in
a struggle that is really ideological. They are part and parcel of a struggle to define the nature of man, to overthrow concepts like
"choice" and "responsibility," and replace them with medical, "scientific," and behavioristic alternatives.
For Szasz, "the language of psychiatry... de-ethicizes and depoliticizes human relations and personal conduct. In much of my work I have
sought to undo this by restoring ethics and politics to their rightful places in matters of so-called mental health and mental illness. In short,
I have tried to re-ethicize and repoliticize the language of psychiatry." It is really that straightforward!
Consider some of Szasz's claims:
"'Mental illness' is a metaphor, and a bad one; we all have problems in living, and some of us may
even—traumatically!—have brain diseases. But problems are not the same as diseases, nor are they necessarily the result of
"'Insanity' is a legal concept, not a medical one; it has its basis in ideology, not medicine."
"Modern psychiatry has is often not a means of helping people deal with problems, but a means of restricting their liberty, and
is thus in league with the state."
"Psychiatry uses its false ideological claims to undermine morality and moral responsibility. It gets innocent people committed
to institutions and guilty ones 'off'—'by reason of insanity'."
"Involuntary mental hospitalization of someone who has committed no crime, or harmed no one, is itself a crime against
The foremost task of Thomas Szasz, as he sees it, is to defend human dignity and individual liberty against the physical force and
ideological fraud of politics and psychiatry. Ideology and Insanity, first published more than twenty years ago, contains thirteen of his
best essays on these themes, with very little overlap. The writing is incandescent, the cause one that deserves to triumph.
THE THEOLOGY OF MEDICINE
Eleven of Szasz's best essays plus the full text of a wide-ranging interview with The Humanist. Includes "The Moral Physician," "The
Ethics of Suicide," and "Justice in the Therapeutic State."
(reviewed by Roay A Childs Jr., October 1990)
Thomas Szasz is one of America's most courageous men, and one of our best writers, as well. For more than thirty years he has been
waging a one-man war against the Paternalistic State and the rhetoric it uses to manipulate and control us "for our own good."
The Therapeutic State
His special targets have been the abuses of modern psychiatry and related disciplines, as he has done battle with involuntary mental
hospitalization, the drug laws, indeed, all aspects of what he has called the Therapeutic State.
National Review once called him the silver bullet of American libertarianism, and the metaphor is an apt one: Szasz strikes at the heart
of hypocrisy and sham of those who would deny our dignity and humanity. Contrary to the opinions of those who haven't read him, he is
no enemy of psychiatry per se, or of modern medicine; he simply sees no reason to enshrine them at taxpayer's expense, or enforce their
beliefs and values at the point of a gun.
Some years ago, in an interview with The Humanist, Szasz defined his key value as "individual self-determination or freedom, in a
political sense. After all, freedom is an issue only when it is threatened by a person, a group, an organization, or some force. I have tried
to identify what the principal forces are that now threaten individual freedom."
Thomas Szasz has relentlessly pursued these goals in literally hundreds of articles and in so many books—nineteen so far, with more
coming—that it is often difficult to keep up with him. As is often the case with intellectuals that prolific, some people who want to
acquaint themselves with his views are intimidated by the sheer mass of material, and don't know where to begin.
A perfect overview
The perfect introduction to Szasz, and overview of his work, is The Theology of Medicine, a collection of eleven of his best essays plus
the full text of that truly remarkable and wide-ranging interview with The Humanist, which touches on many of his basic themes.
As a polemicist, Szasz is unmatched. His style is pithy and direct, he is a master of counterpoint and parallel construction, and he is as apt
at using appropriate metaphor as he is at dissecting false ones. And his care with language is a key to his effectiveness. Paternalists often
hide behind obfuscation, and their greatest enemy is clear thinking. Which makes Thomas Szasz a powerful enemy indeed.
As well as a pleasure to read. The Theology of Medicine is such a wonderful collection because all of his virtues are present in
abundance, and the selection of essays is such that here we have most of his major themes introduced in a particularly powerful fashion.
His book Ceremonial Chemistry, for example, is one of the great books on the drug problem, but Theology contains a superb essay,
"The Ethics of Drug Addiction," that is not only perhaps the best single essay on the problem ever written, but also a sort of condense
overview of Ceremonial.
"The Moral Physician" and "The Moral Justification of Medical Interventions" are full-scale examinations of the moral dimensions of
medicine and treatment, the responsibilities of physicians, and their proper social and political roles. "The Illogic and Immorality of
Involuntary Psychiatric Intervention: A Personal Statement" presents the essentials of his views on this touchy subject, an area where
Szasz was a pioneer.
"The Ethics of Suicide" is a defense of individual sovereignty and self-ownership, and provides a controversial defense of the right to end
one's own life. "Justice in the Therapeutic State" again tackles the tough moral-political dimension of medicine and therapy, while "The
Right to Health" is a truly scintillating libertarian dissection of this pernicious notion and its consequences.
The Theology of Medicine, like Szasz's work in general, is more interesting than most libertarian works because he deals with issues
others leave untouched, and does so with the gloves off. And they include some of the most important and controversial issues of our
time. If you're not already acquainted with his work, grab Theology and you'll get a solid dose of the master iconoclast at work; if you
are, you won't need any encouragement from me. The interview from The Humanist is itself worth the price of admission; the rest is
THE ETHICS OF PSYCHOANALYSIS The Theory and Method of Autonomous Psychotherapy
"A wonderfully insightful book that sets out a fully developed theory of therapeutic relationships of all sorts, and of the moral vision
that should encompass them." Roy A. Childs
(reviewed by Roy A Childs, October 1990)
When Thomas Szasz first burst into public awareness in 1961 with the publication of The Myth of Mental Illness and Law, Liberty and
Psychiatry, he was quickly labeled a critic of psychiatry. As is often the case with such labels, this was a half-truth at best. In fact, Szasz
has always been a critic of only certain kinds of psychiatry: namely, involuntary psychiatric relationships and special legal privileges which
give psychiatrists the power to abuse the liberties of their patients.
Uses and Abuses of Psychiatry
As Szasz himself says of the "anti-psychiatry" label: "This is not so. I have always considered a decent dialogue between a troubled
person and a mental healer (now called `psychotherapy') to be a worthwhile, indeed an important, human service." To clarify these
positive views, he set out in 1965 to write The Ethics of Psychoanalysis, now handsomely reprinted as part of Szasz's "collected works"
by Syracuse University. And wouldn't you know it: it only succeeded in still further alienating the psychiatric community.
While Ethics is something of a critique of psychoanalysis and other forms of psychiatry, it consists much more in Szasz's own unique
vision of psychotherapy. Many people seek psychotherapy or psychiatric help; few reflect beforehand on what they expect to get out of it
and, as a result, too many don't get anything out of it at all. Or their problems get worse. This is a documented fact that too many
therapists duck or avoid.
Reading The Ethics of Psychoanalsis is mind-opening. Szasz is one of the few psychiatrists who puts therapy in its widest perspective.
"Only yesterday," he writes, "psychoanalysis [i.e., psychotherapy as a whole] held high promise for the liberation of Internal Man, as did
the Open Society for the liberation of External Man. Both are aspects of modern Rationalism and Individualism. Together they have
sought and still seek to nurture the Autonomous Personality and the Free Society....Why do I place so much emphasis on autonomy?
What is the special merit of this moral concept? Let us define what we mean by autonomy, and its value will then become evident.
Autonomy is a positive concept. It is freedom to develop one's self, increase one's skills, and achieve resonsibility for one's conduct. And
it is freedom to lead one's own life, to choose among alternative courses of action so long as no injury to others results....In modern
society, based more on contract than on status, the autonomous personality will be socially more competent and useful than its
heteronomous counterpart. Moreover, and very significantly, autonomy is the only positive freedom whose realization does not injure
An Ethic of Therapy
For Szasz, therapy should aim to liberate one from the confining effects of one's own neuroses, and lead to the freedom to achieve
positive things in life. His concern with autonomy, individualism, freedom and the society of contract rather than the society of status—a
classical liberal distinction upheld by writers from Sir Henry Maine to Isabel Paterson—naturally leads him to develop a full-fledged ethic
of therapy compatible with this classical liberal or libertarian paradigm. Thus his continual focus throughout the years on voluntary,
consensual therapeutic relations instead of coercive ones, on therapy as emerging properly from contract and not from superior legal
status. His discussion of contract and agreement in the therapeutic relationship is a classic in its field.
The Ethics of Psychoanalysis is one of Szasz's most important books because it defines the moral perspective from within which he has
worked over the past quarter of a century, the approach that has made him one of the leading figures in his field, as well as one of the
most controversial. But it is more than that—it is a wonderfully insightful book that sets out a fully developed theory of therapeutic
relationships of all sorts, and of the moral vision that should encompass them.
For those who value autonomy, individualism, and personal liberty, as well as the political freedom without which they cannot function,
The Ethics of Psychoanalysis is a milestone. And, as with all of Szasz's amazing works, reading it is a pleasure. What a master!
LAW, LIBERTY, AND PSYCHIATRY
Early, path-breaking essays grouped in five broad sections: "Psychiatry as Science," "Psychiatry as a Social Institution,""Psychiatry and
the Criminal Law," "Psychiatry and Constitutional Rights," and "Psychiatry and Public Policy." Rigorous discussions of Szasz's core
(reviewed by Roy A Childs, Jr., October 1990)
To many people, Thomas Szasz is something of a puzzle. Why should this be so?
Think of him this way: Szasz is a social scientist specializing in psychiatry who approaches everything as a classical liberal. His primary
concern is individual liberty, to which he is willing to subordinate a great deal, even health. No, he is not an opponent of psychiatry; he is
an opponent of coercive psychiatry, which he sees as using base rhetoric to dehumanize human beings, absolving them of both their
humanity and their sense of moral responsibility.
A sane interpretation
He is also known as an opponent of the concept of "mental illness," which he regards as archaic, but here too people misinterpret him. He
isn't saying that no one is crazy. He merely insists that "mental illness" mixes two different things: organic illnesses like brain diseases, and
non-organic problems of living that we all face to a greater or lesser degree. Not all problems are reducible to "illnesses," and if we fall
into that reductionist trap, we rob ourselves of our human dignity.
Law, Liberty, and Psychiatry is one of Szasz's early works, a collection of nineteen essays on related subjects, and is now available in
the uniform edition of the Collected Works of Thomas Szasz from Syracuse University Press.
The Theology of Medicine is, I think, the best introduction to Szasz's work, but Law, Liberty, and Psychiatry should be the next step in
any survey of this master's writings. These earlier essays are more rigorous than those coming later, a little less polemical, and more
concerned with Szasz's core values. In any case, they are pathbreaking, sizzling essays, grouped in five broad sections:
1. "Psychiatry as a Science" contains three major essays, including the definitional "What is Mental Illness?" These all clarify his
basic approach, and contain his most succinct statements of his overall point of view.
2. "Psychiatry as a Social Institution" contains such essays as "Commitment of the Mentally Ill" and "Commitment, Power and
Social Action." Here Szasz deals with the development of psychiatric attitudes to "mental commitment" over the decades, and with
the evolution of psychiatry's relationship with the law nad the powers of civil commitment.
3. "Psychiatry and the Criminal Law" deals with the problems of crime and "mental illness," particularly the issues of responsibility,
and both punishment and acquittal. There is a superb survey of the relevant literature contained in this section, and three other juicy
4. "Psychiatry and Constitutional Rights" will appeal to anyone interested in the issues of individual rights and legal theory.
Particularly intriguing here is Szasz's resurrection of Sir Henry Maine's distinction between the society of status and the society of
contract, showing how it does—and should—apply to his fields.
5. "Psychiatry and Public Policy" contains two summary essays and two case studies, which illustrate his framework's applicability
to specific cases.
Why is all this important? Because we are fast reaching the day when the concepts of choice and morality and responsibility have been
obliterated and replaced by concepts of "addiction" and mental "health" and "sickness" and the universality of "treatment." If we are going
to fight this trend, we have to understand it. And no one helps us better here than Thomas Szasz. He is really a marvel.
PAIN AND PLEASURE A Study of Bodily Feelings
"It seems to me that man's essential nature at once bodily and mental, material and spiritual is displayed most universally through the
mask of pain and is most easily unmasked when it is so disguised."
(reviewed by Roy A Childs, Jr., October 1990)
Pain and Pleasure was Thomas Szasz's first book, originally published in 1957 and revised and expanded in 1975. At first blush it looks
like something outside his normal range of interests, but upon reflection it's easy to see that this isn't the case.
Szasz's early work was scientific, but it always stressed epistemological considerations; specifically, the relationship between language and
reality. Writing Pain and Pleasure, he says, "was a necessary stepping-stone—as I even then dimly realized—to my writing The Myth of
Mental Illness, which, by alienating me from psychiatry, freed me to be myself." By engaging in a serious study of the ambiguities
contained in the concepts of pain and pleasure, and even hinting at the philosophical, religious, and sociological dimensions of the
concepts, Szasz set the stage here for nearly everything else he has written. In this sense, Pain and Pleasure bears the same relationship
to the rest of his work that Hayek's The Sensory Order bears to his.
The Hayekian Parallels
The comparison to Hayek is apt in another sense, too. Like Hayek, Szasz is very concerned with the subtleties of argument, and there is
a sense in which his entire body of work is one extended argument, contained in all his books and articles combined, rather than in any
one place. This means that fully understanding him takes time and study, even if any one book is relatively self-contained and enjoyable
in its own right.
Pain and Pleasure, then, is the book that, by dealing with foundational issues, launched Szasz's career and enabled him to explode upon
the public consciousness with such vivid masterworks as The Myth of Mental Illness, The Manufacture of Madness, Ceremonial
Chemistry and Insanity. It is thus required reading not only for any Szasz fan, but in this case also for anyone who regards the concepts
of pleasure and pain as simple, self-evident and essentially unalyzable. Utilitarians and hedonists, take note!
Pain and Pleasure is divided into two broad sections, dealing with two broad issues, and each section delves into both technical and
symbolic issues. Before covering the psychology of pain, Szasz discusses "The Mind-Body Problem in the Light of the Philosophy of
Science," discussing along the way the nature of physics and psychology and the relationship between brain and mind, and offering a
careful clarification of the basic concepts involved. A key point here is the distinction between feeling pain oneself, being aware of
someone else's pain or communicating one's own pain to someone else, and the more symbolic, social, and communicative aspects of
expressions of pain in a social setting. There are worlds of differences between these three aspects of pain and its expressions. The later
sections on pleasure are just as far-ranging, although Szasz points out that pleasure is somewhat more complicated than pain.
The role of values
Typically, Szsaz discusses the symbolic and religious aspects of his subjects at some length. For example, he points out that "in modern
American and European culture, the social orientation toward pain is characterized by two opposite attitudes. According to one, pain is
considered to be bad, and as such it is to be combated and, if possible, removed" According to the other, "pain and suffering
indicate...that we are good or are trying to be good." Likewise, "our cultural attitudes toward pleasurable experiences also contain many
complicated and arbitrary value judgments."
Pain and Pleasure debunks many popular and scientific myths about pain and pleasure, and looks at how they function in the value
judgments and systems of meaning adopted by both individuals and by societies. Szasz discusses issues as diverse as self-mutilation,
sexual satisfaction, "hysterical anesthesia," false pregnancy, laughter, homosexuality, and dream analysis.
THE MYTH OF MENTAL ILLNESS Foundations of a Theory of Personal Responsibility
The revolutionary work that has become a classic. A fundamental challenge to conventional ideas about mental illness.