Thomas Szasz RIP

Misunderstanding Thomas Szasz

by Jesse Walker

It's hard to think of a writer who expressed himself as clearly as the late Thomas Szasz did, or who argued his points with such precision. You might fault his logic or disagree with his premises, but it ought to be hard to misunderstand what exactly he was saying. And yet he was constantly misunderstood. How many times, for example, has someone suggested that Szasz's argument against the idea of mental illness has been refuted by research on the biological basis of schizophrenia? The implications of that research are routinely overstated, but set that aside: Even if the most breathless pop-science coverage of those investigations were accurate, they wouldn't affect Szasz's distinction between metaphorical mental diseases and actual physical lesions. They would simply move schizophrenia from the first category to the second one. Far from being unable to process such scientific developments, Szasz wrote thoughtfully about something similar that had happened in the past, when the treatment of epilepsy moved from the dominion of the psychiatrists to the dominion of the neurologists.

Meanwhile, there seems to be no limit to the medicalization of our lives. So while Szasz's critics tout those schizophrenia studies as evidence that their target is no longer relevant, I read stories like this CNN report and conclude that he's more relevant than ever:

A federal court judge on Tuesday ordered Massachusetts officials to provide sex-reassignment surgery for a transsexual prison inmate, after determining that it was the only adequate treatment for the inmate's mental illness.

The state's Department of Correction said Michelle Kosilek, previously known as Robert, who is serving a life sentence without parole for murdering his wife in 1990, has a gender identity disorder....

Chief Judge Mark L. Wolf ruled that sex reassignment surgery is the "only adequate treatment" for Kosilek, and "that there is no less intrusive means to correct the prolonged violation of Kosilek's Eighth Amendment right to adequate medical care."

In the old days, "gender identity disorder" or some similar label would have been a license to coerce Kosilek back into a male identity. Now it's a license to coerce taxpayers into subsidizing a sex-change operation. Szasz would have said it's absurd to think of the sexual roles people adopt in terms of a disorder.

The medicalization mindset has taken hold even among the people you'd expect to like it the least. While many transsexual activists object, on understandable grounds, to the idea that they're sick, reporters haven't had trouble finding others willing to say things like "It's great to see a judge recognize that transition-related health care is medically necessary health care." In 2012, there are social advantages as well as social disadvantages to acquiring a psychiatric label -- and not just when it comes to a headline-grabbing subject like sex-change surgery behind bars. The Diagnostic and Statistical Manual of Mental Disorders is filled with diagnoses designed to describe ordinary life problems, some of which might be solved or made more manageable by talking to a counsellor or by taking a mood-altering chemical. Once upon a time, a label from its pages would have been a stigma; now it's a way to get an insurance company to cover the costs of those talks or those drugs. (The flow of money from insurance companies has, in turn, become an incentive encouraging psychiatric coercion, a process Joe Sharkey described in his muckraking book Bedlam. Circle of life!)

It was bad enough when readers misunderstood Szasz's own ideas. It was worse when they misattributed other figures' ideas to his work. Forty years ago, when people heard that Szasz was a critic of psychiatry, they often assumed he must be a countercultural "antipsychiatrist" like R.D. Laing. In fact, while Szasz saw some of the antipsychiatrists as allies early on -- he recommended one of Laing's books in a footnote to The Manufacture of Madness -- he concluded quickly that they were no more opposed to coercion than the psychiatric establishment was. Eventually he grew so aggravated at being conflated with them that he wrote abook-long critique of their worldview. By then, with Laing forgotten, people were more likely to insinuate that Szasz was some sort of Scientologist. L. Ron Hubbard's weird church denounces psychiatry all the time, after all, and it was Szasz's ally in the political fight against electroshock and other involuntary treatments. But no, he wasn't a Scientologist, and no, they aren't the master manipulators behind every challenge to psychiatric authority.

I had my disagreements with Szasz, but I can't think of anyone who wrote with as much bracing clarity about the ways psychiatric ideology distorts our understanding of issues ranging from religion to the drug war. (Did I say "ranging from"? Szasz's best book -- Ceremonial Chemistry -- makes a strong case that the drug war and religion are closely linked.) He had the ability to look at claims that are presented as objective science and to see the cultural assumptions lurking behind the curtain. Just as important, he could see the ways our it served our social hierarchies to pretend those cultural contingencies weren't there.

I met Szasz just once, at a conference sponsored by Liberty magazine. I asked him about Gregory Bateson's theory of schizophrenia in Steps to an Ecology of Mind, which paralleled Szasz's writing in several significant ways but stopped short of Szasz's full critique of the idea of mental illness. "It seemed like he got halfway to your position," I told him. "No, he got all the way there," Szasz replied, "but he wasn't brave enough to say it." Whether or not it was fair to charge Bateson with cowardice, it's difficult to imagine anyone levying such an accusation at Szasz: Here was a man with the courage of his convictions. And here was a man with the literary skill to express those convictions clearly, no matter how hard some might find it to decipher his plainly stated arguments.