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From the program at Upstate Medical University graduation ceremonies, May 20, 2001

[see also Diploma, Citation, Program bios]



May 20, 2001

Thomas S. Szasz, M.D.

Chancellor King, President Eastwood, Mr. Northrup, Distinguished Faculty, Members of the Class of 2001, Families and Friends of the graduates, Ladies and Gentlemen: I wish to thank the Chancellor and Trustees of the State University of New York, and especially President Eastwood, for the honor you have bestowed upon me. I am most grateful for this expression of your esteem. Receiving an honorary degree is always a great honor, never more so than when the university granting it is one's own academic home. Thank you very much!


To those of you graduating today, I want to say, congratulations! You have worked long and hard and deserve to be celebrated, at least for a day. You will not be able to rest long on your laurels. The hardest part of your struggle -- your whole professional life -- lies ahead of you.

What is it that makes the life of professional persons -- especially those who devote themselves to understanding diseases and treating sick patients-- a particularly arduous struggle? One difficulty is that there is too much to know, and that what you know or don't know affects not merely how your patients live but often whether they live or die. Another difficulty is intrinsic to medicine as a learned profession: unlike mathematics or philosophy, medicine is both an academic discipline and an occupation whose practitioners are licensed by the state to provide a service to individuals as well as the public. This often leads to a conflict between what the physician as scientist knows to be true and what the physician as practitioner is expected to do to conform to the requirements of the law and the codes of conduct of his profession; it may also lead to a conflict between what the physician owes his patient and what he owes to the community or the state.

Learned professions -- perhaps none more than medicine -- depend on a shared set of principles and practices as well as on a shared vocabulary. These parameters assure a sort of quality control in research and practice. However, they also mold and constrain thought. At the same time, professional persons -- especially when they are in school -- are regularly told by their elders to think for themselves. Of course, we all think for ourselves. However, the phrase correctly implies that persons who think for themselves are likely to think thoughts that are different from what passes as received wisdom -- or, in current jargon, what passes as politically or professionally correct. What are you to do then? Each of you must answer that question for yourself.

Suffice it for me to say that it will help to be modest and not mistake having a lot of knowledge with having a lot of answers. "Science," the great physicist, Richard Feynman, boldly declared: "is the belief in the ignorance of the experts." It is not by accident that interest in truth and knowledge is more intense among the young than it is among the old, and why new and better understanding is often fought for and advanced by unknown upstarts opposing famous experts. Young upstarts see challenges as tests to be met. Established authorities see them as tasks to be avoided or ignored.

Indeed, test is not a bad metaphor for life. The view that life is am unending test of our strength -- a continuous struggle -- is deeply embedded in western literature and philosophy. Albert Camus wrote: "The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy." Sisyphus -- the mythological figure whom the gods had condemned to ceaselessly rolling a rock to the top of a mountain, whence the stone would fall back of its own weight -- may not have been happy, but he was wise. He recognized that to be human is to be imperfect, to have limitations. Every one has limitations -- physical, medical, intellectual, social, economic, and so forth. It is limitations that make us human, existentially and morally. Every one gets sick. Every one dies. Disease and death are parts of life, not foreign bodies to be eliminated. Dreaming of an America free of disease, free of drugs, free of crime is as delusionary as dreaming of life without death.

Some people think that science can overcome all obstacles. I disagree. Science can give us power over nature, but it cannot give us power over human nature. People are healthier and live longer than they did in the past. But do people behave better? No. Understanding human behavior is a matter of common sense and morals, not medicine or science. The idea that virtue is contingent on self-control, and that insufficient self-control makes people do wicked things, is as old as civilization. We may ponder and debate what aspect of our behavior we ought to control -- for example, with respect to the use of drugs, sexual relations, responsibilities to children and parents, church and state, and so forth -- but there are moral limits we ought not to exceed, much less abolish.

The Founding Fathers took it for granted that limits on human appetite, especially for power over others, is a moral good. That is why they insisted that good government is limited government. The Founders were pious persons. They believed in "liberty under law." They knew there could be no liberty without responsibility -- that is, self-limitation.

What impels us to strive for mastery over ourselves is the recognition of what we don't know, not the reveling in what we do know; the practice of modesty, not the self-indulgence of conceit; the shouldering of obligations, not the satisfying of impulses. If you want to honor those values, you must choose your obligations wisely, so that fulfilling them will be a delight, not a duty.

Let me close, but not before offering you some unsolicited advice. Work hard; stay honest; be good to every one, especially your family and patients; enjoy what you do or don't do it; stay healthy; be courageous, but be careful.

Mark Twain said all this much better: "Always do right. This will gratify some people, and astonish the rest."

Congratulations and good luck!

Thomas S. Szasz Cybercenter for Liberty and Responsibility:
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