(From Journal of Humanistic Psychology
Vol. 38, No. 2, Spring 1998, 8-20.
Reprinted here with permission
from Sage Publications, Inc.
THE HEALING WORD: ITS PAST, PRESENT, AND FUTURE*
Thomas Szasz, M.D.
Psychoanalysis is, _in toto_, a language art, a
language praxis. There can be neither mute patients
nor deaf analysts. Psychoanalysis is as immediate to
word and syntax as mining is to the earth.
George Steiner (1989, p. 107)
Summary
After presenting a brief review of the history of
helping people solely by language (listening and
speaking), the author re-emphasizes the intrinsically
verbal, non-coercive nature of the cure of souls (and
of psychoanalysis as a model of psychotherapy); the
intrinsically non-verbal, voluntary nature of the cure
of bodies (medical treatment): and the intrinsically
physical-and-verbal, coercive nature of the cure of
"minds" (psychiatric treatment). The commingling and
confusing of these distinct enterprises and the
accompanying emphasis on "diagnosis" and "treatment"
has destroyed the cultural and legal conditions
required for the practice of purely verbal, non-
coercive helping ("psychotherapy").
In the _Apology_, Socrates articulated his
vocation as philosopher, by which he meant a person
who cares for the soul (psyche)(1). Because only
persons have souls, this view stamped him as an ally
of the individual and an adversary of the "compact
majority" (community or polis), a role he made no
effort to conceal. Addressing the Athenian
authorities, he pledged: "Gentlemen, I owe a greater
obedience to God than to you" (Plato, 1961, p. 15).
He then defined his role, as physician of the soul, as
follows:
[I]t is my belief that no greater good has
befallen you in this city than my service to my
God. For I spend all my time going about trying
to persuade you, young and old, to make your
chief concern not for your bodies nor for your
possessions, but for the highest welfare of your
souls (p. 16).
For the post-Socratic philosophers, especially
the Stoics, the philosopher was a physician of the
soul who, employing the healing word (_iatroi logoi_),
offered counsel to persons perplexed by problems in
living. Seneca, for example, advised his mother,
grieving over his exile to Corsica, to give herself up
to "the study of philosophy, sovereign remedy for
sadness" (McNeil, 1951, p. 28).
After the triumph of Christianity, the priest as
confessor-counselor replaced the philosopher as
rhetorician of consolation. For most of the next
nearly two thousand years, doctors of divinity (and
parish priests) served as the curers of the Western
soul. The cure of bodies, at the same time, became
the domain of doctors of medicine (and barber
surgeons). The ensuing distinction between the cure
of souls and the cure of bodies was recognized as
early as the fourteenth century. Petrarch (Francesco
Petrarca, 1304-1374) -- the great Renaissance poet-
philosopher, often called "the first humanist" --
warned against the literal interpretation of the
medical metaphor of rhetorical healing. Declaring
that "The care of the mind calls for the philosopher,"
he urged that doctors should use "herbs not words" and
leave the cure of minds to the "true philosophers and
orators" (McClure, 1991, pp. 20, 51).
I should now like to summarize how I see the
birth, growth, and present state of modern
psychotherapy.
The real name of "Anna O." -- the patient who,
according to Freud, "discovered" catharsis and
psychoanalysis -- was Bertha Pappenheim. In 1880,
when Pappenheim became Joseph Breuer's patient, she
was a 21-year old woman, living the existentially
stifled life of an intelligent, overprotected daughter
of wealthy Viennese-Jewish parents. In an effort to
escape from the meaningless existence to which her
family and social station condemned her, she pretended
to be ill and was duly diagnosed as suffering from
hysteria. Aided by the affection and sympathy of an
exceptionally humane physician, who lavished vast
amounts of time on her, Pappenheim rediscovered the
ancient power of the healing word, or, more precisely,
of the healing dialogue. The patient used the English
terms "talking cure" and "chimney sweeping" to
describe the therapy. Her physician named it -- in
Greek -- _catharsis_ (Breuer & Freud, 1893-95;
Freeman, 1972). It was unthinkable, for patient as
well as doctor, to call a spade by its proper German
name, that is, to call the Healing Word _das heilende
Wort_, or its use _Heilung durch den Geist_
("spiritual healing") (Zweig, 1931). Using ordinary
German words to describe these phenomena would have
risked having the patient labeled a malingerer, and
the physician a quack.
To be sure, the word "treatment," like the word
"disease," has a wide range of meanings. For example,
we say that a man treats his dog badly and call seeing
a good play a treat. I do not wish to quibble about
the meaning of words or constrain their colloquial
use. However, I do wish to draw a clear distinction
between the physical (impersonal) cure of bodily
diseases (exemplified by the surgical removal of an
inflamed appendix), and the spiritual (personal) cure
of souls in distress (exemplified by the Catholic
confessional and psychotherapy). I regard the former
as literal treatments, the latter as metaphorical
treatments.
It is important to note here that many of the so-
called "symptoms" Pappenheim exhibited were plainly
self-made and related to her use of speech. For
example, she had mysterious "spells," during which she
was mute in German, her mother tongue, but could speak
in English. Not surprisingly, Breuer -- an astute and
scientifically trained physician -- realized that the
"talking cure" was not a genuine medical treatment and
quickly abandoned its use.
As fate had it, one of Breuer's proteges was a
young physician named Sigmund Freud, to whom Breuer
related his misadventure with Pappenheim. Thereupon
Freud decided to make listening and talking to
patients his life work -- not like other physicians,
as an incidental part of the therapeutic effort, but
as an integral part of it, indeed its sole ingredient.
In the sophisticated intellectual climate of pre-World
War I Vienna, it did not take long before Freud's
sweeping claims about the efficacy of the treatment he
called psychoanalysis were exposed as "the disease of
which it claims to be the cure" ( "Die Psychoanalyse
ist jene Krankheit, fur deren Behandlung sie sicht
halt") (quoted in Szasz, 1990, p. 24). Karl Kraus,
the author of that aphorism, objected to the talking
cure not because it consisted of talking, but because
it was miscast as a treatment.
Because Freud was a practicing physician who
"treated" persons officially denominated as
"patients," and because he defined psychoanalysis as a
"treatment" of "mental diseases," we must now situate
psychoanalysis -- as the paradigm of modern
psychotherapy -- in the context of the history of
psychiatry.
For centuries, madmen and mad-doctors alike were
banished to madhouses, located on the outskirts of
towns or in the countryside. Alienists -- renamed
psychiatrists in the nineteenth century -- worked, and
often lived, in insane asylums, where they oversaw
desolate scenes of human misery. When Freud came on
this scene, insane persons were considered to be
legally incompetent, insanity was considered to be an
incurable illness, and individuals denominated as
insane were incarcerated in insane asylums, usually
for life. Because Freud's work appeared to have
little relevance to the work of professionals engaged
in caring for insane persons (many of whom suffered
from the neurological ravages of syphilis), European
psychiatrists first ignored psychoanalysis and then
rejected it, as unsuitable for "serious" cases of
"mental illness."
In contrast, American psychiatrists, imbued with
characteristically American therapeutic optimism,
considered no disease indefeasible and embraced
psychoanalysis as an ally in the war on "mental
illness." Pari passu, American psychoanalysts defined
psychoanalysis -- ostensibly to protect the public
from "quacks" -- as a medical activity and excluded
non-medical analysts from among their ranks. This
marriage between psychiatry and psychoanalysis was a
catastrophe for both parties, but more so for
psychoanalysis and, derivatively, for psychotherapy.
It is important that we understand the nature and
consequences of this fateful misalliance.
In the eighteenth century, Western societies
began to delegate to mad-doctors (subsequently
called alienists, psychiatrists, mental health
professionals, and therapists) the task of separating
insane persons from sane persons and incarcerating the
former in madhouses. To justify this enterprise,
psychiatrists fabricated appropriate pseudomedical
explanations about why some people display certain
kinds of unwanted behaviors, about the dangers they
pose to themselves and society as a result, and about
the interventions mental healers must use to protect
patients from themselves and the public from the
patients.
At the beginning of this century, psychoanalysts
appeared on the scene and claimed to be especially
adept at explaining why people behave the way they do.
American psychiatrists seized on these explanations as
useful addenda to their own mystifications. The
amalgamation of psychiatric and psychoanalytic
theories received further impetus during World War II.
Many of the analysts were recent refugees from Nazism
who felt it was their patriotic duty to respond to the
needs of the military. There they were happy to do
the bidding of their superiors, finding men fit or
unfit for duty as the military authorities decreed.
This use of psychoanalytic concepts was phony, but
expedient, for the military as well as psychoanalysis.
The result was that psychoanalysis and psychiatry were
joined and, for a brief period, the prestige of this
superficially psychoanalyticized psychiatry carried
over into civilian life.
But it was all show. Psychiatrists in public
mental hospitals, privately practicing psychiatrists
who treated their patients with electric shock, and
psychiatrists accredited as analysts all pretended
that the similarities far outweighed the differences
among them. In the process, the core elements of
curing souls with healing words (non-coercively,
facilitating personal freedom and responsibility) were
replaced by the core elements of treating mad minds
(coercively, imposing statist-medical controls on the
"insane"). The aims and values of these two
conflicting undertakings may be summarized as follows:
*** To effect a cure, the psychiatrist coerces
and controls the "patient": he or she incarcerates and
imposes various chemical and physical interventions on
the subject against his or her will.
*** To conduct a dialogue, the psychoanalyst
contracts and cooperates with the "patient": he or she
listens and talks to his or her interlocutor, who pays
for the service received (Szasz, 1988).
These differences between the psychiatric and
psychoanalytic relationships replicate the differences
between two familiar types of political relationships,
namely, paternalistic absolutism (unlimited
government) and classical liberalism (limited
government and the rule of law). The essence of
individual liberty is the absence of capricious,
unlawful coercions (traditionally present) in
relations between rulers and ruled. Failure by the
state to respect private property and its interference
in voluntary acts between consenting adults destroy
individual liberty. Mutatis mutandis, the essence of
psychoanalysis is the absence of coercions
(traditionally present) in relations between
psychiatrists and mental patients. The analyst's
failure to respect the analysand's personal autonomy
(paternalism) and his or her interference in the
client's life (betrayal of confidentiality and
coercion) destroy the psychoanalytic relationship.
In its initial stages, psychoanalysis represented
a genuinely new social development, namely, a non-
coercive, secular help ("therapy") for problems in
living (called "neuroses"). The term "psychoanalysis"
was then used to denote a confidential dialogue
between an expert and a client, the former rejecting
the role of custodial psychiatrist, the latter
assuming the role of responsible, voluntary patient.
Recast in such light, it is hardly surprising that
psychiatry acquired neither the aims nor the practices
of psychoanalysis. It could not have done so and
fulfilled its social mandate. The two enterprises
rest on totally different premises and entail mutually
incompatible practices:
*** The traditional psychiatrist was a salaried
physician who worked in a mental institution; his
source of income was the state; he functioned as an
agent of his bureaucratic superiors and the patient's
relatives. The typical mental hospital inmate was a
poor person, cast in the patient role against his
will, housed in a public mental hospital.
*** The classical psychoanalyst was a self-
employed professional who worked in his private
office; his source of income was his patient; he
functioned as his patient's agent. The (typical)
analytic patient was a rich person (usually wealthier
than his analyst), cast in the patient role by
himself, living in his own home or wherever he
pleased.
The basic differences between psychiatry and
psychoanalysis are dramatically captured in the
following statements by, respectively, Benjamin Rush,
the father of American psychiatry, and Sigmund Freud,
the father of psychoanalysis:
*** Rush: "Let our pupil be taught that he does
not belong to himself, but that he is public property"
(quoted in Richman, 1994). "Let us view them
[mankind] as patients in a hospital. The more they
resist our efforts to serve them, the more they have
need of our services" (Rush, 1774).
*** Freud: "Nothing takes place in a psycho-
analytic treatment but an interchange of words between
the patient and the analyst" (Freud, 1905). "[T]he
patient should be educated to liberate and fulfill his
own nature, not to resemble ourselves" (Freud, 1917).
The merger between psychiatry and psychoanalysis
was a hopeless match, a marriage of convenience in
which each party proceeded to rob its partner of
whatever seemed of value. Psychiatry acquired the
worst features of psychoanalysis -- its pseudo-
explanations and vocabulary of stigmatizations;
psychoanalysis acquired the worst features of
psychiatry -- disloyalty to the patient's self-defined
interests and coercion. In short, psychoanalysts (and
psychotherapists along with them) sold their noble,
but financially unprofitable, birthright for a mess of
pottage, the fakery psychodiagnostics and
psychotherapy. The result is an ignoble "mental
health" profession, masquerading as biological science
and medical treatment.
How did psychotherapy get itself into this mess,
if a mess it be? Ironically, it was Freud himself who
insisted on the self-contradictory proposition that
psychoanalysis is both a dialogue and a treatment.
"Words," he wrote in 1905, "are the essential tool of
mental treatment" (Freud, 1905). Yet, elsewhere he
asserted that "As a method of treatment it
[psychoanalysis] is one among many, though, to be
sure, _primus inter pares_ [first among equals]"
(Freud, 1919, p. 167). Finally, in 1919 -- at a time
when neighboring Hungary had a communist government
and the Soviet Union became established as a new
nation -- Freud welcomed the historical inevitability
of a "socialist" psychoanalysis, administered -- as
medical treatment -- by the modern bureaucratic
welfare state:
[I]t is possible to foresee that at some time or
other the conscience of society will awake and
remind it that the poor man should have as much
right to assistance for his mind as he now has to
the life-saving help offered by surgery; and that
the neuroses threaten public health no less than
tuberculosis, and can be left as little as the
latter to the impotent care of the individual
members of the community. ... Such treatments
will be free. It may be a long time before the
State comes to see these duties as urgent. ...
Some time or other, however, it must come to this
(p. 159).
Ironically, this passage appears only two pages
after Freud's (1919) claim that the aim of
psychoanalysis is to "liberate" the patient, a
proposition that formed an integral part of Freud's
thesis that psychoanalysis is not a treatment.
Instead of curing the patient, the analyst's task, he
declared, is "to bring to the patient's knowledge the
unconscious repressed impulses existing in him" (p.
159) Finally, in _An Outline of Psychoanalysis_
(1938) -- the summation of his life work -- he wrote:
"We [psychoanalysts] serve the patient in various
functions, as an authority and a substitute for his
parents, as a teacher and educator." (p. 181)
Freud's dexterity as a high-wire artist --
balancing himself between his role as personal
counselor and medical doctor -- never deserted him.
After identifying the therapist as parent, teacher,
and educator, Freud quickly re-asserted his life-long
commitment to a materialist-medical treatment for
personal problems as mental diseases.
But here we are concerned," he wrote, "with
therapy only in so far as it works by
psychological means; and for the time being we
have no other. The future may teach us to
exercise a direct influence, by means of
particular chemical substances, on the amounts of
energy and their distribution in the mental
apparatus (p. 182).
As a result of Freud's labors, it is now a part
of received wisdom that psychoanalysis is a method for
"analyzing" human behavior; that it is a valid
"theory" for explaining the behavior not only of
living persons but also of dead persons and of persons
who never existed -- that is, of myth, religion,
legend, and literature; and that listening and talking
to a person -- called "talk therapy" -- is a bona fide
medical "treatment."
The degeneration of psychoanalysis -- and of
psychotherapy in general -- is an inexorable
consequence of the medicalization of life, that is, of
the tendency to regard despair and deviance as
diseases, and talking as a treatment. Viewing a
person's complaints about his or her life as if they
were the symptoms of a mental illness defines the
complaint as a disease and the effort to ameliorate it
as a treatment. However, ideas have consequences that
have a habit of coming back to haunt us. If we view
diabetes as a disease, we rightly consider it a
serious error -- prima facie medical negligence -- to
treat a diabetic person solely by listening and
talking to him. The same goes for viewing mental
illnesses -- whose disease status is established as
legal "fact" by the _DSM-IV_ diagnoses attached to
them -- as chemical disturbances in the brain
treatable with drugs. The upshot is that practicing
the "talking cure" (especially by a physician) has
been rendered de jure malpractice, and hence de facto
impractical and irrelevant. And that is not all.
With the liquidation of the most essential
prerequisite of psychotherapy -- namely, that the
relationship between therapist and client be based on
a free contract between them -- the nature of the
"correct therapy" is no longer defined jointly by the
two parties to the agreement; instead, henceforth the
_DSM-IV_ "scientifically correct diagnosis" of the
patient's "disease" determines the American
Psychiatric Association authenticated "scientifically
correct treatment" he or she needs and the therapist
must provide. (Despite this political-economic
climate, or more likely because of it, many American
psychologists are clamoring for prescription
privileges.)
Freud's assertion that his method was a genuine
treatment for genuine diseases -- superior to all
other treatments -- naturally provoked a torrent of
controversy and criticism that is still continuing.
Eager to eclipse Freud, competitors typically gave
faint praise to psychoanalysis as an early form of
psychotherapy, the better to claim superiority for
their brand of mental healing. Eager to execrate
Freud, critics typically claimed that psychoanalysis
"is no more effective than no treatment at all"
(Eysenck, 1952). Recasting psychotherapy as dialogue
transcends this futile controversy and dispels the
mystery that continues to envelope mental healing,
especially the question of its so-called
effectiveness.
Since ancient times, people have recognized that
words powerfully affect the listener and that, like
double-edged swords, they cut both ways. Indeed, our
vocabulary possesses numerous adjectives for
characterizing both types of speech acts, such as:
blasphemous, impious, obscene, perjurious,
pornographic, profane, and sacrilegious for words
deemed to be harmful, and such words as calming,
cheering, comforting, consoling, encouraging,
heartening, inspiring, motivating, and reassuring for
words deemed to be helpful.
Dreading the effects of harming words and
desiring the effects of healing words, every society
prohibits speech acts it considers deleterious, and
encourages those it considers beneficial. It seems to
me that the fact of censorship is proof enough that
words can heal. My point here is simply to show that
it is absurd to contend -- as many people have
contended and continue to contend -- that
psychotherapy is (inherently) ineffective. The truth
is far simpler: The benefit or detriment of a
particular discourse depends on the subject's
susceptibility to the speaker's message. In the final
analysis, just as the beauty or ugliness of a face
lies in the eyes of the viewer, so the benefit or
detriment of a speech act lies "in the ears" of the
listener. It is a priori impossible to marshall
objective evidence to support or refute claims about
the effectiveness or ineffectiveness of psychotherapy.
The validity of this assertion is intrinsic to the
ontological character of psychotherapy-as-discourse.
Let me now briefly restate my concept of
psychotherapy, as the name of a class of interactions
in which two (or more) persons voluntarily listen and
talk to one another. In this view, psychotherapists
dispensing diverse therapies resemble clerks in a
department store, each selling a different merchandise
under the same roof. To be sure, psychotherapists
differ from clerks: Selling merchandise (or performing
a standardized medical procedure) is an impersonal act
that a person does in his persona as the purveyor of
goods (or services); whereas healing with words is a
personal activity, not just a job a person does but
something that he or she is. It is morally fitting
that it should be so. The person who seeks help
through the healing word suffers not from an
impersonal illness, like an inflamed appendix, but
from a distinctively personal perplexity. It follows
that just as it would demean both marital partners to
speak of a "method" a husband uses to relate to his
wife or vice versa, so it demeans both therapist and
client to speak of a method of psychotherapy.
Mental illness and psychotherapy are fictions.
Neither exists. Only the patient, the therapist, and
a particular relationship between them exist. Both
participants are responsible moral agents. Each is
existentially equal to the other, each influences the
other, and each is responsible for his or her
behavior. The therapist can neither cure the patient
not make him or her sick. However, the patient can do
both of these things -- for or to himself or herself
-- by making use of the therapist's helping or harming
words (Bohart & Talman, 1996). These simple insights
-- commonplaces to the early religious and rhetorical
curers of souls and their clients -- have disappeared
into the mystifications of the mental health
professions and the Gulag of the Therapeutic State.
In my view, there are as many authentic types of
psychotherapies as there are authentic persons using
words to help. I respect every one of these
"methods," provided their practitioners eschew force
and fraud. My own work as therapist was based on the
premise that the focus of the therapeutic relationship
can only be how the patient lives, how he or she might
live, and how he or she ought to live. The expert's
role is to engage the clients in a process of
searching self-examination, with the aim of enabling
them, if they so choose, to become more free and more
responsible. To accomplish this task, the therapist
must eschew interfering, in any way whatever, in his
client's life outside the walls of the consulting room
(including receiving information from, or giving
information to, anyone other than the client). Such a
curer of souls must reject playing doctor or
therapist. Instead of promising relief from suffering
-- or promising any particular outcome -- his or her
duty is to fulfill a promise to the client, that is,
to respect his or her autonomy and confidences and
engage him or her in a searching, open-ended dialogue.
The outcome of the interaction must be left in the
client's hands, because he or she has more control
over it than the expert and, more importantly, because
that is where it rightly belongs. Although it is
obvious that practicing mental healing in accordance
with these principles is, in the United States today,
synonymous with malpractice, mental health
professionals continue to pretend that it is not.
When I assert that the outcome of the interaction
must be left in the client's hands, I am simply re-
articulating an insight W. H. Auden phrased far more
elegantly:
Though it is absolutely required of a man that he
should intend to help others, the power to do so
is outside his control.... [T]he final aim of
every critic and teacher must be to persuade
others to do without him, to realize that the
gifts of the spirit are never to be had at
second hand" (Auden, 1948, p. 13).
To paraphrase Shakespeare, I have come to praise
the healing word, not to bury it. But I must report
to you that the healing word is no more: It has
committed suicide by overdosing on therapy.
The modern soul-doctors succumbed to the
temptation to treat people as material susceptible to
improvement by experts, ceased to respect the Other as
a moral agent, and renamed discourse "treatment." They
are the sinners whose offense W. H. Auden satirized
thus: "We are all here on earth to help others; what
on earth the others are here for, I don't know"
(Auden, 1968, p. 14).
NOTE
1. In ancient Greek, as in modern German, there is no
word for "mind" as a noun.
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AUTHOR'S NOTE: This article is adapted from the text
of an invited address presented at the Milton Erickson
Evolution of Psychotherapy Conference, Las Vegas,
Nevada, December 13 through 17, 1995, and from a
keynote address presented at the First Congress of the
World Council for Psychotherapy, Vienna, Austria, June
30 through July 4, 1996.
THOMAS SZASZ, M.D., D.Sc., is professor of psychiatry
emeritus at the State University of New York Health
Science Center in Syracuse. He is the author of 24
books, among them the classic The Myth of Mental
Illness (HarperCollins, 1961). His most recent work
is The Meaning of Mind: Language, Morality, and
Neuroscience (Praeger, 1996). The foremost critic in
the world of psychiatric coercions and excuses, Dr.
Szasz has received many awards for his defense of
individual liberty and responsibility threatened by a
totalitarianism masquerading as therapy. A frequent
and popular lecturer, he has addressed professional
and lay groups and has appeared on radio and
television in North, Central, and South America as
well as in Australia, Europe, Japan, and South Africa.
his books have been translated into every major
language.
Reprint requests: Thomas Szasz, M.D., Department of
Psychiatry, 750 East Adams Street, Syracuse, NY
13210; e-mail: tszasz@aol.com
*This article appeared in _Journal of Humanistic
Psychology_, Vol. 38, No. 2, Spring 1998, 8-20, and is
reprinted here by permission of Sage Publications,
Inc. Copyright 1998 Sage Publications, Inc.
Thomas S. Szasz Cybercenter for Liberty and Responsibility:
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