Thomas Szasz
Obituary
Anthony Stadlen
 |
| Thomas Szasz Szasz’s 90th-birthday seminar Inner Circle Seminar No. 153 London, 13 June 2010
Photograph copyright jennyphotos.com
Not to be used without permission |
Copyright © Anthony Stadlen 2013, 2020
Existential Analysis 24.1 (January 2013): 7-18.
[See also my obituary of Szasz in The Guardian:
https://www.theguardian.com/society/2012/oct/04/thomas-szasz]
Existential Analysis 24.1 (January 2013): 7-18.
[See also my obituary of Szasz in The Guardian:
https://www.theguardian.com/society/2012/oct/04/thomas-szasz]
The Hungarian-American psychiatrist and writer Thomas
Szasz, who has died aged ninety-two, is regarded by many as the leading twentieth-
and twenty-first-century moral philosopher of psychiatry and psychotherapy. Others
see him as a dangerous and seductive influence, advocating neglect of some of
society’s most helpless members.
Szasz had a deep faith in human freedom. Human
beings, he said, are free agents, fully responsible for their actions – not passive ‘patients’, whose ‘behaviour’ is
‘caused’ by their brains, or by ‘mental illness’. His faith in freedom led him
to a deep sympathy with existential thinking. However, he denounced any incursions on civil liberties in
the name of psychiatry and deplored that most existential therapists did not do
likewise.
In the best known of his thirty-five books, The
Myth of Mental Illness: Foundations of a Theory of Personal Conduct (1961)[1],
Szasz argued that mental health and mental illness are alienated, pseudo-scientific,
pseudo-medical terms. He maintained that the term ‘illness’, in the modern,
scientific sense, cannot be applied to ‘minds’ – except as a metaphor. A bodily organ, the heart, can be
diseased; but to be heartsick or homesick, though real enough, is not to be
medically, but only metaphorically, ill. Equally metaphorical, said Szasz, were
such supposed mental illnesses as hysteria, obsessional neurosis,
schizophrenia, and depression.
Having discussed Szasz with a great many people
over half a century, and having read much of what has been published about him
during this time, I have found that most of his admirers and advocates, as well
as most of his adversaries, misunderstand him. For example, many who claim to
be influenced by him, including many existential therapists, call themselves
‘mental health workers’. They talk about ‘mental health issues’, while claiming
that they are following Szasz in not using what they call ‘pathologising labels’
such as ‘mentally ill’. They seem to assume that he was merely urging a kind of
politically correct euphemism, like the bizarre term ‘service user’ they use
for incarcerated, compulsory, psychiatric ‘patients’ no less than
for voluntary ones. But Szasz discarded the discourse of ‘mental illness’ and
‘mental health’ more than half a century ago, simply because he saw it as a mistake.
Szasz insisted that his analysis of the myth of
mental illness – and mental health – was purely logical. A mental illness was
like a square circle, not like a unicorn. One might discover a unicorn, but one
could never discover a square circle or a mental illness.
To some, Szasz appeared almost frivolously to
ignore the anguish and incapacity of many. However, he went on to point out the
empirical, ethical and political implications. His primary concern was the use
of the myth of mental illness, not just to describe, but also to prescribe. He
saw it not as an innocent mistake
but as a socially and politically motivated act of bad faith. It gave false legitimacy to compulsory psychiatry – coercing the innocent – and the insanity defence –
excusing the guilty. He denounced these complementary uses of psychiatry as
crimes against humanity, and called for them to be legally abolished.
He wrote[2]: ‘The
Myth of Mental Illness was intended to be more than just an academic
exercise in semantics. It was also intended to be a denunciation of the moral
legitimacy of the most violent method that the modern state possesses and
wields in its perpetual effort to domesticate and control people, namely,
depriving innocent individuals – with the full support of physicians and
lawyers – not only of liberty but of virtually all their constitutional rights,
in the name of helping them.’
He defended an individual’s right to buy, sell
and take drugs; to give informed consent to ‘treatment’, such as drugs,
electroconvulsive therapy or even destructive psycho-surgery; and to engage in
consensual, contractual psychotherapy. But he pointed out that, even if any of
these made the individual feel better, this did not prove that he or she had
been ill. If someone diagnosed as mentally ill should turn out to have a brain
disease, then this would be a genuine physical illness, not a metaphorical
mental one, and should be treated by neurologists, not ‘treated’ by psychiatrists.
Szasz’s opponents said he was so obsessed with abstract justice,
freedom and responsibility that he denied the ‘medical problems’ of ‘suffering
patients’ whose ‘mental illnesses’, so it was claimed, made them unable to take
responsibility. But Szasz was deeply concerned with human suffering. His point
was that suffering was not necessarily a medical problem, did not imply lack of
responsibility, and should not be forcibly ‘treated’. Forcible ‘treatment’ did
not imply the person ‘treated’ was suffering – except, very likely, from
forcible ‘treatment’. Indeed, almost every week desperate
involuntary ‘patients’ wrote to him as the only person they trusted to understand
their predicament.
He saw compulsory psychiatry, no matter how ‘compassionately’
intended, as patronising and infantilising. Many observers have found that his early
descriptions of the ever-increasing medicalisation of many human situations –
what he termed the ‘therapeutic state’[3]
– remain uncannily accurate in the new millennium.
But it is not generally realised how committed
he was to voluntary psychotherapy. At an Inner Circle Seminar in 2007[4]
he said: ‘Psychotherapy is one of the most worthwhile things in the world.’ In The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric, and Repression (1979 [1978])[5]
he wrote that Freud had misdescribed psychotherapy as
a science and medical treatment. But Szasz revered the possibility Freud had
opened up, of searching conversation between consenting adults. However, Szasz saw
most psychotherapists as confused, prostituting their potentially noble art by
making it the handmaiden of psychiatry. But he affirmed the right of consenting
adults to engage in even the silliest forms of psychotherapy, provided it was
voluntary. And he practised and promoted what he regarded as true
psychotherapy, in which there was no ‘psyche’ and no ‘therapy’. He tried new
names for it, such as ‘iatrologic’[6]
and ‘autonomous psychotherapy’[7],
but he disliked pretentious terminology. Szasz approved of child welfare, but,
since children cannot give consent, he denounced ‘child therapy’ as child abuse[8]
and child torture.
Born in Budapest 15 April 1920 ,
Thomas Szasz was the son of a Jewish businessman-lawyer, Julius, and his wife,
Lily. His preoccupation with liberty began when, as a boy of six, he was forced
to go to school. On long walks, he was shown prisons, hospitals – and mental
hospitals, which he thought, even as a child, should also be called prisons. By
adolescence, he found that ‘inquiring into the justification for locking up mad
people is taboo. Crazy people belong in madhouses. Only a crazy person would
ask, why?’[9] He
thought, even then, that mental illness was not an illness. He never had to
give up a belief in mental illness, since he had never had such a belief.[10]
He wrote to me that, as a boy, he was moved by
how, in Mark Twain’s novel The Adventures of Huckleberry Finn[11],
‘an ignorant child, Tom Sawyer –
another Tom S.!, – could recognise
the evil of slavery, though the adults could not’.[12]
Later, Szasz wrote detailed comparisons of compulsory psychiatry to slavery in Psychiatric
Slavery: When Confinement and Coercion Masquerade as Cure (1977) and Liberation by Oppression: A
Comparative Study of Slavery and Psychiatry (2002)[13], and to the Inquisition in The Manufacture of Madness: A Comparative Study of the
Inquisition and the Mental Health Movement (1970)[14].
By 1938, Hungary
had sided with Nazi Germany, and the family moved to Cincinnati , Ohio University
of Cincinnati US naval hospital, Bethesda , Maryland
He settled in the Upstate Medical Centre of the
State University of New York, in Syracuse
Szasz called himself an ‘out-and-out atheist’,
but he said his atheism was ‘religious’. He and I agreed that existential thinking
had to start from the axiom that human beings – whether or not made in the
image of an ineffable God – are ineffable in the sense that they can not
be ultimately described by a system or a science. ‘And therefore,’ he said, ‘psychotherapy
is ineffable’.[16]
It was a secular form of the ‘cure of souls’. He said psychotherapists were more
like rabbis or priests than like medical doctors. He held that confidentiality
should be absolute, as in the confessional. It was no business of third
parties, or the state.
In 1965 Szasz published two of his most original
and refreshing books: Psychiatric Justice[17]
and The Ethics of Psychoanalysis: The
Theory and Method of Autonomous Psychotherapy[18].
Psychiatric Justice (1965) is a careful analysis of the insanity defence.
Szasz asks under what circumstances someone accused of a crime may reasonably be
found incompetent to stand trial. The book repays close reading, as it is often
supposed that Szasz demanded that everyone accused of a crime should stand
trial. This is quite untrue. His point is that ‘mental illness’ should not be a
ground for denying the right to trial or for requesting to be excused trial.
However, he states many possible legitimate grounds for finding someone
incompetent to stand trial, and he discusses who would be best placed to assess
them. He is certain only that the assessors should not be psychiatrists.
The book contains wonderful excerpts from the
transcript of a 1962 court hearing to determine whether ‘Mr. Louis Perroni’ was
competent to stand trial. For example[19],
the Assistant District Attorney, for The People, asks Szasz, as expert witness:
‘Do you think everybody is against Mr. Perroni in this case?’ Szasz replies:
‘On the
contrary, I have just tried to explain that everybody is for him. You should be
against him and then he could stand trial. This is my point. You shouldn’t be
for him; be against him. Let Mr. Gross be for him and me. Don’t let Dr. Lipsky be
for him, but let him be his adversary. I believe in the American adversary
system of justice. It may be old-fashioned but I believe in it.’
Szasz, a refugee from fascism and Nazism, believed
passionately in Anglo-American democracy, freedom and justice. He was deeply
dismayed by the corruption of the democratic, adversarial system by totalitarian,
inquisitional psychiatric thinking and practice. The Assistant District
Attorney’s incomprehension of Szasz’s love of democracy can be seen in the
following exchange.[20]
The lawyer quotes a passage[21]
from The Myth of Mental Illness:
Q. The sentence…is: ‘Lincoln
A. I like that.
Q. You like that statement?
A. I like that statement.
Q. Who said that?
A. Lincoln.
Q. Lincoln said that?
A. Yes.
Q. And then you differ from Abraham Lincoln’s
definition of democracy in your book, is that correct?
A. That is not correct.
Szasz placed at the head of each chapter in Psychiatric
Justice an epigraph from Camus’s essays against fascism in Resistance,
Rebellion, Death[22]
or from his book The Rebel[23].
The Ethics of Psychoanalysis (1965) was one of Szasz’s own favourites among
his books. It is a fundamental contribution to thinking on existential
psychotherapy. It is typical of Szasz that, having subtitled it The Theory
and Method of Autonomous Psychotherapy, he wrote in his preface to the 1988
edition: ‘there is – there can be – no such thing as a…psychotherapeutic
method’! But in no sense was he repudiating his book. I have been greatly
helped by it, as have other psychotherapists. It is invaluable in clarifying,
among other things, how not to get into a false position with clients.
I shall draw on some of what he called our ‘years
of fruitful conversation’[24]
because he said that I was the only person with whom he had ever been able to
talk about psychotherapy.[25]
When I drew his attention to the writings of Peter Lomas, who had just died, he
wrote: ‘I didn’t realize there were three of us. (Well, four, counting
Esterson.)’ [26] But
he thought even Lomas wrote too ‘gingerly’ about medicalisation, although
(wrote Szasz): ‘Honesty shines through his writing’.[27]
I apologise for quoting my own words, but his
endorsement of them throws light on his position in relation to existential
analysis. I wrote in connection with an Inner Circle Seminar, ‘Freud as
Existential Analyst’[28],
last year:
Existential psychotherapy and
psychoanalysis are often taught nowadays as if they were diametrically opposed
disciplines. But this is a tragic misunderstanding: an ill-informed and
destructive splitting. The
pioneering existential analysts were psychoanalysts. Medard
Boss wanted Daseinsanalysis to be nothing other than a ‘purified’ psychoanalysis[[29]]
– ‘purified’ of pseudo-science. Despite his scientistic and
medical-psychiatric aspirations, Freud – at his best – was a true existential
pioneer. Existential psychotherapy is gravely limited unless it is informed by the
crucial phenomenological findings of psychoanalysis (though it should indeed
jettison Freud’s ‘metapsychology’, which he himself said was dispensable).
Szasz wrote:
Good summary. As you know, we
agree completely about this.[30]
It goes without saying that, without my blessed discovery
of Szasz in the early 1960s, I might never have got to the point of writing
words with which he agreed.
In 2004, I gave a lecture in which I asked whether psychotherapists’
understanding of love was an
advance on popular understanding, let alone on the Holiness Code [Leviticus
19] or on writers such as Shakespeare, Jane Austen and Tolstoy. I argued that
the
language of ‘mental
health’
encourages people, even great thinkers like Freud and Jung, to talk in
alienated ways.[31]
He wrote to me that he ‘very strongly’ agreed. He added[32]:
Herein is our problem: How
can one make a profession, how can one make a living, out of being ‘simply human’, in
the sense of the Holiness Code? This was a problem for Freud and Boss, etc.,
and is a problem for all of us. It is a pseudoproblem, solved by our
forefathers ages ago: being a rabbi is not a job, not a moneymaking profession.
First, you have to do something practical – be a teacher, tailor. Then, in your
spare time, you are a rabbi.
In Szasz Under Fire: The Psychiatric Abolitionist Faces
His Critics (2004)[33],
edited by Jeffrey Schaler, his views were challenged from various angles by
leading psychiatrists and philosophers, and defended meticulously by Szasz
himself, at such length that this can be seen as his thirty-sixth book. The
book also contains an important and fascinating autobiographical account by
Szasz of his early life and how he developed his ideas.
The same year, in Faith in Freedom: Libertarian Principles and
Psychiatric Practices (2004)[34],
he lamented that even leading libertarian thinkers of the left and right – John
Stuart Mill, Bertrand Russell, Ludwig von Mises, Friedrich von Hayek – held
that the so-called mentally ill were not responsible for their actions and
could legitimately be incarcerated and forcibly treated.
He and R. D. Laing are often wrongly linked as ‘antipsychiatrists’,
but Szasz showed in Antipsychiatry: Quackery Squared (2009)[35]
that Laing practised both the compulsory psychiatry and the insanity defence
that Szasz deplored.
Szasz learned much from the existential
tradition, especially from Kierkegaard and Sartre, as well as from Camus. Some
existential therapists have learned from him, but too many get no further than
accusing him of dualism. They claim he split mind from body and ignored the
ancient holistic concept of illness. But Szasz was well aware of the ancient
concept. He meant that mental illness is a metaphor relative to the modern
natural-scientific, Virchowian concept of illness as cellular pathology, of the
body-as-object, not the lived body. Szasz explained this in innumerable books
and papers, most rigorously in Pharmacracy: Medicine and Politics in America (2001)[36].
He wrote to me that the ‘dualism’ accusation was a red herring. Even if he were
a ‘dualist’, he asked, how would this justify coercive psychiatry and existential
therapists’ collusion with it?
His last book, Suicide Prohibition: The Shame
of Medicine (2011)[37],
written when he was ninety, was a protest against suicide prevention, the primary
justification for compulsory psychiatry. However, he was equally opposed to
physician-assisted suicide, which he saw as yet another intrusion of medicine
into living and dying.
Szasz was a courteous listener and greatly
enjoyed dialogue. He preferred it to lecturing, although he was a brilliant
speaker. He listened intently, relishing each question, often thanking the
other person for such a good one. He published ten books (eleven with Szasz
Under Fire) after turning eighty, and conducted three electrifying all-day
Inner Circle Seminars[38]
in London, in 2003, 2007 and 2010, the last at ninety, attended by exactly ninety
people, the dialogue an incandescence of ninety birthday candles.
In dialogue, there was a chance to try to understand
his interlocutor’s possible misunderstanding and to clarify what he himself was
saying. This was at least as difficult a task as Heidegger’s in the Zollikon
seminars. Although listeners to both men were curious and interested, they were
often unprepared for the radical nature of what Heidegger and Szasz were
saying. The seminar participants’ unexamined natural-scientistic and
medicalistic assumptions (I do not mean the regular participants in the Inner Circle
Seminars) often made it virtually impossible for them even to hear what
the speaker was saying. They were disconcerted by what they heard, or thought
they heard. They had not made the fundamental shift of thought that Heidegger
and Szasz, in their different but related ways, had made. Since Szasz’s
language was usually simple and colloquial, listeners often assumed they knew
what he meant; and they found what they thought he meant shocking.
This was as true of many existential therapists
as of other listeners. This may explain why, for example, one former senior officer
of the Society for Existential Analysis called Szasz ‘a fascist’, and why another
former senior officer of the Society called him ‘a little fascist’ (a nice
distinction). It may explain why one member of the Editorial Board wrote to me,
and circulated widely, an abusive and scatological email denouncing me for having
invited Szasz to speak at an Inner Circle Seminar in 2003; and why another member
of the Editorial Board wrote to me, and also circulated widely, an email demanding
to know what, in view of my invitation to Szasz, I was doing on the Advisory Board
of the Society for Laingian Studies (he had himself invited me).
Szasz had been invited to address a seminar and
conference of the Society for Existential Analysis as early as 1989 and 1991,
and he had himself been a member of the Editorial Board since 1994. I have
described, in my paper ‘“A poor model for those in training”: The case of
Thomas Szasz’ (2003)[39],
how, despite the support for Szasz from Emmy van Deurzen, Ernesto Spinelli and
myself, a number of existential therapists expressed suspicion and mistrust of
Szasz from the beginning.
At the 2003 Inner Circle Seminar a psychotherapist
and teacher said she was ‘angry’ because Szasz ‘supported slavery’. She
lectured him at length about ‘drapetomania’, the ‘mental illness’, ‘discovered’
in the nineteenth century, that ‘explained’ the perplexing tendency of black
slaves to try to escape. Szasz listened politely. Only when I intervened to
tell her that she almost certainly would never have heard of ‘drapetomania’ if
Szasz himself had not rediscovered and written about the literature on ‘it’ in
his paper ‘The sane slave’ (1971)[40], did he confirm this. ‘So please don’t be angry with me
about this,’ he said gallantly. ‘Be angry with me about something else.’
I have come across countless similar
misunderstandings of him. Szasz himself wrote in Words to the Wise: A
Medical-Philosophical Dictionary (2004) that people often brought arguments
against him ‘founded on so successful a distortion of my position that it is
virtually impossible to counter’ them.[41]
However, he never gave up seeking new ways to do so.
Existential therapists often try to present
Heidegger as profound and non-dualistic, Szasz as superficial and dualistic. I
am not the only person who finds them both profound and both non-dualistic. For
example, Keith Hoeller, a scholarly translator and editor of both Heidegger[42]
and Szasz[43],
is of the same opinion.
Heidegger observes that tears cannot be
understood by natural science although their physical properties can be.[44]
Szasz observes that a wedding ring cannot be understood by natural science
although its physical properties can be.[45]
Heidegger and Szasz are making the same point, and Laing made it too. It is not
dualistic. The two ways of seeing tears or a wedding ring, the personal and the
physical, are like the two ways of seeing a human being, as person or as
organism, which Laing discusses in The Divided Self: An Existential Study in
Sanity and Madness (1960)[46]
published a few months before The Myth of Mental Illness. As Laing puts
it, in the language of existential phenomenology, each of the two ways of
seeing is a different ‘initial intentional act’[47].
Laing writes:
There is no dualism in the sense
of the co-existence of two different essences or substances there in the
object, psyche and soma.[48]
Thus those existential therapists who accuse Szasz of
dualism are wrong. The two ways of seeing, the two different intentional acts, that
Heidegger, Szasz and Laing are defining, do not constitute a ‘mind-body dualism’.
However, Heidegger and Boss still cling to the idea of Daseinsanalysis as
medical, as I have discussed in my paper ‘“Medical Daseinsanalysis”’ (2005)[49].
There are a few existential psychotherapists who
have a real understanding of Szasz’s work. But for the most part it appears
that Szasz is misunderstood by existential therapists in the ways I have
described above and in various papers.[50]
And it is surely significant that not one of the sixteen or seventeen books
Szasz published since the Society was founded in 1988 has ever been reviewed in
this Journal.
But ordinary working people, who have nothing to
do with psychiatry or psychotherapy or existential analysis, often understand
immediately what Szasz was talking about. My wife,
Naomi, asked the recording technician at Szasz’s all-day ninetieth-birthday
seminar whether it had been a long day for him. He looked surprised at the
question. His eyes lit up and he replied: ‘No, he’s very clear.’ It was obvious
that he had been completely absorbed in listening. He told her that he did not
normally listen to the content of what he was recording.
I found our decorator sitting in my consulting
room, having downed tools in the kitchen, listening to the recording of Szasz’s
seminar which I had left on. ‘He’s great, isn’t he?’ he said. ‘He really talks
sense. Who is he?’
Szasz’s wife Rosine died in 1971. He is survived
by his daughters, Margot and Suzy, by his grandson, Andrew, and by his older
brother, George.
PS (2020) From my obituary of Szasz in Hermeneutic Circular
(October 2012)
After [Szasz’s 90th-birthday] seminar [13 June 2010 Szasz conducts 90th-birthday seminar: The Myth of ...] I drove him to the Cotswolds,
the Lake District, and then Edinburgh and Manchester Manchester
But I was to spend two more short holidays with
him in his home town, Manlius ,
NY
I was deeply moved that he saw the decency of
these people. They would surely have come to the help of neighbours or
strangers, if only to open the door with kindness and courtesy. This was our
last meal together. He drove me to the airport and we said goodbye. He was
going to drive Naomi and me to Niagara next
time.
On 11 September I heard from Jeff Schaler
that Tom had died. A few days earlier Tom and I had exchanged humorous emails.
He must have been in excruciating pain, but he did not tell me. Then he didn’t
answer an email. At the beginning of September, he had fallen and broken the tenth thoracic vertebra in his spine. He had refused to stay in
hospital, accepting only a prescription for painkillers. On 8 September, at
home, he had died. [Note, 2020: He had exercised the right he had so fiercely defended for so long, in particular in his last book: to take enough drugs to kill himself.] Had he not fallen, I think he could have gone on for years.
Thomas Stephen
Szasz, psychiatrist and writer, born 15 April 1920, Budapest ; died 8 September 2012 , Manlius , NY
An all-day seminar, Thomas Szasz: In Memoriam (Inner
Circle Seminar No. 188), will be conducted by Jeffrey Schaler,
Morton Schatzman and Anthony Stadlen on 3 March 2013 from 10
a.m. to 5 p.m.
at Durrants Hotel, London
Notes
Notes
[1] Szasz 1961.
[2] Szasz 2004b: 175.
[3] Szasz 1984.
[4] Szasz 2007.
[5] Szasz 1979 [1978].
[6] Szasz 1979 [1978]: 208.
[7] Szasz 1988 [1965b].
[8] Szasz 2004a: 18.
[9] Szasz 2002: 14.
[10] Schaler 2004: 28.
[11] Twain n.d. [1885].
[12] Szasz to Stadlen (email).
[13] Szasz 1977, 2002.
[14] Szasz 1970.
[15] Szasz to Stadlen (email) 2004.
[16] Szasz to Stadlen (conversation, Bath , UK 15 September 2007 .
[17] Szasz 1965a.
[18] Szasz 1965b.
[19] Szasz 1965a: 134.
[20] Szasz 1965a: 129.
[21] Szasz 1961: 199.
[22] Camus 1961.
[23] Camus 1956.
[24] Szasz 2009: xi.
[25] Szasz to Stadlen (conversation, Bath , UK 15 September 2007 .
[26] Szasz to Stadlen (email) 14 February 2010 .
[27] Szasz to Stadlen (email) 10 February 2010 .
[28] Stadlen 2012.
[29] Boss and Holzhey-Kunz 1982 [1981]: 111.
[30] Szasz to Stadlen (email) 13 March 2012 .
[31] Stadlen 2004.
[32] Szasz to Stadlen (email) 2004.
[33] Schaler 2004.
[34] Szasz 2004b.
[35] Szasz 2009.
[36] Szasz 2001.
[37] Szasz 2011.
[38] Szasz 2003, 2007, 2010.
[39] Stadlen 2003.
[40] Szasz 1971.
[41] Szasz 2004a: 128.
[42] Hoeller 1988, Heidegger
2000.
[43] Hoeller 1997, 2012.
[44] Heidegger 2001: 201.
[45] Szasz 1996: 140.
[46] Laing 1960.
[47] Laing 1960: 19-20.
[48] Laing 1960: 19-20.
[49] Stadlen 2005.
[50] Stadlen 2000, 2003, 2008.
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