Thomas Szasz, R.I.P.

by Adam Keiper

The rebel psychiatrist Thomas Szasz passed away over the weekend at the age of 92. His criticism of the standard psychiatric understanding of mental illness and addiction made him a hero to some libertarians, as did his opposition to the war on drugs.

Szasz’s iconoclastic views, expounded upon in three dozen books and countless articles, brought him an ardent (if small) popular following. They also resulted in some strange partnerships — as in his alliance with the Scientologists in their denunciation of psychiatry. But they made him a pariah in the academy and among clinical psychiatrists. As Jeffrey Oliver wrote in a 2006 profile of Szasz in The New Atlantis:

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 . . .

One can hardly be surprised if Szasz has assumed the role reserved for all failed revolutionaries — 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 — aside from utter disregard — is typically something like: “Just look around — anguished teenagers, depressed adults, distracted children. Only a fool would believe that mental illness is a myth.” 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.

However, as Oliver reported, as the decades wore on, some of Szasz’s ideas were earning the grudging respect of eminent psychiatrists, including some of his former critics. Oliver’s essay (which prompted some debate here on the Corner at the time) ended by noting the continuing relevance of at least some of Szasz’s challenges to psychiatry:

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 . . .

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 “schizophrenia” to describe, among others, the “irritable, odd, moody, withdrawn, or exaggeratedly punctual,” those who “vegetate as day laborers, peddlers, even as servants,” and “the wife … who is unbearable, constantly scolding, nagging, always making demands but never recognizing duties,” the only way to diagnose this “disease,” 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 — to explain the human condition, to heal every broken soul — the reliance on behavioral observation has led to the medicalization of an ever-growing range of human behaviors. It treats life’s difficulties and oddities as clinical conditions rather than humanity in its fullness.

— Adam Keiper is editor of The New Atlantis and a fellow at the Ethics and Public Policy Center.