Click on the link for this fascinating interview with Thomas Szasz, professor of psychiatry emeritus at SUNY Health Science Center in Syracuse, New York, where he has taught since 1956. Randall describes him as ‘the foremost psychiatric critic of our times’.
This is a long-ish read, but a worthwhile one – and a needful one in any meaningful debate of the ‘mental illness’ model and of current psychiatric/psychotherapeutic landscapes.
From a person-centred perspective, Thomas’ arguments are important – generally, and specifically to the increasingly deep hole into which the talking therapy world appears to be digging itself. They are relevant to some of the scarily unreflective and anti-intellectual material we are reading in the ongoing debate about the regulation or not of psychotherapy, and the tendency to present that in terms of ‘safety’, rather than in its true (oppressive, repressive, coercive, political) colours – also the oft-stated justification for a much wider cultural movement into State control at the expense of human sovereignty and personhood.
There is so much that is good in this, it is challenging to pick out a few quotes to give the flavour:-
‘Diagnoses are NOT diseases. Period. Psychiatrists have had some very famous diseases for which they have never apologized, the two most obvious ones being masturbation and homosexuality. People with these so-called “diseases” were tortured by psychiatrists — for hundreds of years. Children were tortured by antimasturbation treatments. Homosexuals were incarcerated and tortured by psychiatrists. Now all that is conveniently forgotten, while psychiatrists — prostitutes of the dominant ethic — invent new diseases….’
‘prostitutes of the dominant ethic’ – this is not a man who pulls his punches.
‘….all psychiatry is coercive, actually or potentially — because once a person walks into a psychiatrist’s office, under certain conditions, that psychiatrist has the legal right and the legal duty to commit that person. The psychiatrist has the duty to prevent suicide and murder. The priest hearing confession has no such duty. The lawyer and the judge have no such duties. No other person in society has the kind of power the psychiatrist has. And that is the power of which psychiatrists must be deprived, just as white men had to be deprived of the power to enslave black men. Priests used to have involuntary clients. Now we call that forcible religious conversion and religious persecution; it used to be called “practicing the true faith” or “loving God.” Now we have forcible psychiatric conversion and psychiatric persecution — and we call that “mental health” and “therapy.” It would be funny if it were not so serious.’
The writer would like to discuss with him his comments on the medical model of medicine – that ‘We don’t speak of …..the medical model of pneumonia. There is no other model’. It’s perhaps accurate that ‘We don’t speak of the electrical model of why a light bulb emits light’, but there are arguments for seeing any biological problem as metaphor, in a similar way to his points about what is currently termed ‘mental illness’. That is not about throwing out the medical model, more about bringing into aspects of its current culture – which can be disempowering and reductive – a more holistic sense of what it is to be human: that we are whole beings, not a collection of parts, and that whatever arises in our bodies is not separate from what is happening in our psyche or spirit or inward emotional world (whatever your way of making sense of this may be). In other cultures/conceptual systems, for example traditional Chinese medicine, there is a far more holistic conception.
On the other hand, the writer shares his view that:-
‘The important issue is not the “medical model,”….the issue is the “pediatric model,” the “irresponsibility model” — treating people labeled as mentally ill as if they were little children and as if the psychiatrist was their parent. The pillars of psychiatry are medically rationalized and judicially legitimized coercions and excuses….
….this tendency to call more and more human problems “diseases” and then try to remedy them, or “attack” them, as if they were diseases is what I call “the therapeutic state.”…..
….Three hundred years ago, every human predicament was seen as a religious problem — sickness, poverty, suicide, war. Now they are all seen as medical problems — as psychiatric problems, as caused by genes and curable with “therapy.” In the past, the criminal law was imbued with theology; now, it’s imbued with psychiatry..’
We resonate with many of his comments about therapy:-
‘Because the therapeutic relationship is an intimate, human relationship with another human being, the kind of psychotherapy that makes sense to therapists reflects the kind of person they are……
The proper analogies to psychotherapy are not medical treatment but marriage or raising children. How should a man relate to his wife, and vice versa? How do you raise your child? Different people relate differently to their wives or husbands or children. As long as their life style works for them, that’s all there is to it. So, first I say that I believe that any kind of so-called “therapy” — any kind of human helping situation that makes sense to both participants and that can be entered and exited and conducted wholly consensually, voluntary, and that is devoid of force and fraud — any and all of that is, by definition, helpful. If it were not helpful, the client wouldn’t come and pay for it. The fact that a client returns and pays for what he gets from a therapist is, prima facie evidence for me, that he finds it helpful.’
‘The relationship has to be wholly cooperative. The two people may meet only a few times, or they meet many times over many years. The therapist is the patient’s agent. This doesn’t mean that he must agree with everything the patient believes or wants; far from it. But it means that the therapist is prohibited — by his own moral code — from doing anything against the patient’s interest, as the patient defines his interest. That is part of my idea of the contract with the patient. That’s why I titled my book, “The Ethics of Psychoanalysis.” Therapy is a matter of ethics, not technique.’
His comments on client confidentiality also feel extremely important in the current landscape.
He answers a couple of questions at the end about the level of criticism and attack he has faced for his views, and the help he has found in aspects of his own background/personal world and in literature, as well as in the support of others:-
‘It also helped at lot that I felt there were many people who agreed with me — that what I’m simply saying is simply 2 + 2 = 4 — but that many people are afraid to say this when it is personally and politically improvident to do so. I haven’t made any scientific discoveries. I’m simply saying that if you are white and don’t like blacks, or vice versa, that’s not a disease, it’s a prejudice. If you’re in a building that you can’t get out of, that’s not a hospital, it’s a prison. I don’t care how many people call racism an illness or involuntary mental hospitalization a treatment.’
We would like to send wind to lift the wings of Thomas Szasz and all those who are willing to voice what they see, in the service of all of us, even when it carries risk and may indeed be ‘personally and politically improvident to do so’.
Thomas has written a great deal – including:-
Thank you to Micah Ingle for bringing this article to our attention, and of course to http://www.psychotherapy.net
Palace Gate Counselling Service, Exeter