[25] Nanny just told people what to do; counselors also tell them what to think and what to feel. As I picture the scene (from Laings perspective), he figured that since the effort to remove or protect Fiona from ECT would probably be futile, that he might as well spare himself and his first family the shame and embarrassment that would inevitably accrue from making a public stink about the matter. Our evolved cognitive bias is magnified in illuminating ways in mental illness. Psychology Today 2023 Sussex Publishers, LLC. Still, decades of research on psychosomatic, psychophysiological, and psychoneuroimmunological disorders indicate that Szaszs dicta are predicated on a distinction between mental and physical disease that is completely untenable . The Nazis spoke of having a "Jewish problem". Verbal intercourse, especially, the psychoanalytic dialogue, entails existential intimacy, often more intense than sexual intimacy. Either all of the best clinical research in medicine is false since it is based on randomized placebo-controlled research, or Szasz is wrong. Two decades later, however, Gartnavel was under new management, and Laing had earned a reputation as the pre-eminent critic of mainstream psychiatry. [36], Szasz was a strong critic of institutional psychiatry and his publications were very widely read. The efficacy of two forms of ketamine treatments for depression is compared. Szasz cited drapetomania as an example of a behavior that many in society did not approve of, being labeled and widely cited as a disease. We have no right to impugn the mental health of people who take their lives voluntarily in such circumstances, rather than impoverish and inconvenience their families, or placate the kinds of medical professionals who have convinced themselves that they know better than their terminal patients what is good for them, etc., but lack the decency and insight to let them be. Since the foreword was rejected, I have decided to publish it here, in a slightly edited version so that it can stand alone, to make it available to interested readers: It is held that one should not speak ill of the dead, as they cannot defend themselves. If we take the pertinent historical evidence into account, this statement probably represented a vote of non-confidence in Anne Laings ability to restore her daughters emotional equilibrium, rather than an endorsement of involuntary hospitalization per se. Presumption of competence and death control, Abolition of the insanity defense and involuntary hospitalization, American Association for the Abolition of Involuntary Mental Hospitalization, Relationship to Citizens Commission on Human Rights, "The Nazis sought to prevent Jewish suicides. He criticized the war on drugs, arguing that using drugs is in fact a victimless crime. The Hungarian-American psychiatrist and writer Thomas Szasz, who has died aged 92, was regarded by many as the leading 20th- and 21st-century moral philosopher of psychiatry and psychotherapy.. In The Secular Cure of Souls (JSEA, issue 14.2), and a talk delivered to the International Federation for Psychoanalytic Education on November 2, 2002, entitled The Cure of Souls in The Therapeutic State, Thomas Szasz goes to great lengths to differentiate between himself from R.D. Too often we err in the opposite direction, speaking well of the dead out of respect. In a 2009 interview aired by the Australian Broadcasting Corporation, Szasz explained his reason for collaborating with CCHR and lack of involvement with Scientology: Well I got affiliated with an organisation long after I was established as a critic of psychiatry, called Citizens Commission for Human Rights, because they were then the only organisation and they still are the only organisation who had money and had some access to lawyers and were active in trying to free mental patients who were incarcerated in mental hospitals with whom there was nothing wrong, who had committed no crimes, who wanted to get out of the hospital. Because that conclusion would not be warranted by the evidence. His main arguments can be summarized as follows: "Mental illness" is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behavior, such as packaged under the wide-ranging term schizophrenia, as an "illness" or "disease". But this is not one of them. [25] The "nanny state" was punitive, austere, and authoritarian, the therapeutic state is touchy-feely, supportive and even more authoritarian. His wife, Rosine, died in 1971. I am an atheist, I don't believe in Christianity, in Judaism, in Islam, in Buddhism and I don't believe in Scientology. For terms and use, please refer to our Terms and Conditions But the surgical analogy for psychoanalysis is perverse, because it presupposes a patient who is passive and unconscious throughout the entire procedure, and by implication, invalidates the agency and the experience of the patient, and his capacity to affect the therapist, which are central to any meaningful therapeutic encounter . There are other better concepts. Anyone acquainted with Dr Thomas Szasz's previous writings about mental disorder, the nature of its relationship to the Law and to the problems of drug dependance (Szasz, 1961, 1963, 1970, 1972, 1975) has learned to look in the first instance for the dualism, the poles of which are to be demonstrated as irreconcilable. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. Medicalized psychoanalysis (psychotherapy) denies the quintessential intimacy of its own distinctive method, illustrated by the obtuse conception that it is something the therapist gives or does to the patient, as if it were a surgical operation. In Szasz's view, people who are said by themselves or others to have a mental illness can only have, at best, "problems in living". Thomas Szasz famously was a polarizing figure, and he appeared to revel in it. New research examines emerging trait-based approaches to personality disorder. Mental incompetence should be assessed like any other form of incompetence, i.e., by purely legal and judicial means with the right of representation and appeal by the accused. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic. And clearly, he meant it at the time. On reflection, there is probably no more potent method for silencing dissatisfaction, dissent and the sense of having been violated or misunderstood than by treating (inner or interpersonal) conflict per se as symptomatic of mental illness. Or a cardiologist who claims that there is no heart disease. In his IFPE address of November 2, 2002, Szasz stated: Psychoanalysis possesses a valuable moral core that has never been properly identified and is now virtually unrecognized: it is, or ought to be, a wholly voluntary and reliably confidential human service, initiated and controlled largely by the client who pays for it (p.2). To keep this ethical relationship intact, says Szasz, the practitioner must confine his or her role to conversing with the client in the privacy of a professional office, and to completely refrain from meddling in their life outside it. It currently publishes more than 6,000 new publications a year, has offices in around fifty countries, and employs more than 5,500 people worldwide. Just as a person suffering from terminal cancer may refuse treatment, so should a person be able to refuse psychiatric treatment. Enfant terrible of psychiatry and widely known as one of its most indefatigable as well as iconoclastic critics, Thomas Szasz (1961-2012) had a prolific writing career that extended some 51. Diagnoses of "mental illness" or "mental disorder" (the latter expression called by Szasz a "weasel term" for mental illness) are passed off as "scientific categories" but they remain merely judgments (judgments of disdain) to support certain uses of power by psychiatric authorities. After I wrote the foreword, the editors rejected it. "One of the smartest and most thorough defenders of autonomy and liberty of our time.". This paper attempts to clarify Szasz's own political perspective. He would have to revise his claims so as to admit that schizophrenia and manic-depressive illness are medical diseases. "No one has exposed the oppressive medicalization of human conflict and politicization of medicine as thoroughly and radically as Thomas Szasz. Therapists should stick to their proper role and function, and not usurp the legal or medical professions practices or prerogatives. And that to me was a very worthwhile cause; it's still a very worthwhile cause. Szasz is a libertarian, Laing an existentialist, and despite their similarities on important points, libertarians and existentialists also diverge on a number of issues, as I hope to show in the pages that follow. In his 2006 book about Virginia Woolf he stated that she put an end to her life by a conscious and deliberate act, her suicide being an expression of her freedom of choice. It is published biannually. Although Szasz was skeptical about the merits of psychotropic medications, he favored the repeal of drug prohibition.[20]. Schizophrenia wasnt caused by cold mothers, as they believed. Illness, says Szasz, pertains to the body, not to the mind, as if the mind were some inviolate realm or essence that is separate from the body; as if mind and body were not so deeply and intricately intertwined that, in functional terms, they form a unity. Thomas Szasz challenged mental health practice perhaps more than any other American psychiatrist in the decades after World War 2. If there ever was a critic of our enchantment with psychiatry, it was Thomas Szasz, M.D., who died this past week at the age of 92. Szasz argues that the diagnosis and treatment of mental illness stands in the same relationship to the . [26]:496, Civil libertarians warn that the marriage of the state with psychiatry could have catastrophic consequences for civilization. In addition to contemporaries R D Laing in the UK, the Canadian sociologist Erving Goffman, and the French philosopher Michel Foucault, Szasz provided much of the high octane intellectual fuel for the genesis of the . The psychiatry that Szasz railed against in his most famous book was full of myths and was mostly false. Drug addiction is not a "disease" to be cured through legal drugs but a social habit. Award for Greatest Public Service Benefiting the Disadvantaged (1974), Szasz's conception of disease exclusively in terms of "lesion", i.e. Similarly, the state should not be able to interfere in mental health practices between consenting adults (for example, by legally controlling the supply of psychotropic drugs or psychiatric medication). She has not yet lived, and to allow such a one to take her own life freely without attempting to alert or assist her family in any way is perverse, in my view. Chapt. And from 1953 till 1956, he held civilian psychiatric posts at the Royal Gartnavel Hospital and Southern General Hospital, where he was called upon to certify people insane from time to time. Ketamine and psychedelics work in profoundly different ways. He maintained that, by calling people diseased, psychiatry attempts to deny them responsibility as moral agents in order to better control them. Second, to be confirmed as a disease, a condition must demonstrate pathology at the cellular or molecular level. In those cases, so-called "patients" have something personally significant to communicate their "problems in living" but unable to express this via conventional means they resort to illness-imitation behaviour, a somatic protolanguage or "body language", which psychiatrists and psychologists have misguidedly interpreted as the signs/symptoms of real illness. Moreover, and more importantly, in terms of general principles for clinical practice, it is quite possible to be compassionate and respectful toward the client, and to put their interests first, while still trying to be helpful to the clients significant others. These anatomic findings, along with strong genetic evidence of almost complete genetic heritability of these diseases (and clear genes associated with them in the human genome project), would meet some of Szaszs requirements for claiming that one is dealing with a bona-fide medical disease. Through his remaining friends and colleagues in Glasgow, Laing was still fairly current with the situation at Gartnavel, and probably knew or strongly suspected that the new brass would greet any of his overtures or representations on Fionas behalf with cold hostility. For example, in his 2002 IFPE address, and in his recent remarks in the JSEA, Szasz cites a line from The Divided Self to prove that Laing favored involuntary hospitalization. The good that men do may be interred with their bones, as Shakespeare's Marc Antony famously intoned over Caesar, but it also is true that the evil men do lives after them. Thinking Twice About Ultra-Rapid Cycling Bipolar Disorder. Hetherington (2002: 227-228) writes about Szasz as follows: . The serotonin hypothesis of depression never was a legitimate scientific hypothesis that could be proven or disproven. Perhaps the most charitable thing one can say on behalf of Szaszs case against Laing is to render the old Scottish verdict: Not proven. Szaszs problem is not that he suffers from an excess of conviction as Hugh Heatherington remarked. Join our mailing list and get the latest in news and events. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Szasz traces psychiatry's origins to the widespread use of private madhouses in England, where relatives would send their unwanted family members (see Parry-Jones's ( The Trade in Lunacy ). Szasz motivation was libertarian, which has some value, just as an anarchists skepticism about government has value. Tragic as it was, her confinement to hospital was neither instigated nor approved by Laing, who was in London when it occurred, and was informed of her situation only after the fact. One could still use psychological concepts even though one realizes that such notions are based in the brain. In his IFPE address (Szasz, 2002), for example, Szasz wrote that. Existential-Humanistic Institute, Inc. A California Benefit Corp, Musings on Being an Existential Psychotherapist, Track 1: Existential Therapy Foundations Certificate, Track 2: Experiential Training Course (Retreat Only), About Existential Therapy Training Retreat. With this superb collection, the essence of Szaszs case against the Therapeutic State is now accessible to everyone. All claims to science and disease and an external source of truth are false pretensions. . To sum up his description of the political influence of medicine in modern societies imbued by faith in science, he declared: Since theocracy is the rule of God or its priests, and democracy the rule of the people or of the majority, pharmacracy is therefore the rule of medicine or of doctors. Because of their calling, priests have a right and a responsibility to maintain confidentiality at all costs. I will not assert that in the 1970s and 1980s, as it shifted to a more biological perspective, psychiatry got mental illness right. When they first appeared, of course, his remarks on the myth of mental illness were an invaluable stimulus to thought, because they called attention to the misconceptions that arise from the thoughtless application of the medical model to existential problems, or problems in living, as H.S. Dr. Thomas Szasz 19202012. According to Szasz, to understand the metaphorical nature of the term "disease" in psychiatry, one must first understand its literal meaning in the rest of medicine. Thomas Szasz was one of those few and now joins the rest of those freedom fighters who belong to history.". He accepted the existence of medical disease; he just denied such status to psychiatric diagnoses. Admittedly, by valuing life above the principle of confidentiality, we are making an ethical judgment the wrong one, in Szaszs view; the right one, in mine. Where it draws that line goes far in defining the kinds of laws its citizens live under, the kinds of medical care they receive, and the kinds of lives they are allowed to live. For Szasz, given his personal biography, such differences may have been difficult to distinguish. Long inspired and informed by the humanistic and existential perspectives, Pierson's scholarly interests include psychotherapist preparation and training, the transformation of women's self and world view in relation to . because the greatest obstacle to success may be success. "Sheldon Richman, Editor, The Freeman, "It takes an iconoclast with temerity and acumen to illuminate how unexamined myths and metaphors insidiously determine prevailing normsnorms considered unassailable and sacrosanct by the established medical/legal system. 1980 Oxford University Press Szasz was a biological libertarian in psychiatry. Of course not , even if you disapproved of your colleagues previous behavior toward his distressed child (as you should). Indeed, in the preface to the Pelican edition of The Divided Self, Laing went so far as to say In the context of our present pervasive madness that we call normality, sanity, freedom, all our frames of reference are ambiguous and equivocal. Even if a disease existed though, whether psychiatric or not, he argued for a libertarian approach to practice. Szasz is a libertarian, Laing an existentialist, and despite their similarities on important points, libertarians and existentialists also diverge on a number of issues, as I hope to show in the pages that follow. In any case, reading Szaszs reflections on liberty and confidentiality, one sometimes gets the impressions that his clear-cut, crystalline ethical principles are designed to spare us the agonizing and often inconclusive reflections that many clinicians face frequently in the course of their work. [25], According to Szasz, "the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. Men have long been silent and stoic about their inner lives, but theres every reason for them to open up emotionallyand their partners are helping. But, as Ronald Pies describes well, it wasnt false for the reasons Szasz thought it was false. Homosexuality was not a perversion. That said the fact that Szasz is not an existentialist does not deprive him or anyone else of the right to criticize existential psychotherapists who have trampled on the liberties of others in the past. That line reads: When I certify someone insane, I am not equivocating when I write that he is of unsound mind, and may be dangerous to himself and others, and requires care and attention in a mental hospital. The figure of the psychotic or schizophrenic person to psychiatric experts and authorities, according to Szasz, is analogous with the figure of the heretic or blasphemer to theological experts and authorities. In this passage from his 1960 essay (later, . KW - Szasz He was a staunch opponent of civil commitment and involuntary psychiatric treatment, but he believed in and practiced psychiatry and psychotherapy between consenting adults. In surgery, all things being equal, doctor and patient are fungible. For decades, Thomas Szasz has publicly challenged the excesses that obscure reason. Thomas Szasz Thomas Szasz Born in hungry Spend most of his time in USA He started his career as a psychiatric Very quickly realize the psychiatric system is deeply faulty Wrote his first essay in 1960 which became famous Title is "The myth of mental illness"Szasz Myth of Mental illness This is not a conventional . Szasz presents mental health professionals with two stark alternatives: he must choose between serving the interests of the client, as the client defines them; or serving the interests of the clients family or employer or insurance company, or the interests of his profession, religion, community, or the state, as they define them. The prospect of being a double agent, as Szasz calls it, and therefore, presumably, of betraying the clients trust and confidence isnt very appealing, of course. Even if a disease existed though, whether. "[25] The "nanny state" has turned into the "therapeutic state" where nanny has given way to counselor. Dr. Keith Hoeller, Editor, Existential Psychology & Psychiatry. From 1951 to 1953, Laing did his psychiatric training in the British Army, where he differentiated (to the best of his ability) between malingerers and those who were genuinely deranged, and therefore incapable of fighting in the Korean war. This is the postmodernist perspective, enshrined in Michel Foucaults work (also based in the psychiatry of the 1950s), of psychiatrists as policemen, mere agents of societys laws. It is a vastly elaborate social control system, using both brute force and subtle indoctrination, which disguises itself under the claims of being rational, systematic and therefore scientific. The orthodox position is that mental illness is a fact; critics argue that it is a myth. This is self-congratulation concealing personal and professional self-aggrandizement. [13]:85. It is quite true, as Szasz points out, that Szasz, Laing and Foucault are often lumped together indiscriminately as anti-psychiatrists by spokesmen for the psychiatric establishment, and indeed, by its critics as well. Hysteria wasnt a fantasy of childhood libido, but a reflection, too often, of real-life sexual trauma. Because Laing had spent most of the past two decades criticizing the mentality and methods of mainstream psychiatry, and Fionas crisis could be used to discredit him, personally and professionally. Many cannot weep because they do not feel anything. If so, that cannot be helped. [23][24]:17 Thus suicide, unconventional religious beliefs, racial bigotry, unhappiness, anxiety, shyness, sexual promiscuity, shoplifting, gambling, overeating, smoking, and illegal drug use are all considered symptoms or illnesses that need to be cured. To the extent that psychiatry presents these problems as "medical diseases", its methods as "medical treatments", and its clients especially involuntary as medically ill patients, it embodies a lie and therefore constitutes a fundamental threat to freedom and dignity. It has become familiar to millions through a diverse publishing program that includes scholarly works in all academic disciplines, bibles, music, school and college textbooks, business books, dictionaries and reference books, and academic journals. And note that Szaszs case against Fischer rests on a single sentence, on which he hangs a very weighty condemnation supported by little (or in her case, no) evidence, as it did with Laing in The Divided Self. Depression wasnt a reflection of not-good-enough early childhood experiences, as they speculated. Let us say that you have a colleague who divorced and re-married, whose first family lives in a city several hundred miles from him. In short, not one, but both of the tacit assumptions embedded in the term mental illness are tendentious, and at variance with one another. Pop culture's most prominent depiction of OCD was among its worst. Areas covered by the journal include: conflict and social action; crime and juvenile delinquency; drinking, drugs, and addiction; health policy and services; race and ethnicity; and sexual behavior and politics. New Book by Kirk Schneider Released Feb 1st! As to the solutions for its errors, better guides have existed, like Jaspers and Frankl and Havens. Another way of saying this is that Szaszs emphasis on honesty, responsibility and freedom puts too much emphasis on the clients relationship to himself, at the expense of his being with (and for) others. Subtracting all the specific historical and contextual determinants may make our case more effectively. In his article he argued that mental illness was no more a fact bearing on a suspect's guilt than is possession by the devil. Thomas Scheff, also a sociologist, had similar reservations.[37]. So was Laings (more or less contemporaneous) abuse of his erstwhile friend and collaborator, Aaron Esterson, with whom he co-authored Sanity, Madness and the Family, and who, in due course, became Dr. Szaszs dear friend. His 1961 book, The Myth of Mental Illness, provided the . But that is not the issue. Unbeknownst to your colleague, an estranged son or daughter from his first marriage experienced a severe romantic disappointment, and was hospitalized involuntarily. Lithium is proven to prevent suicide based on double-blind placebo-controlled studies; it is the only drug proven to do so in our highest level of scientific research. It is only one of several interpretive possibilities, and a pretty hostile one at that. As a result, his ethical judgments, though enviably clear and consistent, on a purely logical plane, often lack realism, generosity and simple common sense., References:Burston, D., 1991,The Legacy of Erich Fromm, Cambridge: Harvard University Press.Burston, D., 1996,The Wing of Madness: The Life and Work of R.D.Laing, Cambridge: Harvard University Press.Clay, J., 1996,R.D.Laing: A Divided Self, London: Hodder & Staughton.Fischer, C.T., 2002, introduction,The Humanistic Psychologist, 30:1-9.Laing, A.C., 1994,R.D.Laing: A Biography, London: Peter Owen.Laing, R.D., 1960,The Divided Self, Harmondsworth: Penguin Books.Stepansky, P., 1999,Freud, Surgery and the Surgeons, Hillsdale, NJ: The Analytic PressSzasz, T., 2002, The Cure of Souls in the Therapeutic State, International Federation for Psychoanalytic Education annual Conference, Fort Lauderdale, November 2.Szasz, T., 2003, The Secular Cure of Souls, Journal of the Society for Existential Analysis, 14.2, Life-Enhancing Anxiety makes a bold proposal: It is not less anxiety that we need today, but more, at least of a certain kind of anxiety. And I sincerely thank him for it. But on reflection, neither is the alternative, which is serving the interests of the client, as the client defines them. Szasz's inconsistencies and nonsociological underpinnings lead to a clear political bias in his own work, as well as provide a rationale for regressive social policies. In his Preface to the first edition of The Myth of Mental Illness (1961), Szasz wrote that he had a twofold purpose: A genuine disease must also be found on the autopsy table (not merely in the living person) and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. Szasz also drew analogies between the persecution of the drug-using minority and the persecution of Jewish and homosexual minorities. Does Dr. Szasz maintain that he never treated involuntary mental patients during his psychiatric training, as Laing did then ceased to do? Thomas Stephen Szasz ( / ss / SAHSS; Hungarian: Szsz Tams Istvn [sas]; 15 April 1920 - 8 September 2012) was a Hungarian-American academic and psychiatrist. Should psychotherapists limit their clients liberty and right to self-determination by committing them against their will? Szasz wrote: "If you talk to God, you are praying; If God talks to you, you have schizophrenia. [14] He thought that psychiatry actively obscures the difference between behavior and disease in its quest to help or harm parties in conflicts. Presumably, to be consistent Szasz would have to hold that she simply had a problem of living that led to suicide and that she freely chose to kill herself. Get EHI News, Event Announcements, and E-H Therapy insights delivered to your inbox. For some time now, Szasz has maintained that psychotherapy is an essentially ethical enterprise a secular cure of souls analogous, in some ways, to Catholic confession even though the analysts stance toward his patient/client, by Szaszs account, is more akin to the purely voluntary association between a Jewish rabbi and a fellow Jew than between a Catholic priest and his parishioner. Existential-integrative psychotherapy, developed by Kirk Schneider(2008), is a relatively new development within humanistic and existential therapy. And let us imagine that, for one reason or another, your colleague feels helpless to intervene on his estranged childs behalf without potentially doing harm to himself and others in the process. Szasz's arguments have provoked considerable controversy over the past five decades. Self-help is also included in humanistic psychology: Sheila Ernst and Lucy Goodison have described using some ofthe main humanistic approaches in self-help groups. I have worked alongside Dr. Fischer at Duquesne University for more than a decade, and can attest that the kind of collaborative psychological assessment she teaches to our graduate students who authored many of the articles in this issue of The Humanistic Psychologist does not take instances of inner or interpersonal conflict to be symptomatic of mental illness per se. The fact that none of this registers in Szaszs interpretation of Laings statement strikes me as very significant, and characteristic of his whole approach to Laing. Psychiatrists testifying about the mental state of an accused person's mind have about as much business as a priest testifying about the religious state of a person's soul in our courts. In short, prior to composing the line that Szasz seizes on, there was an interval of five years at the beginning of Laings career when he did hospitalize patients, possibly against their will.
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