Laing, R.D. (1979, July 20). Round the bend. New Statesman.

The Theology of Medicine, The Myth of Psychotherapy and Schizophrenia

by THOMAS SZASZ, Oxford £5.75, £5.95 and £5.75.

Millions of people believe that psychiatric illnesses exist. To Szasz this is an evil, pernicious error, and anyone who perpetuates it is a charlatan and a criminal. Good intentions are no excuse. In these three books, Szasz continues, extends and deepens his diatribe, which began in 1961 with The Myth of Mental Illness, against what he regards as the abuse of the medical metaphor in our society.

When a doctor examines a patient he is looking at him in terms of whether he is well or ill. What is the matter with him, if anything? If, from this medical point of view, there is something the matter with him, it is because he is suffering from a pathological condition. Physically, mentally, morally, socially, spiritually, it means you are ill. If anything is the matter with you, whether you are pregnant and are upset about it, or you are about to die and don’t like the prospect, you do not want to go on living, or there is no one at all who wants you around, or you can’t think straight, one set of people has the simple and comprehensive answer: you are ill. For instance, para 4 (1) of the British Mental Health Act, 1959, states that:

“In this Act ‘mental disorder’ means mental illness, arrested or incomplete

development of mind, psychopathic disorder, and any other disorder or disability of

mind; and ‘mentally disordered’ shall be construed accordingly.”

But all mental ‘disorders’ have been psychiatrised. There is not one possible disordered state of mind not covered by a psychiatric name. Every position is something North, South, East or West on the psychiatric compass. Szasz is inflamed with indignation at psychiatry, this metaphorical branch of medicine, which manufactures metaphorical illnesses; that is, phoney illnesses. He insists that the difference between a physical disease and a psychiatric disease is the difference between literal and metaphorical, real and unreal, true and false, genuine and fake, being and nonbeing. Just as metaphorically it may be said we are all asleep, so metaphorically some people may be said to have sick minds. Unfortunately, this metaphor has got the contemporary world in its spell.

There is a rich vernacular to describe allegedly disordered states of mind—a person can be daft, round the bend, freaked out, out of his mind, fey, unhinged, have a screw loose, be off the rails, be gone, be past it, be nuts, be crazy, be shattered, be frozen stiff with terror, be bewildered, be confused, be in consternation Somewhere along the line in the last 150 years all nuances of terror, misery and alleged disorder and evil have been declared to be due to mental illnesses, just as bodily disorders are said to be due to physical illnesses As Szasz says, these were no discoveries: they were a series of declarations. In the last ten years, the desire to take one’s life has officially become a mental illness in the USA, and the desire for one’s own sex has ceased to be one. However ludicrous all this may be, behind this childish game and metaphorical play lie enormous interests of money and power.

“In regarding the desire to live, but not the desire to die, as a legitimate human

aspiration, the suicidologists stands Patrick Henry’s famous exclamation, ‘Give me

liberty, or give me death!’ on its head. In effect, he says, ‘Give him commitment, give

him electroshock, give him lobotomy, give him lifelong slavery, but do not let him

choose death!’”

Szasz indefatigably inveighs against this panmedicalism, this medicalisation of morals, this conversion of desires into diseases, this turning any person into a patient by a doctor’s dictat against which there is virtually no appeal, and which, once uttered, licenses the utterer, in the name of the taxpayer, to treat (medically of course) the patient almost any way he cares to, for virtually as long as he cares to. He can imprison him, drug him, torture him, but his brains out or shut them off entirely at his (the doctor’s) own discretion.

Szasz sees this sort of thing as an evil and criminal abuse of human liberty, imprisonment and torture concealed by the metaphor of hospitalization and treatment. Szasz believes that there are real diseases and that only physical diseases are real. But apart from such real diseases, all ascriptions of pathology to behaviour and experience are metaphorical. You may be daft. That does not mean that ipso facto there is something medically the matter, however. Your mind might be filthy, as it were, or it might be sick, as it were, but it is not literally filthy, nor is it literally sick. But if I am treated as though I were literally sick when I am not and when I know I am not, then deeply scandalous things are liable to happen.

Szasz condemns the social consequences of this epistemological error. Corruption, he feels, has set in from two sides. On the one hand, no one, not even criminals, should be treated in the ways doctors are licensed to treat patients against their will. On the other hand, undeserving or bad people should not be mollycoddled, through being treated as ill, but should simply be left to rot, or be punished. Perhaps this latter side of Szasz’s argument is not so well known.

“The state does not simply allow a woman to have an abortion as it allows her to take

aspirin. It forces the taxpayer to pay for it. Since abortion is now defined as

treatment, if a poor woman has an abortion, the taxpayer pays for it. I think that is a

grave moral wrong. After all, an abortion is necessary only because a man and a

woman have engaged in sexual intercourse – which may be very nice. It is what’s

called sumptuary behaviour, in fancy language. And so are drinking and smoking.

Hence, in my mind, forcing taxpayers to buy abortions for poor women is like forcing

taxpayers to buy alcohol or cigarettes for poor men. What mischievous nonsense.”

Unfortunately, Szasz has been repeating himself so often, and for so long, that his conclusions, however controversial or tendentious, have become his premises, even axiomatic truths. No hint of uncertainty, mystery, or doubt, or of any problematic clouds his discourse. Rather, he has become a grandmaster in the art of ‘of course’, ‘to be sure’, and ’in fact’. Thus ‘Facts are, of course, stubborn.’

“. . . neurosis is illness-imitative behaviour and the habituation of such faking! That

simple idea applies, of course – with the slight modification that the behaviour

adopted need not be the imitation of bodily illness – to the so-called psychoses as

well. [My italics]”

and (you have to believe it!) ‘The ideas I articulate here are, of course, timeless truths . . .’

At the risk of seeming tedious, let me register that a so-called neurosis (a compulsion neurosis) is not ‘illness-imitative behaviour’, that this simply idea is simply wrong, and that it does not apply, as a valid broad generalization, to the so-called psychoses. Szasz castigates everyone, from Freud to Janov, who wants to help people in distress. He takes me to task for idealizing so-called schizophrenics. But I do not think that so-called schizophrenics are better or worse in any sense than the rest of us. He is at pains, however, to dissociate himself from what he regards as the vulgar error he attributes to me of ‘idealising insanity as supersanity, and mythologizing the madman as a person of superior artistic, moral, or psychological gifts, virtues, or powers’.

I have said and written repeatedly that all sorts of people like you and me get diagnosed as psychotic, and among these there are some who are in states of extreme mental distress. I think there is a place for a domain of distinctive concern to do with the nature of relationships between us. It is a perfectly decent activity to seek to cultivate competence in skilful means of helping people whose relations with themselves and others have become an occasion of wretchedness. When a person’s suffering becomes insupportable to himself and to others, and yet will not go away, we may fairly say that person is in a state of extreme distress. Most of us, thank God, may sometimes find ourselves in great misery, and yet not be in distress of this order.

Szasz does not confine his insults to psychiatrists. The persons who have become patients (like the pregnant women) are subject to the same sort of abuse.

“. . . allowing incompetent, destructive and self-destructive persons to wallow in their

self-contempt and contempt of others will suffice to guide them safely through their

journey in the Alps of alienation, after which all will arrive in the neat and clean Swiss

village and live happily ever after. Such are the promises of the propagandists for

psychiatric research on the one hand, and for anti-psychiatric retreats on the others.”

But suppose we do drop the medical metaphor. If the rest of us could recognize that what Szasz is propounding are, of course, eternal verities, then psychiatry would disappear, and with it what he calls anti-psychiatry. What exactly would happen next?

“In sum, it seems to me that if the ideas I have set forth here, and elsewhere, are valid,

and if they gain wider adherence, then psychiatry, as we now know it, would gradually

disappear. Specifically involuntary psychiatry, like involuntary servitude, would be

abolished, and the various types of voluntary psychiatric interventions would be

reclassified and reassessed, each according to its true nature and actual characteristics.

Some of these practices might then reemerge as medical interventions, perhaps vis-à-

vis persons who do not suffer from demonstrable bodily illnesses – a practice by no

means limited to psychiatry. Most psychiatric practices, however, would either

disappear or reappear as ethical and political interventions. These psychiatric

practices, vis-à-vis voluntary clients, would then be recognized for what I believe they

really are, namely, the ‘theories’ and ‘techniques’ of – or, better, the justifications for

and the applications of – various systems of secular ethics.”

It sounds as though it would all be much the same. It makes one wonder what he is making all the fuss about, whether he is not making a sort of fetish out of the medical metaphor, and a scapegoat out of psychiatry. We miss in these books any in-depth analysis of the structures of power and knowledge such as we find in Foucault and Derrida.

It is a pity about Szasz. He is so insulting and abusive that it is almost embarrassing to find oneself agreeing with him sometimes. As the years have gone by, the important points have become so shrouded in a smoke screen of such garbled dogmatism and arrogance as to be almost inaccessible. He now seems to believe that an insult is an argument, and that his assertions are self-validating proofs of their own truth.