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Symposium Materials:

· Symposium Program

· Upstate Update

· A Letter from Azerbaijan Psychologists

· Greetings from the Department of Psychiatry by Mantosh Dewan, M.D.

· "Forty Years of Consequences."
Remarks by Nelson Borelli, M.D.

· "The State's Insatiable Need to Incarcerate Those Who Frighten It."
Remarks by George J. Alexander, JSD

· "Psychiatry's Moral Anchor"
Remarks by Robert Daly, M.D.

· "Electroshock -- Epitomizing the Myth."
Remarks by John M. Friedberg, M.D.

· "Thomas Szasz's Personalist and Ethical Conception of the Cause and Cure of Character, Conduct, and Conflict."
Remarks by Zvi Lothane, M.D.

· "Therapeutic Paternalism in Australia: A Szaszian Critique of Repetition Strain Injury (RSI)."
Remarks by Professor Robert Spillane

· "Thomas Szasz: Rhetoric and Mental Illness."
Remarks by Richard Vatz, Ph.D.

· "Thomas Szasz's Impact on Political Issues: Two Examples from Germany."
Remarks by René Talbot

· "Some Recollections of a Psychiatry Resident-in-Supervision with Professor Thomas S. Szasz, M.D."
Remarks by Laura W. Neville, M.D.

· Introduction Letter
· Accommodations
· Registration Form
· Driving Directions


Some Recollections of a Psychiatry Resident-in-Supervision with Professor Thomas S. Szasz, M.D.

Laura W. Neville, M.D.
Cotuit, Massachusetts

In awe of Professor Szasz, as were most of my fellow Residents, I had been warned that he could be abrupt at times; one of them had been ordered to "get out" of his office when he'd been arguing with him. He didn't tolerate "rudeness," I was told. I finally got the nerve in my second year to ask for him as a Supervisor; I was in luck and assigned to him for my last two years of training. It was a treat.

As he opened the door of his office he looked to me to be about 10 feet tall, dressed all in black (in those days, though this changed later). He would sit at the far end of his office from where I sat on a couch, solemnly sipping tea from a very large mug. I would barge ahead relating my cases from my notes; he listened quietly, attentively, nodding occasionally. He'd think for a bit, then pop out with a brief sentence or two which seemed always to go right to the heart of the matter. Sometimes he would simply suggest a passage to read from a book or the book itself. Once he said, "read Adler." "Read Adler? Which, what?" I'd ask. The reply was just "read Adler." Another time he said, "read Fanny Hill." I was startled, as it seemed out of context. "Fanny Hill?" I exclaimed, not yet used to his Hungarian accent. "Yes," was the answer: "F-E-N-I-C-H-E-L . . . Otto Fenichel!" Always the suggestions turned out to be exactly right for the particular situation or patient/client I had been describing.

These readings were often not from Psychiatric literature; he said to me, as well to others in seminars or teaching conferences, that the best Psychiatry/Psychology is learned from the great novelists, not from textbooks. He would refer us to Tolstoy, Chekhov, Dickens, Shakespeare, etc. Once, when I was fretting about some work in Family Therapy he referred me to "The Way of All Flesh" by Samuel Butler. He said that he had read it soon after coming to this country and that it had "blown him away," that he grasped immediately the futility of any such things as "Family Therapy." I rushed out to buy the paperback, read it, and saw exactly what he meant. I can't tell you how much that helped me in later years and kept me from despair over certain difficult situations with my own patients' families.

I selected carefully the patients I chose to have him supervise. I brought only those with whom I thought I could work without medication or hospitalization. He claimed to me and to others (I think he has written this) that his own patients/clients usually selected him because of his approach, so he did not run into situations where medication and/or hospitalization were involved. He said that he always made sure his clients knew immediately that he did not "take care" of them, give medicines or send them to a hospital, etc.

One young woman assigned to me in the out-patient clinic was a newly-wed who had grown up in a strict Orthodox Jewish family. She was depressed and anxious in her marriage because of anorgasmia, in fact, she said she felt "totally numb (sexually) from the neck down." After I described all this to Dr. Szasz he just smiled and said, "of course, to her it's like eating PORK! She may improve, but I'd guess it would take 10 years on the Couch!" I understood and kept chipping away with that in mind, and she was able to make some small progress before we had to leave each other. Her childhood had been austere, and once when she had described having had a lovely time in the park flying a kite, Dr. Szasz looked surprised and said, "that's mashuga!" I new enough Yiddish to understand that and disagreed with him right off, telling him that I, too, liked to fly kites on the beach at the Cape, "for goodness sake!" He laughed. "I thought you didn't believe in 'crazy,'" I teased, and he laughed at that, too.

At the end of my Residency when I was working on termination issues in the out-patient clinic with a young man who had been diagnosed as a paranoid Schizophrenic, I became very anxious when the positive psychotic transference switched suddenly to negative transference and the man said he was going to go kill his mother. I understood, naturally, how angry he was at me for leaving him, but I didn't know just what my responsibility was. My supervisor for this case was out of town, so I grabbed Dr. Szasz in the hall asking if he would help me on this. He took me into his office and listened to the case. "What do you think you can do?" he said. "It's not your problem. If he kills his mother, the police will get him." I quoted the Tarasoff court decision, etc., but he was adamant about my own role in this. I think he may also have thought the young man wouldn't really do it (from my recounting of the case). I gritted my teeth, told myself that I had asked for help, and made the appropriate notes in the chart. When the young man appeared for our next appointment with a suitcase, packed, ready (on his own decision) to go into the hospital, I admitted him immediate to our Psychiatry in-patient unit. Thus, I guess I ducked the issue, but Dr. Szasz remained consistent with his philosophy.

Later he did admit to me that under certain circumstances he believed a brief involuntary hospitalization would be justified in order to rule out any possible contributing medical problems. He showed great interest in the physical health of my patients, asking for medical details, what medications they might be on and what dosage.

Once I recall complaining that a patient seemed mainly to intellectualize in our sessions, and I wondered how to get her to let out more feelings. He replied, "ah, but the intellectual material here is AFFECT-LADEN!" I wish I had written down all his bon mots. Most of them are scattered throughout his books, some of which have a lot of funny material, I think . . . especially the little paperbacks: "Second Sin" and "Heresies." Also the book "Sex By Prescription" for which he had let me provide a very small amount of suggestion and for which he asked me to proof-read the galleys. I did so with some anger (in the midst of my laughter) becaue I was right in the middle of studying for my "Boards" at the time. He appeared to love irony and oxymoron, saying and writing some things with "tongue-in-cheek," I think. I disagreed with him vigorously from time to time on what I thought were hyperboles . . . he'd tell me not to be so literal. He told me also that I was not "paranoid enough" and later, while studying Psychology testing, I took the "MMPI"; sure enough, my score on paranoid was way down below "normal," whatever that means. (I took it to mean partly that I had been too gullible, and I tried to make adjustments in my practice.)

In all my observations of Dr. Szasz's approach to patients, students, colleagues, I was impressed by the way he maintained courtesy and respect. Even when I had heard him refer to a colleague in town as "a Crook," I saw him shake that person's hand at a conference and treat him with courtesy. And after he had written and spoken scathing remarks about one sub-specialty of Psychiatry I saw him in close friendship with a practitioner of that particular sub-specialty. When I asked him about it, he merely replied, "haven't you heard of compartmentalization?"

He had what I consider a true sense of humor in that he could laugh at himself. At our annual Spoof-of-the-Faculty skits during the departmental Christmas party, he always attended and laughed loudly at all the spoofs, including the ones about himself.

Here are the lyrics I wrote one year to the tune of "Man of La Mancha." One of the male Residents sang it, dressed as Don Quixote.

"Hear me now, oh thou wretched Psychiatry world,
Thou art base and debauched as can be.
And a Knight, with his manuscript bravely unfurled,
Now hurls down his gauntlet to thee!


I am I, Don Thomaso, the
Lord of All Ethics,
Destroyer of Evil am I.
And I march to the sound
Of Autonomous trumpets of freedom
To conquer or die.

Hear me, doctors and lawyers and psych-o-logists,
All your Medical Models are past.
For Religious endeavor is now to begin,
And Commitment shall vanish at last!


I am I, Don Thomaso, the
Lord of All Ethics, --
My publisher calls, and I go.
And old Plato's Republic
Will carry me onward
To Bury Psychiatry now!?

--Laura W. Neville

Copyright 2000, Laura W. Neville, MD

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