{"id":9935,"date":"2006-06-21T00:00:00","date_gmt":"2006-06-21T04:00:00","guid":{"rendered":"http:\/\/localhost\/thenewatlantis.com\/publications\/the-myth-of-thomas-szasz"},"modified":"2020-09-26T14:08:08","modified_gmt":"2020-09-26T18:08:08","slug":"the-myth-of-thomas-szasz","status":"publish","type":"article","link":"https:\/\/www.thenewatlantis.com\/publications\/the-myth-of-thomas-szasz","title":{"rendered":"The Myth of Thomas Szasz"},"content":{"rendered":"\n\n

By the 1960s, American institutional psychiatry was a very large elephant caught in a seemingly inexhaustible growth spurt. \u201cNothing of human concern is really outside psychiatry,\u201d proclaimed Dr. Karl Menninger, the profession\u2019s unofficial dean. \u201cSo in one sense I have no hobbies. They are all part of my work.\u201d This was to be the beginning of a golden age in psychiatry\u2019s relationship with the American public. Psychoanalysis was busily remaking psychiatry after its own image \u2014 a new medicine born equally of natural and spiritual sciences. Practitioners were more than mere medics, they were soul doctors<\/em>. The profession, as one practitioner predicted, would become \u201cthe integrator that unifies, clarifies and resolves all available medical knowledge … into one great force of healing power.\u201d The number of psychiatrists in the U.S. was increasing at roughly twice the rate of the population. In turn, practitioners were christening some five new mental illnesses every year.<\/p>\n

Well, overconfidence will inevitably curdle, and in this case fairly quickly. In November 1982, a New York Times <\/em>article was already describing \u201cPsychiatry\u2019s Anxious Years.\u201d Some time in the early 1970s, the number of incoming practitioners as a percentage of all medical students had fallen by half. \u201cSome psychiatrists conclude that the decade-long plunge … reflects a disillusionment on the part of medical students over the scientific validity and practical effectiveness of the discipline,\u201d the Times<\/em> reported. The article went on to cite \u201cthe withering criticism\u201d of one \u201coutspoken\u201d Dr. Thomas Szasz, \u201cwho has argued for years that \u2018these things called mental illnesses are not diseases at all but part of the vicissitudes of life,\u2019 dismissing psychiatry as a specialty without a medical cause.\u201d<\/p>\n

It was twenty years earlier, somewhere near the peak of psychiatry\u2019s promise, that Szasz published his declaration of war, called The Myth of Mental Illness: Foundations of a Theory of Personal Conduct<\/a><\/em> (1961). His title was not hyperbole. \u201cPsychiatry is conventionally defined as a medical specialty concerned with the diagnosis and treatment of mental diseases,\u201d he wrote. \u201cI submit that this definition, which is still widely accepted, places psychiatry in the company of alchemy and astrology and commits it to the category of pseudoscience. The reason for this is that there is no such thing as \u2018mental illness.\u2019\u201d Szasz\u2019s attack targeted the cornerstone of modern American psychiatry: the marriage of mind and molecule, the notion that behavior can safely be classified as \u201csickness\u201d and that the mind can safely be \u201ctreated\u201d just like any other organ. In calling that marriage a sham, Szasz mocked the efforts of almost every major American psychiatrist back to Benjamin Rush, the profession\u2019s founding father. \u201cThe subjects [mental diseases] have hitherto been enveloped in mystery,\u201d Rush wrote in the late eighteenth century. \u201cI have endeavored to bring them down to the level of all other diseases of the human body, and to show that the mind and the body are moved by the same causes and subject to the same laws.\u201d This was the error Szasz aimed to correct.<\/p>\n

Some hailed The Myth of Mental Illness<\/em> as a work of genius; others saw it as a pernicious attack or foolish waste of time. The book made Szasz a public figure, and by the late 1960s he was perhaps the most famous psychiatrist in America. Among peers, he was also the most despised and most feared \u2014 a bitter, well-educated critic with a sharp pen. He was, above all, a master of the analogy. \u201cTo put it succinctly,\u201d he wrote,<\/em> \u201cGuillotin made it easier for the condemned to die and Charcot [early champion of the disease model of mental illness] made it easier for the sufferer, then commonly called a malingerer, to be sick. It may be argued that when dealing with the hopeless and helpless, these are real accomplishments. Still I would maintain that Guillotin\u2019s and Charcot\u2019s interventions were not acts of liberation but were rather processes of narcotization and tranquilization.\u201d<\/p>\n

Today, of course, Szasz is mostly remembered, if he is remembered at all, as the great silly, a flat-earth adherent in the time of telescopes and globes. Most medical students graduate without ever hearing his name. Peers who once grappled fiercely with his ideas are now surprised to find out he is still alive. His voluminous writings largely gather dust in libraries and used book stores. At a 1996 debate, well-known psychiatrist E. Fuller Torrey summed up the sentiment nicely with a joke that began: \u201cLet me ask an important question. And this is a question that will be asked by future generations. The question is: Who was Dr. Szasz?\u201d Few in the audience needed a punch line. The question itself was d\u00e9nouement enough. \u201cIf he is unable to acknowledge his big mistake,\u201d Torrey finished, \u201cI think the answer to the question will be: \u2018Dr Szasz was the man who wrote The Cat in the Hat<\/em>, Hop on Pop<\/em> and Horton Hatches the Egg<\/em>.\u2019\u201d The audience roared.<\/p>\n

One can hardly be surprised if Szasz has assumed the role reserved for all failed revolutionaries \u2014 a marker of backwardness against which to measure our enlightenment, his name a synonym for error. The disease model of mental illness is now so central to American medicine and culture that the most common response to Szasz \u2014 aside from utter disregard \u2014 is typically something like: \u201cJust look around \u2014 anguished teenagers, depressed adults, distracted children. Only a fool would believe that mental illness is a myth.\u201d Indeed, to the modern psychiatric mind, rejecting the legitimacy of mental illness is not just an error but an act of inhumanity, leaving the sick without the hope of a cure. The Szaszians of the world are not just fools but monsters.<\/p>\n

Like most war stories, the Szasz story has passed into legend, bearing little resemblance to reality. A reconsideration of this piece of psychiatry\u2019s forgotten history might shed some useful light on psychiatry\u2019s present, showing us the excesses of both Szasz and his adversaries.<\/p>\n\n

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O<\/span>ne place to begin such a reconsideration is by returning to a minor New York county courthouse in May 1962. Dr. Thomas Stephen Szasz, a first-generation Hungarian-American and newly tenured professor of psychiatry at the State University of New York Upstate Medical College in Syracuse, was there to testify on behalf of Michael Chomentowski, a second-generation Polish-American and seven-year veteran of various state mental institutions.<\/p>\n

Chomentowski\u2019s story provides a rare inside view of mid-century American institutional psychiatry, the milieu from which The Myth of Mental Illness <\/em>sprang. The pertinent history begins seven years earlier in June 1955, on the morning Michael Chomentowski slung a rifle over his shoulder and took to patrolling a patch of ground in front of his gasoline station in Fairmont, New York. He was, as he would later try to explain, \u201cwalking his post in a military manner.\u201d At some point, he also fired two shots into the air \u2014 successfully frightening two men who had come to erect a sign on the station\u2019s property. The sign advertised a new shopping center. Construction was to begin soon. The developers had done their best to convince Chomentowski to vacate and Chomentowski was doing his best to convince the developers that he meant to stay.<\/p>\n

Later that day, an officer idled into Chomentowski\u2019s station. He asked for an oil check and Chomentowski, a mechanic in World War II, obliged, setting his rifle down and stepping toward the car. The officer then stepped forward and placed Chomentowski in handcuffs. He found a dysfunctional French machine gun in the trunk of Chomentowski\u2019s car and subsequently booked Chomentowski for unlawful possession of a dangerous weapon \u2014 a charge for which he would never be tried or convicted.<\/p>\n

Two weeks after his arrest, Chomentowski was transferred from the Onondaga County Jail to the Syracuse Psychopathic Hospital, where two court-ordered psychiatrists conducted an examination. The transfer was in accordance with the New York State Code, Sec. 658 which states: \u201cIf at any time before final judgment it shall appear to the court … that defendant is in such a state of idiocy, imbecility or insanity that he is incapable of understanding the charge … the court may order such defendant to be examined to determine the question of his sanity.\u201d<\/p>\n

At the hospital, Chomentowski sat quietly, responded affably and insisted that he had only been \u201cwalking his post in a military manner.\u201d He was a thin man of average height. He wore a beard and he believed the beard was bringing him closer, both in nature and appearance, to Jesus Christ. His neighbors often greeted him derisively with a \u201cHello, Davy Crockett,\u201d which Chomentowski was content to take as a compliment. When the arresting officer asked Chomentowski what he was doing, Chomentowski told him: \u201cI\u2019m a soldier for the people walking my post in a military manner. The people now have the original Davy Crockett. This will be the biggest story in history and I\u2019m glad that it happened.\u201d<\/p>\n

During that initial interview, Chomentowski told the psychiatrists: \u201cThere are two stories that I can\u2019t tell because they belong to my father.\u201d He told them anyway. The first: There was gold buried under his gas station. The second: Jesus Christ had been born somewhere on the property. He also described a recent experience in front of his station. \u201cI realized I was nailed to the cross,\u201d he said. \u201cI wasn\u2019t actually nailed, but I was frozen to the cross. I was sitting with my feet crossed and my hands outstretched and then it began to rain. I sat in the rain for over an hour, unable to move.\u201d The diagnosis of mental illness was fairly straightforward. The American Psychiatric Association had recently published its first diagnostic manual. The two psychiatrists deemed Chomentowski \u201cgrandiose and mildly euphoric.\u201d They considered his \u201caffect inappropriate…. The patient states that he does not think he is Davy Crockett but that because of his belief in re-incarnation, he might well be Davy Crockett…. Patient is oriented in all spheres…. Recent and remote memory unimpaired, retention and recall good. Insight and judgment impaired. Intelligence, probably average … bizarre delusions … suffering from schizophrenic reaction.\u201d<\/p>\n

Around the same time, Thomas Szasz faced imminent unemployment. His two-year tour of duty as a psychiatrist at the Bethesda Naval Base would end in 1955. He was considering private practice but his burning desire was to demolish American institutional psychiatry, and hopefully feed his family while doing so.<\/p>\n

Szasz traced his opposition to modern psychiatry to his teens. At eighteen, when he left Hungary for the United States, he knew that \u201cincarcerating people and talking to them were not medicine,\u201d as he later wrote. \u201cAny intelligent child would have known that. Of course, such simple-minded clarity had to be educated out of people to make them normal members of society, especially American society.\u201d Szasz studied both Freud and his critics, but he was especially taken with a prominent Hungarian writer named Frigyes Karinthy. In one particular short story, Karinthy included the following dialogue between two psychiatrists, one of which is having a delusion of insanity:<\/p>\n\n\n

Psychiatrist:<\/strong> So, am I insane?<\/p>

Colleague:<\/strong> Well, since you have a delusion, evidently you are.<\/p>

Psychiatrist:<\/strong> Oh, no, there you go again! Now you say that if I have a delusion, I am insane. But you just said that I am insane. In that case, my belief is not a delusion, but a correct idea. Therefore I have no delusion. Therefore I am not, after all, insane. It is only a delusion that I am insane; hence I have a delusion; hence I am insane; hence I am right; hence I am not insane. Isn\u2019t psychiatry a magnificent science?<\/p>

Colleague:<\/strong> The most magnificent, my dearest colleague! But of course it\u2019s necessary to master it as well as only you or I have.<\/p><\/blockquote>\n\n\n

In 1956, Szasz accepted a post at SUNY-Syracuse. The offer came through Marc Hollender, a close friend from the Chicago Institute for Psychoanalysis, where he and Szasz had previously studied. Hollender hired Szasz hoping the two would implement Chicago\u2019s curriculum and grow the school into a premier psychiatric residency. Szasz, for the most part, went along with the plan. He was quickly popular in and outside the classroom. His doubts regarding his own profession did not deter potential residents. Indeed, his lectures, often dramatic and seldom dull, drew crowds and eventually newspaper reporters. During the course of one routine hour in 1971, a student recommended drugs as the best treatment for a woman\u2019s \u201cchronic, severe depression.\u201d The New York Times Magazine<\/em> was there to record the subsequent scene, which Szasz has spent the majority of his career reproducing:<\/p>\n\n\n

\u201cSo you would treat this \u2018sickness\u2019 she\u2019s got with drugs<\/em>?\u201d There are several uncomfortable, uncomprehending laughs from around the room. \u201cBut what, exactly, are you treating? Is feeling miserable \u2014 and needing someone to talk things over with \u2014 a form of medical illness?\u201d <\/em>Szasz gets to his feet, walks over to a blackboard and picks up a piece of chalk.<\/p>

\u201cI don\u2019t understand \u2014 we\u2019re just trying to arrive at a diagnosis,\u201d protests the student, his voice confused.<\/p>

\u201cOf what?\u201d demands Szasz. \u201cHas she got an illness called depression, or has she got a lot of problems and troubles which make her unhappy?\u201d He turns and writes in large block letters: \u201cdepression.\u201d And underneath that: \u201cunhappy human being.\u201d \u201cTell me,\u201d he says, facing the class, \u201cdoes the psychiatric term say more than the simple descriptive phrase? Does it do anything other than turn a \u2018person\u2019 with problems into a \u2018patient\u2019 with a sickness?\u201d He puts down the chalk so hard that a cloud of dust rises. There is a low muttering among the students as he returns to his seat.<\/p><\/blockquote>\n\n\n

Of course, Szasz aimed for more than a low muttering, and outside of class he devoted himself to his typewriter. He soon began publishing at an envy-inducing pace. As one of his former colleagues recalls: \u201cTom came here as kind of the fair-haired boy of Marc Hollender…. He was expected to write and be smart.\u201d That he did quite well. In 1958, the Columbia Law Review <\/em>commissioned a piece on the increasingly controversial relationship between psychiatry and law. Szasz remembers: \u201cI thought, \u2018Well, I was invited, this is the Columbia Law Review<\/em>, I can really say something.\u201d Titled \u201cPsychiatry, Ethics, and the Criminal Law,\u201d <\/em>the essay revolved around the following argument: \u201cDisregarding even the most obvious doubt concerning exactly what the expression \u2018mental illness\u2019 is supposed to denote, it denotes a theory<\/em> (if it denotes anything) and not a fact…. It is no more \u2014 or less \u2014 a fact than it would be to assert that the accused is possessed by the devil; that is another \u2018theory\u2019 now discarded. To believe that one\u2019s own theories are facts is considered by many contemporary psychiatrists as a \u2018symptom\u2019 of schizophrenia.\u201d Though short of his subsequent assault, the essay was clearly meant to pick a fight. In the end, it failed to do anything of the sort. While his arguments may have influenced a few lawyers, among psychiatrists they were almost completely disregarded or ignored, a fact that served mostly as further motivation for Szasz.<\/p>\n

A year later, in May 1959, Szasz typed a brief letter in which he spelled out the rest of his career. \u201cI have put aside for the time being … my manuscript on the theory of psychoanalytic technique,\u201d he informed Arthur Rosenthal, head of Basic Books. \u201cInstead, I am now well on my way toward finishing a book on what is really an attempt to examine, in extense<\/em>, the idea of \u2018mental illness.\u2019… I think no really meaningful work on psychotherapy is possible until the nature of the alleged illness which is so being \u2018treated\u2019 is fully examined and clearly defined.\u201d<\/p>\n

It was a minor prelude and Rosenthal\u2019s eyebrows surely arched three months later when he received the manuscript, tentatively titled Human Behavior and the Myth of Mental Illness: Foundations of a Theory of Psychiatry<\/em>. \u201cLet us suppose that there is no such thing as mental health or mental illness,\u201d Szasz wrote, \u201cthat these words refer to nothing more substantial or real than did the astrological notions of the influence of planetary positions on personal conduct. What then?\u201d<\/p>\n\n

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S<\/span>zasz never knew exactly how the Chomentowski family first heard of him. It may have had less to do with The Myth of Mental Illness<\/em> than with his testimony at a 1961 U.S. Senate hearing titled \u201cThe Constitutional Rights of the Mentally Ill.\u201d By then, Chomentowski had languished for years in a psychiatric institution, and Szasz\u2019s testimony seemed tailored to his situation. \u201cThe crucial issue in all of these situations is whether the psychiatrist is to be considered the agent of the patient or of someone else,\u201d Szasz told the Senators. \u201cWe must constantly ask ourselves questions such as these…. Is he a therapist or a custodian? Is he a \u2018doctor,\u2019 or is he a \u2018warden\u2019 of an institution which, although it is called \u2018hospital,\u2019 functions as a prison, inasmuch as patients cannot leave it at will?\u201d<\/p>\n

At the time, Szasz found himself in fairly good company criticizing psychiatry\u2019s relationship with the law. In 1961, an exasperated Circuit Court Judge (and later Chief Justice) Warren Burger complained: \u201cNo rule of law can possibly be sound or workable which is dependent upon the terms of another discipline whose members are in profound disagreement about what those terms mean…. [The term \u2018mental disease\u2019] which has no fixed, agreed or accepted definition in the discipline which is called upon to supply expert testimony and which, as we have seen, is literally \u2018subject to change without notice\u2019 is a tenuous and indeed dangerously vague term to be a critical part of a rule of law on criminal responsibility.\u201d<\/p>\n

Chomentowski\u2019s predicament seemed to prove the point. By 1962, he had been hospitalized for seven years, some five years longer than the prison sentence he would have received if convicted of his crime. After the initial diagnosis, Chomentowski\u2019s family quickly appealed. The appeals, however, simply resulted in confirming psychiatric opinions. Walter Chomentowski soon advised his younger brother simply to stop speaking with the psychiatrists. The counsel must have seemed quite prudent, and Michael was content to shut his mouth. But the tactic wildly backfired. By the time his family contacted Szasz, Chomentowski had been declared legally insane by seven different psychiatrists. While the repeated confirmations served to stamp the first with authenticity, mostly they illustrated an institutionalized dependence on precedent and a disturbingly broad definition of \u201cinsanity.\u201d A close review of the case history reveals a kind of galloping guesswork. In each of the subsequent examinations, the prime evidence of continuing insanity was the fact that the patient refused to speak with the psychiatrists.<\/p>\n

A few examples will suffice. The following conversations are excerpted from a series of psychiatric examinations in late January 1957, two years after Chomentowski\u2019s initial diagnosis. The psychiatrists are Dr. H and Dr. S. The echo of Frigyes Karinthy is uncanny. First, from the examination of January 24, 1957:<\/p>\n\n\n

Dr. S:<\/strong> Well, first of all to have a jury trial, there has to be a charge of some kind. Now, the charge … was that you were carrying a dangerous weapon and I think you fired it as I recall it. Did you? You were marching up and down with a gun on your shoulder and were threatening somebody who came out there to put up a sign. Do you remember that? All you have to tell me is, do you remember?<\/p>

Chomentowski:<\/strong> I\u2019ve got nothing to say.<\/p>

Dr. S:<\/strong> Well, I would say that is in evidence that you\u2019re not really well, that you should at least answer innocuous questions that I\u2019m asking here.<\/p>

Dr. H:<\/strong> That doesn\u2019t show very good judgment, does it?<\/p>

Dr. S:<\/strong> All I asked you, for instance, was what my name was. You remember what [Dr. H\u2019s] name is? I introduced you to him. Do you remember that?<\/p>

Chomentowski:<\/strong> I\u2019ve got nothing to say.<\/p>

Dr. S:<\/strong> You wouldn\u2019t even tell what date this is, I suppose? Or would you?<\/p>

(No answer)<\/p>

Dr. S:<\/strong> When did you come here? You know the name of this place don\u2019t you?<\/p>

Dr. H:<\/strong> Do you know why they send people up here?<\/p>

Dr. S:<\/strong> Well, I don\u2019t suppose we could do very much about this, he isn\u2019t going to talk. This, in itself, is in evidence of a suspicious, paranoid attitude, isn\u2019t it Dr.?<\/p>

Dr. H:<\/strong> I should think so. Very definitely….<\/p><\/blockquote>\n\n\n

From January 30, 1957:<\/p>\n\n\n

Dr. S:<\/strong> Are you willing to discuss your case with us today?<\/p>

Chomentowski:<\/strong> Only at the proper time.<\/p>

Dr. S:<\/strong> I understand you protected Dr. Brew the other day when she was attacked by another patient.<\/p>

Chomentowski:<\/strong> Dr. Brew has never done anything to me and I\u2019m always glad to help out.<\/p><\/blockquote>\n\n\n

From January 31, 1957:<\/p>\n\n\n

Dr. S:<\/strong> Are you willing now to discuss your behavior of July 1955?<\/p>

Chomentowski:<\/strong> I\u2019m not talking until the proper time.<\/p>

Dr. S:<\/strong> You know that Dr. H and I have been appointed by the court to determine whether you are sick or well. How can we tell what is going on in your mind unless you talk freely with us? From that standpoint, I believe this is the proper time to talk.<\/p>

(No answer)<\/p>

Dr. S:<\/strong> What is for you the proper time to talk?<\/p>

Chomentowski:<\/strong> When ever the judge decides.<\/p>

Dr. S:<\/strong> Why would you appear before a judge?<\/p>

Chomentowski:<\/strong> I want him to tell me the crime I have committed. I haven\u2019t committed any crime.<\/p>

Dr. S:<\/strong> You admit you had firearms?<\/p>

Chomentowski:<\/strong> I\u2019m not committing myself to anything.<\/p>

Dr. S:<\/strong> Did you fire two shots over the head of two men?<\/p>

Chomentowski:<\/strong> I\u2019m not committing myself to anything.<\/p>

Dr. S:<\/strong> Do you think your mind is or has been upset?<\/p>

Chomentowski:<\/strong> Just what do you mean by that?<\/p>

Dr. S:<\/strong> You have been here before haven\u2019t you?<\/p>

Chomentowski:<\/strong> That\u2019s right.<\/p>

Dr. S:<\/strong> At that time you wore a full beard?<\/p>

Chomentowski:<\/strong> That\u2019s right.<\/p>

Dr. S:<\/strong> What was the purpose of wearing a full beard?<\/p>

Chomentowski:<\/strong> This is the first time I found out that it is a crime having a beard.<\/p>

Dr. S:<\/strong> That alone is not the crime, but at the time you said you were emulating Christ.<\/p>

(No answer)<\/p>

Dr. S:<\/strong> Do you remember telling me in 1955 that you get your orders from above?<\/p>

(No answer)<\/p><\/blockquote>\n\n\n

The resulting diagnosis was, as ever, a masterpiece of qualified conviction. \u201cIn view of the refusal to fully cooperate, it is difficult to determine the presence of any definite delusions at this time,\u201d Dr. S concluded. \u201cHowever, the patient\u2019s attitude and manner have been of a stilted character and the fact that he refuses to answer, indicates a suspicious and paranoid attitude … he is without question, a case of dementia praecox of the paranoid type in a state of partial remission. Moreover, we are convinced that he should still be considered unpredictable with a possibility that he should still be considered potentially dangerous and that therefore, further institutional care is indicated.\u201d<\/p>\n

That last part bears repeating in light of Szasz\u2019s critique: The doctors were \u201cconvinced\u201d of the \u201cpossibility\u201d that Chomentowski was \u201cpotentially\u201d dangerous. Moreover, Chomentowski\u2019s 1957 diagnosis, along with a subsequent diagnosis in 1962, was identical to that of 1955, even though the latter two were based on symptoms that were not only different but precisely opposite. In 1955, Chomentowski was \u201cgrandiose,\u201d \u201cmildly euphoric,\u201d \u201cover-productive and spontaneous.\u201d In 1962, \u201cHis stream lacked spontaneity; he was negativistic with delayed reaction time and psychomotor retardation and his affect was blunted.\u201d In both cases, it was \u201cundoubtedly\u201d a schizophrenic reaction; Chomentowski was in such a state of insanity as to be incapable of understanding that he had been caught with a dysfunctional French machine gun.<\/p>\n\n

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W<\/span>hen Szasz agreed to testify on Chomentowski\u2019s behalf, news of the impending hearing spread quickly through the small but influential group of psychiatrists populating upstate New York, many of whom had been waiting for an opportunity to confront Szasz. By the time the hearing actually rolled around, what was supposed to be an inquiry into the mental status of Michael Chomentowski had quietly become an inquisition into the philosophy of Dr. Szasz.<\/p>\n

The idea was mostly that of Dr. Abraham L. Halpern, the newly appointed commissioner of mental health for Onondaga County. For his part, Halpern believed Michael Chomentowski was neither sick nor violent. This, however, was not his prime concern. At the time of the hearing, Halpern was also an associate professor of psychiatry at SUNY-Syracuse and thus in fairly routine contact with the man who was making his life difficult. \u201cSee, he had just written his book,\u201d Halpern remembers. \u201cHere I was trying to tell the community, \u2018Hey, you know you ought to allocate tax funds for the development of psychiatric units in the general hospital.\u2019 And people would say, \u2018Why should we do that when mental illness is a myth?\u2019 You can see why I would oppose some of his ideas, only from a practical point of view.\u201d<\/p>\n

Halpern, now in his eighties, considers himself a close friend to Szasz, so he cringes at the manner in which he went about denouncing him. \u201cI mean, here\u2019s my dear friend Tom Szasz, I feel almost embarrassed in retrospect. But at that time, this was an opportunity for some of his extremist positions to be exposed in open court. Not where he has a bunch of medical students to indoctrinate, but a lawyer who was well prepared to challenge a lot of his ideas.\u201d Halpern coached Onondaga County Assistant District Attorney Jack Schultz before the hearing; at the hearing itself, he sat near the prosecution\u2019s bench, passing notes and recommending questions.<\/p>\n

The event itself lasted two days, with Szasz\u2019s testimony comprising the bulk of it. Szasz assured Chomentowski\u2019s lawyer that he considered the defendant capable of understanding the charges against him, at which point the D.A. began his cross-examination. Schultz\u2019s inquiries ranged from the theoretical to the comical, often in no particular order and with no apparent reason. In addition to seeking Szasz\u2019s opinion on Chomentowski, the D.A. sought the doctor\u2019s views on democracy, religion, the Bible, charity, and his own legacy as a psychiatrist. At one point, near the middle, Schultz stopped and said: \u201cDoctor, let me ask you this. This will take the process off your mind, but I would like to ask it. There was a time when Sigmund Freud was told that he was all wrong … people didn\u2019t ascribe to his theories. Now he is looked upon by a great many eminent psychiatrists as the \u2018Father of Psychiatry\u2019…. Do you feel you are in the same position \u2014 do you feel you are ahead of your time, doctor, with all due respect to your natural modesty?\u201d<\/p>\n

Between the non sequiturs, Schultz returned to the topic of mental illness. \u201cNow doctor, you call it the \u2018myth\u2019 of mental illness. In my layman\u2019s terms, would that mean that mental illness does not exist?… Could anyone be mentally ill, doctor?… If somebody is directing traffic on Salina Street naked, would you say that person is mentally ill?… Is there any such thing as mental disease?\u201d Szasz was content to expound, at one point explaining exactly what he meant by \u201cmyth\u201d:<\/p>\n\n\n

You seem to think that a myth refers to something that doesn\u2019t exist…. A myth is not a word properly used that refers to something that doesn\u2019t exist. It refers to a kind of collective reasoning that people make; that odd things which are variably upsetting to people \u2014 odd things that people do, such as killing their mothers or mothers throwing their children out of a seventh-story window, all sorts of terrible things \u2014 these things that exist, they very much exist. I am trying to do as much about these things as anybody else. I think a little bit more. The issue is what are these things? The myth refers to the fact that the people say they are illnesses that doctors can cure. I say they are wrong. They are not illnesses people can cure. They are using the term mental illness mistakenly…. People who drink and beat up their wife \u2014 I don\u2019t like them any more than you do \u2014 but I don\u2019t think they are insane. I think they are badly mistaken, ignorant, stupid, misled, upset \u2014 but they are not sick like with pneumonia. If that isn\u2019t clear I will be glad to answer it further.<\/p><\/blockquote>\n\n\n

Shortly after that response, Halpern\u2019s effort to discredit Szasz \u2014 the subtext of the whole hearing \u2014 met with success. In response to another series of repetitive questions, Szasz said that he \u201cwould not be caught dead\u201d in a mental institution, and eventually he declared institutional psychiatry a form of \u201cbrutality.\u201d \u201c[B]eing called a psychiatric patient when one does not want to be called a psychiatric patient, being given drugs \u2014 psychiatric drugs \u2014 when one doesn\u2019t want psychiatric drugs. I would consider all of these things together as brutality, yes.\u201d<\/p>\n

In truth, nothing Szasz said at the trial was new. He had published it all before in academic journals and in The Myth of Mental Illness, <\/em>then already a year on the shelf. The only new<\/em> element, the only reason to take action, was the fact that Szasz was now addressing the general public. \u201cSaying this in an open courtroom and not in a textbook means that newspapers pick it up; and the Syracuse newspapers picked this up and played Tom as the heretic of Upstate Medical Center,\u201d recounts Al Higgins, a sociologist at SUNY-Albany who worked with Szasz in Syracuse at the time. \u201cAt this point Tom\u2019s colleagues in the medical profession said, \u2018We got you.\u2019 And they did! They made it terrible for him.\u201d Higgins discusses the events with the barely suppressed excitement of an academic describing a very conclusive round of lab results: \u201cThe reaction of the medical profession, the reaction of his fellow psychiatrists is a wonderful, wonderful example of the ways in which a profession controls its members.\u201d (Chomentowski, for his part, was eventually released, but only after the U.S. Supreme Court deemed certain aspects of involuntary commitment unconstitutional.)<\/p>\n

Paul Hoch, New York\u2019s commissioner of mental hygiene, wanted Szasz banned from the Syracuse Psychiatric Hospital, which was then functioning as the hub of Hollender\u2019s department. Hollender\u2019s temporary solution was to move Szasz from the psych hospital to the Veteran\u2019s Administration Hospital a few blocks away. Szasz initially went along with the transfer, but then decided he wouldn\u2019t stand for it. \u201cI don\u2019t want to belabor this metaphor, but it was as if Marc told me: You have to wear a yellow star,\u201d Szasz says. Colleagues and prot\u00e9g\u00e9s eventually protested the banishment, boycotting class and staff meetings. Local newspapers provided breathless color commentary: \u201cOne of the most flagrant breaches of academic freedom in the history of the school,\u201d wrote reporter T. Lee Hughes. Szasz is \u201cthe victim of a virtual academic crucifixion.\u201d Szasz appealed to the American Association of University Professors and to the American Civil Liberties Union. His attorney met with the officials in charge and asked, \u201cWhat are you going to tell the federal judge when I tell him you tried to silence a professor\u2019s academic freedom?\u201d Eventually, however, the crisis dissipated.<\/p>\n

For Szasz, the events served mostly as an education. He was soon publishing abbreviated versions of his books and papers in prestigious, non-professional outlets including Harper\u2019s<\/em>, National Review,<\/em> and The New Republic<\/em>. A piece in The New York Times Magazine <\/em>titled \u201cMental Illness Is a Myth\u201d reportedly <\/em>induced more reader response than any article in the magazine\u2019s history. If he had preached from the pulpit with The Myth of Mental Illness, <\/em>he had now nailed his thesis to the church\u2019s front door.<\/p>\n

In <\/strong>1964, two years after the Chomentowski trial, the American Psychiatric Association invited Szasz, for the first and last time, to present his arguments at their annual conference. It was a heresy trial. Six APA psychiatrists presented papers denouncing Szasz. Howard Rome, a future APA president, accused him of extending \u201can unquestioned constitutional freedom to an impermissible degree,\u201d the equivalent of shouting fire in a crowded room. Dr. Henry Davidson read from a paper titled: \u201cThe New War on Psychiatry.\u201d \u201cThe net result of Dr. Szasz\u2019s writing,\u201d he argued, \u201chas been to make people think that we psychiatrists are a menace to our patients. His views have had considerable effect on the less sophisticated elements of the public.\u201d Another psychiatrist rose to say: \u201cCertainly on our staff of a hundred we have some who would treat a certain type of patient largely through insight psychotherapy, others who would use pharmacotherapy, and still others who would use electroconvulsive therapy. But the public cannot be educated to these differences of opinion.\u201d<\/p>\n

Ironically, in this attempt to dismiss Szasz, official psychiatry was helping to make his case. In his writings, Szasz often echoed Max Weber\u2019s The Sociology of Religion<\/em><\/a>, which states: \u201cUnderstandably, all magic lore originally has the character of secret knowledge, to protect the professional interest of the guild.\u201d Szasz was a threat to the guild, both its lofty self-image as \u201cdoctors of the soul\u201d and its practical interests as the beneficiaries of public esteem and largesse. And in the battle between Szasz and institutional psychiatry, each side moved the other to ever-greater extremes.<\/p>\n\n

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\r\n\t\tThe Limits of Psychiatry\t<\/h5>\r\n<\/div><\/div>\n\n

I<\/span>t is hard to doubt the reality of mental illness, especially when the suffering of affected individuals is so complete and the impairment so extreme, when psyche and identity are crippled almost beyond repair. But it is also remarkable how much of modern psychiatry is still theoretical rather than empirical, and how many of the supposed mental illnesses that appear (and multiply) in the Diagnostic and Statistical Manual of Mental Disorders<\/em> have no known biological underpinnings or explanations. Although Szasz\u2019s critique often became a caricature, his intuition about the limits and deformations of modern psychiatry cannot be ignored. Many sick people have surely benefited from psychiatric treatment, both \u201ctalk therapy\u201d and pharmacotherapy. But psychiatry\u2019s long history of error \u2014 from snake pits to ice baths to spinning chairs to electroshock to lobotomy \u2014 should give us pause. Skepticism is not backwardness, even if Szasz often took his skepticism to rhetorical extremes.<\/p>\n

At his best, Szasz actually clarified the Sisyphean predicament in which psychiatry remains largely stuck. For almost half a century, he has obstinately argued that a mind can only be sick in a metaphorical sense. And all this time, psychiatry has been desperate to prove what it claims to have already proven \u2014 to bring mental illnesses \u201cdown to the level of all other diseases of the human body, and to show that the mind and the body are moved by the same causes and subject to the same laws.\u201d In response to the image crisis that psychiatry had suffered at Szasz\u2019s hands, past-APA President Robert Felix offered the following cure: \u201cMore of us must intensify our efforts to become more identified with the mainstream of American medicine.\u201d In other words, the legitimacy of psychiatry\u2019s refutation of Thomas Szasz rests entirely on the profession\u2019s ability to prove Benjamin Rush right. This was the goal implicit in Felix\u2019s proposed merger with \u201cthe mainstream of American medicine.\u201d<\/p>\n

Not surprisingly, over the last four decades, psychiatry has systematically placed its greatest hopes in the biology of mental illness. We are led to believe that new disciplines like neuroscience are putting old ambiguities to rest. We hear of \u201cexplosions in scientific knowledge of the brain\u201d and \u201cremarkable advances in understanding the human mind.\u201d Evidence of the biological basis of mental illnesses would seem to be so overwhelming that to doubt is akin to doubting evolution. Yet a review of the facts fails to reveal the sort of breathtaking advancement commonly claimed.<\/p>\n

In her 2001 book Brave New Brain: Conquering Mental Illness in the Era of the Genome<\/a>,<\/em> Nancy Andreasen writes 174 pages before offering this tellingly brief and couched confession: \u201cBecause we cannot yet point to a specific lesion or a specific cause … some critics (most notably Thomas Szasz of the University of Syracuse) have argued that mental illnesses must be myths.\u201d Considering its context, the confession\u2019s delay is disconcerting. In her introduction, Andreasen lauds the \u201cpowerful new technologies\u201d that have already<\/em> illuminated \u201cthe causes and mechanisms of mental illnesses on many different levels.\u201d The reader must either assume that the technology is over-hyped or that mental illnesses are veritable black holes, reflecting very little of the blinding light we have apparently thrown on them. (Meanwhile, Szasz\u2019s superfluity somehow continues to supersede the need for historical accuracy. Contrary to Andreasen\u2019s description, he has never worked for the University of Syracuse.)<\/p>\n

If mental illnesses truly begin in the brain, no psychiatrist on earth can conclusively say when, where, why, or how. Nearly one hundred years after Eugen Bleuler invented the word \u201cschizophrenia\u201d to describe, among others, the \u201cirritable, odd, moody, withdrawn, or exaggeratedly punctual,\u201d those who \u201cvegetate as day laborers, peddlers, even as servants,\u201d and \u201cthe wife … who is unbearable, constantly scolding, nagging, always making demands but never recognizing duties,\u201d the only way to diagnose this \u201cdisease,\u201d or any other mental illness, remains the observation of behavior. Given the complexity of the human psyche, this makes sense: we can hardly expect the many moods and miseries of human life, even the most extreme, to have simple neurological explanations. But given the grand ambitions of modern psychiatry \u2014 to explain the human condition, to heal every broken soul \u2014 the reliance on behavioral observation has led to the medicalization of an ever-growing range of human behaviors. It treats life\u2019s difficulties and oddities as clinical conditions rather than humanity in its fullness.<\/p>\n\n

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\r\n\t\tSzasz’s Uncertain Legacy\t<\/h5>\r\n<\/div><\/div>\n\n

F<\/span>or Szasz, the extreme induced by his war against psychiatry was both equal and opposite to that of his profession. When psychiatry failed to shut Szasz up, it went about forgetting him. When Szasz failed to persuade his peers, he seemed to devote his career to enraging them. In 1963, shortly after the crisis at SUNY, Szasz wrote: \u201cTo maintain that a social institution suffers from certain \u2018abuses\u2019 is to imply that it has certain other desirable or good uses…. My thesis is quite different: Simply put, it is that there are, and can be, no abuses of<\/em> Institutional Psychiatry, because Institutional Psychiatry is, <\/em>itself, an abuse.\u201d By the 1970s he was comparing psychiatrists to witch hunters. By the 1980s it was slave owners and Nazis. While such extreme rhetoric made Szasz a public figure for a while, his polemical excess eventually ensured his professional obscurity.<\/p>\n

Yet we are also right to give the earlier Szasz his due. \u201cQuite probably,\u201d wrote Edwin Schur in The Atlantic<\/em> Monthly <\/em>in the 1960s, \u201che has done more than any other man to alert the American public to the potential dangers of an excessively psychiatrized society.\u201d A fellow psychiatrist put it thus:<\/p>\n\n\n

We no longer have the right to be offended by what Szasz says. It is too late for Aesculapian arrogance. Szasz has been telling us over and over again that the ways in which we comfortably define behavior as \u201csick\u201d … can be more devastating to the human spirit than any persecution. He has been telling us over and over again that whatever \u201chealth\u201d is, it is closer to whatever \u201cfreedom\u201d is, than any other two conceptualizations that we push aside in our little black bags.<\/p><\/blockquote>\n\n\n

Perhaps the most remarkable tribute, however, came in 1989, when an ailing Karl Menninger, the long-time patriarch of American psychiatry, wrote Szasz the following:<\/p>\n\n\n

I am holding your new book, Insanity: The Idea and Its Consequences<\/em>, in my hands. I read part of it yesterday and I have also read reviews of it. I think I know what it says but I did enjoy hearing it said again. I think I understand better what has disturbed you these years and, in fact, it disturbs me, too, now. We don\u2019t like the situation that prevails whereby a fellow human being is put aside, outcast as it were, ignored, labeled and said to be \u201csick in his mind.\u201d<\/p><\/blockquote>\n\n\n

For his part, Szasz seems ambivalent about his legacy. \u201cI really don\u2019t think I am falsifying it when I say I never had much hope of having an impact on psychiatry,\u201d he told me. \u201cI viewed psychiatry all along as more like the Catholic Church. What impact did Voltaire make on it? If you think about what happened since then, nothing! No I didn\u2019t expect to make any difference.\u201d<\/p>\n

Today, Szasz lives alone in a suburb of Syracuse where he continues to write. He has already published one new book this year \u2014 \u201cMy Madness Saved Me\u201d: The Madness and Marriage of Virginia Woolf<\/a><\/em> \u2014 and he recently finished a draft of yet another critical history of his profession. If the trend continues, the books will be read by few and endorsed by almost none. After forty years of comparing psychiatrists to the scum of the earth, Szasz now stands as one of the biggest obstacles to his own ideas. It is simply too easy to dismiss him <\/em>as an axe-grinding zealot, a \u201cmusician who does not like music,\u201d as one critic put it. \u201cThe atheist who cannot stop speaking about God.\u201d But perhaps a new generation of critics will arise \u2014 aware of psychiatry\u2019s achievements but also its limits, leading us not to extremes but to a much-needed reformation of psychiatry from within, and a much-needed de-medicalization of human life in the culture as a whole.<\/p>","protected":false},"excerpt":{"rendered":"

Jeffrey Oliver on the legacy of psychiatry\u2019s forgotten critic<\/p>\n","protected":false},"author":1,"featured_media":17627,"template":"","article_type":[13],"noteworthy_people":[],"topics":[5049,5014],"_links":{"self":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article\/9935"}],"collection":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article"}],"about":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/types\/article"}],"author":[{"embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/users\/1"}],"version-history":[{"count":0,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article\/9935\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/media\/17627"}],"wp:attachment":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/media?parent=9935"}],"wp:term":[{"taxonomy":"article_type","embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article_type?post=9935"},{"taxonomy":"noteworthy_people","embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/noteworthy_people?post=9935"},{"taxonomy":"topics","embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/topics?post=9935"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}