Thomas Szasz, M.D. died on September 8, 2012 at the ripe old age of 92. He was a pioneer in the field of making us rethink what we mean when we say someone is “mentally ill.” Is it really a purely physical disease, or is it part physical, part social construct?
And if it’s partly a social construct (and, to be honest, it is), it must be subjective. We’ve all simply agreed that this set of symptoms = mental illness. Keep in mind that his theories were based with our knowledge of mental illness in the 1950s and 1960s — a time when our understanding of mental illness was truly in its infancy. At that time, mental disorders truly were quite arbitrarily defined.
While many associate Szasz with the anti-psychiatry movement, that’s a label he never was comfortable with. It also over-simplifies his complex and nuanced views about mental illness as one of the most vocal critics of psychiatry.
Szasz’s views about psychiatry stemmed from his understanding and perception of how mental illness was defined (in the 1960s). If mental illness is just a set of arbitrary symptoms defined not by scientific data, but by doctors, then committing people to state psychiatric hospitals was unconscionable.
As a libertarian, Szasz believed that government should limit its interference in a person’s pursuit of happiness and their own lives. Psychiatry is the only specialty in medicine that had the power to take away a person’s freedom and used it with regularity.
Ironically, some of Szasz’s ideas were eventually embraced — but not for the reasons he thought. We saw the deinstitutionalization movement pick up steam in the 1980s, with the shuttering of many state hospitals. But this was due more to budget cuts than for philosophical reasons, with many deinstitutionalized patients ending up on the streets, homeless. Free, indeed. But often penniless with little social support or prospects for their future.
States toughened up their commitment laws as well, making it harder to “lock people up” indefinitely. Most states now have only a 72 hour hold period for someone with psychiatric issues. Longer periods of involuntary commitment need to be regularly reviewed by judges and other doctors.
Szasz often found himself as a lone voice in a profession where the power differential was emphasized between doctor and patient. He eschewed that relationship, recognizing that such power could be corrupting and ultimately harmful to the patient.
He argued that what are called mental illnesses are often better described as “problems in living,” and he opposed involuntary psychiatric interventions. His reputation in defense of these principles was launched in 1961 with The Myth of Mental Illness. He published 35 books, translated into numerous languages, and hundreds of articles in the subsequent 50 years.
Recognized worldwide as one of the most important critics of psychiatric coercion and a defender of individual responsibility and freedom, Dr. Szasz was the recipient of several honorary degrees and many awards, including the Humanist of the Year, Jefferson Award from the American Institute of Public Service, Mencken Award from the Free Press Association, establishment of “The Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties” by the Center for Independent Thought, and the George Washington Award from the American Hungarian Foundation.
Szasz was a true pioneer in every sense of the word, and his contributions to the discussion about mental illness were invaluable. He should be required reading for not just all psychiatrists and psychologists, but all doctors and patients too.
Because while we have a much greater scientific understanding of mental illness today, our knowledge about how the brain works — and therefore, also sometimes doesn’t work (in the case of mental illness) — is still in its infancy.
Read his full obituary: Thomas Stephen Szasz Obituary – Manlius, New York
5 comments
The mainstream must always have outliers who have the courage to question as we too are full of our biases. RIP.
I knew him personally. When I was a kid back in the 60s and 70s my parents had a resort on Cape Cod. He used to come and stay for a week some years.My father was not crazy about him. He was a bit of a pain in the neck to deal with. But I remembered he did come on as friendly. I remembered that I helped carrying his stuff from his car to the cottage that he was staying in.
Great man. Never confused the menu for the meal nor conformed to the cooks and the chefs.
Thanks for your reflections, John. Tom Szasz was one of my teachers when I was a resident over 30 years ago and I knew him quite well. Although we disagreed on nearly everything related to psychiatry, he was always unfailingly kind and polite to me, as he was to my fellow residents.Ironically–and tellingly–Szasz never had any real contact, during his training or subsequently, with those diagnosed with the conditions Szasz regarded as “myths” or “metaphorical” illnesses (such as schizophrenia). He makes this clear in his own autobiographical statements. I believe this was a catastrophic loss for him that shaped his perspective evermore.For those who want to see an interesting recent debate, go the the “Cato Unbound” website for August 2012. See, especially, the comments of Prof. Amanda Pustilnik. Also, I have a piece in Psychiatric Times, titled, “Mental Illness is no Metaphor.” It’s rather technical and theoretical, but might be of interest to some readers.On this we can all agree: Thomas Szasz made us all think carefully and critically about our theories and assumptions, and framed the nature of the debate for over 50 years. He was truly a “gadfly” in the Socratic sense!Respectfully,Ronald Pies MD
What a loss. I wonder how many will continue to have the courage to stand up for debate against the mainstream as big business takes over. I missed this article back when it came out. Not only is psychiatry in it’s beganing, we do not yet understand how the med’s that are more and more often are being offered as the only treatment affect the mind or the body as a whole.