The Legacy of Thomas Szasz

I came across Thomas Szasz by accident back in the 1990s when I was researching something peripherally related to his field. I read his book The Manufacture Of Madness, which is subtitled A Comparative Study Of The Inquisition And The Mental Health Movement. Recently I re-read this, or large parts of it, and also looked at his earlier book THE MYTH OF MENTAL ILLNESS Foundations of a Theory of Personal Conduct, Revised Edition, (1974).

Thomas Szasz was a true iconoclast and he made enormous contributions to his field which, if applied, would liberate especially Western society from some truly enormous and self-serving shibboleths. But a word of warning; like many people at the cutting edge, he overstated his case. Broadly speaking, Thomas Szasz said mental illness does not exist, and in that bracket he included schizophrenia, extreme depression and other disorders which most of us would and do equate with severe mental illness.

He didn’t stop there though, he said there was no such thing as mental illness because there is no such thing as mind! Extreme statements of this nature invite summary dismissal not only by those who have not the slightest interest in following the discourse but by most skeptics. Let us though begin where he is obviously right.

Broadly speaking, most of the so-called mental illnesses that are alluded to as such are not illnesses in the proper medical sense, because they have no pathology. If you go to your doctor feeling unwell, he may order some tests which may determine you have some sort of infection: a virus in your blood, and so on. If you are so unfortunate as to be suffering from cancer of the liver or cancer of anything else, this too can be determined by medical tests. The very cells of the organ will be infected, damaged or even destroyed. There are no such tests for mental illness. As Szasz pointed out consistently, when the pathology behind a mental illness is identified, that mental illness is removed from the list of mental illnesses. The example he usually gave was neurosyphilis. When the underlying pathology for this disease was discovered – the bacterium Treponema pallidum – it was reclassified as a neurological disease.

Indeed, if all conditions that are defined as ‘mental illness’ were found to have biological bases then psychiatry as a discipline would actually disappear up its own exhaust pipe.

In The Manufacture Of Madness, Szasz gives another striking example, one that should give us all food for thought.

“In 1970, homosexuality was an illness so dangerous to the commonwealth that the U.S. Immigration and Naturalization Service was charged with excluding homosexuals from entering the country...Today, homosexuality is a normal life style; disapproving of it is a mental illness called ‘homophobia’...”

Whatever one thinks of male homosexuality – and personally I try not to – it is clear that if it was a mental illness in 1970, it should still be regarded as a mental illness today in the absence of some extraordinary medical discovery. In fact what actually happened was that the nascent homosexual lobby subjected the American Psychiatric Association to intense pressure – to put it mildly – and this resulted in that organisation reversing its diagnosis.

This was far from the first time something like that has happened, and in fact when one traces the dubious origins of psychiatry, it beggars belief that it was ever recognised as a branch of medicine.

As Szasz observed again, Benjamin Rush, the acknowledged father of American psychiatry believed Negroes were black not because of the melanin in their skin but because of a disease called negritude. The basis for this was that around 1792, white spots began to appear on the body of a black slave named Henry Moss, and in 3 years he was almost entirely white.

Presumably the bone structure of this man didn’t change, but Rush was too stupid to realise what he was seeing. We know now the cause of this condition is purely cosmetic – something that should have been obvious even then. Vitiligo is by no means confined to Negroes; Martin Turner of Wishbone Ash fame suffers from it.

In 1851, Samuel A. Cartwright identified another curious disease that afflicted (presumably many) American blacks. He called this drapetomania; it was a mental affliction that made them want to escape from slavery. Although Cartwright was a physician (and a fool) rather than a psychiatrist, it is clear this faux pas and similar, later ones, can and do lead to almost any behaviour, belief or desire being labelled a mental illness.

For Thomas Szasz there was no difference between sadness and depression; between kleptomania and theft; between the diseases of alcoholism or obesity on the one hand, and drunkenness or over-eating on the other. But while he stressed the role of personal responsibility in dealing with anti-social and just plain undesirable behaviours, he was profoundly concerned that from the beginning, psychiatry was used as a tool of state repression, with particular reference to depriving those diagnosed as mentally ill of their liberty but also because of enforced medicalisation.

If I may venture a personal view here. There are broadly speaking three fields in which we have been subjected to tyranny by institutions that have been allowed to get away with murder – at times literally – because they are a law unto themselves. One is in relation to race, so-called racism and increasingly politically correct adjuncts such as attitudes towards homosexuality, sexism, etc. Although the word appeared in print as recently as 1935, over the past 30 or so years the extent and forms of racism have mushroomed out of all proportion as new versions of this mythical disease have been conjured up out of thin air – or more usually out of contrived statistics.

We have seen the multiplication of laws and the creation of new offences by unaccountable bodies like the European Parliament, and their use to tyrannise us. The latest example of this in the UK is the harassment of Moslems for the heinous crime of burning poppies.

Then there is the mental health establishment – far worse in America than anywhere else – that has been creating new mental illnesses en masse. Yes, when real doctors discover a new disease, they present physical evidence, identifying the bacterium or virus concerned. When psychiatrists discover a new disease, they literally invent it. If you can find the time, watch Psychiatry: An Industry Of Death, and you’ll see what I mean, what Szasz meant, and how ludicrous this is.

So what is really going on here? Apart from a gravy train for psychiatrists and the big pharmaceutical companies, as Szasz wrote in the Revised Edition of The Myth Of Mental Illness, at page 182: : “...the notion of mental illness is used chiefly to obscure and explain away problems in personal and social relationships”, here he drew a comparison with witchcraft. He said too that many so-called mental illnesses are due to people failing to comply with or even to recognise the unwritten rules of human interaction and behaviour.

This is hardly surprising because among other things, these rules are constantly evolving, or changing in other ways – for better or worse. To take a few examples, the recent revelations concerning Jimmy Savile have provoked outrage. In spite of many, even most of the allegations against him being either unprovable or more likely false, it does appear that in the 1970s at least he was doing things with girls of 14 and 15 that no man of his age should even think of, yet a hundred and fifty years ago it was not a criminal offence for a man to have sex with a girl of 13. The age of consent in Spain is still 13. In the 19^th Century, young boys were still being shoved up chimneys; young women, boys and girls would perform backbreaking labour down the mines. Then there are cultural differences. To take a rather harmless example, in some countries, burping after a meal is considered a compliment to the chef. But not here!

Unwritten rules aside, there are other reasons for so-called mental illness. Up until fairly recently, life was a struggle for most people. Although once an individual had reached his or her twenties, a reasonable life span could be expected (three score years and ten according to the Bible), death at a very young age was extremely common. Things we take for granted nowadays, like central heating, hot running water, flushing toilets, refrigeration, were by and large unheard of, certainly for all but the tiniest percentage of the elites.

If you lived in the 18^th Century, you really didn’t want to break a leg, or even suffer a toothache. People had to be tough to survive, either that or they succumbed. In short, mental illness was a luxury they couldn’t afford.

Nowadays, we take mental illness in all its forms for granted. In spite of its use, misuse and abuse for political and other purposes, the stigma attached to it is not what it once was. Furthermore, like all medical conditions, mental illnesses fall into three broad categories: fatal, chronic and self-limiting. Fatal mental illnesses are few and far between, but of course suicide is one possibility. Some people are regarded as congenitally weird, spaced out or simply crazy, but for most of us, mental abnormalities are self-limiting.

Depression is very common in women, especially immediately after giving birth, it even has its own classification – post-natal depression. After giving birth, especially for the first time, a woman may become tired, run down, the baby cries constantly and needs frequent changing. Maybe her husband is not around or she has no husband to take care of her...who wouldn’t feel depressed?

We all experience grief, sometimes profoundly, loss, disappointment, failure...we may be ridiculed or bullied, sometimes it seems like the world has it in for us. As the man said, life’s a bitch, and then you die. We suffer, sometimes visibly, then we recover, we pull ourselves together, realise things could be worse, or simply turn our attention to other things.

For Thomas Szasz, this was SNAFU, all of it. Again, most of us wouldn’t go as far as him. Sure, we can all become depressed or go crazy once in a while, but by the same token, we accept the fact that there are some people who are so totally deranged, demented, or whatever, that they are clearly not living on the same planet as the rest of us.

I would like to add another category to the vested interests of institutional psychiatriatry, statists and Big Pharma identified by Szasz as the driving forces behind this pernicious movement of branding us all mad, this is the anti-death penalty movement.

Capital punishment is not universally popular, but most people consider it appropriate for certain types of heinous crimes. Few of us lost any sleep in January 1989 when serial killer Ted Bundy was fried after ten years on death row. Other cases are not so clear cut; was it right to execute Troy Davis or even Donald Moeller two decades after their convictions, each for a single murder?

There is no end to this debate in sight, but in order to bring about the abolition of capital punishment in the UK and elsewhere, its opponents created the legal fiction of diminished responsibility.

This was effected in England with the Homicide Act, 1957 by the persistent – and at times dishonest – lobbying of the Labour MP Sydney Silverman and his gang. They also made much out of the case of Timothy Evans, who was claimed and is still claimed to this day to have been innocent of the murders of his wife and baby daughter, on account of the activities of John Reginald Halliday Christie, who was a key witness against him.

Murder is fortunately extremely rare, so the issue of what to do with convicted murderers is something that concerns only a tiny percentage of the population, but mental illness – however it is defined – is something that affects each and every one of us in a world where we are probably all a little mad.

Now it seems that almost any anti-social action can be not only blamed on but excused by some form of diminished responsibility, including child abuse, which is said to run in families, as though a man who is abused, sexually or otherwise as a child, has no free will and must in turn visit such abuse on his own offspring, or on the children of others. While he would doubtless have agreed that a bad environment or bad upbringing was not conducive to good behaviour, Szasz believed first and foremost in free will and personal responsibility; he had no truck with lame excuses for personal cruelty or misbehaviour anymore than he had for institutional ones.

Thomas Szasz was born in Hungary, and never lost his thick Hungarian accent, but he lived in the United States since 1938 and was not only as American as mom’s apple pie but was a true Libertarian. Although he is now dead, his work and just as importantly his spirit lives on, and a new generation of critical thinkers has taken up where he left off. Administering drugs to correct defective human behaviour is like passing laws to do the same, and often has the same effect, namely that of creating new problems that require new, more, and increasingly expensive solutions, whether the price is paid in dollars, or more often in human misery and suffering.

[The above op-ed/obituary was first published November 15, 2012.]

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