HomeIntroductionSzasz MaterialsDebatesLinks/Related Items

Selected M.E. Grenander Materials:

The fourfold way: Determinism, moral responsibility, and Aristotelean causation.
published in:
Metamedicine, Vol. 3, 375-396. (1982).

Science, Scientism, and Literary Theory.
published in:
Annals of Scholarship, 2 (No. 3), 65-84. (1981).

Benito Cereno and legal oppression: A Szaszian perspective.
published in:
Journal of Libertarian Studies. Vol. 2. No. 4, pp. 137 - 342. (1978).

"Of Graver Import Than History: Psychiatry in Fiction"
published in:
Journal of Libertarian Studies, 2: 29-44.

BOOK REVIEW - Pull Down Thy Vanity: Psychiatry And Its Discontents
published in:
Political Psychology, Vol. 6, No. 3. (1985).

Book Reviews: Thomas Szasz, Sex by Prescription
published in:
Journal For The Humanities & Technology, 3 (1981), 39-42.

M.E. Grenander letter regarding Szasz Web Site

[Note: This review was donated to the Szasz Site by M.E. Grenander shortly before her death. Copyright Journal for the Humanities & Technology, 1981.]



Thomas Szasz, Sex by Prescription
Garden City, New York: Anchor Press/Doubleday, 1980. $10.95.



 	This book adds yet another chapter to Professor 
Szasz developing oeuvre: an analysis of and an attack 
on the continuing attempt to insinuate moral values 
and social policies into the body politic under the 
guise of medical diagnoses and treatments. His 
particular focus here is on sex, which he himself 
regards as a profound personal interaction between two 
people that satisfies a, basic human need and that 
involves a deep commitment on both their parts. 
Celebrated as love throughout human history, it can 
and does reach spiritual heights which may transcend 
the mere release of physiological tension. But the 
sexologists he describes as peopling the contemporary 
scene discuss it in the vocabulary of medicine. 
Epithets like impotence, premature ejaculation, and 
anorgasmia (the modish term for what used to be called 
frigidity) convey an aura of pathology. Such a 
judgment, however, is culturally conditioned. 
Particular kinds of sexual behavior, whether 
undertaken alone or with someone else, may be pleasant 
or unpleasant, good or bad, reflecting the 
individual's tastes, attitudes, morals, and ethical 
standards. But they are neither diseases nor 
treatments. As a quasi-theological social enterprise, 
medicine throughout its history has swayed like a 
pendulum with regard to sex. Accordingly, in Szasz¹s 
view we should "erect a wall between medicine and the 
state maximally impervious to the rhetorical 
incantations and financial temptations of each 
directed toward the other." Under the rubrics of 
"sexual medicine" and "sex education," he therefore 
takes apart the new-fangled discipline of "sexology."

	His concern with "sexual medicine" has nothing 
to do with venereal diseases like gonorrhea, which are 
indeed legitimate grounds for medical interventions, 
but rather with sexual dysfunctions expressing 
someone's life-style, with the individual 
participating actively in both their diagnosis and 
their treatment "Sex therapy" therefore resembles 
learning more than medicine. Szasz describes how the 
modern concern with sexual medicine fails to relate 
sex to the self, then with a broad brush sketches the 
ways in which physicians, with the rise of science in 
the seventeenth century, began to displace priests as 
the experts on sexual behavior, wielding disease 
instead of sin as their symbol of control. He traces 
the medicalization of sex through such historical 
figures as Benjamin Rush, Jean-Etienne Esquirol, 
Richard von Krafft-Ebing, and Sigmund Freud (who 
considered squeezing blackheads to be a form of 
masturbation). In Szasz's view, psychoanalysts even 
today regard unconventional sexual behavior as an 
illness which they are especially adept at diagnosing 
and treating, with Karl Menninger still claiming that 
masturbation is psychologically harmful, and Charles 
Socarides defending the disease concept of 
homosexuality, despite its deletion in 1973 from the 
American Psychiatric Association's official list of 
mental illnesses. For the most part, however, 
physicians now regard sex not as disease but as 
medical treatment, bestowing their approval on 
behaviors like female sexuality and masturbation that 
were formerly considered pathological.

	For Szasz, the paradigm theorists of sexual 
medicine are Masters and Johnson, naive moralists who 
pretend to be value-free scientists. They reinvented 
the wheel by observing in impersonal, bureaucratic, 
and pompous prose that sexual arousal causes erection 
in the male and vaginal lubrication in the female; 
interaction in this condition results in a pleasurable 
release of tension. The ecstatic media response to 
such banalities can be attributed to pornography's 
enduring appeal, especially when it is respectably 
medicalized. While posing as sexual egalitarians, 
Masters and Johnson in fact use different standards 
for treating men and women, and for treating 
homosexual and heterosexual couples. As described in 
Szasz¹s mordant prose, their clinic seems to differ 
little from a high-class bordello. Hence it is not 
surprising that prostitutes, wanting to get in on the 
"sex therapy" act, have updated their ancient 
profession to a remarkable degree, with their services 
even subsidized occasionally by the taxpayer in 
America, England, and Germany. Since the Masters and 
Johnson clinic and its numerous epigones are very very 
expensive, costing seven or eight times as much as 
psychoanalysis, the taxpayer could even be getting a 
bargain by underwriting the relatively cheap fees of 
the hooker. The real problem, of course, is that the 
state has no business intervening in the sexual lives 
of its citizens. But regardless of who foots the bill, 
since most sex therapy clinics are at universities and 
hospitals, the academics may be on to something almost 
as good as a winning football team to far as balancing 
the budget is concerned.

	Sexual surgery, like prostitution, goes far back 
in time, beginning with circumcision of the Jews (who 
copied it from the Egyptians). Throughout the 
nineteenth century, brutal operations on both male and 
female genitalia were imposed in order to cure the 
dread disease of masturbatory insanity. But today's 
sexual surgeon is handier than ever with his knife,
turning men into imitation women with artificial 
female genitalia; and, to a lesser extent, turning 
women into *imitation men with artificial male
genitalia. The zaniness of even these operations, 
however, is exceeded by those now being performed on 
impotent men in order to give them artificial 
erections, either permanent or temporary. The patient 
could have silicone rods implanted in his penis, with 
the result that he has to wear a jock strap to hide 
his condition when he does not want to use it. Or
he might opt for a "hydraulic prosthesis," consisting 
of two cylinders in his penis connected to a little 
reservoir in his abdomen; he squeezes a pump in
his scrotum to create an erection. Women are not 
supposed to know about this gimmickry, whose 
therapeutic effect is apparently based on deceiving
the female. The reader who recalls Faulkner's 
Sanctuary can only share Szasz's wonder at this 
surgical updating of Popeye's corncob.

	Sex education, like sexual medicine, is a vast 
meadow in cloud-cuckoo land. It, too, has ancient 
historical roots, in the Jewish, Christian, and
Moslem religions, each having promoted its own sexual 
ethic. Modern sex education, however, is in the hands 
of the medical profession. Mary Calderone, M.D. (who 
was furious when this book appeared), is the guru
of sex education for children and youths, operating 
through her Sex Information and Education Council of 
the United States (SIECUS). Sex education in the 
public schools is now omnipresent; despite 'its 
pretensions to medical objectivity, it has replaced 
biology and ethics with a sexual ideology many people 
find offensive, and illegitimate pregnancies among
teenage girls are on the increase. In the medical 
schools, however, sex education becomes low comedy, if 
not farce: pornographic movies are shown with multi-
media pizzazz to groups of students in conjunction 
with their sexual partners. Once they get their 
degrees, the physicians continue with tax-deductible 
postgraduate sex education, which consists either of
Masters and Johnson methods cloned at various 
universities or, alternatively, cruises and resort 
vacations laced with pornography and casual sex. Szasz 
criticizes such practices not only for their dubious
educational value, but because they tend to loosen the 
physician's sexual morality. He characterizes as 
"intellectual bankruptcy compounded by moral 
paralysis" the rationalizations of those medical sex-
educators, - including clinical psychologists, who 
justify their sexual abuse of both female patients and 
female students as therapy

	The general thrust of Szasz¹s argument is clear. 
Yet he has little to say about the obvious topics of 
birth control and abortion. For example, he fails to 
engage the question of whether the popularity in the 
nineteenth century of a surgically induced menopause 
among women whose average age was only thirty may not 
have been due to its having been a form of permanent 
birth control. Moreover, although he opposes 
compulsory sterilization and compulsory abortion, he 
does not indicate whether he is also against 
compulsory pregnancy, even when it results from rape 
or, incest. Given America's current social ambience, 
this seems to be a far greater danger. On the other 
hand, he has certainly given us the-relevant principle 
concerning the individual's right to express personal 
sexual values. Freedom, he says, implies the 
responsibility of everyone "to confront his own sexual 
nature; to relate it to his vision of himself; and to 
construct and conduct ... a sexual life that is 
genuinely his own." The 'obvious biological and 
cultural" conditions of women's lives make such 
choices for them even harder than for men. Judging 
various types of human sexual acts (apparently 
including those which involve attempts to avert or 
terminate pregnancy, although he does not say so) to 
be "legitimate or illegitimate, much less prohibiting 
them by means of criminal (or mental health) laws, 
falls outside the proper scope of government." This 
passionate commitment to the individual's own deeply 
internalized values informs the entire book. It is 
perhaps quibbling, then, to wish that Szasz had 
confronted more squarely the spectre of compulsory 
pregnancy which looms on the American horizon.

	Be that as it may, he believes that the issues 
he has discussed are problems of political philosophy, 
not of medicine, and that the answers depend on 
whether one supports a paternalistic society or a 
libertarian one. The libertarian stance stipulates 
that the only aspect of sexual conduct the law should 
be concerned with is that which might entail the use 
of force or fraud. Such coercion justifies and indeed 
requires that the law protect the individual who is 
imposed upon. (This would seem to take care of rape, 
although that, too, is a topic he does not discuss.)

	Thus, whatever one may think of the foolish 
practices Szasz does describe, he himself believes 
that, so long as they are undertaken by adults and are 
not subsidized by the state, one can interpose no 
objection to them. Unfortunately, however, most 
sexologists seek to impose their views on others 
through the machinery of government. His basic concern 
is that the consequent transformation of sex from a 
private into a public act entails "the end of 
individual freedom and dignity." He certainly does not 
deny the existence or reality of sexual problems. But 
since they are basic human problems, the individual 
must learn to handle them for himself; this view is 
the antithesis of saying that their solutions should 
be formally taught. Szasz not only opposes government-
sponsored and tax-funded sex education and sex 
therapy; he supports "an economic, legal, and 
political order that allows the individual a maximum 
amount of freedom to learn about and engage in sexual 
activities." And he concludes his book on a sombre 
note which is quite at -odds with the cheerful 
insouciance of those sexologists who forget that -the 
ultimate organ of human sexuality is not the genital 
but the mind." Szasz reminds us of that basic fact. 
Reading the right sex manual, being counselled by the 
right sex therapist, finding the right partner, does 
not mean that people "will enjoy unremitting sexual 
satisfaction, in a loving encounter with another, with 
integrity and dignity, day after day, year after year, 
for forty, fifty, or more years. The absurdity of this 
image is a measure of the absurdity of modern sex 
education and sex therapy."

The Institute for Humanistic Studies
State University of New York at Albany


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