Dissertation Yes Mum

5849238The Heresy of Thomas Szasz It’s Philosophical, Moral and Political Dimensions Can they be taken as a consistent and coherent whole? Abstract The Journal of Psychiatry and Law claimed in 1987 that ‘Arguably, Szasz has had more impact on the actual practise of psychiatry in this country than anyone since Freud’. He has undoubtedly been the most controversial figure in psychiatry. Ever since he embarked on a crusade to discredit institutional psychiatry’s foundation as de facto medical healers of the ‘mentally ill’ almost forty nine years ago he has made numerous enemies but also many passionate supporters. His work has often been misunderstood and his sharp polemic often deters readers. However behind his witty façade, there is clear philosophy that has been formed from the ideas of a wide range of philosophers and thinkers from many different disciplines and periods, which are then applied, to psychiatry. It is the aim of this paper to clearly formulate and critically assess the three distinct philosophical parts of his denunciation of institutional psychiatry. The analytical and semantic philosophy, the moral and ethical philosophy and finally the political philosophy constitute these three parts. This paper will assess the importance of each and will then calculate whether these three parts form a coherent and consistent whole. 5849238 “What is implied in the line of thought set forth here is something quite different. I do not intend to offer a new conception of "psychiatric illness" nor a new form of "therapy." My aim is more modest and yet also more ambitious. It is to suggest that the phenomena now called mental illnesses be looked at afresh and more simply, that it be removed from the category of illness, and that it be regarded as the expressions of man's struggle with the problem of how he should live.” Thomas Szasz (The Myth of Mental Illness (1960)). Thomas Szasz’s work is about the profession, practise and concepts of psychiatry by a former professional psychiatrist, yet it is first and foremost a philosophical work and will be approached as such. Firstly, by claiming that ‘mental illness is a myth’, Szasz was presenting an analytical/semantic argument in the tradition of Immanual Kant. This paper will therefore present his argument in this vein. Secondly, by seeking to replace ‘mental illness’ with ‘problems with living’, Szasz was presenting a existential and ethical philosophy to confront and understand mans problem of broadly how he should live in the face of the essential tragedy of life. This paper will argue that these two parts are immutable. They constitute core part of Szasz’s aim as presented above. Despite this, it can also be said that in a strict philosophical sense the analytical argument partly fails. This is because the analytic argument is heavily dependent on the verbal conventions that underlie the meaning of the analytic propositions. So the preposition ‘a disease is a structural or functional 5849238 abnormality of cells, tissues, organs or bodies”, is only analytically true if you apply by the definition of disease as disease as “the structural or functional abnormality of cells, tissues, organs or bodies”. This is a contentious issue, as is the whole concept of analytic truth as argued by W.V Quine, which will be explored in this paper. This paper will conclude that Szasz’s “analytic” argument may not necessarily be analytic but is it is still a necessary foundation of his moral philosophy and his criticism of psychiatry as a whole. Finally Szasz’s political ideology will be addressed. This essay will address two opposing viewpoints against Szasz’s right-libertarian political ideology. The first viewpoint was expressed by the ex-editor of the magazine Radical Psychology Rob Brown, who said that there was a contradiction between Szasz’s political view and his criticisms of psychiatry. Peter Sedgwick responded by saying ‘Szasz’s politics are not an aberration, and in no sense contradict the positions he has taken on psychiatric issues’.1 This paper will argue that Szasz’s political prescriptions can be kept separate from his criticisms of psychiatry. This is justified because one of Szasz’s most consistent criticisms of psychiatry is from a libertarian viewpoint. However there are different political strands of libertarian thought and so a libertarian critique of psychiatric practises like Szasz’s does not commit you do following a definitive strand of political liberalism. Also there are examples of psychiatrists who apply broadly Szasz’s criticisms of psychiatry but have distinctly different political views. The paper will begin with a historical overview of the changes in mainstream psychiatry since Szasz was first published up until the ten years ago. 1 Sedgwick, P. (1982). Psycho Politics. (1st ed). Pluto Press Limited.p158 5849238 In the context of the Psychiatric profession To contextualise Thomas Szasz’s work as a critique and response to the methods and conceptual definitions of mainstream psychiatry, it is important to provide a brief summary of the APA2 (American Psychiatric Association) definitions and criteria of mental illnesses or disorders as provided in their DSM (Diagnosis and Statistical 3 Manual). In addition to this, it is necessary to provide a brief account of the change in mainstream treatment provided by psychiatrists to the most severe mental disorders prevalent throughout the last fifty years. This paper has as its paradigm six of Szasz’s books.4 The first chronologically “The Myth of Mental Illness” published eight years after the first DSM, DSM-I in 1952, and the last chronologically ‘The Meaning of Mind, Language, Morality and Neuroscience’ published just two years after the fourth major revision, DSM-IV in 1994. Since the publication of the first DSM (DSM-I) and the fourth major revision (DSMIV), there have been 191 additionally added disorders, from 106 disorders in 1952 to 297 in 19945. In the DSM-IV, the manual defines a mental disorder as: “ A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (A painful symptom) or disability (Impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, pain or disability.”6 2 The APA (American Psychiatric Association) was created in 1844 under different names until 1921. The latest DSM, It is now used widely across institutional America: by the court system, social services, the Government, schools, prisons and insurance companies. APA website, http://www.dsmivtr.org 3 The International Variant of the DSM-I at that time was the ICD-6, Published by the World Health Organization. 4 The six books in chronological order are. The Myth of Mental Illness (1960), Schizophrenia(1974) Manufacture of Madness(1977).Insanity:The Idea and Its Consequences(1987). Meaning of Mind (2006). 5 From “Separating Psychiatric Disorder from the Medicalisation of “Something else- A Psychiatric Into A DSM-IV diagnosis’-Dr Howe Synnot-Psychiatrist Micoa. 6 From the DSM-IV, Fact Sheet, presented here http://www.healthsystem.virginia.edu/internet/psychtraining/seminars/apa-dsm-iv.pdf. 5849238 Amongst additions to the manual there have also been examples of retractions. For example, Homosexuality described as ‘homodsyphilia, homosexual conflict disorder, and ego-dystonic homosexuality’7 in its various apparent dysfunctional manifestations was deleted in 1974 under pressure from various homosexual support groups.8 The APA stresses the change in how new disorders are established. The early DSM manuals in 1952 and 1968 had little empirical data foundations, in contrast to the present day when ‘the overall driving force in the decision to include or exclude a potential diagnosis from the DSM is the availability of scientific data’.9 This empirical data seems to take the form of a variety of structural interviews and rating scales applied to a large number of data sets. Yet the initial stage of diagnosis still largely depends on ‘common sense and clinical experience in judging the number and type of characteristic symptoms’.10 The introduction of the anti-psychotic drug chlorpromazine in 1954, and the eventual marketing of a host of anti-psychotic drugs, described by Roy Porter as a ‘psychotropics revolution’11 introduced a lengthy process of de-institutionalization of state asylums to be replaced by ‘community care’. Andrew Scull, however, claims to the contrary that anti-psychotic drugs did not cause de-institutionalization but it was an inevitable result of the tight fiscal budgeting of advanced capitalist countries towards traditional welfare policies that generally started before large-scale advancements in anti-psychotic drugs.12 Despite disagreements in the causes, in the 7 Shorter, E A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. 1st ed. John Wiley and Sons.p301. (1997) 8 Ibid, p301. 9 DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, http://www.dsmivtr.org/index.cfm 10 DSM-IV sourcebook: http://www.dsmivtr.org. 11 Porter. R. Madness: A Brief History. 1sted. Oxford University Press.p207.(2003). 12 Scull, A Decarceration. 2nd ed. Rutgers University Press. p 23. (1984) Psycho Politics. 1st ed John Wiley and Sons. Social Class and Mental Illness.14 Despite this. with Irving I. managerials. such as ECT. Pluto Press Limited. In ‘Social Class and Mental Illness’.13 Apart from the advancement of anti-psychotic drugs. Shorter. most notably that drug treatment had become part of the therapeutic mix of all classes.16 While there has always been a suspicion in modern psychiatry and hence the prevalence of the medical model. P. other organic treatments had become prevalent in the 1950s onwards. P191 (1982) 16 Work done on the Biological basis: Schizophrenia and Manic-Depressive Disorder: The Biological Roots of Mental Illness as Revealed by a Landmark Study of Identical Twins (senior author). insulin comas and brain surgery. there is increasing belief amongst psychiatrists that severe mental illnesses such as schizophrenia are brain diseases. While Class II.5849238 United States from 1955 until 1988 there had been a decrease of 80 percent of patients in state and county asylum hospitals. length of stay and likelihood of re-admission largely depended on class. containing professionals executives and.B and Redlich FC. Edward H.15 Finally and most notably. Ann E. Taylor.p301. New York (1958) 15 Sedgwick. Bowler. 13 p280. increased likelihood of re-admission and little active treatment. Hollingshead and Redlitch demonstrated that the types of treatment. with a demonstrative biological course deducible from results from brain scans. Gottesman. (1997) 14 Hollingshead. Thus unskilled or semiskilled workers of poor education were more likely to receive organic treatment (ECT. Drugs etc). were treated predominantly with talking therapy and considerable active treatment. A. a 1975 New Haven study described a number of important changes in styles of therapy. receive longer hospitalization. Perseus Books Group . E A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. there is now more confidence in proving and demonstrating this. and research gathered from twin studies. stanfordalumni. during the 49 years since Szasz’s ‘The Myth of Mental Illness’ was published the organs of mainstream Psychiatry have acknowledged and defined considerable more mental disorders. Torrey claims that they are close to finding evidence of a virus that releases toxins into the nervous system causing schizophrenia.5849238 For example.com/p/articles/mi_m1568/is_1_37/ai_n13593350/pg_8/ [Accessed 15th of April 2009] . the psychiatrist E. Now it is important to explain Szasz’s main theory. Fuller. started in the ‘Myth of Mental Illness’.html [Accessed 11th of April 2009] 18 Thomas Szasz takes on his critics: is mental illness an insane idea? http://findarticles.org/news/magazine/2003/janfeb/features/torrey. Thus in short the medical model is clearly the predominant model of Psychiatry.17 Despite a lack of conclusive evidence he confidently states that "schizophrenia is a disease of the brain in the same sense that Parkinson's disease and multiple sclerosis are diseases of the brain. Torrey. biological bases of severe mental illnesses. that relates to the practices and concepts of the mainstream psychiatric profession described above. they have expressed further the empirical. Tracing Szasz’s thoughts-The argument from analytic and semantic reasoning 17 Stanford Magazine. Brain Storm Article on E.”18 In summary. In addition. Fuller Torrey has spent a large amount of time investigating the brain tissue of diseased mental patients since 1989 when he set up the Stanley Medical Research Institute. and have generally accepted neuroleptic drugs as the primary treatment available for people suffering from mental illnesses. by Tom Nugent http://www. So for Szasz in ‘The Myth of Mental Illness’. (1960/1974). 20 Ibid. Accordingly to assert that someone is ‘mentally ill’ is a semantic fallacy that has grave consequences for the person diagnosed in respect to viewing and treating them as a free acting and responsible moral agent . and ethical problems in living are medical problems. p23. New York: Harper & Row. . p. capricious and generally unsatisfactory character of the widely used concept of mental illness and its corollaries. xiii. it is argued that they must be treated within a medical conceptual framework.5849238 The ‘Myth of Mental Illness. The myth of mental illness: foundations of a theory of personal conduct (Rev. for Szasz. T. T. (1987).20 Yet.). prognosis and treatment’.21 To reassert.19 For Szasz the use of the term mental illness makes historical sense because of the historical tradition of integration between Psychiatry and Medicine. New York: John Wiley & Sons.: 7he idea and its consequences. this is a semantic error. mental illnesses are not the same as bodily illnesses. was influenced by what Szasz saw as the ‘vague. S. Szasz. when it is actually used metaphorically. Insanity. In this metaphorical use of the term. Being also that the experienced and expressed psychiatric symptoms of these ‘problems in living’ are seen as similar to bodily diseases. The term ‘mental illness’ as it is commonly used in psychiatry and amongst the lay public expresses the belief that personal. social. S. To use the term literally is to commit a categorical error first established by 19 . the logical use of the term ‘mental illness’ is metaphorical: mental illnesses are like bodily illnesses. published in 1958. Foundations of a Theory of Personal Conduct’.262 21 Szasz. diagnosis. they are instead behavioral and psychological manifestations of ‘problems in living’ non reducible to biological processes. and written during Szasz’s early tenure as a psychiatrist. for Szasz. ed. yet it does not make rational sense. one can only say that minds can be “sick” in the sense that economies are “sick” or jokes are “sick”. in which a word is attributed to a state literally. (1966) Micale M. 26 Cresswell. who described a myth as ‘the presentation of facts belonging in one category in the idioms appropriate to another. Szasz and His Interlocutors: Reconsidering Thomas Szasz’s “Myth of Mental Illness” thesis. in the Rylian term.’22 Thus for Szasz. which must be adequately defined before one can establish a full understanding of Szasz major philosophical argument against the term ‘mental illness’ and the practices it justifies.htm 25 Szasz. the presentation of the fact that there are behavioral and psychological symptoms of ‘problems in living’ is erroneously categorized as belonging to a category of disease.p321 (1994) 24 Szasz Review/Interview conducted by Ross Levatter. ethical and political problem and not a medical problem. place “mental illnesses” outside the category that relates only to bodily diseases and in a new category described broadly as ‘problems in living’.as the structural or functional abnormality of cells. as psychiatrist and other academics have argued.24 Two terms have been introduced here.p10.szasz. and as a consequence Szasz denies the psychological and sociological existence of problems that ‘Mental Illness’ refers to. (1987). p24 (2008) .25 Thus disease is a medical enterprise which is committed to physicialism and natural scientific methods of study.5849238 the philosopher Gilbert Ryle. G The Concept of Mind. Firstly. the definition of disease that Szasz adheres is most competently addressed in “’Insanity. for Szasz. Journal of the Theory of Social Behaviour vol38. Porter R Discovering the History of Psychiatry. In this book Szasz makes it clear that he defines disease as ‘the pathologist defines it .. organs or bodies’. Insanity: 7he idea and its consequences. tissues. Hence Szasz belief that he desires to ‘re-ethicize’ and ‘re-politicize’ psychiatry’. (1983) http://www.ed) Hutchinson.com/Levatter.S.26 ‘Problems in living’. .p12. T. As a consequence they should be treated as a moral. the Idea and Its Consequences’. New York: John Wiley & Sons. (1st ed) Oxford University Press.23 This simply implies that Szasz wishes to. This does not imply that a ‘myth’ is something that is fabricated. ‘disease’ and ‘problems in living’. is. (rev. M. S. is related to the realm 22 23 Ryle. Ideology and Insanity: Essays on the Psychiatric Dehumanisation of Man. T.143.29 The question that arises from this injunction is that.p 195. Szasz explores the historic use of the word mind as both noun and verb. 28 Cresswell. (1st ed) Greenwood Publishing Group. Szasz and His Interlocutors: Reconsidering Thomas Szasz’s “Myth of Mental Illness” thesis. that Psychiatrists commit is a process of mechanomorphism. the word “mind’. 30 Quoted in Szasz T. The concept of the mind as we now understand it is the symptom of the modern and scientific age and not the medieval religious age. The Meaning of Mind. While disease is a deterministic medical enterprise relating to ‘natural scientific methods of study’ and ‘physicalism’. M.5849238 of how humans conduct themselves and relate to societal norms. there was no existence of the noun mind. Morality and Neuroscience. such as psychology. This is epitomized. Language. meant minding in its verbal sense.S.30 In the “Meaning of Mind”. is it not possible to Mechanomorph the mind? Do we not speak of the mind as a noun. Before the sixteenth century.). p25 (2008) 29 Szasz. (1996) . sociology. The error therefore. where man “modern man ‘thingifies’ persons”. the way humans conduct themselves in society belongs in the social sciences. (1970). an entity reducible to the brain? This question has arisen from the current assimilation of neuroscience theories of the mind with psychiatrists’ biological explanations of the causes of severe mental illnesses such as Schizophrenia and Bi-Polar disorder. rule-following. therefore. This essentially evolves around “sign using. as people had souls and not minds. S. The myth of mental illness: foundations of a theory of personal conduct (Rev. 263 (1960/1974). Szasz believes that today we misuse the verb ‘to mind ‘with the noun ‘mind’ denoting an observable 27 . Journal of the Theory of Social Behaviour vol38. (rev ed) Anchor Books. ed. “Basic brain research is seeking answers that may ultimately help guide social policy’. New York: Harper & Row. philosophy and anthropology28. and games playing…in terms of human relationships and social arrangements promoting certain types of learning and values’27 underpinned by free will.p. Szasz. by the Neuroscientist Dr Carla Shatz’s quote. T. and cannot be understood from a material and biological reductionism stance. The mind is a personal attribute and a part of the moral discourse. learnt a lot from the American Pragmatists George Herbert Mead (1863-1931).34 Now that we have acquired the clarity of how Szasz defines the concept ‘disease’. qua living persons. Instead. that Szasz is not a Cartesian Dualist in the traditional sense of the word. ‘we misunderstand “minding” as using our ‘mind’. ‘mind’. is that they deal with two different conceptual categories. Gary A.31 Szasz. The Making of a Social Pragmatist.’33 Finally it is important to note. But we have no minds. As Szasz puts it. who believed that the self was intimately tied to the development of language. even its biological functions are primarily social’. George Herbert Mead. for the development of his theory of mind. although it has its focus there. mind. should be understood as dependent on language and how we interact with other people.32 Where neuroscience and psychiatry differ. ‘The brain is a bodily organ and part of a medical discourse. How and what we mind is who we are. .5849238 material structure like the brain. The Meaning of Mind..17(1996) 32 Cook. Urbana: University of Illinois Press. Morality and Neuroscience. He believes simply that the use of the noun mind. 33 Ibid. (1st ed) Greenwood Publishing Group. for. (1993).S. Language.p. we. it is essentially a social phenomenon. p92. as he does believe that there can be no existence of self or thought processes without a material structure. Language being a social tool Mead argued ‘It is absurd to look at the mind simply from the standpoint of the individual human organism. 34 Ibid p94. Szasz’s theory can broadly be placed now in the philosophical tradition of distinguishing between analytic and synthetic propositions as argued by Immanuel 31 Szasz T. ‘brain’ and ‘problems in living’ we can delve more deeply into the philosophical structure of Szasz’s key argument that we have already touched upon. Minding is quintessentially our own business’. therefore. (2004) 37 Ibid. either p or not p not (p and not p) 39 (Where p means ‘Any Proposition’) 35 Although. G.(2004) . p is analytic = df p is true solely in virtue of the meanings of its constituent terms36 p is synthetic = df p is not true or false solely in virtue of the meanings of it constituent terms. Socrates is mortal. “All ophthalmologists are doctors” is an example of a proposition that is true in virtue of the meanings of its constituent terms. p11. And Socrates is a Man Conclusion 1. Kant’s Theory of Knowledge and Analytical Introduction (1st ed) Oxford University Press. (2004) 39 Dicker. J. explains that it ‘analytic if and only if the antecedent ‘All men are mortal Socrates is a man’ entails the consequent ‘Socrates is mortal’.35 The core of analytic and synthetic statements is semantic.38 For example with the hypothetical preposition Premise 1. If all men are mortal Premise 2. Accordingly the basic definition an analytic or synthetic statement is this. In this example Jonathan Harrison. p9 38 Harrison. p9. referring to do what makes a preposition true or false. Kant’s Theory of Knowledge and Analytical Introduction (1st ed) Oxford University Press. This is because analytical statements follow.5849238 Kant. G. being that the definition of ophthalmologist is ‘doctor’. this presentation of Kant’s initial argument is a widened version as shown by Georges Dicker and Jonathan Harrison 36 Dicker.37 As Szasz’s argument is based in analytical philosophy. it is now necessary to look solely at analytic propositions. The basic definition of an analytic statement can also be edifies in terms of entailment. Our Knowledge of Right and Wrong (1st ed) Routledge p39. Conclusion 2.which is true in virtue of the concept ‘round’.42 This.’ This is the same as the way that ‘something cannot be both round and square’. 42 Indebted to Dicker for this example.p11.5849238 Presently we now can formulate Szasz’s theory as an analytic proposition. defined as “the structural or functional abnormality of cells. 43 Kant.40 Hence: Premise 1. as Kant argued ‘analytic judgements are very important. and indeed necessary. Mental Illness is a myth. and the concept of “the mind” defined as “a non material entity” it follows logically that ‘the mind cannot both be materially non-reducible and diseased. A myth here is defined as Gilbert Ryle defined. As it was on page9. which is ‘true solely in virtue of the meanings of its constituent terms’ or in which the antecedent entails the consequent. For the concept ‘disease’. Premise 2. However. but only for obtaining…clearness in the concepts’. Translated by Norman Kempt Smith (1st ed) Read Books.reducible and nonobservable and be diseased (Ill)--The mind therefore can be ill only in a metaphorical sense. If Disease is a predicate of material (human) bodies.43 So while analytic statements are important in clarifying concepts. P51 . defined as “having no angles”. they tell us nothing else that relates to 40 41 Ibid.41 What we have established is that the statement articulated above ‘the mind cannot both be materially non-reducible and be diseased’ is true in virtue of its ‘conceptual truths’. therefore. page 11. I Critique of Pure Reason. and square as defined as a ‘rectangular with four angles’. tissues. And the noun “the mind” is materially non-reducible and nonobservable. potentially debunks the psychiatric medical model diagnostic term ‘mental illness’. organs or bodies” and ‘predicated of the body’.The mind cannot both be materially non. Conclusion 1. the analytical argument just formulated seemingly forces one to commit to the belief that mental illness is meaningless in an analytical/semantic sense. Due to the redundancy of the term ‘mental illness’. The Moral and Ethical Dimension. T. It cannot. imprison. synthetically. under any circumstances. Law. ‘.. “The Wager of Our Generation”44 Szasz’s argument is not just a clever analytical endeavor. We will now turn: to the moral and ethical dimension criticisms of the practice of psychiatry.Brien (New York university press)(1960) Quoted at the beginning of Szasz’s Law. dehumanize. but because they are used to stigmatize. Rebellion. and torture those to whom they are applied’..5849238 reality of our world outside these concepts. . be to reduce or suppress that freedom. even temporarily’ Albert Camus. Szasz’s resolutely held belief that humans are moral autonomous agents that conduct themselves and express themselves both meaningfully and freely is incompatible with both the conceptual definitions and treatments held and practiced throughout the history of psychiatry. This must be done through experience i.45 As Szasz indicates. it is now necessary to 44 Albert Camus. and Death. 45 Szasz. Liberty and Psychiatry (1st ed) x. Thus from the proposition ‘Mental Illness is a Myth’ we cannot ascertain anything about the practice of psychiatry.“The Wager of Our Genration” Resistance.The aim of a life can only be to increase the sum of freedom and responsibility to be found in every man and in the world. As Szasz puts it “I have objected and continue to object to psychiatric diagnostic terms not because they are meaningless.e. Liberty and Psychiatry. it is an endeavor steeped in moral and ethical philosophy.iii Routledge(1974). translated by Justin O. ‘confronted with the overwhelming powers aligned against the person.p25 48 Nasar. The Sacred Symbol of Psychiatry (rev ed) Syracuse University Press. in mental illness one makes others suffer.50 . Sylvia. presumably.49 It is the abnormal pronouncements and deviant behavior which often annoying and upsetting that causes psychiatric intervention or.47 Yet how and by what criteria are these ‘political and ethical decisions are made and by whom and for what reason? Sylvia Nassar states that in Schizophrenia.p3. Schizophrenia. S. they may elect to seek psychiatric help. T. A Beautiful Mind. (1st ed) New York: Simon and Schuster. (1974) 47 Ibid. Schizophrenia. regardingg social control of deviance through labeling. 49 Szasz. is that while in physical illness one seeks help because of pain. As Szasz argues ‘The claim that some people have a disease called schizophrenia (and that some.’51 This is an argument heavily documented by sociologists.46 It follows that if they are not the result of scientific work or empiricism then they must be the products of ‘political and ethical decision making’.(1987). p12 (1974) . if they are not scientific medical discoveries. Insanity: 7he idea and its consequences.5849238 explore what the diagnosis of certain ‘mental illnesses’ are for Szasz. essentially ‘from abnormal bodily structure to abnormal personal behavior. (Scheff 1967) 46 Szasz. (1998). T.p3. T. p39 51 Szasz. do not) was based not on any medical discovery but only on medical authority’. As Szasz says about the founders of the “illness” schizophrenia. Emil Kraepelin and Eugen Bleuer succeeded in moving so called medically based diagnosis from histopathology to psychopathology. 50 Ibid. New York: John Wiley & Sons p43. so people seek help for you. The Sacred Symbol of Psychiatry (rev ed) Syracuse University Press. the main symptom is the ‘profound feeling of incomprehensibility and inaccessibility that sufferers provoke in other people’.48 Szasz would concur with this view arguing that a difference between physical illness and mental illness. when for Szasz it is something people act or do. and the other the concept of the responsible ‘moral man’. The libertarian in Szasz.org/due-proc.000 from 1971 to 1991. In 2002.htm). Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum.com/news/show/27767. S. Jean Paul Sartre and in its broad sense existential. one based on libertarianism. to go further arguing that the way this problem is masked is to account for human behavior in two ways. more than 2. Involuntary hospitalisation of teenagers has increased from 16. and abnormal behavior being causal. Involuntary hospitalization is consequently the antithesis of this ideal.53 His belief is that autonomy and self-ownership of one’s body and mental faculties are clear natural rights. Szasz claims in the United States alone. New York: John Wiley & Sons p352 (1987). normal behavior being motivational.500 per day and that this practice is common in all advanced societies. The view that man is free acting and responsible agent come from a dual understanding of man. . This paper will explain the two and explain the connection. He believes that there should be just one account of all human behavior. Insanity: 7he idea and its consequences.54 In contrast Szasz expresses the consensual nature of physician based practices as enshrined in the Hippocratic oath as an example of the extremity of the psychiatrists’ position.( http://www. as you lose the self-ownership of your body and are physically coerced in the process. that is. The act of involuntary hospitalization forms the main pillar of Szasz’s attack on psychiatry.antipsychiatry. based on work by Albert Camus. as is the right to be free from physical coercion from others.reason. there were approximately one million civil commitments per year. however seeks. This inevitably leads to the assumption prevalent in the medical model of psychiatry that mental illness is something that people have.5849238 Szasz.000 to 263. August 26. equates liberty as the highest and natural pre-condition of human nature more than health. as motivated. Depriving a person of liberty for what is said to be his own good is immoral. 52 53 Szasz. T. goal directed and meaningful to the agent.52 For Szasz this is entirely unnecessary. Szasz quote found in ibid. For Reason online(2000) http://www.html 54 Time Magazine reported in 1991. Translated by O’Brien J .janpols. T.. In an analogy to law. which for Szasz is difficult if not impossible for people to accept.long distance race.(1st ed) Routledge (1974) p40 This is explicit in the work of Jean Paul Sartre.55Thus involuntary hospitalization is akin to incarceration.P81 (1974) 57 Szasz as a Humanist. In Jan Pols Critical Analysis of Thomas Szasz http://www. acquired through silence and suffering’.net/Contents. is now ‘insane until proven sane’.p3. T.. quite solitary and very exhausting. is the foregoing of this struggle for freedom and liberty.html 58 Szasz. Seven Theories of Human Nature.—he must first assume more responsibility (than he has been) 55 56 Szasz. p46 (1991) .S. The Sacred Symbol of Psychiatry (rev ed) Syracuse University Press. and a subjection to the paternal dominance of psychiatrists.Vintage Books. but in explaining that the idea that life is meaningless. full of sound and fury signifying nothing’57. The Second Sin.”59 Szasz claims that insanity as defined as an illness. Responsibility is morally speaking anterior to liberty. with modesty and patience. The Fall.. p83 (1974) 59 Camus. The connection of responsibility of a moral agent as believed by Camus and Sartre and libertarian is key for Szasz. L. and then have to decide what to make of ourselves. Schizophrenia. the phrases ‘existence proceeds essence’ So for Sartre and Szasz we just find ourselves existing . More on Sartre can be found in Stevenson..5849238 Just as a person suffering from terminal cancer may refuse treatment.56 He quotes Shakespeare when he says ‘life is tale told by an idiot.Oh no! It's a. “Freedom is not a reward or a decoration that is celebrated with champagne. A. his wife. his work. The existentialist thought in Szasz lies not just in understanding the responsibility that comes with being a free moral agent. so should a person be able to refuse psychiatric treatment. (2nd ed) Oxford University Press. In the face of the essentially meaningless of life and the hardship it entails Szasz takes a rather strong view of sanity as the ‘confronting of conflict. etc. Szasz says “So if a person wants to gain more freedom—in relation to his fears. he argues that involuntary hospitalization is the opposite to the assumption ‘innocent until proven guilty’.58 This is resembles the Camus quote. The medical model therefore encompasses the denial of both the analytic and moral dimension just presented.). and mental treatment like medical treatment’. It has to be seen as inextricably linked.R. S. New York: Harper & Row. The myth of mental illness: foundations of a theory of personal conduct (Rev. Thomas Szasz. the moral dimension of Szasz’s work is predominantly about responsibility and liberty. The apparent expertise that comes with ‘scientific’ foundations and how this appears to others is an important factor for Szasz in the prevalence of the medical model. ed. for Szasz has a clear agenda behind it other than attempting to help the patient. . Finally the prevalence of the medical model.p71-85 (2004) 61 Szasz. p249 (1960/1974). For Szasz the use of the term ‘mental illness’ leads to an assumption of man and human nature that is the anti-thesis of Szasz’s view on liberty and the responsibility of man in the face of the tragedy of life. The medical model for Szasz means that ‘the upshot is the professional credo of mental health professionals: that mental illness is like medical illness.”60 The modern Psychiatrist that utilises the medical model deprives responsibility and therefore the liberty of the patient to resolve these issues.vol 44. Liberty and the practice of Psychotherapy Journal of Humanistic Psychology.5849238 toward them. T. then he will gain more liberty in relation to them.61 There is a clear existential benefit to presuming the role of the medical psychiatrist. This facet cannot be understood as independent from the analytical and semantic argument previously given. In conclusion. 60 Wyatt C. and this term has been shown to be semantically redundant and the actions related to it morally suspect.5849238 Analytical and Semantic Dimension revisited The medical model is implicit in the diagnostic term ‘mental illness’. This means that the burden of proof falls on supporters of mainstream psychiatry and critics of Szasz to provide evidence to reclaim the use of the term . when one defines the concept round as “having no angles”. Definitions are a matter of human verbal conventions. Conclusion 2. To begin with. the proposition ‘the mind cannot be both materially nonreducible and be diseased’ is analytically logical. non observable Conclusion 1. While it is indeed difficult to define ‘round’ as something different to ‘having no angles’. The same can also be said of the definition of the mind as ‘ materially non-reducible and non-observable’. it is much easier for people to differ on how they define disease. is that the definitions of the concepts in the former proposition are open to controversy. . seemingly in the same way that ‘something cannot be both round and square’.5849238 ‘mental illness’ and its implications. and non observable and be diseased (Ill)--The mind therefore can be ill only in a metaphorical sense. Hence: Premise 1. And the noun “the mind” is materially non reducible. Premise 2. As we noted earlier. If Disease is a predicate of material (human) bodies. supporters of the medical model must address the analytical and semantic argument first articulated at the beginning of this paper. and verbal conventions can easily be altered. and square as defined as a ‘rectangular with four angles’. The problem with the statement ‘the mind cannot be both materially non-reducible and be diseased’ unlike the proposition ‘something cannot be both round and square’. due to the conceptual definitions of ‘round’ and ‘square’. the noun ‘mind’ similar to ‘disease’ seems to be as semantically divisive. Mental Illness is a myth.The mind cannot be both materially non-reducible. However. Pies (1979). Journal of the Theory of Social Behaviour vol38.5849238 Many authors have argued against Szasz’s belief that only symptoms from physical lesions are legitimate indicators of disease. . M.(2004) 65 Cresswell. P32. 1939:Leriche. as of yet.E Kendell argues that in reality. Kendell (2004). though they share many common elements despite this. (1st ed) Open Court Publishing. there is little difference in the characteristics of mental illnesses from physical illnesses in either symptomatology or etiology. (2008) 66 Work done here by Canguilhem.65 There is a large tradition of thought supporting this psychosomatic holism. less explicitly biological. This is a spectrum according to quantity. this is not the case for all. In addition.J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. in the sense that mental diseases are. (Brown. This blurring of etiology or symptomatology exists when mental states such as fear and emotion play an important role in the genesis of hypertension. Pies.66 62 All these raise question Szasz’s conceptual definition of ‘Brown and Ochberg (1971). hence the quantitative aspect to the difference between somatic and psyche illnesses. asthma and other somatic illnesses and when bodily changes and somatic lesions occur in so-called ‘mental illnesses’ such as weight loss.64 This blurring of the line between somatic and mental disease has been termed by Mark Cresswell as an argument from psychosomatic holism. R. in contrast to physical diseases.p32. 1979. 63 Begelman (1971). Moore (1975).1991:Goldstein. Szasz and His Interlocutors: Reconsidering Thomas Szasz’s “Myth of Mental Illness” thesis. Engelhardt Jr. 1985. 64 Schaler. Kendell claims biological dysfunctions underlie most of the main groups of so called mental disorders. as he admits.62 Other opponents of Szasz’s definition of disease argue that it is more cogent to look at the similarities between physical diseases and mental illnesses. 63 A different approach to disease is therefore formulated in the claim that there is a broad spectrum of contingent conditions that are predicates of both mental and physical diseases.Mindham et al.1939. (1981). (1992). A. For Szasz there are three replies to the Kendell’s psychosomatic holism.e. A. and when they do both. psychiatric and bodily symptoms.for example subdural hematoma’68 this however is lacking for mental illnesses such as schizophrenia.67 This psychosomatic holism therefore presents a genuine problem to the first premise of the analytical argument. namely.e.(2004) 68 69 Ibid p39 Ibid p40 . in contrast to mental illnesses which are identified by observing the patients speech i. physical diseases are treated with informed consent (unless the patient is incompetent. while the third is moral and will addressed in due course. i. (1st ed) Open Court Publishing.5849238 Thus an inevitability of psychosomatic holism for Kendell is that..J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. while mental illnesses are often treated without the person’s consent i. claiming to be God. are usually involved’. i.p32. Szasz argues in response that physical illnesses are usually identified by observing the patients body. 69 67 Schaler. biological causes. fever. vomiting blood. mind and body. The first two relates to the definitions of his analytic argument so will be addressed first.e. physical-chemical markers to ascertain whether someone has a particular brain disease. ‘Disease is a predicate of material (human) bodies. Thirdly and finally. unconscious etc). Secondly that there are ‘objective.e. ’neither minds nor bodies suffer from diseases only people (or in wider context organisms) do so.’ Being that Kendell’s concept of disease is a quantitative spectrum of various conditions (suffering.) shared to a lesser or greater extent by both sufferers of mental illness and physical illness. disability. psyche and soma. and which happen to people as whole persons and not disparate bodies. independent of their own beliefs and desires. although Kendell presents a formidable argument he essentially ignores what Szasz’s aim is in proposing that ‘mental illness’ is a myth. New York: John Wiley & Sons p78 (1987).html Szasz takes on his critcs: Mental illness is an insane idea.74 70 Szasz. Constraints and Mental Illness Rationality and Society Aug2006 vol.5849238 For Szasz. it will be a brain disease.S. that there is always a chance that schizophrenia will be identified as a brain disease. Language. who although believing that Schizophrenia is a brain disease. while suffering without a biological disorder is a problem in life.’71 Ironically this is view echoed by mainstream psychiatry. As he readily admits.p. Szasz does not believe that there are no such things as brain diseases or that there is no suffering in “mental illness”. DSM-IV. http://findarticles. He believes that suffering from a brain disease is a problem for neurologists and not psychiatrists.reason.com/news/show/27767. 2000 re-edition. yet for the time being the evidence is unflattering.com/p/articles/mi_m1568/is_1_37/ai_n13593350/pg_8/ 73 Szasz T. T. Fuller Torrey and Julius Ledd. claim "there is no single abnormality in brain structure or function that is pathognomonic for schizophrenia”72 and “there is no pathological test for schizophrenia”73. Insanity: 7he idea and its consequences. exactly in the way that neurosyphilis was recognised as a brain disease.70As Szasz says ‘a laboratory technician can blindly make a diagnosis of anaemia simply on the basis of vials of blood submitted to him or her-without having any idea of whose blood it is. 71 72 Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum. respectively. B.87(1996) 74 Caplan. S. The Economics of Thomas Szasz: Preferences. This view is also expressed in the APA. Two prominent psychiatrists. and how one should live. As soon as that can be done with schizophrenia. E. For Reason online(2000) http://www. (1st ed) Greenwood Publishing Group.18 Issue 3 p335 . Morality and Neuroscience. The Meaning of Mind. Schizophrenia. there is an additional concept of objective validation of the symptom between patient and physician. There is as of yet “no pathological test for schizophrenia”. which it clearly is not. therefore. but as Szasz says ‘verbal pronouncements’ of the patient. (1st ed) Open Court Publishing.J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. apart from a non-medical one. There is no pathological validation in the subjective diagnosis of ‘thought disorder’. The Sacred Symbol of Psychiatry (rev ed) Syracuse University Press. tissues.as the structural or functional abnormality of cells. organs or bodies’ because whatever other similarities might suffice such as symptoms they cannot be objectively validated.p32. for this would. consequently that the quantitative gap between physical illness and mental illness is much wider than Kendell believes. T. then this will mean that they would be officially classified as 75 Schaler. as Kendell shrewdly observes make poverty etc an illness. Finally if somatic causes can be found in mental illness.5849238 It seems. p123 (1974) . Despite this.(2004) 76 Szasz. expressing the similarities of characteristics between physical and mental diseases merely leads one instead to re-acknowledge the main difference.76 In short. While the above is undeniably true the diagnosis of a mental illness is not based on the its physical symptoms primarily. suffering which is another one of Kendell’s criteria is as he describes himself “insufficient on its own”75. This leaves now the belief that somatic illnesses involve psychiatric symptoms and vice versa. while symptoms are often a subjective complaint by the person. This also ignores an important part of diagnosis. explaining the often strange idiom of schizophrenics for example. Therefore psychosomatic holism is true only in subjective symptoms but not in objective causes. This is that mental illness unlike physical illness cannot be described as ‘the pathologist defines it. A. 5849238 brain diseases. having the belief that the earth is flat. Quine argued that our beliefs of the world form a web. The Social Nature of Illness (1st ed) Routledge. (2000) 78 For example. what we perceive to be analytic truths. Yet Quine would argue that if given intractable evidence through experience we would be forced to give up these so-called analytic truths78. Amongst psychiatrists the two words have become interchangeable and both denote in many cases the use of medical treatment. L. Morgan and Kleinman have attempted to bridge this problem by arguing that ‘illness’ is how people respond to the condition socially. Some of our beliefs at the centre of the web seem unrevisable i. In conclusion. and ‘disease’ is the biological disorder. and thus out of the scope of psychiatry and into the scope of neurology. though for a summary of both positions see Bowers. It seems relatively arbitrary. although it seems that the way that diseases are discovered (in terms of bodily diseases) is very different to how mental illness are discovered.V Quine argued doggedly against the analytic/synthetic distinction in “Two Dogmas of Empiricism”. concerning Szasz’s analytic/semantic argument there is still need to explore why a supposedly analytical argument is open to derision. Importantly these beliefs face the test of experience collectively and not 77 These two works are separate Morgan (1975) and Kleinman (1980).77 However this misrepresents how the term ‘illness’ is used in practise. that the analytic truth is ‘true solely in virtue of the meanings of its constituent terms’ when matters of meaning seem to be about the deliberate conventions with which the word is used? The philosopher W.e. . p151. 80 So Szasz proposing this analytic statement does not capture “the meaning” of an expression.5849238 separately.O (1951) Two Dogmas of Empiricism http://www. Routledge Encylopedia of Philosphy Taylor and Francis.html Ibid. and the same can be said of Szasz’s critics. argues that we cannot understand analytic statements by defining it using other terms such as synonymy or definitions or meaning because together this forms a circular chain of concepts.’81 While Szasz is interested in preserving a theory of disease as having a certain conceptual definition.p11(1998) . presupposes or stipulates a synonymy but doesn’t help us understand what an ‘analytic truth’ is. tissues.ditext.V. Moral and Ethical Dimension Revisited 79 80 Quine W.com/quine/quine. Instead he ‘explicates or proposes a theory of the referential features he is interested in preserving. this is still just a theory and must be treated as such. E. and strip down both Szasz and Szasz’s interlocutors to their moral framework. organs or bodies”. Hence we can propose primarily that we temporarily bracket the assumption that Szasz has made mental illness a conceptual myth or alternatively that his critics have disproved him. 81 Craig. Therefore the conceptual definition of disease as “the structural or functional abnormality of cells. but only as a corporate body’79. So Quine argues ‘our statements about the external world face the tribunal of sense experience not individually. In addition to this Quine. none of which are actually explained. 5849238 We have seen that Szasz’s analytical and semantic argument is open to objection yet remains strong. (2004) 84 This train of though is influenced primarily by R. which is the factual basis behind treatments and diagnoses responding to ‘the growing complexity of facts relevant to decision making in all areas of healthcare’.J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. value judgements are a necessary condition of all diagnosis and treatments behind all illnesses. if there were differing values between those 82 83 Fulford (1994) Sedgwick(1982). evidence based medicine. thus presenting a conflict of interest. most notably here by Fulford. To reiterate we have seen that the term ‘mental illness’ for Szasz is a moral and political decision that denotes a value-laden system that is applied to people against their will. for Fulford the difference in value-laden decisions between physical illness and mental illness occurs because the values of parties involved in the diagnosis and treatments of physical illness are closer aligned. physical or mental.83 Relating to (VBM). In short. Sedgwick and Illich. It is now appropriate to present an analysis of the criticisms of the moral aspects of the use of the terms ‘illness’ and ‘disease’. which is an objective and valueneutral diagnosis of a pathological lesion etc and is consensual. and his work in The Language of Morals (1952) and Freedom and Reason (1963) . complimentary factor in diagnosis for Fulford is (EBM). The second. Suffice it to say that for Fulford conflict would also occur in physical illness diagnosis and treatment and decisions.Illich (1976) Schaler. A. However the value-neutral aspect of physical illness is greatly contested by academics. This is as opposed to ‘bodily disease’. while in mental illness they often greatly diverge.M Hare. (1st ed) Open Court Publishing. p94.82 Fulford attempts to blunt the effect of Szasz warnings over the value-laden diagnosis of mental illnesses by placing value-laden decisions into a larger context of valuebased medicine (VBM).84 A conflict that has intended to favour the strong (The psychiatrist) over the weak (the patient) throughout the past. Medical Nemesis: The Expropriation of Health. to acknowledge the differing equally valid values in psychiatric decisions between the patient. which is a hierarchy format of ‘quasi legal ethics (that) prescribes right values’. affect.p67 88 Illich.p172 (1976). This he argues differs to bio-ethics. ‘in psychiatry we are concerned with ‘emotion. desire.’86 Therefore for Fulford.p173 90 Ibid p173 .J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. Fulford has missed the point. Limits to Medicine. the patient’s family. who is or might become sick. motivation and belief. and what shall be done with such people’. it is the prophetic mission of psychiatrists understanding VBM.89 The consequence of this is that ‘society has transferred to physicians the exclusive right to determine what constitutes sickness. I.90 While Szasz describes ‘the medicalisation of 85 Schaler. the psychiatrist and negotiate and compromise to satisfy the values of all concerned.5849238 concerned. A. So Illich argues the danger with modern medicine. Illich might however have been grateful for an appreciation that medical treatment is all value-laden since he argues that Szasz as well as other “anti-psychiatrists”. This is because for Illich. (1st ed) Open Court Publishing.85 So Fulford writes.87 Ivan Illich in ‘Limits to Medicine’. p94. are ‘rendering it more and not less difficult to raise the same kind of question about disease in general. is that ‘a passive public that has come to rely on superficial medical house-cleaning’. as in Fulford’s view patient irresponsible passivity falsely masquerades as acceptance and physician’s dominance falsely masquerades as benevolence and expertise. values converge and thus conflicts are avoided. (2nd ed) Penguin Books. p66 87 Ibid. all of which are areas of human experience in which our values differ widely and legitimately. (2004) P68 86 Ibid. would disagree with Fulford about the extent of the value-laden element in physical illness. ”88 Yet he would disrepute Fulford’s belief that in physical illness. 89 Ibid. judges that the individual does not fit into an environment ‘that has been engineered and is administered by other professionals. for Illich physicians rob the lay man of responsibility and mastery of his health in order to preserve modern technology and means of production that underlie the profession.The Foundations of Ivan Illich’s Social Thought Educational Theory. Vol. (1982). Where for Szasz psychiatrists rob mental patients of their responsibility to change their own situation in society. whether conceived in localised bodily terms or within a larger view of human functioning. however. Thus medicine indoctrinates people to believe that ‘they can be discharged from any political responsibility for having collaborated in increasing the sickening stress of high intensity industry’.p26. .92 Not only would Szasz disagree with the subjectivity of physical illness. T. Pluto Press Limited. which has been described by Timothy Reagan as a ‘medieval ideal of society’. p176 93 Raegon. p297 (2007) 94 Sedgwick. Sedgwick argues that ‘all illness. p175 Ibid. Illich has replaced it with the ‘the medicalisation of life’.94 91 92 Ibid. Psycho Politics. it means actively seeking and inciting change of that environment to precipitate good health.91 The political dimension here. expresses both a social value judgement (contrasting a person’s condition with certain established norms) and an attempt at explanation (with a view of controlling the disvalued condition”. for Illich. for whereas for Szasz responsibility means adapting and hence coping with one’s changing environment. is where Szasz and Illich differ sharply. a member of the dominating classes. instead of accusing his colleagues of creating an environment into which human organisms cannot fit’. P. the physician.Issue 4.5849238 problems in living’.93 The final important objector of viewing physical illness as value neutral is Peter Sedgwick in both Psycho Politics and reiterated in (Illich 1976).30. he would abhor the political Marxist analysis of dominating classes coupled with Illich’s antiindustrial standpoint. (1st ed). For Illich. argues that all these objections actually miss Szasz’s point. P65 (2004) . (1st ed) Open Court Publishing. and Schaler. the act of involuntary hospitalisation rears its ugly head again.17 p738(1997) 96 Schaler. should not be called a hospital’96 In conclusion after presenting two dimensions of Szasz thought (the analytic semantic/ dimension and the moral dimension) it is important to see that for Szasz they are immutable. Vol. P65 (2004) 97 Bowers.J Damman. such as homosexuality. such as pneumonia. for example ‘a physical disease. exists independently of the prevailing societal norms. An institution of person cannot leave. (2000).J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. therefore. A. Yet despite this academics such Bowers and Engelhardt Jr.5849238 E. p146. Clinical Psychology Review. The wrongful use of the term mental illness leads to a view of man and woman that is morally dubious. and that an analytic truth cannot be derived logically from the way we speak and act.97 Yet to refer back to Kant.J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. says ‘illness qua illness. Szasz. legally or physically. conclude that Szasz’s argument is solely a moral argument. A. Instead Szasz is emphasising that the actual disease itself is ‘independent of theses social norms’ and that is why. L. Szasz’s analytic argument does succeed in “clarifying concepts”. while a supposed mental disease.J. (1st ed) Open Court Publishing. is never a justification for depriving an ill person of their liberty.95 Aside from this. It has meant that the definition of disease and the mind is re-assessed in the 95 Damman E. Continuing Controversies and there Implications for Mental Health Professionals. The “Myth of Mental Illness”. does not’. Szasz does not believe that diagnoses cannot be social constructions affected by certain societal values.. The Social Nature of Illness (1st ed) Routledge. However if we decide that instead of an analytic truth it is a subjective formation of Szasz’s theory of disease.5849238 psychiatric profession. it is now important to present Thomas Szasz’s political views as a third part of his criticisms of institutional psychiatry. following Quine. and this can only be a good thing. His right-libertarian political thought is inherent in his prescriptions of how the future of an ethical and moral psychiatric would work within society. This paper will explore Szasz’s pure ideological views and will contrast these with the political reality of mainstream and alternative psychiatric practice in Britain and the U. It is a response to Peter Sedgwick. then we can see that together the analytic argument and the moral argument that compliments it present a logically consistent and constantly compelling whole. is dubious just in the nature of it being an analytic argument. even though there is as of yet or possibly never will be consensus. This will essentially separate his philosophical critique from his political thought. who in an . This paper will now turn for its final part to the political thought of Thomas Szasz. Yet it is still true that the analytic argument in a wider philosophical sense. The Political Dimension. Finally there will be an attempt to define Szasz’s political thought as not a necessary aspect of his philosophical critique of psychiatry. After acknowledging that the moral and analytic dimensions form a coherent argument in tandem.S. As has previously been mentioned involuntary hospitalisation. Pluto Press Limited.99 Concerning psychiatry he believes that the term “libertarian psychiatrist” is quite simply an oxymoron. (He defines his political philosophy as aligned with the writings of Ludwig von Mises and Friedrich von Hayek. A. Key to this individual liberty is the belief in private property and a minimal rule of institutional law to protect the right to private 98 99 Sedgwick. P113 (2004) 101 Edgley.p158 Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum. provided a spectrum of different political beliefs such as libertarian. For Reason online(2000) http://www.html . believed deeply in the free market as the economic system that is most productive and most conducive to individual liberty. (1st ed) Open Court Publishing.com/news/show/27767. P. a successor of Mises and a supporter of his ideas.5849238 extensive critique of Szasz. Psycho Politics.101 These two ideals have. (1st ed). which differ in the prescriptions of how best to achieve these states.p44 102 Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum. For Reason online(2000) http://www.html 100 . is incompatible with his interpretation of libertarianism.com/news/show/27767.98 Szasz describes himself broadly as a ‘classical libertarian’. Schaler. Concerning his political thought he defines himself as ‘what in the 19th century. Szasz is confident that freedom and equality can only be achieved through traditional libertarianism or right-libertarianism.102 Hayek. was called liberalism. (1982). argued that ‘Szasz’s politics are not an aberration.reason.reason. and in no sense contradict the positions he has taken on psychiatric issues’. which is essentially psychiatric coercion against individual liberty. A. anarcho-capatlist. it has it concurrent ideals in both freedom (liberty) and equality. since he believes that individual liberty is a more important value than mental health. Today is called “classical liberalism’.J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. libertarian socialist.(2000) The Social and Political Though of Noam Chomasky. however. (1st ed) Routledge.100 Although liberalism comes in a variety of different political guises. net/Contents.).106 Szasz views can be expressed clearly by the maxim that ‘people pay for what they value. S.p32 105 Interview by Randall C. A. if determined by impersonal force.p55 . 108 Ibid.5849238 property. and affects the dignity of the person much less. While alternatively ‘the development and safeguarding of therapeutic privacy are. beyond a shadow of a doubt. than when it is due to design. is going too far for Szasz.net/interview/thomas-szasz.’104 These ideas are for Szasz important in his development of libertarianism.e. Even adding chemicals to the water or bread.A. Now lets approach this adage from the confines of psychiatric practice.psychotherapy. the role of the state for Szasz should be limited to national defence. (1944) (1986/ The road to serfdom. this is due to the belief that 103 104 Ebenstein. In Jan Pols Critical Analysis of Thomas Szasz http://www. ed. These are the political and economic ethics of individualism and collectivism. New York: Harper & Row. london. because this ultimately compromises freedom. Healthcare should of course be private. 106 Szasz’s Political Theory. or a Rawlsian position of redistribution. Routledge and Kegan Paul. that the two variables that correlate most closely with good health are the right to property and individual liberty i.105 In this vein.O (2003) Hayek’s Journey. p51 (1960/1974). and value for what they pay for’.html 107 Szasz. Wyatt. and is even officially devalued. http://www. A therapeutic practise in a collectivist society for Szasz means that ‘privacy cannot be maintained.janpols. closely tied to the individualistic-capitalist socio-economic system’’108 (Ibid). (1st ed) Palgrave Macmillan p65 Hayek. T. The myth of mental illness: foundations of a theory of personal conduct (Rev. the police. He claims ‘Economists and epidemiologists have shown. and certain public works such as the water supply and litter disposal.103 Hayek disagrees with any form of state redistribution of wealth. Szasz defines two different possibilities of socialeconomic circumstances in which two opposite and distinct therapeutic practises can operate. F. the free market’. in communist-collective societies’107. Hayek states ‘inequality is undoubtedly more readily borne. thus implying a sharp capitalist-communist dichotomy. In ‘the Myth of Mental Illness’. in which perspective patients “shop’ around the various therapeutic alternatives with guidelines clearly defined by the therapist according to the patient’s own desires and financial capabilities.5849238 the physician is ultimately responsible to no third parties.110 This is essentially a market based solution to mental healthcare. freely terminable by both’.p56 Szasz. while in insured practices there are three often conflicting agents. Secondly the agent of the therapist in the private practice is only the patient. just to the interests of the patient.p58 . the only clear difference is that the financial reward from social insurance comes from the system or state. while it can fluctuate to a several people in insured practises. Szasz places social insurance as a situation when the ‘physician may sometimes be for the patient and sometimes against him. ed. In conclusion for Szasz you can separate private practise from the social insurance practise of therapy in these ways. p51 (1960/1974). T. (1977) The Manufacture of Madness (2nd ed) Harper and Row.109 In line with Szasz’s political ‘classical liberalist’ thoughts he defines the ideal situation between a patient and a therapist as contractual in which the patient hires a therapist to assist him according to the goals the patient defines which the therapist is free to accept or deny. the patient’s agent. 111 Szasz. New York: Harper & Row.). namely. and the therapist’s agency (where he tries to maximise his own gains). 111 109 110 Ibid. society’s agent. T.p215. freely entered into by both and. This however relates back to the conflict of interests between the therapist and the patient and the therapist as a state worker. firstly the number of patients are kept to two in the private practice. The myth of mental illness: foundations of a theory of personal conduct (Rev. in general. Thus ‘The relationship between contractual psychiatrist and patient is based on contract. In between this sharp dichotomy. S. Thirdly there is little difference between the sources and nature of the therapist’s rewards. Routledge (1997) 115 Sedgwick. Pluto Press Limited. 114 Kotowicz. P.D Laing and the paths of Anti-Psychiatry.114 So for Szasz while psychiatrist see patients as villains and psychiatrists as heroes. and inadvertently diminish the responsibility of the patient. argued that ‘There is a contradiction between his political views and his condemnations of psychiatry’ Radical Psychiatry. the Anti -Psychiatrist inverse these terms. 4. For Spencer it is the myth that ‘all social suffering 112 The Editor of Radical Psychiatry.D. (1st ed).116 Sedgwick therefore emphasises each authors attempt to highlight the essential struggle of existence: for Szasz this is masked by psychiatry as the institutional denial of tragedy. Z. Laing who Szasz believes ‘as communist seek to place the poor above the rich. Peter Sedgwick in his book ‘Psychopolitics’ wishes to expose these elements of Szasz’s political belief and to discredit Szasz’s by claiming his philosophical views on psychiatry contain his political views explicitly.R. Sedgwick argues that they both start from very simple and similar first premises: ‘the supreme value of the individual competition in a race whose course and progress is to be traced by the record of evolution’. to be consequently lampooned and told from the platform that they were a pack of reds and should got back to Moscow. Pluto Press Limited. so anti-psychiatrist (Laing) seek to place the sane above the insane’. pp.112 A telling example is when a group of New Left students went to applaud a speech he made at the University of Michigan.113 This distinctly separates him from the others brushed by the AntiPsychiatry brush such as R.P149 (1982). 116 Ibid p161 . 1973.P158 (1982). New York. Psycho Politics. 113 Sedgwick. His aim therefore is to relocate Szasz as the ‘doyen of the movement of mental health revisionism and the herald of the newer orthodoxy’s of right wing thought on welfare in the post collectivist epoch of Ronald Reagan and Margaret Thatcher.xxi.5849238 Szasz’s right-libertarian views have caused much confusion to supporters of his criticisms of Psychiatry. (1st ed).115 Sedgwick in order to emphasise right libertarian thought in Thomas Szasz traces Szasz’s political views as a continuation of Herbert Spencer’s. Psycho Politics. P. Phil Brown. ‘the old and the indignant are hardly in a position to compete. The man versus state. (3rd ed) Caxton Printers. in the therapypurchasing market with clients who are as their peak of economic capacity’. The Politics of Thomas Szasz. M.:The Sociological View. Goldstein.5. Vol 27. like Sedgwick.:The Sociological View. P. believes that Szasz is woefully naïve. Psycho Politics. arguing that ‘he overlooks the fact entrepreneurial fee for service medicine is also tied historically and functionally to the government and other institutions’.H. Journal of Social Problems. These criticisms of the implications of the libertarian philosophy as a political criticism throughout Szasz’s work are cogent and strong. (1980) .119 Thus the unadulterated cash nexus that Szasz speaks of and the individualism it supports is an idealism that as its most harmful consequence feeds the ‘post collectivist epoch’ of welfare reductions. for Spencer state help for the needy through poor laws and other state measures is worthless unless we come to understand the long-term evolutionary effects of these acts.5849238 is removable. (1980) 119 Sedgwick. No. 120 Goldstein. (1st ed). M. Pluto Press Limited.120 The individualistic capitalist ideology rightfully has been criticised as ignorant of many social problems and social inequalities that deny the ability for true liberty. and that it is the duty of somebody or other to remove it. p23 (1945) . Journal of Social Problems. No.’117 As a result. p576.5. p582. Yet libertarianism as a political view has different strands and 117 118 Spencer. The reality of a contractual psychiatry and supposed ‘free enterprise’ would leave the most unequal in society to suffer. Vol 27. In conclusion Goldstein like Sedgwick believes that ‘ideologies that claim to be humanistic through offering the individual as the basis unit of social life can provide justifications for dehumanising policies and practises’. Concerning free enterprise Mark Goldstein.P165 (1982).118Steven (1971) and Berlant (1975) have both explored the accumulation of private power with use of government apparatus. This is akin to Szasz’s warning that the Christian charitable ethos just like psychiatric meddling fosters and deepens the ‘ethic of helplessness’ in the needy. The Politics of Thomas Szasz. M. On the under hand equality could be founded on the principle that labour must be freely undertaken and under the control of the producer. (1st ed) Routledge. namely.(2000) The Social and Political Though of Noam Chomasky. A. Social libertarianism is an alternative political variant of libertarian principles.5849238 these must be discussed in order to differentiate libertarian principles as a criticism of psychiatry from right-libertarianism as a political and social prescription. Journal of Social Problems. The Politics of Thomas Szasz. No.’123 Despite this. Inequality is maintained through the private means of production and wage slavery. ‘the contact merely formalises and legitimises the difference in money. http://www.org/reference/archive/bakunin/works/various/reasons-of-state. Therefore the statement by Geoff Pearson that ‘the conservative theory which is largely implicit and unstated) in Szasz’s work and the 121 Bakunin. In spite of libertarian socialism and right-libetarians profoundly disagreeing in political prescriptions both would agree that liberty involves the right not to be coerced by others.122 Thus this reading of libertarian political ideology falls in line with Sedgwick’s and Goldstein’s criticism of the contractual private therapeutic relationship as disadvantaging the unequal. injustice.Federaism.p44 123 Goldstein.htm 122 This is a common assumption amongst Libertarian socialist see Noam Chomsky.121 As such libertarian socialists believe that contractual capitalist relationships are not truly free if these exist within a society that is inherently unequal. knowledge. p577. So Szasz’s criticism of involuntary hospitalisation comes from a Libertarian sentiment that is neither specifically conservative nor socialist. Vol 27. power. Bakunin. Socialism Anti-Theologism. etc in Edgley. (1980) .marxists. as well as self-ownership of the body.:The Sociological View.5. this paper takes Szasz libertarian principle at its most consistent when it attacks psychiatric practises. For libertarian socialists freedom is not true freedom without equality: as Bakunin said ‘Liberty without socialism is privilege. involuntary hospitalisation. socialism without liberty is slavery and brutality’. Pluto Press Limited. p282.125 Because of the denial of the term ‘mental illness’ Sedgwick argues that Szasz and other “anti-psychiatrists” could be used as a justification for further cuts in welfare spending.5849238 libertarian sentiments (which are worn boldly on his sleeve) never meet up’ seems to be an equally valid conclusion to come to. when Governor Jerry Brown after cutting California’s mental health budget by 40 percent partly justified his action by claiming ‘I didn’t have any confidence it could be spent well…. (1st ed). Pluto Press Limited. It is important not to forget the main tenet of Szasz theory. http://www.I’m aware of Thomas Szasz’. at the end of Sedgwick’s book. And that to truly radicalise psychiatry for Szasz. it would be difficult to make demands on the health service. As quoted from Goldstein. P. in which mental patients board and live in the community with other people without stigma. (1st ed). or the ‘medical details of schizophrenia’.jstor. 128 Ibid.128 124 Review of Law. Liberty and Psychiatry by Thomas Szasz by Geoff Pearson.124 However this is not all.p40 (1982). and many of the patients do not take medicine and ‘have not seen a doctor in years’. P.org/stable/pdfplus/1409792. he appeals for organised and socialised welfare similar to the therapeutic culture of the Belgian town Geel. that the term ‘mental illness’ implies a literal disease when it is only a metaphorical disease. This has already happened.127 Sedgwick celebrates this type of therapeutic community where the caregivers in Geel know no science. For Sedgwick this is dangerous because without a blanket term ‘mental illness’ clumsy and ill defined as it is.126 As an alternative. Psycho Politics.256 . 126 New York Times ‘Brown Study’III.p256 (1982).pdf 125 Sedgwick. 127 Sedgwick. Involuntary hospitalisation is just one aspect of Szasz’s critique of psychiatry. would mean that the term ‘mental illness’ and the treatments it justifies would be given up immediately. Psycho Politics. ’ In line with the Szasz view of making Psychiatry a moral.critpsynet. 129 The medical model can be seen here in The limits of psychiatry Duncan Double.5849238 This image of Geel is revealing because it shows a conflict in Sedgwick’s thought. which relegates social contexts to a secondary role. the ‘process of medicalisation of deviant behaviour conceals complex political issues about the tolerance of diversity. consultant psychiatrist The number of antidepressants has increased twofold in seven years.129 These concerns are partly borne out in a British group called The Critical Psychiatry Network based in Bradford that started in 1999. However if one looks at this through the work of Thomas Szasz there is an obvious inherent contradiction here. while on the overhand he believes that the term mental illness should be kept to keep funding for helping people with mental illnesses.’ Tolerance of the diversity of human life and respect for people’s autonomy is key to the ethos of Critical Psychiatry. and Psychiatrist treat this as a medical problem. similarly the number of consultant psychiatrist has doubled in 22 years.gov/articlerender.com/healthmatters.freeuk.htm . Thus a situation where ‘people know no science’ or aren’t on medication becomes increasingly difficult when ‘medical illness’ is widely used as a literal term. Mainstream Psychiatrists sees themselves as having medical authority. This is because the term ‘mental illness’ throughout the history of Psychiatry implies a medical problem.nih.fcgi?artid=1122838 130 Critical Psychiatry Network.’130 And ‘(We aim)to introduce a strong ethical perspective on psychiatric knowledge and practice…and to politicizes mental health issues. they state ‘The biomedical model locates distress in the disordered function of the individual's mind/brain.pubmedcentral. political and ethical practise. Phil Thomas and Joanna Moncrieff http://www. For on one side he calls for a more humanitarian and non-medical approach to people with ‘mental illness’ as in the example of Geel. http://www. In an article explaining their beliefs Phil Thomas says ‘It is often difficult to work in the biomedical model in a way that really respects and engages with the patient's beliefs and preferences. Similarly this phrase could be straight out of one of Szasz’s books. Critical Psychiatry Clinical Psychiatrists. “as agents of the state”. This is a solution that is moral in nature and not medical. they also understand that if there is a case for involuntary coercion i.com/sound.freeuk. for the Critical Psychiatrists social equality is anterior to liberty.5849238 the control of disruptive behaviour and the management of dependency. As well.htm . To conclude it seems that there are criticisms of psychiatry proposed by Thomas Szasz and the Critical Psychiatrists that are very similar. Also in the belief that social inequalities increase both ‘problems in living’.’. Yet despite this they work. Yet they both lead to different political conclusions.131 The approach of the Critical Psychiatry group provides an interesting answer to the question of whether Szasz political persuasions are a necessary component of his broader theory. the term ‘mental illness’ and involuntary hospitalisation and seek to treat their patients as morally responsible and meaningfully acting agents. in their belief that Psychiatry can only be radically transformed if the political and social system changes. but also problems in how society treats and defines deviant behaviour. Their political convictions are radically different to Szasz.e. This means his theories sole aim is to help mental patients. violence etc than this is a legal problem and not a medical problem.critpsynet. http://www. This is important as it shows that Thomas Szasz’s work does not have to be seen through a prism of a political ideology only. It is essentially at its core humanistic. responsibility and liberty as much as possible. Therefore just as for Szasz responsibility is anterior to liberty. They deny the necessity of a medical model. like Szasz. increase their autonomy. For as a group of Psychiatrists they are a living and practising embodiment of Szasz’s criticism of Psychiatry. This is the most important part of 131 Another Critical Psychiatry article. as Szasz would have it. This is because his analytical argument is still important in showing how Szasz defines what constitutes a disease and what constitutes a ‘mental illness’. his views on psychiatry do in no way explicitly support . It has shown with the philosophy of Kant and the moral philosophy of libertarianism and existentialism that the analytic/semantic and moral aspects do form a coherent and logical argument. It is also because his moral argument serves to undermine other possible definitions of ‘disease’ and ‘the mind’. that means together they both form a formidable and coherent argument that ensures psychiatrists have to seriously reexamine their concepts and treatments. In addition to this. if they decide to challenge the dominance of institutional psychiatry. Szasz’s argument is not just a moral endeavour.e. that even with this view in mind. This is because despite important queries made by Quine into the nature of analytic arguments in general. and one which people of all political persuasions would be wise to take head of. comprised of an analytical/semantic philosophical. but most importantly.5849238 Szasz’s theory. In conclusion this paper has attempted to assess whether Thomas Szasz’s theory of ‘The Myth of Mental Illness’. moral argument and political argument forms a coherent and consistent whole. The fact that this definition as part of a ‘web of belief’ is potentially revisable from empirical experience does not detract from the strength of it as a workable definition which results in a logical conclusion i. Peter Sedgwick’s belief that Szasz’s political ideology in no way contradicts his views on psychiatry is true in one sense. the political dimension of Szasz’s work has been shown to be separate of his main analytic and moral argument. mental illness is a myth. Clinical Psychology Review. This is because the libertarian though that encompasses his work could potentially manifest itself in a different strand of Libertarian political thought. Constraints and Mental Illness Rationality and Society Aug2006 vol.freeuk.com/index. in fact in the case of the Critical Psychiatry movement it can lead one to altogether different political conclusions and prescriptions. Bibliography Caplan. The Economics of Thomas Szasz: Preferences. 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