Judicial Interference--Justified Paternalism?

Correspondence, Medical Sentinel, Volume 4, Number 4, July/August 1999

The Death of Ethics: A Human Construct

Reflection of a Practicing Psychiatrist

Thomas Szasz came to my attention for the first time in 1960 when he lectured us, psychiatric residents, as part of the official Northwestern University Medical School, Department of Neurology and Psychiatry teaching program for residents. I have thanked the University many times for the exposure and its consequences in the succeeding 37 years: I have read and study each one of Szasz's 24 books and most of his single articles, related with him personally, by regular mail (until last year, now by email), introduced medical students, residents, colleagues and the public in general to Szasz's writing on a number of subjects. All that has helped me a lot. I have been able to look at myself in the mirror with less shame. The shame of lying, directly or by half truths, or by turning the head the other way.

Reading Szasz has always been very refreshing - and teaching - so has visiting with him in different parts of the country, his home included. His "don de gentes" has no parallel: a vibrant, jovial conversationalist, a loving father and friend, a diner with mucho gusto, a brisk walker...

My writings or talks about Szasz or in "Szasz's fashion" have not caused me too much trouble. Disbelief and/or indifference have been more common reactions. The large majority of people are as convinced of the existence of mental illnesses - this is the loss of moral agency due to an alleged neuropathology - as the folks of prior centuries were convinced of the devil's possession or, for that matter, the Emperor's subjects were convinced the Emperor looked great in his new clothes. It looks as if the Emperor's story may help to explain the phenomena: terror as related to losing material posessions/life, induced subject's farce. In the mental health industry the disbelief seems to correlate with income, - "Quo bono" (who profits), as Szasz puts it. It is more difficult to explain the public's need to hang on to the farce.

I have been a faculty member at Northwestern University for 32 years whose services have been graciously recognized by the University Board of Trustees. I have been an Attending man at Northwestern Memorial Hospital, department of Psychiatry, in solo private practice of psychiatry for 27 years. I have never treated anyone against his/her will, let along initiate or pursue civil commitment procedure. When people ask me how can you treat mentally ill patients if you do not believe in mental illness, I tell them I do not treat mental illnesses but I treat people that come to me with complaints often attributed to mental illnesses. Then I bring to their attention the fact that they are contracting with me for services like any "mentally well" person will do.

The bulk of the time I spend with patients is pointing at their tendency to try to convince me they are mentally ill at least partially. In more conventional terms, my service consists in pointing at defenses. Many consultees, particularly public aid recipients, quickly fire me and go to a psychiatrist that believes in mental illness.

I congratulate Dr. Jeffrey A. Schaler for his work in the Internet to popularize Szasz's ideas. This is a much needed service to enhance peoples' health, spiritual comfort and to decrease the risk of totalitarism.

Nelson Borelli, MD Northwestern University