Szasz Hailed in U.K. for 'Questioning Spirit'

American psychiatrist is celebrated for 50th anniversary of The Myth of Mental Illness, by Bruce Jancin

EDINBURGH—Anyone interested in how American and British psychiatry differ might find a useful starting point in the Royal College of Psychiatrists' decision to bring in famed psychiatry critic Dr. Thomas S. Szasz to give a keynote address on the occasion of the 50th anniversary of his book, The Myth of Mental Illness.

"It's unimaginable that the American Psychiatric Association would have done this," Dr. Szasz, professor emeritus of psychiatry at the State University of New York at Syracuse, told an overflow crowd.

Indeed, in a stirring introduction to the lecture, Dr. Bill Fulford declared, "We owe Thomas Szasz a debt. In spite of vilification, deliberate misunderstanding, and downright abuse, this man has kept alive a questioning spirit around the issue of psychiatric harm. I believe that it behooves all of us who aspire to act as doctors and professionals in the 21st century to work to nurture just such a questioning spirit."

"I put it to you that we need Thomas Szasz now more than ever," added Dr. Fulford, professor of philosophy and mental health at the University of Warwick in Coventry, England, who called Dr. Szasz "one of my early heroes—one of the main reasons I went into psychiatry."

Dr. Szasz, a somewhat frail but mentally spry 90-year-old, then proceeded to hammer home the same criticisms of the scientific and moral basis for psychiatry that he has raised for half a century.

"My theme is about liberty, and how there is no comparison to be made between liberty and health. Under no circumstances can any kind of question about health make it legitimate to deprive an adult from full liberty," he said.

Among the American psychiatrist's key points:

  • Suicide, which he called "a longing for nonexistence," is "the most fundamental of all human rights."
  • Mental illness is not a disease, but rather a form of socially unacceptable behavior and a problem in living. A true illness requires a lesion in the body.
  • Mental hospitals are akin to prisons, and involuntary commitment for psychiatric treatment can never be justified.
  • Psychiatrists have allowed themselves to become state-sponsored agents of social control and coercion. "Everyone who is a mental health professional is now legally responsible for preventing his patients being dangerous to themselves or others. If that is not social control, I don't know what is," he observed.
  • Mental incompetence and detention for forced treatment should be decisions reached through purely legal and judicial means. "A legal procedure is infinitely more humane, reasonable, and protective of human rights than any psychiatrist's conclusion," Dr. Szasz said.
  • Psychiatrists, whether British, American, or otherwise, ought to read the U.S. Bill of Rights. "The Bill of Rights is a fantastic document. It's really a list addressed not to the people; it's addressed to the government. It tells the government what it cannot do to people, like deprive them of liberty without due process of law."
  • The Myth of Mental Illness, he said, should not be mistaken for a contribution to psychiatry. "It was a contribution against psychiatry."

One Scottish audience member rose to say that, while he appreciates in the abstract Dr. Szasz's libertarian arguments, as a caring psychiatrist he feels compelled to intervene with coercive measures when he encounters someone who is severely mentally ill and unable to act rationally in his own best interests.

"To me it's a mark of a civilized society that we don't just leave people in that situation, but that we're prepared to offer them protection and treatment when they're not able to make these decisions for themselves," he argued.

"Your comment is very relevant, and it intensifies my opposition," Dr. Szasz replied.

He drew parallels between the situation of those who are today labeled mentally ill and women in the era before they won voting rights, which they were denied because, he said, "it was all for their own good."

"I remember when homosexuals were locked up for treatment," Dr. Szasz continued. "It's impolite to mention in psychiatric circles that homosexuality was formerly considered a disease. It reminds people of what they did before, only a few years ago."

In a similar vein, he recalled that when he was at the Chicago Institute for Psychoanalysis, where he did his analytic training, he was considered abnormal because he was the only person in the building who did not smoke.

"Everybody smoked, nonstop," he said. Today they would be called nicotine dependent.

"This is society's unbelievable power to define abnormality," Dr. Szasz said.

"It's like he's a living piece of history," one admiring audience member was overheard saying to another.