My views on psychotherapy have been influenced by existential philosophers, a debt I have acknowledged. Also, to the best of my knowledge, I was the first medically trained psychoanalyst in the United States to condemn the opposition of American psychoanalysts to non-medical analysis and psychotherapy (Szasz, 1959). For these reasons, it seems to me that my writings ought to appeal to existential analysts. However, this is not always the case, as two contributions in the July 2002 issue of Existential Analysis illustrate. Many existential analysts are ambivalent, antagonistic, and even maliciously hostile toward my views and, it appears, my persona as well. I shall not speculate about the reasons for this. In this brief essay, I should like to use the comments of three contributors, two unsympathetic and one sympathetic, in an attempt to clarify differences and misunderstandings.

Hugh Hetherington

Hetherington's essay, "Comprehension and Apprehension," is an example of the intense, albeit unfocused, displeasure that some existential analysts exhibit toward what I say, how I say it, and who I am. Hetherington (2002: 227) introduces his criticisms with the remark, "While good doctors and therapists may aspire to be open, some are surprisingly prone to adopt positions based on convictions and conclusions."

Let me clear the ground right off the bat. (1) Hetherington writes "some," but as he cites no one else guilty of the offense, I assume he means me. (2) His models are "doctors and therapists." I have made it clear that I regard psychoanalysis (psychotherapy) as a special type of dialogue -- listening and talking -- that has nothing to do with doctors (medicine) or therapists (persons who treat diseases) or "analyzing" (any object or person). (3) When Hetherington writes that "some are surprisingly prone to adopt positions based on convictions and conclusions," it is clear that he condemns this position. I believe that such an a priori and unqualified objection to moral convictions is unwarranted and mistaken. It is, indeed, my conviction and premise (not conclusion), that chattel slavery, Communism, Nazism, and psychiatric slavery are evil, because they diminish individual liberty and personal responsibility.

Hetherington, it appears, dislikes and objects to any and all "positions based on convictions," regardless of content. In what follows, I offer brief comments, item by item, on Hetherington's criticisms. My subsequent remarks are intended to clarify my own views and express no opinion about Spinelli's writings, against which Hetherington compares mine.

"Let us take Thomas Szasz and Ernesto Spinelli as examples. The former offers an example of ideological conviction that could get in the way of good therapy or philosophizing. The latter offers a paradigm of a more apprehensive and less comprehensive approach."

When matters concern ideology, as they do when they concern basic human values such as freedom and coercion, then it is appropriate to have ideological convictions, which one may profess candidly or protect from scrutiny by concealment and evasion. A polemical presentation is not, ipso facto, unhelpful to uncovering truths and values. Hetherington does not say what constitutes "good therapy." Is locking up people who talk about killing themselves good therapy?

"Of course, Szasz has never professed to be an existentialist."

This is correct. I prefer not be categorized. However, if people want to categorize me, I would opt for being called a libertarian whose primary value is personal responsibility. In addition, many psychiatrists and psychologists identified as existentialists embrace conventional psychiatric brutalities, which I reject. Medard Boss uncritically accepted imprisoning "patients" and "treating" them against their will. Heidegger never criticized National Socialism and remained silent about the systematic murder of German mental patients by Nazi psychiatrists. Similarly, Sartre never criticized the Gulag and remained silent about the systematic murder of mental patients by French psychiatrists during the Occupation.

"... but this did not deter him from assuming that his views were in 'harmony and sympathy' with an existential audience in a speech delivered to the 4th SEA conference in December 1991. Dr. Szasz is also on the editorial board of the Existential Analysis journal; and some existential thinkers laud his views."

I fail to see what I did wrong in assuming that a group of people who came to hear me speak would likely be in sympathy with what I say. Is Hetherington suggesting that I be purged from the editorial board of Existential Analysis? Is there nothing at all in my views that existential thinkers could laud? I always find something laudable in the views of thoughtful people many of whose views I repudiate, such as Heidegger and Sartre, or Freud and Bleuler.

"Buffon's saying 'le style est l'homme meme' suggests that we can gauge a persona and world from style as well as content. Spinelli's style in speech and writing tends to be careful, tentative, gently probing, philosophical, open. Szasz's style tends to be closed and might be seen as slightly bombastic. Conclusions have already been drawn -- and here they are! ... With Szasz the style reflects the professed certainty of the content."

I agree that Buffon's saying "le style est l'homme meme" expresses an important truth. Style is how one says something, content is what one says. Surely, both are relevant to evaluating the empirical validity and the ethical worth of an assertion. Asserting truth clumsily does not make it less true, and asserting wickedness in style does not make it less wicked. Hetherington divorces content and style and confuses premise and conclusion. It is quite true that, sometimes, my "style reflects the professed certainty of the content": I am certain that freedom and responsibility are better than slavery and irresponsibility; that the "therapist" ought be the agent of the client who seeks his services and pays for them, not the agent of his relatives or the state; and so forth. If Hetherington prefers to be, and prefers other existential analysts to be, "open and tentative" toward such matters, that is his and their privilege. His comment is so absurdly inclusive that it suggests that he believes that we ought to be tentative about whether London or Paris is the capital of France or prefer to speak English or French.

He cites my saying,

"It always seemed obvious to me that the so-called therapy of neurotics consisted of... [and interprets this to mean] Right from the womb, Szasz has had a view! Even more worryingly, he has nursed the same view, unexamined, to the present moment" (pp. 227-228).

"Le style est l'homme meme," indeed. Consistently ignoring content, Hetherington praises Spinelli's style: "The repeated parentheses and commas in some of Spinelli's writings may irritate some; but they reflect care and philosophical doubt rather than overblown conviction disguising anxious doubt..." (p. 228). One man's philosophical doubt is another man's political waffling. Hetherington's praise of the virtue of tentativeness misrepresents the essentially moral and normative nature of the psychotherapeutic encounter. He makes it appear as if it were an empirically verifiable or falsifiable scientific affair, not an ideologically-centered dialogue about unresolved conflicts that plague the client's life. In the end, Hetherington objects even to my defense of freedom, rejecting my very conception of it. He writes:

" An irony of the support Szasz receives from some soi-disant liberal and left-leaning existentialists is his own rather conservative approach on economic freedom and non-interventionism. In fact his whole analysis of 'freedom' seems much too narrow to bear philosophical scrutiny."

Hetherington does not share with the reader his ideas about how my conception of freedom -- which is not mine, but John Locke's, Adam Smith's, and Lord Acton's -- could be broadened, but he hints that it needs to include opinions that regard private property as something akin to theft. Hetherington then cites the unspecified criticisms of other existential analysts of my views or me:

"Other ethical reservations were well set out by Emmy van Deurzen many years ago. Hans Cohn accurately pinpointed inconsistencies in Szasz's thinking about the same time (i.e., just after Szasz's address to the SEA). Andrea Sabbadini may be getting to the heart of it in suspecting that Szasz possibly does not believe half of what he is saying."

It is sad to see serious people descend to this sort of base rhetoric, the "analyst" arrogating to himself insight into other people's mind superior to the individual's own, and if the "interpretation" is inconsistent with the subject's overt behavior (Szasz, 1963, 1999, 2002). Note that Hetherington approvingly cites Sabbadini's remark that "Szasz possibly does not believe half of what he is saying." Is this his way of saying that I am possibly either a liar or mentally ill? Surely, such an insinuation is not a substitute for acknowledging their position on the core ethical issues that therapists face: Do they believe that individuals deemed dangerous to themselves or others by psychiatric agents of the state ought to be incarcerated in "hospitals" and "treated"? Or is such a question not "philosophical" enough for them to merit an answer?

Darren Wolf

Wolf criticizes me for my definition of illness, specifically for asserting, in The Myth of Mental Illness (1961): "Strictly speaking, disease or illness can affect only the body; hence, there can be no mental illness" (Wolf, 2002: 299). He continues:

"Disease or illness are undoubtedly conditions of the body; but as Nietzsche points out in the preface to The Gay Science: 'We philosophers are not free to divide body from soul as the people do; we are even less free to divide soul from mind [Geist].' ... as philosophical therapists, we have a much larger concept of the human body than Szasz allows for. The human body includes all of the organs which constitute it, including mind and soul."

Of course, Wolf is free to include in his concept of the body anything he wishes. However, since ordinary language is, through and through metaphorical as well as rhetorical, we must ask what Wolf seeks to accomplish by his definition. The most obvious answer is that he seeks to claim a place for existential analysis at the table of professionals who treat real diseases, especially medical doctors (psychiatrists). Indeed, were such a definition accepted by the state -- which now controls medical practice -- it would justify the claim that existential philosophers qua therapists treat bona fide diseases on a par with real doctors treating real diseases, such as a cancer and diabetes. I have written extensively on this subject. My book Pharmacracy: Medicine and Politics in America (2001) is my most up to date statement of my views regarding the economics, ethics, philosophy, and politics of the ideas of disease and treatment.

I wish to offer only two more brief comments on Wolf's suggestions: one, concerns the problem of translating German into English, the other relates to the history and meaning of the English word "mind." I discuss both in depth in my book, The Meaning of Mind (1996). Suffice it here to point out that, prior to the seventeenth century, the word "mind" was used only as a verb. Englishmen then knew of no such entity, organ, or thing as a ""mind" (noun). Instead, they used the word soul or spirit. With the decline of religion and the ascent of science, soul became a term primarily or solely used in religious discourse. In educated, scientifically enlightened discourse, the "spiritual" aspect of human existence was assigned to the domain of the mind. This is important not only for a proper understanding of my views, but also for an understanding -- in simple, practical, economic, legal, and political terms, rather than in abstract philosophical metaphors -- precisely what so-called psychotherapists do, why they do it, and who pays for their services (Szasz, 1965, 1978, 2001, 2003. Szasz, ed. 1973).

In his enthusiasm to change medical terminology into what he evidently regards as a desirable discourse for a medicalized philosophical therapy, Wolf writes what, from a medical point of view, is nonsense.

A diagnosis is a statement about what we would like to be different about our existence (p. 300).

In modern, scientific medicine, the core meaning of the term "diagnosis" must be situated at the autopsy table: diagnosis is the lesion / disease the pathologist finds in the cadaver that had been the patient. This is a point in time when the subject's existence has ceased and he has become a dead object.

The impetus behind every way of conceptualizing pathology is undoubtedly the desire to move therapeutically from sickness to health (emphasis added, p. 300).

Wolf does not say why he proposes such a radical redefinition of the terms "diagnosis" and "pathology." One of the reasons for his terminological revision is to criticize my criticism of the "psychiatric dehumanization of man" (Szasz, 1970), as dehumanizing:

The power of the designation is what horrifies us when it is used by others; it is also a power to which we are often completely blind when we exercise it ourselves. It is in this way that the liberal-humanist arguments of Szasz are revealed for what they are. Szasz denounces psychotherapy and psychiatry because these professions pathologise particular ways of being or behaving. In other words, he designates the use of the terms psychopathology or mental illness as pathological [author's emphasis], as wrong, as empty of all positive values and associated with all negative values instead. ... Essentially, he is arguing that he, and not therapists or doctors, should have the power to decide what will be designated as wrong, sick, pathological (p. 303)."

Wolf manages to discuss mental illness and the consequences of pathologizing behavior without ever mentioning psychiatry's -- and now the entire mental health profession's -- two paradigmatic procedures, civil commitment and the insanity defense. Naomi Stadlen

It is a refreshing change to turn now to the third piece in the July 2002 issue of the Journal that considers my writings, Naomi Stadlen's review of a book on the ethics of counseling, by Tim Bond. Stadlen observers that Bond credits Laing for some of my ideas of which he approves:

He [Bond] also claims: "R. D. Laing has argued that suicide is the ultimate right of any individual. But the book to which he refers, The Politics of Experience and the Bird of Paradise, nowhere argues this" (Stadlen, 2002: 335).

My views on suicide -- in no way novel, reprising the views of David Hume -- have formed one of the cornerstones of my lifelong opposition to involuntary mental interventions, exemplified by imprisonment in a mental hospital, subjection to assaults called "treatment," such as electroshocking, and, more generally, mental health laws that authorize (indeed, mandate) the psychiatric incarceration of individuals whom psychiatrists deem "dangerous to themselves (and others)." Laing squarely rejected this moral-political premise animating my psychiatric views (Szasz, 1965, 1971,1978, 1999). In The Divided Self, Laing (1960: 27) wrote: "When I certify someone insane, I am not equivocating when I write that he is of unsound mind, may be dangerous to himself and others, and requires care and attention in a mental hospital" (emphasis added). When it suited his personal needs, Laing made use of this psychiatric power even in managing his own family. In 1976, Laing's daughter Fiona, then twenty-four years old, was rejected by her boyfriend. According to Laing biographer John Clay (1966: 181), "She had 'cracked up,' and had been found weeping outside a church" near the family home. Committed to a local mental hospital, she is given ECT:

He [Adrian] rang his father up and asked him "in despair and anger" what he was going to do about it. Laing reassured him that he would visit Fiona and "do everything in his power" to ensure that she was not given ECT, but when it came to the crunch, as Adrian Laing relates, all he could say was "Well, Ruskin Place [the family home] or Gartnavel [the mental hospital] -- what's the difference?" Such a scathing and deprecatory remark showed once again an avoidance of responsibility for his first family, indefensible since his line had been that the breakdown of children could be attributed to parents and families. Instead, Laing went into denial. When he gave an interview shortly afterwards in New Society he declared, "I enjoy living in a family. I think the family is still the best thing that exists biologically as a natural thing."

Focusing on my emphasis on the fundamentally moral character of the psychoanalytic-psychotherapeutic encounter, Stadlen (2002: 335-336) writes:

"Yet Dr Bond doesn't do justice to Dr Szasz's starting point. In The Ethics of Psychoanalysis, Dr Szasz states: 'Clearly, then, psychoanalysis is a moral exercise or, if one wishes to put it that way, a moral therapy. ...' This embodies existential philosophy although, at that time, Dr Szasz defined himself as a psychoanalyst."

I thank Stadlen for her sympathetic acknowledgment of my efforts.

Concluding Remarks

In October 2002, The International Federation for Psychoanalytic Education honored me with its annual Hans Loewald Award. The occasion prompted me to re-address, once more, the subject of psychoanalysis.

In a paper entitled, "Cleansing the Modern Heart: Is there a Place for a Pacific-Secular Cure of Souls in the Therapeutic State?" (2003), I endeavored to re-articulate what I regard as the moral and political-economic core of, and the social conditions for, the psychoanalytic situation. They are: the inviolable privacy of the professional-client relationship; the client's willingness to assume responsibility for his behavior and pay for the service he receives; the analyst's willingness to eschew coercion justified by the legal-psychiatric principle of the "duty to protect" (the client from himself and the community from the client); the legal system's willingness to exempt the analyst from this principle (at present an integral part of the mental health professional's legal and social mandate); and the public's willingness to accept that a secure guarantee of privacy and confidentiality, similar to that granted the priest, as an indispensable condition for the proper conduct of psychoanalysis as a secular "cure of souls." These conditions are absent in the therapeutic state. The result is a tragic loss of liberty for client, "therapist," and society (Szasz, 2001).

Psychoanalysis was conceived, raised, and over-indulged by medicine. Like many spoiled children, it chose not to reject its comforting but crippling patrimony, medical-therapeutic paternalism. As a result, it has failed to grow up and fulfill its potential, that is, adopt an explicitly anti-paternalist, libertarian stance as the proper posture towards adults who seek and are willing to pay for a private, confidential, secular, and trustworthy setting for looking into their hearts and souls and, perhaps, making themselves better persons.

The psychoanalyst's job is to help his client live his life as honestly and as responsibly, and hence as freely, as he can or wants to. This task has nothing to do with illness and treatment in the sense in which these terms are used in medicine and psychiatry. However, it has a great deal to do with custom, law, economics, politics, and especially with religion as ethics. The term "psychoanalytic treatment" refers to, or ought to refer to, a particular kind of strictly confidential, private human relationship, similar to the Catholic confessional: it is a type of secular "cure of souls." The analyst's duty is to listen, speak, and fulfill his contract with the client, for example, by keeping the client's communications inviolably confidential and punctually collecting the fees due for his services.

Notes

1. I hold no brief against existentialism or existential analysis. However, I lament that even existential analysts endorse involuntary mental hospitalization and the insanity defense and remain silent in the face of the war on drugs waged in large part under "mental health" auspices.

2. I find Viktor Frankl's activities particularly distressing and improper. In German-speaking countries, Frankl is viewed as a leading existential analyst. Yet, consider what he did, according to his own account: "I have signed authorizations for lobotomies without having cause to regret it. In a few cases, I have even carried out transorbital lobotomy. However, I promise you that the human dignity of our patients is not violated in this way. ... What matters is not the technique or therapeutic approach as such, be it drug treatment or shock treatment, but the spirit in which it is being carried out" (1969: 55). It is worth mentioning in this connection that Raul Hilberg, one of the founding fathers of Holocaust research, goes so far as to bracket Victor Frankl's Man's Search for Meaning with Benjamin Wilkomirski's infamous Memoirs. "The approximate dating of his [Frankl's] stays in Theresienstadt and Auschwitz is deducible from the book ... The ghetto museum of Theresienstadt could find no records of Frankl's arrival and departure" (cited in Friedlander, 2002: 5-6).

Thomas Szasz is professor of psychiatry emeritus at the State University of New York Upstate Medical University in Syracuse, New York.

Correspondence to: tszasz@aol.com

Bibliography

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