Szasz, Thomas (1920-2012)

Thomas Stephen Szasz was born in Budapest, Hungary, and is currently a Professor Emeritus of Psychiatry at the State University of New York Health Sciences Center in Syracuse. Although many of his colleagues regard Dr. Szasz as a bird that fouls its own nest, he is highly esteemed among many humanists, libertarians, and critics of psychiatry, including an increasingly growing number of attorneys. Libertarians are often especially attracted to him because of what they would describe as his unremitting defense of personal freedom and responsibility, two values he regards as indivisible. He has received numerous national awards, including Humanist of the Year in 1973. His “passion against coercion” has led him to oppose involuntary mental hospitalization (as well as all other involuntary treatment), and his esteem for personal responsibility has led him to oppose the insanity defense. If people commit crimes, they should, according to Dr. Szasz, be punished, “not treated.” If they do not commit crimes, they should be left alone regardless of how bizarre their behavior is. Should they want help increasing their self-​knowledge and understanding of others with whom they have contact, psychiatrists and other health care professionals can legitimately help them, provided that the relationship is contractual and educational and free of coercion and domination.

After emigrating from Budapest, Hungary, to the United States in 1938, Dr. Szasz attended the University of Cincinnati from 1939 to 1944, earning an undergraduate degree in physics and a medical degree. In 1956, he went to Syracuse, where he took a position as a professor of psychiatry at the Upstate Medical Center at the State University of New York, from which he retired in 1990. Besides teaching and writing, he has had a private practice throughout most of his career.

A prolific writer, he has written more than 700 articles and two dozen books (the number increases almost yearly). His most famous and most controversial book is his second one, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, published in 1961. He had been thinking about many ideas in that book since the 1950s, and he presented them in an address at the annual meeting of the Southern California Psychiatric Society in the fall of 1960. The central thesis of the book, crucial to understanding Dr. Szasz’s point of view, is that the expression mental illness and its relatives are metaphors not for problems special to medicine, but for problems of living concerned with internal and external conflict involving roles or games. In his 1990 book The Untamed Tongue, he describes how he believes the concept of mental illness is connected to social norms or expectations:

He holds that, although real illness is physical and defined by such bodily criteria as lesions and organic malfunctions, what qualifies as mental illness can be almost any behavior that is perceived as unpleasant, obnoxious, or threatening to its author, others, or both. Historically, behavior classified as mental illness or a form of mental disorder has been wide ranging, including refusal to support oneself through work, reckless gambling, drug habits, unconventional sexual practices, dissatisfaction with one’s physical appearance, impulsive violence, and political nonconformity (as in the former Soviet Union).

“Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish,” he writes on his Web site (www​.sza​sz​.com). For him, mental illness no more describes a species of illness than decoy duck describes a species of duck. He would contend, however, that although everybody knows that decoy ducks are not ducks, people commonly think that mental illness describes a species of illness. The unquestioning belief in mental illness has profound social consequences because it provides the justification for what Dr. Szasz would describe as state-​sponsored social control, as when people labeled mentally ill are involuntarily hospitalized. Although Dr. Szasz never denies that people can have real problems coping with life and dealing with others, he denies that those problems are properly regarded as a form of illness. What is more, although he acknowledges that some organic conditions, such as Alzheimer’s disease, can influence thought and behavior, he argues that the behavior is never a disease.

By asserting that the concept of mental illness is a myth, Dr. Szasz intends, among other things, to reject a medical frame of reference for describing, understanding, and attempting to control people’s actions and habits. When people regard actions and habits as illness, they are, he insists, rejecting the conception of people as free and responsible moral agents and accepting instead the conception of people as patients and victims needing the intervention, at times forced, of medical professionals. Because most people have uncritically accepted the appropriateness of applying medical concepts to disapproved behavior, we, as a society, have replaced a moral-​theological outlook with a therapeutic one. By treating habits, actions, and complex social performances as illnesses, we increase the power of psychiatrists and other health care professionals while we devalue personal freedom and responsibility. (Dr. Szasz’s influential writings on drug prohibition illustrate his central thesis well.)

Because of his work and the actions of civil libertarians and other social critics, there has been a growing uneasiness about coercive psychiatry, leading to legal reforms that have made it more difficult to hospitalize involuntarily those labeled mentally ill. His writings are important not only because they require people to question foundational definitions in psychiatry, but also because they provide a point of view for defending personal freedom and responsibility against therapeutic paternalism.

Further Readings

Szasz, Thomas. Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers. Rev. ed. Holmes Beach, FL: Learning Publications, 1985 [1974].

———. Cruel Compassion: Psychiatric Control of Society’s Unwanted. New York: Wiley, 1994.

———. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Harper, 1961.

———. Our Right to Drugs: The Case for a Free Market. New York: Praeger, 1992.

———. The Untamed Tongue: A Dissenting Dictionary. LaSalle, IL: Open Court, 1990.

Vatz, Richard, and Lee Weinberg. Thomas Szasz: Primary Values and Major Contentions. Buffalo, NY: Prometheus Books, 1982.