Leaving Psychiatry Chapter 11; Liberty
The FDA calls certain substances ‘controlled’. But there are no ‘controlled substances’, there are only controlled citizens
“In the animal kingdom, the rule is, eat or be eaten; in the human kingdom, define or be defined.”
Prologue; May 2023
As I look back on the typos of this draft chapter from 4 years ago, I am reminded of how prescient Thomas Szasz was.
This year marks the 60th anniversary of a grave danger he coined “the therapeutic state”. It is to him this chapter is dedicated.
Climbing Mt Szasz. Oct 2019
Regrettably, Thomas Szasz was a man I never met or shared correspondence.
I suspect we would not agree on everything, most especially his atheism replacing faith in God with an almost dogmatic commitment to libertarianism and laissez fare capitalism (a sure route on one hand to losing the battle to those who are more subtle in their aggression, and on the other by those “capitalists” who appear more free market than they will tolerate themselves).
But these two ideologies of atheism and libertarianism informed his psychiatric critique, and we can hardly regret him being disposed to them. As Szasz was oft to mention, why is it sane for a man to talk to God but not to claim that God has replied?
There are dangers lurking behind that question, not the least of which are the assumptions behind hastily dismissing it. Many materialist psychiatrists might conclude both men are insane, albeit only the second of the two can be subjected to treatment.
Szasz saw both as living in a world of unreality, along with the cherished beliefs of the church of psychiatry also. He wished all to live and let live.
My own thoughts were well on their way to development before discovering Szasz. Still, the master comes before the apprentice and deserves the greater due. And he is one of the few coordinate points around which this apprentice formed his views (the others know who they are).
Though Szasz disavowed the term “anti-psychiatry”, it’s difficult to deny its goodness of fit to the man himself. So for lack of a better term, he remains the gauge in extremis to measure how far you can go in a critique antagonistic to psychiatry.
I call this adventure “Climbing Mt Szasz”. Consequently, he ought to be the mandatory reading for all would be psychiatrists, best read as a challenge to radical empathy as opposed to the secondary reading from those good for nothing but building straw men. Szasz was a polyglot polymath far brighter than the best of them.
Almost single handed Szasz took on American psychiatry as his star rose very high in the 1960’s and 1970’s only to burn dim long before the man himself reposed in 2012. We can attribute the fading only partly on account of psychiatry finally succeeding in ignoring him away (an early example of cancel culture), and many a career patient preferring his message not exist either.
Indeed, it seems we moved from the 1960’s call to liberty from medicalized labels towards to a current infantilized want to be respected and cared for with or as a label. Now mental illness is variously held as excuse, a fashion or some twisted masochistic badge of honour.
Like Rousseau, man everywhere is free and everywhere in chains, to which we might say he seeks both despite the contradiction, the freedom of the chains. When all the asylum walls were torn down, as many as were liberated then built their own.
We even see the same in the otherwise brilliant 2019 cinematic take on 1980’s life, “Joker”. The character is downtrodden and deeply troubled, and even his reality is placed in question. And yet in a crucial climactic scene he asserts himself not as a downtrodden man, yet rather as the downtrodden sufferer of a “mental illness”, taking it on himself as a radical identity as opposed to being a man with problems and understandable responses to trauma.
(any good psycho-dynamically minded practitioner will likely not diagnose pseudobulbar affect).
His was thus never to be a freedom from psychiatry and those critics of psychiatry who would milk him for all the pathos they could get. He took it to his heart as himself. Ergo he can never escape his asylum.
But neither can the audience who agrees with his self-identification leave the asylum of their worldview. “If only the world had treated this psychotic man better” they think to themselves. The joke really is on an audience who leaves the cinema believing in the mental illness of the protagonist more than a mental illness of the sick world in which he lived.
Returning to the conspired forgetting of Szasz, in my own psychiatric apprenticeship, his was not a name included on any prescribed text, and the sum total devoted to him was approx. 15 minutes in a single lecture where his arguments were straw manned, mischaracterised and irrationally bundled up in a quasi-diagnostic category known as “antipsychiatry”.
Actually, though Szasz was a brilliant and witty polemicist, my own opinion is that he became lost in his own Ivory tower and partisan arms of the likes of the Cato institute, all too often failing to enter empathically into the minds of the swinging voters he wished to persuade. Or maybe that’s just me.
That said, some posthumous attacks against the man still do persist. Even as an octogenarian he was fighting virtually the entire psychiatric establishment more or less single handed and, in a way, not shared by those who came to label or be labelled as “anti-psychiatry” or “critical psychiatry”.
He rejected both. Championing a man outnumbered and who is no longer around to defend himself is a cause noble enough. To this end I will try and be faithful to Szasz’s own thoughts in the earlier parts of this chapter.
The reader will forgive if I drift into my own ideas in places, and hopefully will discern the difference if or when it arrives.
As a final preamble, in this chapter as in others I’ll be faithful to not burdening the text with references. If the reader wishes to explore the matter further, I commend to them the excellent work “Szasz Under Fire” edited by psychologist and Szasz fan Jeffrey Schaler, along with of course Szasz own books (approximately 30 in number, I have read but 3) and also the published work of his key opponents, e.g. Robert Kendell, Edwin Torrey and, especially, Ronald Pies.
These latter works are predominately to be found in the specialist journals, where each article will cost the lay reader more than this entire book and a lunch to read it with. Such is the sharing and caring socialist spirit of disseminating knowledge in science and medicines fourth estate. It is yours if you can afford it, at approx. 20-35 dollars per article .
Thomas Szasz; a Brief Biography
Tamas Istvan Szasz was born to wealthy atheist ethnically Jewish parents in Budapest April 15th 1920. Had his father not changed the family name a generation earlier he would have likely been born Tamas Schlesinger.
By all accounts the home was a harmonious one, with much love shared between Tamas, his parents, his older brother and the beloved Nanny, herself essentially a de facto member of the family and not the only member of staff.
There is no doubt that he did have recurrent serious infections as a child, this being an era before the antibiotic golden age, and he could well be stereotyped as the sickly homebody child with the precocious intellect.
Szasz himself admits on reflection that the lessons he learned as a child he transferred into his later reflections on the psychiatric patient. For having been doted on when ill, he would later embellish symptoms and malinger in order avoid the gymnasium.
The uncharitable formulation would then have Szasz as the consummate child liar, later projecting this negative character trait out into the world of the “mentally ill” in accusation, a callous call to make them responsible for what was obviously beyond them.
The more charitable, and I would submit more realistic, formulation is that lying is a thing many a child does, and many an adult also. Further, ies can be so subtle as to be hidden even from the one who makes them.
Anyone who works in psychiatry comes to see this as a pervasive fact of human nature. We cannot blame Szasz for his confession to introspection of himself let alone observation of others. Inferences from our own minds is a time-honoured technique in psychology.
Szasz was an expert psychoanalyst all too aware that therapy of the other always involves checking oneself also.
Like many a continental European product of high learning in the Gymnasium, by the time of graduation Tamas was fluent in Hungarian, German, French, Latin and (I assume in virtue of his contact with the rabbis whose faith he saw as superstition), Hebrew also.
Just as there is no substitute for interviewing a patient in their mother tongue and sharing an intimate knowledge of their cultural mores, Szasz was able build up a critical metanarrative of psychiatry from a reading of original psychiatric works in the authors mother tongues, availing himself of not simply the psychiatric literature itself, yet also the political and philosophical discourse of the time and place of the preceding 300 years.
And he was a voracious devourer of it all. With the rising spectre of Nazism, Szasz left Hungary in 1938 as part of the Jewish Diaspora, arrived in The United States as anglo Thomas, added English fluency to his arsenal in an immersive couple years and managed graduate in physics with highest honours before attending medical school where he continued to excel.
His claim to have topped the class has never been contested. Szasz chose medical studies even prior to leaving Hungary, not as a route to a vocation so much as a want to understand the body as the property in which his person lived.
A walk through the body was a walk through his own most intimate backyard, and example of just how attuned he was to the body as a bio-political object, a first point to explore and embark upon the philosophy of liberty and private property.
Despite Szasz never really intending on practicing medicine, he did flirt with becoming a physician before deciding on psychiatry, as was always fated to do. Szasz completed much of the training in an internal medicine residency in Harvard and Ohio before jumping ship to psychiatry.
This was still the golden era of the asylum, and Szasz needed plan assiduously and use his all his guile to avoid being placed in a compromising position of forcibly hospitalizing and treating another human being.
He chose a psychoanalytically orientated training program in Chicago with this express goal in mind and threatened to resign when they sought to seconder him to the state psychiatric hospital. He may quite well be the last psychiatrist to be able honestly say never used coercion.
Of course some may see this as his Achilles heel, never being confronted face to face with someone so mad as to require the straight jacket and the like. How does he know what he would not have done, or know it ought not to be done unless he is there?
However it is fair and true to say that Szasz did see an ample share of madness. And his principled objection was not to avoid a confrontation with hypocrisy so much as the upholding of principle for its own sake.
He was going to always be honest to himself and others. After all, he had been scrupulously honest and acted against any selfish interests when turned down from numerous ivy league medical schools for admitting he was a Jew, an admission he did not need to make and which sabotaged entry at the final turn.
Nonetheless he was shrewd enough to realise a manoeuvre of ducking and weaving the asylums were also strategic to avoid being placed in a conflict of revealing his hand against the state until his strength was up to the occasion.
He needed complete training and find himself safe tenure. He had wisely taken stock of history and lessons learned, e.g. of a fellow Hungarian Semmelweis who became a pariah for speaking the truth about hand hygiene and lacked the political strength to stay in the game.
By the late 1950’s, Szasz had arrived. He was a staff academic with stable income and time on his hands at the State University of New York. Now he could turn that time and those hands against psychiatry.
For the next half century he would dig in, defend his tenure against sometimes ferocious attack and launch a salvo of a few dozen books and articles aimed at undermining psychiatry.
Taking from the old adage that the enemy of the enemy is my friend, Szasz with atheist even sidled up with the anti-psychiatric cult come official religion scientology (made official religion when it barraged the IRS with complaints such that the IRS relented and granted it tax exempt status).
The outcome was the founding of the scientology front group, the citizens commission on Human Rights (CCHR).
I said earlier that Szasz was trained in and incredibly well versed in psychoanalysis. He received his own analysis by fellow Hungarian Jewish ex patriot Therese Benedek, who in turn received analysis by Hungarian Jewish Sandor Ferenczi, who in turn received analysis by the unanalysed (or self analysed) master himself, the secular Jewish Moravian Sigismund Freud.
Such is the way classical analysis was practiced and taught, a predominantly secular Jewish enterprise similar in some respects to the Kabbalah, requiring two adults to dive into the gnostic territory of the unconscious, and pulling out truths to set the world aright.
Christian readers will see in the requirement for the analyst to be analysed a metaphor of catechism and baptism, or alternatively the anointing of the apostolic line of priests. Yet it would be a mistake to assume that Szasz saw psycho-analysis as Freud did. Rather he saw it simply as a conversation.
The Myth of Mental Illness
Szasz basic argument was aimed philosophically and practically at containing medicine to the matter of physical pathology of the physical body, and mental phenomena only if directly causally related to the pathology in question.
All else that resides in the mental life and behaviour of the person is not medicine, and better left to be discussed as part of psychology to be sure, along with rhetoric, law, philosophy, ethics, politics, theology and plain old village life.
Should we fail to observe and defend this boundary he warned, we run the risk not only of many a logical transgression, yet also one where the doctor becomes a political actor, a tool of tyranny if not a tyranny itself.
This was the gist behind the title of the article “The myth of mental illness,” in the Feb 1960 issue of American Psychologist and followed up with the book of the same name, just as importantly subtitled “Foundations of a Theory of Personal Conduct”.
The subtitle has much to say about the theory and is often ignored by critics and fans alike.
This is taken from a long document. Read the rest here substack.com
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