A Branch of the Law," The Freeman, 56: 18-20 (December), 2006.
The Pretense of Psychology as Science: The Myth of
Mental Illness in Statu Nascendi
Address, "Controversies in End of Life Care: Terri Schiavo's Lessons"
AND FOLLY: Bertrand Russell, C. S. Lewis, and the Existential Identity
bogus Benjamin Rush quote: contribution to the history of pharmacracy"
6 "Idiots, infants, and the insane": mental illness
and legal incompetence.
vs. "Malresult". A new form of insurance for an eternal problem.
4 Caveat Emptor (Let the Buyer Beware).
3 Self-Ownership or Suicide Prevention?
2 Psychiatrist who changed the view of homosexuality
as a mental disorder.
1 The psychiatric protection order for the "battered
by Thomas Szasz on the massacre at Virginia Tech:
Is Not a Disease
Did the perpetrator of the Tuscon massacre have a reason?
Therapeutic State | Thomas Szasz
Freeman: Posted January 20, 2011
people really want to know why, on January 8, 2011, in Tucson, Arizona,
a young man named Jared Lee Loughner engaged in mass murder? I submit
they do not. Politicians, psychiatrists, pundits, and the press univocally
assert that Loughners deed is the senseless product
of mental illness. This belief in a non-existing mental disease causing
mass murder is on a par with young childrens belief in Santa
Claus. It is false but satisfies the believers. The great French essayist
Michel de Montaigne (1533-1592) sagely observed: Nothing is
so firmly believed as what is least known.
his shooting spree Loughner had produced a video he called My
Final Thoughts, stating: All humans are in need of sleep.
Jared Loughner is a human. Hence, Jared Loughner is in need of sleep.
On the morning of his massacre he posted a message on his MySpace
account acknowledging his sense that he was at the end of his rope
and his decision to let go: Goodbye. Dear friends . . . Please
dont be mad at me.
is a continuation of politics by other means, said Prussian
general Carl von Clausewitz (1780-1831). I suggest that, similarly,
mass murder in plain sight, such as Loughner committed, is a continuation
of suicide by other means. Sometimes it is called suicide by
proxy or suicide by cop.
to use his metaphor, has gone to sleep. And so have we if we prefer
to believe that his self-destructive and destructive act is the senseless
product of his mental illness rather than the result of
his planned, sensible decision. The latter view is unpopular
and unacceptable because it acknowledges Loughners humanity
and free will, precisely the qualities that psychiatrists aided
and abetted by the criminal justice system are intent on removing
from persons they label mad. This medicalized view of
certain offenses usually crimes that particularly upset people
has, for reasons I have presented elsewhere, become widely
accepted in our society, embraced equally by the right and the left.
we infer the motive for an action from its consequences. For Loughner,
one of the consequences of his action is that his life is over, if
not biologically then socially. Loughner was well aware of his failure
to transition from childhood to adulthood. After years of fruitless
travail, he decided to bring his life to a dramatic end. He committed
mass murder and let himself be destroyed by the society that, he felt,
obstructed his efforts to succeed.
crime, like any act, was not senseless at all, provided we are willing
to put ourselves in his shoes. Of course, it makes no sense if we
are unwilling to do that, denying the personhood of the actor, dismissing
a priori his possessing free will, attributing his action to mental
disease instead of personal decision.
Is Alleged, Craziness Is Asserted
only thing we know with certainty about the Loughner case is the identity
of the shooter. We do not know why he committed this crime. Nevertheless,
commentators ritually refer to Loughner as the alleged
assailant and confidently assert that he is a crazy, deranged, lunatic,
mentally ill and schizophrenic. Former Vice President Dick Cheney
told NBC News: We need to be a little careful about assuming
that somehow the rest of society or the political class bears the
responsibility for what happened here when it was the act of a deranged,
crazed individual that committed a crime.
Fuller Torrey, a recognized expert on schizophrenic murderers, agrees.
He refers to Loughner as the alleged shooter and states
that he is reported to have had symptoms associated with schizophrenia
and almost certainly was seriously mentally ill and untreated
These tragedies are the inevitable outcome of five decades of failed
remedy for the problem of people being at liberty to commit crimes
and suffer the consequences is intensifying the traditional legal-psychiatric
practice of incarcerating innocent individuals and calling it hospitalization
and treatment and even suicide and crime prevention:
The solution to this situation is obvious make sure individuals
with serious mental illnesses are receiving treatment. The mistake
was not in emptying the nations hospitals but rather in ignoring
the treatment needs of the patients being released
. Others are
unaware they are sick and should be required by law to receive assisted
outpatient treatment, including medication and counseling
they do not comply with the court-ordered treatment plan, they can
and should be involuntarily admitted to a hospital.
contrast, Ashley Figueroa, a former girlfriend of Loughner, told ABC
News that she remembers Loughner as a drug user with a grudge
against the government
. I think hes faking everything
I think that he has been planning this for some time. A writer
for Salon.com adds: Figueroa is not a doctor, and these claims
conflict with the opinion of top doctors in the field of psychiatry.
(Dr. E. Fuller Torrey actually told Salon that Loughner looks like
a textbook case of paranoid schizophrenia.)
Figueroa is not a doctor. Do we need to have a medical
degree to diagnose a person we have never laid eyes on as schizophrenic?
Does the fact that Figueroa knew Loughner, that they had a real-life
human relationship, count for nothing?
did not take long for authorities, in Arizona as well as nationally,
to heed Torreys advice to cure would-be schizophrenic
murderers by constricting the liberties of all Americans. On
January 15, exactly one week after Loughners rampage, one of
his victims, J. Eric Fuller, 63, a military veteran, attended a televised
forum on helping the community to heal and angrily confronted
a fellow participant with the metaphor, Youre dead.
Fullers words were interpreted as a threat, and
he was involuntarily committed for a 72-hour mental-health evaluation.
According to CBS News, [Pima County sheriff's spokesman Jason]
Ogan said the hospital will determine when Fuller will be released.
war on words continued in Congress. Before Tucson, the Republicans
opposed Obamacare, calling the bill job killing. Overnight,
that term vanished from the political vocabulary, replaced by job
crushing and other metaphors. Foolishly, Washington Post columnist
Dana Milbank hailed this piece of semantic surgery: [House Speaker
John] Boehner, in a pair of statements on his Web page, dropped the
job-killing phrase in favor of job-crushing
and job-destroying. House Majority Leader Eric Cantor
did not allow the k-word to escape his lips at Tuesday afternoons
. [T]he new GOP majority generally showed a skill
that had been lacking in the Republican caucus for the past two years:
to the idea that we have two kinds of lawbreakers in America, sane
and insane, we are unable to attend to the human problems we call
mental illnesses. But not to worry, we can always operate
on the vocabulary.
The Illegitimacy of the Psychiatric Bible
Freeman December 2010 Volume: 60 Issue: 10
health experts ask: Will anyone be normal? So read the title
of a July 27 Reuters report. The experts warned that the
fifth version of the Diagnostic and Statistical Manual of Mental Disorders
(DSM), scheduled for publication in 2013, could mean that soon
no-one will be classed as normal. . . . [M]any people previously seen
as perfectly healthy could in future be told they are ill.
is not news. More than 200 hundred years ago Johann Wolfgang von Goethe
(17491832) warned: I believe that in the end humanitarianism
will triumph, but I fear that, at the same time, the world will become
a big hospital, each person acting as the others humane nurse.
Goethe foresaw the moral hollowness of the humanitarian science
on which such therapeutic tyranny would rest: I could never
have known so well how paltry men are, and how little they care for
really high aims, if I had not tested them by my scientific researches.
Thus I saw that most men only care for science so far as they get
a living by it, and that they worship even error when it affords them
depths to which such men would happily sink when worshiping error
brings them fame and fortune became obvious only in the twentieth
Maria Machado de Assis (18391908), the great Brazilian novelist
and playwright, advanced the prescient literary satirization of the
dark art of psychiatric diagnosis and the engine that drives it: the
phony experts insatiable vanity and thirst for controlling his
fellow man. His short story O alienista (1882, The
psychiatrist) is a fable of a celebrated doctor retiring to
a small town to pursue his scientific investigation of the human mind,
gradually finding more and more of the townsfolk insane and needing
to be incarcerated in his private asylum. Eventually he alone is left
at liberty. As soon as modern psychiatry became a legitimate branch
of medicine, Machado de Assis recognized and exposed its quintessentially
remained for the French playwright Jules Romains (18851972)
to call public attention to the corruption of modern medicine by political
power. Its a matter of principle with me, declares
his protagonist, Dr. Knock (1923), to regard the
entire population as our patients. . . . Health is a word
we could just as well erase from our vocabularies. . . . If you think
it over, youll be struck by its relation to the admirable concept
of the nation in arms, a concept from which our modern states derive
Freud (18561939), too, has played an important part in persuading
people that health is an abnormal state. This old joke is illustrative:
If the patient is early for his appointment, he is anxious;
if he is on time, he is obsessive-compulsive; if he is late, he is
psychiatric diagnoses have not escaped professional criticism. Wishing
to make a name for themselves as psychiatrists, critics
object to one or another diagnosis (homosexuality)or to overdiagnosis
(ADHD)but continue to respect the American Psychiatric Association
(APA) as a scientific organization and regard the various incarnations
of the DSM as respectable legitimating documents. This is dishonest.
Confronted with the DSM, the challenge we face is to delegitimize
the authenticators, the APA and DSM, not distract attention from their
fundamental phoniness by ridiculing one or another diagnosis
and trying to remove it from the magical list.
have consistently rejected this piecemeal approach. In my essay The
Myth of Mental Illness, published in 1960, and in my book with
the same title that appeared a year later, I stated my view forthrightly.
I proposed that we view the phenomena conventionally called mental
diseases as behaviors that disturb others (or sometimes the
self), reject the image of mental patients as helpless
victims of patho-biological events outside their control, and refuse
to participate in coercive psychiatric practices as incompatible with
the foundational moral ideals of free societies. In short, I rejected
the authority of the APA as a legitimating organization and of the
DSM as a legitimating document. I believe nothing less can undo the
mischief wrought by the successive editions of the psychiatric
Settled by Political Power
have changed. Fifty years ago it made sense to assert that mental
illnesses are not diseases. It makes no sense to do so today. Professional
debate about what counts as mental illness has been replaced by political-judicial
decree. The controversy about the nature of so-called mental diseases/disorders
has been settled by the holders of political power: They have decreed
that mental illness is a disease like any other. Political
power and professional self-interest have united in turning false
beliefs into lying facts: Mental illness can be accurately diagnosed,
successfully treated, just as physical illness (President William
Clinton, 1999). Just as things go wrong with the heart and kidneys
and liver, so things go wrong with the brain (Surgeon General
David Satcher, 1999).
claim that mental illnesses are diagnosable disorders of the
brain is not based on scientific research; it is a deception
and perhaps self-deception. My claim that mental illnesses are fictitious
illnesses is also not based on scientific research; it rests on the
pathologists materialist-scientific definition of illness as
the structural or functional alteration of cells, tissues, and organs.
If we accept this definition of disease, then it follows that mental
illness is a metaphor, and asserting that view is stating an analytic
truth not subject to empirical falsification.
centuries the theocratic State exercised authority and used force
in the name of God. The Founders sought to protect the American people
from the religious tyranny of the State. They did not anticipate,
and could not have anticipated, that one day medicine would become
a religion and that the alliance between medicine and the State would
then threaten personal liberty and responsibility exactly as they
had been threatened by the alliance between church and State.
Founders faced the challenge of separating the cure of souls by priests
from the control of people by politicians. Today the therapeutic State
exercises authority and uses force in the name of health. We face
the challenge of separating the consensual treatment of patients by
medical doctors from the coercive control of persons by agents of
the State pretending to be healers.
psychiatry was in its infancy the belief that all human dysfunctions
are manifestations of brain diseases was a naive error. In its maturity
the mistake was treated as a valid scientific theory and the justification
for a powerful ideology and the powerful institutions based on it.
Today, in its senescence, psychiatry is deceit and self-deceitcoercion
concealed as objective science (medical diagnosis) and
benevolent help (medical treatment). As a result, paraphrasing
Orwell, telling the truth becomes a revolutionary act.
Madness, myth and medicine
on the continuing relevance of
Thomas Szasz, now in his 91st year
vol 23, no 8, August 2010, pp. 694-695
after we abandon the pretence that mind is brain and that mental disease
is brain disease can we begin the honest study of human behaviour
and the means people use to help themselves and others cope with the
demands of living (Szasz, 2007a, p.149).
Fifty years ago American Psychologist published a seminal article
by the Hungarian-born psychoanalyst and psychiatrist Thomas Szasz,
The myth of mental illness (Szasz, 1960). The thesis
was elaborated at length in a book of the same name a year later (Szasz,
As the decade got into full swing, Szaszs critique of psychiatric
theory and practice was herded into the same conceptual basket as
the musings of Scottish psychiatrist R.D. Laing, and his erstwhile
friend and collaborator David Cooper. The quite different ideas of
these men came to be bracketed inappropriately under the rubric of
anti-psychiatry an expression coined by Cooper
though disclaimed by Laing and rejected outright by Szasz.
Since then biological psychiatry has developed a stranglehold on research,
teaching and practice in the field of mental health, and
Szaszs opposition to psychiatry and the basis for it has been
mislocated in the art and culture of the day, its relevance for today
denied. Szaszs view has become viewed by many as a supposed
child of its time a component in the social manufacture of
the so-called anti-establishment Swinging Sixties. To let such misapprehension
pass unchallenged into the history of the behavioural sciences would
be a serious error, and Szasz for his part has constantly
endeavoured to set the record straight.
First it must be said that Szaszs insights into the shortcomings
of conventional psychiatry pre-date the 1960s by some considerable
margin. In a brief autobiographical sketch Szasz makes clear that
the absurdity of psychiatric fictions had dawned on him long before
Fellinis masterpiece was highlighting the shallowness of La
Everything I had learned and thought about mental illness,
psychiatry, and psychoanalysis from my teenage years, through
medical school, and my psychiatric and psychoanalytic training
confirmed my view that mental illness is a fiction; that psychiatry,
resting on force and fraud is social control, and that psychoanalysis
properly conceived has nothing to do with illness or
medicine or treatment (2004, p.22).
Szasz graduated in medicine in 1944, having migrated to the US from
his native Hungary in 1938, a fugitive from the looming menace of
Nazism. He undertook a psychiatric residency and trained in psychoanalysis.
The appeal of psychoanalysis, besides its intellectual and interpersonal
attractions, lay in its ostensibly consensual and contractual nature.
Less well known than his other works, his dissection of power in psychoanalytic
relationships published as The Ethics of Psychoanalysis (Szasz,
1965) is central to his thinking and stands complementary to
the assertions that mental illness is a myth. In this Szasz effectively
provides a practical guide on how to ensure a level playing field
in psychotherapeutic relationships, to the benefit of both parties.
He is honest and open enough to explicitly explore the role that money
may play in distorting therapeutic means and ends. As such, it not
only stands the test of time but stands squarely against the numerous
vested interests, both pharmaceutical-financial and professional,
which dominate the mental health industry past and present
Anti-psychiatry or pro-consent?
Szasz is not anti-psychiatry. He advocates the right to
agree consensual contractual relations of any kind, including consensual
psychiatry if that is what suitably informed people want. He has proposed,
for example, the use of advanced psychiatric directives whereby people
could agree to accept or refuse specific interventions to be made
on their behalf in the event of their becoming extremely
distressed and irrational in future. Such ideas have unfortunately
been rejected outright by leading figures in both psychiatry and medical
ethics, and accordingly Szasz sees little possibility of any kind
of consensual psychiatry until the use of coercion, whether explicit
or tacit, is relinquished.
As psychiatry continues to function for the most part as an extension
of the criminal justice system, Szasz asserts that psychiatry in its
current form must be abolished. This would require a concerted challenge
to its support structures, premised as they are on the notions of
behaviour as disease, the fear of dangerousness and the necessity
medical treatment under the guise of protecting the individual from
his or herself. The championing of the latter notion in particular
owes much to an ignorance of its origins. A careful reading of Szaszs
historical analysis of the origins of the insanity defence in 17th-century
England goes some way to clarifying where behavioural scientists got
the idea from that people of unsound mind were not responsible
for their actions and could not be held accountable for them. In Coercion
as Cure, he writes
With suicide defined as a species of murder, the persons sitting in
judgment of self killers had the duty to punish them. Since punishing
suicide required doing injustice to innocent parties
and minor children of the deceased eventually the task proved
to be an intolerable burden. In the seventeenth century, men sitting
on coroners juries began to recoil against desecrating the
corpse and dispossessing thesuicides dependants of their means
of support. However, their religiousbeliefs precluded repeal of the
laws punishing the crime. Their only recourse was to evade the laws;
The doctrine that the self-slayer is non compos mentis and hence not
responsible for his act accomplished this task (Szasz, 2007a, p.99)
And so a social practice became reified into an imaginary biological
ravaging through the brains of its unfortunate victims, necessitating
The label of anti-psychiatry that continues to be attached
to Szasz is one which he has been at pains to condemn (Szasz, 2009),
used as it is to stultify and nullify any criticism of contemporary
psychiatry. While Laing saw himself as essentially on the same
side as Szasz (Mullan, 1995, p.202), Szasz sees considerable
distance between them, for a number of reasons. Perhaps at the forefront
of these Laing was known to have forcibly drugged one of his patients
(Szasz, 2008) and for all his eloquence and insight into human misery
his writings do not in principle condemn the forced treatment or incarceration
of people against their will on psychiatric grounds. Finally whilst
The Divided Self (Laing, 1960) and Sanity Madness and the Family (Laing
& Esterson, 1964) amongst other outpourings proclaimed the intelligibility
of going mad within a
human rather than biological framework, Laing did not reject outright
the notion of mental illness, which in Szaszs view remains at
best a metaphor.
Szasz has throughout his career stood firmly to his principles and
eschewed psychiatric practice in an environment where people have
deprived of their liberty. He has on occasion appeared in court both
to represent individuals deprived of their liberty and to uphold the
principle of criminal responsibility in murder cases where those accused
have sought to evade it through the insanity defence (see Szasz, 2007b,
chapter 13 in particular). Such consistent challenges to institutional
psychiatry have been made at some professional cost. Szasz has not
simply been the recipient of fierce criticism from the psychiatric
fraternity, who feel
betrayed by his actions, but has also endured attempts to limit his
academic freedom. In the aftermath of the publication of The Myth
of Mental Illness, for example, attempts were made to ban him from
teaching at the state hospital medical school citing his beliefs
as proof of his incompetence as a psychiatrist
(Schaler, 2004, p.xix).
Some confusion about Szaszs work has arisen through the quite
different political cultures within which it is interpreted, even
by those who oppose institutional psychiatry in its current incarnation.
His work has been claimed and repudiated by those on both the left
and right deemed a liberal in some quarters and
a fascist in others with the claims and counterclaims rooted
in the predilections of the critics for different
configurations of state power. European intellectual tradition on
the left, for example, clings to a belief and a desire that state
power can be harnessed for the good. This means that while Szaszs
attacks on psychiatric authority are applauded, his admonitions against
the therapeutic state (Szasz, 2001, 2002), with its merging
of psychiatric and state power on the one hand and private and public
health on the other, are glossed over. In truth, if such a thing can
be said, Szaszs ideas belong to neither the right nor the left.
His work challenges and questions all operations of organised
power from the state downwards, as long as they are used to crush
human freedom. His work implies unanswered questions concerning the
forms of community and social organisation which people can harness
the individual and common good in order to enable them to deal elegantly
insatiable demands of living.
While preparing this article I encountered Philippe Petits (2002)
wondrous account of his high-wire walk across the twin towers of the
World Trade Center in 1974. Immediately after performing his artistic
crime of the century Petit was arrested and subject to psychiatric
examination. Petit was judged to be sane, but the outcome of the psychiatric
interview is less revealing than the fact that psychiatrists were
willing to play their part in a pseudo-medical intervention provoked
by nothing more than social rule breaking of the highest imaginative
order. It struck me that Petit an imaginative, unusual and
beguiling figure exemplifies much that modern psychiatry stands
in antipathy to. Petit cares not for the rules and regulations that
structure and govern the lives of citizens and lives, in his terms,
only to dream projects that ripen in the clouds (Petit,
can be little doubt that psychiatry is an enterprise that is engineered
to destroy these that it cannot tolerate idiosyncrasies of
thought, whether grandiose or mundane. Petit succeeded in his outlandish
and highly improbable quest but why should one have to achieve
outlandish success to be embraced by society and enjoy the right to
pop ones head in the clouds or spend the afternoons in
treetops? Szaszs efforts over the years can be seen in
many lights, but without doubt he has toiled on behalf of the dream
of human accountability and responsibility, for the freedom to be
different and to take charge of ones life, free from the machinations
of statesponsored psychiatric interference.
Roberts is a Senior Lecturer
in Psychology at Kingston University
original article in pdf format
Laing, R.D. (1960). The divided self. London: Tavistock.
Laing, R.D. & Esterson, A.E. (1964). Sanity madness and the family.
Mullan, B. (1995). Mad to be normal: Conversations with R.D.Laing.
Petit, P. (2002). To reach the clouds. London: Faber and Faber.
Schaler, J. (Ed.) (2004). Szasz under fire: The psychiatric abolitionist
critics. Chicago: Open Court.
Szasz, T. (1960). The myth of mental illness. American Psychologist,
Szasz, T. (1961). The myth of mental illness. New York: Harper &
Szasz, T. (1965). The ethics of psychoanalysis. Syracuse, NY: Syracuse
Szasz, T. (2001). Pharmacracy: Medicine and politics in America. London:
Szasz, T. (2002). Liberation by oppression:A comparative study of
psychiatry. New Brunswick, NJ: Transaction.
Szasz, T. (2004). An autobiographical sketch. In J. Schaler (Ed.)
fire. Chicago: Open Court.
Szasz, T. (2007a). Coercion as cure: A critical history of psychiatry.
Brunswick, NJ: Transaction.
Szasz, T. (2007b). The medicalization of everyday life: Selected essays.
Syracuse: Syracuse University Press.
Szasz, T. (2008). Debunking antipsychiatry: Laing, law, and
Largactil. Current Psychology, 27, 79101.
Szasz, T. (2009). Antipsychiatry: Quackery squared. Syracuse: Syracuse
Shame of Medicine:
Alan Turing Redux"
by Thomas Szasz
Freeman, Volume: 60•Issue:2
my May 2009 column I recounted the tragic story of the medical-legal
persecution of the famed British mathematician and World War II code
breaker Alan Turing. In June, John Graham-Cumming, a British computer
programmer, created a petition on the “No. 10 Downing Street”
website asking for a government apology for Turing’s mistreatment.
On September 10, Prime Minister Gordon Brown issued a formal apology
on behalf of the U.K. government, stating, in part:
Earlier this year, I stood with Presidents Sarkozy and Obama to
honour the service and the sacrifice of the heroes who stormed the
beaches of Normandy 65 years ago. And just last week, we marked the
70 years which have passed since the British government declared its
willingness to take up arms against fascism and declared the outbreak
of the Second World War. So I am both pleased and proud that, thanks
to a coalition of computer scientists, historians and LGBT [lesbian,
gay, bisexual, and transgender] activists, we have this year a chance
to mark and celebrate another contribution to Britain’s fight
against the darkness of dictatorship: that of code-breaker Alan Turing.
was clueless. Turing had nothing in common with LGBT activists. Comfortable
in his identity as a homosexual man, he killed himself because the
“treatment” “transgendered” him in ways he
did not expect and was not told about. Calling Turing “a quite
brilliant mathematician” was another of Brown’s gaucheries.
Turing, Brown continued, “was one of those individuals we can
point to whose unique contribution helped to turn the tide of war.
The debt of gratitude he is owed makes it all the more horrifying,
therefore, that he was treated so inhumanely.” Would Turing
have been less deserving of belated compassion if he had been just
another Englishman caught in the web of his country’s anti-homosexual
warned Solon, the sixth-century B. C. Athenian philosopher, “are
the spider’s webs which, if anything small falls into them they
ensnare it, but large things break through and escape.” The
special irony of the Turing case is that he was not treated as any
ordinary violator of the prohibition against gay sex would have been:
He was allowed to choose between imprisonment and “medical treatment.”
He made the wrong choice. Despite his high intelligence and familiarity
with medical crimes in the Third Reich, Turing failed to understand
that medical criminals abound in all modern societies, most insidiously
in so-called “free societies.”
says that Turing was “treated inhumanely.” That’s
not exactly true. He could have gone to prison, where he could have
worked, had visitors, and would have been unmolested by psychiatrists,
and from which he would have emerged physically and mentally undamaged,
as had Gandhi, Nehru, Castro, and many other prominent historical
figures. Turing was treated inhumanely because he as well as his doctors
failed to heed George Washington’s famous warning: “Government
is not reason; it is not eloquence; it is force. Like fire, it is
a dangerous servant and a fearful master.”
who work for the government’s law-enforcement apparatus do not
practice therapeutic medicine and are not healers. They practice anti-therapeutic
prosecution, governed by the principle Primum nocere (first, do harm):
They are professional injurers who define the harm they do as help.
Such doctors are medical criminals, the gravity of their crimes depending
on the particular laws they help to enforce and the methods they use.
was blind to the nature of the political system that victimized him.
Brown is blind to the nature of the political system over which he
presides and the fundamental similarities between it and the system
he criticizes. Many more people are now persecuted in the United Kingdom
(and in the United States) for “abusing” drugs than were
persecuted for “abusing” sex. Neither of these modern
(quasi-religious) scapegoat-persecutions could have occurred without
the approval and assistance of medical professionals. Yet it does
not seem to occur to Brown to mention the role of doctors in the Turing
affair, much less blame them or suggest that they, too, owe apologies
to Turing and others.
politicians have apologized for the Holocaust. American politicians
have apologized for slavery and post-Pearl Harbor concentration camps.
Psychiatrists have not apologized for their institutionalized misdeeds.
The American Psychiatric Association (or the Royal College of Psychiatrists)
is not about to declare:
We apologize. We erred when we declared homosexuality a disease
and the forcible injection of female sex hormones an effective treatment
for it. We committed evil when, instead of joining the defenders of
liberty and endorsing the abolition of anti-homosexual legislation,
we eagerly supported the coercive apparatus of the State and prostituted
ourselves in the service of the social control of society’s
an aside, it should be noted that the past medical treatment of homosexuals
had included procedures such as surgical sterilization, carbon dioxide
inhalation (a kind of suffocation by “gas-boarding”),
and electric shock therapy.
will never apologize for their crimes because they never acknowledge
responsibility for harming people. For example, when criticized for
depriving people of liberty, they assert that they do not commit mentally
ill persons to insane asylums—judges do. “Mental health
professionals must understand,” explains Robert Simon in Psychiatry
and Law for Clinicians, “that it is not they who make commitment
decisions about patients. Commitment is a judicial decision that is
made by the court or by a mental health commission.” Psychiatrists
call ordinary criminals who deny responsibility for their misdeeds
“psychopaths” and say they have no conscience. Doctors,
lawyers, politicians, and the press call psychiatrists who deny responsibility
for 300 years of psychiatric slavery “conscientious physicians”
and honor them as medical healers. Reality, not just history, is written
by the victors.
long as psychiatrists are accepted as medical specialists possessing
the privilege to forcibly classify persons as patients and impose
tortures on them as treatments, they will not apologize. Acknowledging
that the classification of homosexuality as a disease was a mistake
would open a Pandora’s box of doubts about the disease status
of currently fashionable mental illnesses.
ended by exulting, “This recognition of Alan’s status
as one of Britain’s most famous victims of homophobia is another
step towards equality, and long overdue. . . . Alan and the many thousands
of other gay men who were convicted, as he was convicted, under homophobic
laws, were treated terribly.”
was not a victim of homophobia. Many persons are still “homophobic”—and
“phobic” as well of Catholics, Jews, Muslims, and atheists,
among others—but they have no power to deprive the persons they
fear and hate of liberty. Turing was the victim of medical doctors
who declared male homosexuals ill and declared torturing them a form
of humane “medical treatment.”
Freeman, Volume: 60•Issue:2
Shame of Medicine:
The Case of General Edwin Walker
by Thomas Szasz
Freeman, Volume: 59 Issue: 8
1962 James Meredith, an African-American student, tried to enroll at
the University of Mississippi. His admission was opposed by Ross Barnett,
the Democratic governor of the state, former Major General Edwin A.
Walker (19091993), a decorated hero of World War II and prominent
right-winger, and a group of segregationist white students.
To ensure Merediths enrollment and maintain order, President John
F. Kennedy sent 400 federal marshals and 3,000 troops to Oxford, Mississippi.
September 29, 1962, Walker issued a public statement: This is
Edwin A. Walker. I am in Mississippi beside Governor Ross Barnett. I
call for a national protest against the conspiracy from within. Rally
to the cause of freedom in righteous indignation, violent vocal protest,
and bitter silence under the flag of Mississippi at the use of Federal
troops. . . .
campus demonstration led to a riot in which two people were killed and
six federal marshals were injured. Importantly, according to a United
Press report, During a lull in the rioting, General Walker mounted
a Confederate statue on the campus and begged the students to cease
their violence. . . . His plea was greeted with one massive jeer.
at the time and forgotten today is the fact that while the federal government
used the military to guarantee Merediths constitutional right
to equal protection of the laws, it used psychiatry to deprive Walker
of his constitutional right to trial. This was another example of my
long-held view that we are replacing social controls justified by race
with social controls justified by psychiatric diagnosis.
on four federal charges, including inciting, assisting, and engaging
in an insurrection against the authority of the United States,
Walker was taken before a U.S. commissioner and held pending the posting
of $100,000 bond. While he was making arrangements to post bail, Attorney
General Robert Kennedy ordered Walker flown, on a government aircraft,
to Springfield, Missouri, to be incarcerated in the U.S. Medical Center
for Prisoners for psychiatric observation on suspicion that
he was mentally unfit to stand trial.
entry in Wikipedia mentions neither this nor the ensuing confrontation
between Walkers legal team and the governments psychiatric
team. The reader is told only that Walker posted bond and returned
home to Dallas, where he was greeted by a crowd of 200 supporters. After
a federal grand jury adjourned in January 1963 without indicting him,
the charges were dropped.
could this happen? Was it legal? It was legal, and in Psychiatric Justice
(1965) I presented a detailed, documented account of how it happened.
Here I wish to add a few personal details not previously reported.
of Walkers psychiatric incarceration had barely hit the newspapers
when I received a telephone call from Robert Morris, then president
of the University of Dallas, formerly chief counsel to the Senate Judiciary
Subcommittee on Internal Security. He identified himself as one of Walkers
attorneys, explained he had been given my name by William F. Buckley,
Jr., and asked me to help his team to free Walker from psychiatric imprisonment.
flew to Dallas and spent a long afternoon and evening with Morris and
his team of lawyers. They believed it was obvious that Walker was sane.
They wanted me to examine him and say so in court. It was not easy to
disabuse them of their conventional beliefs about mental illness as
a medical disease and psychiatry as a medical specialty. I summarized
the evidence for my view that psychiatry is a threat to civil liberties,
especially to the liberties of individuals stigmatized as right-wingers,
illustrated by the famous case of Ezra Pound, who was locked up for
13 years while the government ostensibly waited for his doctors
to restore his competence to stand trial. Now the Kennedys and their
psychiatrists were in the process of doing the same thing to Walker.
reminded the attorneys that a courtroom confrontation concerning his
sanity would not be a search for truth or justice (which
they well understood), and noted that they were on the losing side of
the civil rights battle (which they well knew). I urged them to avoid
unnecessary dramatics and focus on freeing Walker from psychiatric detention
as their sole goal. Finally, I persuaded them that in a Mississippi
courtroom, Iwith a foreign name and a foreign accentwould
not be the best possible expert for Walker and talked them out of their
plan to have me examine him and engage in a contest of expert
opinions about the predictably dire diagnoses of the governments
psychiatric experts. Instead, I proposed that they nominate
a prominent Dallas university psychiatrist as their defense expertthat
is, a local, publicly employed physician who could ill afford to declare
Walker insane on the basis of his racist views. (Before
the Civil War, proslavery physicians in the South diagnosed black slaves
who tried to escape to the North as mentally ill, suffering from
drapetomania. In the Walker case, pro-integration psychiatrists
in the North diagnosed white segregationists as mentally ill, suffering
from racism.) Next morning I flew back to Syracuse.
Whose Own Good?
competency hearing was scheduled. Dr. Robert L. Stubblefield, chief
psychiatrist at the Southwest Medical Center in Dallas, was to examine
Walker and testify in his defense. The prosecutions expert was
Dr. Manfred Guttmacher, long-time chief medical officer at Baltimore
Citys Supreme Court. Walkers attorneys had no trouble exposing
Guttmacher for the evil quack he was. Guttmacher kept referring to Walker
as if Walker were his patient and supported the prosecutions request
that Walker be incarcerated (hospitalized) for up to three
months, testifying under oath that doing so would be for Mr. Walkers
own good from a medical point of view.
the end, the governments psychiatric plot failed. Walker was declared
mentally fit to stand trial, a federal grand jury refused to indict
him, and the charges against him were dropped.
than two years later, my view that organized American psychiatry was
becoming overtly political, seeking the existential invalidation and
psychiatric destruction of individuals who do not share the psychiatric
establishments left-liberal progressive views, received
further dramatic support. In 1964, when Senator Barry Goldwater was
the Republican candidate for president, 1,189 psychiatrists publicly
declaredwithout benefit of examinationthat Goldwater was
psychologically unfit to be President of the United States.
Many offered a diagnosis of paranoid schizophrenia as the
basis for their judgment.
is despotism in the service of the Therapeutic State, rationalized as
progressive science and compassionate medical
care. In the past, racial stigmatization and segregation were indispensable
for the political class and the State. Today, psychiatric stigmatization
and segregation are indispensable for the political class and the State.
This is why no exposure of brutal psychiatric injustices makes a dent
in the mental health systems lofty social status as a benevolent,
ethical, scientific medical discipline.
Freeman, Volume: 59 Issue: 8
The Shame of Medicine
by Thomas Szasz
Freeman, 59: 12-13 (March), 2009
practice of medicine rests on cooperation and the ethical-legal premise
that treatment is justified by the patient’s consent, not his
illness. In contrast, the practice of psychiatry rests on coercion and
the ethical-legal premise that treatment is justified by the mental
illness attributed to the patient and must be “provided”
regardless of whether the patient consents or not. How do physicians,
medical ethicists, and the legal system reconcile the routine use of
involuntary psychiatric interventions with the basic moral rule of medicine,
“Primum non nocere,” a Latin phrase meaning “First
do no harm”?
answer is: by the medicalization of conflict as disease, and coercion
as treatment. Carl Wernicke (1848-1905), one of founders of modern neuropathology,
observed, “The medical treatment of [mental] patients began with
the infringement of their personal freedom.” Today, it is psychiatric
heresy to note, much less emphasize, that psychiatry-as-coercion is
an arm of the punitive apparatus of the state. Absent the coercive promise
and power of mental health laws, psychiatry as we know it would disappear.
since its beginning approximately 300 years ago, psychiatry’s
basic function has been the restraint and punishment of troublesome
individuals justified as hospitalization and medical care. For two centuries,
all psychiatry was involuntary psychiatry. A little more than 100 years
ago individuals began to seek psychiatric help for their own problems.
As a result, the psychiatrist became a full-fledged double agent and
psychiatry a trap. The film “Changeling”--written by J.
Michael Straczynski and directed by Clint Eastwood--is a current example.
story, set in Los Angeles in 1928, is said to be the “true story”
of a woman, Christine Collins, whose son, Walter, is kidnapped. The
police are corrupt, and little effort is made to find Walter. Months
pass. To repair its damaged image, the police decide to stage a reunion
between an abandoned youngster pretending to be Walter and his mother,
played by Angelina Jolie. Unsurprisingly, she realizes that the fake
Walter is not her son. After confronting the police and city authorities,
she is vilified as an unfit mother, branded delusional, and incarcerated
in a “psychopathic ward,” where she is subjected to the
brutalities of sadistic psychiatrists and nurses, and watches fellow
victims being punished by electric shock treatment--ten years before
its invention. So much for the truth of the story.
about the true nature of the psychiatric terrorization to which the
Jolie character is subjected, film critic Kirk Honeycutt praises Clint
Eastwood who “again brilliantly portrays the struggle of the outsider
against a fraudulent system. . . . ‘Changeling’ brushes
away the romantic notion of a more innocent time to reveal a Los Angeles
circa 1928 awash in corruption and steeped in a culture that treats
women as hysterical and unreliable beings when they challenge male wisdom.’”
Jolie character does not simply challenge “male wisdom.”
Instead, her actions illustrate the insight of the Hungarian proverb,
“It is dangerous to be wrong but fatal to be right.” The
psychiatrist as brutal agent of the state enters the story only after
the mother proves--by securing the testimony of her son’s teacher
and dentist--that “Walter” is an impostor. The psychiatrically
incarcerated individual’s greatest crime--for which psychiatrists
cannot forgive her--is that she is innocent of lawbreaking and objects
to being deprived of liberty.
Psychiatric coercion is medicalized terrorism. So-called critics of
psychiatry--who often fail or refuse to distinguish coerced from contractual
psychiatry--are unable or unwilling to acknowledge this disturbing truth.
As a result, the more things change in psychiatry, the more they remain
the same, as the following conveniently forgotten example illustrates.
May 21, 1839, Elizabeth Parsons Ware (1816-1897) married the Reverend
Theophilus Packard. The couple and their six children resided in Kankakee
County, Illinois. After years of marriage, Mrs. Packard began to question
her husband's religious and pro-slavery beliefs and express opinions
contrary to his. In 1860 Mr. Packard decided that his wife was insane
and proceeded to have her committed. She learned of this decision on
June 18, 1860, when the county sheriff arrived at the Packard home to
take her into custody. The law at the time stated that married women
“may be entered or detained in the hospital [the Jacksonville
State Insane Asylum] at the request of the husband of the woman or the
guardian . . . without the evidence of insanity required in other cases.”
Packard spent the next three years in the Asylum. In 1863, due largely
to pressure from her children who wished her released, the doctors declared
her incurable and released her. Mrs. Packard stayed close to her children,
retained their support, founded the Anti-Insane Asylum Society, and
published several books, including Marital Power Exemplified, or Three
Years Imprisonment for Religious Belief (1864) and The Prisoners’
Hidden Life, Or Insane Asylums Unveiled (1868).
Beginning, Not the End
Little did Mrs. Packard realize that she was living at the beginning,
not the end, of the Psychiatric Inquisition. Today, “inquiry”
into the minds of unwanted others is a pseudoscientific racket supported
by the therapeutic state. Millions of school children, old people in
nursing homes, and persons detained in prisons are persecuted with psychiatric
diagnoses and punished with psychiatric treatments. Nor is that all.
Untold numbers of Americans are now psychiatric parolees, sentenced
by judges--playing doctors--to submit to psychiatric treatment as so-called
outpatients, or face incarceration and forced treatment as inpatients.
subtext of films such as “Changeling” is always subtle psychiatric
propaganda seeking to make people believe they are witnessing past “psychiatric
abuses.” The truth is that every new psychiatric policy or practice
labeled an “advance” is a step toward making psychiatric
deception and brutalization more legal and more difficult for the victim
I write this column, I learn from an “antipsychiatry” website
that a man named Ray Sandford is being subjected to court-ordered outpatient
and every Wednesday, early in the morning, staff shows up at Ray’s
sheltered living home called Victory House in Columbia Heights, Minnesota,
adjacent to Minneapolis. Staff escorts Ray the 15 miles to Mercy Hospital.
There, Ray is given another of his weekly electroconvulsive therapy
(ECT) treatments, also known as electroshock. All against his will.
On an outpatient basis. And it’s been going on for months.”
the forced psychiatric treatment of competent adults living in their
own homes becomes the “standard of medical practice,” the
failure to provide such betrayal and brutality becomes medical malpractice.
In a democracy people are said to get the kind of government they deserve.
In a pharmacracy they get the kind of psychiatry they deserve.
by Thomas Szasz
23: 27-28 (March), 2009.
"The Changeling," the recent Clint Eastwood movie, reveals
the perversity of a system in which it is virtually impossible to prove
ones sanity, writes Jo Ann Skousen (Liberty, Jan.-Feb. 2009).
This statement completely misses or avoids the point about the problem
psychiatric incarceration poses for many libertarians.
To begin, the term insanity refers to a judgement, not a
phenomenon or illness or fact. In The Changeling, the Angelina
Jolie character, has no trouble proving to her sons dentist and
teacher that the boy impersonating the child is not her son. She has
trouble proving it to the police and the psychiatric system. Why? Because
they are corrupt and destructive, each having its own fish to fry. The
polices fish is staging a publicity stunt to enhance its soiled
image. Psychiatrys fish is convincing the world and itself that
the lie that insanity is an objectively identifiable illness like
any other is true.
When psychiatrists categorize (diagnose) an unwanted individual
as mentally ill or insane, they do not describe
or identify a disease, they delegitimize a person or behavior--formerly
homosexuality, now substance abuse. However, our culture and laws authenticate
psychiatrists as bona fide medical doctors and define the conditions
they call mental illnesses as diseases on a par with cancer
and diabetes. At the same time, psychiatrists continue to incarcerate
mentally sick persons and possess the power to compel patients
to submit to unwanted invasions of their bodies with toxic chemicals
and electrically induced grand mal seizures.
How do friends of freedom deal with the conflict between elementary
libertarian principles and prevailing psychiatric practices? This is
the question I addressed and answered in my book "Faith in Freedom:
Libertarian Principles and Psychiatric Practices" (2004). The distinguishing
feature of the libertarian philosophy of freedom is the belief that
self-ownership is a basic right and initiating violence is a fundamental
wrong. In contrast, psychiatric practice is based on the belief that
self-ownership-- epitomized by suicide--is a medical wrong and that
initiating violence against persons called mental patients
is a medical right.
Are self-medication and self-determined death exercises of rightful
self-ownership, or manifestations of mental diseases requiring deprivation
of liberty? Does deprivation of liberty under psychiatric auspices constitute
odious preventive detention, or is it beneficial, therapeutically justified
hospitalization? Should forced psychiatric drugging be interpreted as
assault and battery or medical treatment?
These questions point to delicate, embarrassing, uncomfortable human
dilemmas that most people prefer to avoid. Although "Faith in Freedom"
received glowing prepublication endorsements from several prominent
libertarian scholars, neither Liberty nor Reason reviewed it.
Skousen describes the Jolie charactes psychiatric imprisonment
as follows: When she complains to the police and begs them to
continue the search [for her kidnapped son], the police chief has her
committed. Skousen realizes that there is a problem here that
stares us in the face and yet we do not want to look at:
Its a frightening issue, one that hasnt gone away: many
states have the equivalent of Floridas Baker Act, under which
a person can be committed to 30 days in a mental institution without
recourse, if a psychologist [sic, not psychiatrist] deems the person
dangerous to himself or others. (And when the psychologist is employed
by the police department, its pretty easy to predict whether the
detainee will be so deemed. My own daughter came frighteningly close
to being Bakered when she was 17, so I know how quickly it can happen.)
Nevertheless, Skousen avoids a more serious moral engagement with the
routine use of psychiatric coercions (and excuses) in the United States.
She is not alone.
Deirdre McCloskey--the Tinbergen Distinguished Professor at Erasmus
University in Rotterdam--is an internationally recognized economic historian,
teacher, and writer. In addition to numerous works on economics, she
is the author of "Crossing: A Memoir" (1999), an autobiographical
account of her journey from Donald to Deirdre McCloskey. What makes
McCloskeys "Memoir" of particular interest and importance
is that she is, to my knowledge, the only prominent libertarian who
has been personally violated by psychiatrists: she was hospitalized--twice--because
she suffered from a dread disease called transsexualism.
If not for her professional and social status, good attorney, and financial
ability to fight the Chicago psychiatric machine, McCloskey might still
be languishing in some Illinois state mental hospital. And she, too,
probably wisely, chose to not engage the psychiatric Leviathan.
In a review of "Crossing" in the New York Times, the poet
and writer Maxine Kumin attributes McCloskeys ordeal in part to
mistakes by poor psychiatrists:
His sister and one of her academic colleagues played a sinister role
in trying to thwart him. They conspired to have him committed as mentally
incompetent--unfit to sign papers for optional surgical procedures.
. . . Twice during his determined journey into womanhood, they managed
to have him incarcerated--handcuffed, locked away where he could not
harm himself, at first in the University of Iowa Hospital's mental ward
and later in the University of Chicago Hospital--to await evaluations
by psychiatrists whose knowledge of his situation was less than rudimentary.
The shrinks he had the misfortune to encounter seemed still to be operating
at a pre60's level.
The truth is that the psychiatrists McCloskey encountered were among
the leaders of the profession. In Iowa, McCloskeys psychiatrists
were Raymond Crowe, Professor of Psychiatry, an expert on Genetics and
Developmental Neurobiology, a seasoned, well-funded researcher;
and Robert Robinson, Professor and Chairman of the Department of Psychiatry,
a recognized researcher in neuropsychiatry, and former Chairman of the
Neurosciences Review Committee, National Institute of Mental Health.
In Chicago, McCloskeys psychiatrist was Fred Ovsiew, a Member
of the American Psychoanalytic Association, Associate Professor of Clinical
Psychiatry at the University of Chicago, and director of its Inpatient
Psychiatric Unit. These men cannot be dismissed in the way Kumin dismisses
them. The fact that she assumes the doctors who abused McCloskey were
bungling psychiatric troglodytes speaks for itself.
Revealing her inability to see past the psychiatric rhetoric to the
psychiatric slavery it conceals, Kumin remarks, Gender crossers
are still waiting for the gender identity disorder to be removed from
the list of mental illnesses. After their experiences with the
mental health system, I would expect at least some gender crossers to
scoff at psychiatric diagnoses and not care what unpopular behaviors
psychiatrists classify as diseases. During my own lifetime, psychiatrists
have removed masturbation, fellatio, cunnilingus, and homosexuality
from the list of mental illnesses, yet managed to triple and quadruple
the number of disorders listed in the American Psychiatric Association=s
(APA) "Diagnostic and Statistical Manual," adding, for example,
caffeinism, nicotinism, dysmorphobia, and pathological gambling.
The legitimacy of psychiatry rests entirely on its being a branch of
medicine. It has no legitimacy as a quasi-theological system allied
with the state for the forcible resolution of family conflicts and social
problems. Sadly, there is, in modern society, no legitimate space for
thinking and speaking clearly about psychiatry. Even emphasizing the
differences between consensual psychiatric practices helping patients
and coercive psychiatric practices harming them is now anathema.
The practices of psychiatric slavery are deeply embedded in our society.
Even an account as fine as "Crossing," written by so eminent
a witness as Deirdre McCloskey, makes no impact on the unquestioning
approval of this peculiar institution by bioethicists, journalists,
writers--and many libertarians.
Therapeutic State ~
Mendacity by Metaphor
by Thomas Szasz
58 No. 8
upon a time, law-abiding citizens acknowledged that they wanted lawbreakers
punished. They did not say the offenders “needed” punishment.
When they used the term “need” metaphorically—as when
an outlaw in a bar told his buddies that one of their adversaries “needed”
killing—they knew what they were talking about. They did not lie
to themselves, nor did they deceive others. This is no longer true.
In our society soaked in psychiatry, we systematically use the term
“need” metaphorically, to lie to ourselves and to deceive
others. Here is an example.
In February 2008 David Tarloff—a career “schizophrenic”—is
released from a type of prison we call “hospital.” Ten days
later he kills a psychologist who shares offices with a psychiatrist
whom Tarloff holds responsible for depriving him of liberty. In June
the New York Times reports: “A lawyer for a schizophrenic man
accused of killing an Upper East Side psychotherapist tried three times
on Tuesday morning to persuade his client to leave his holding cell
for a hearing.” The lawyer was unsuccessful. Tarloff was not interested
in being cooperative. He was interested in his life situation as he
saw (constructed) it. Of course there is nothing new about defendants—especially
defendants charged with a capital crime—not cooperating with the
judicial system. What is new about it is the way the medical-judicial
system now deals with such a person. According to the Times,
The hearing, held in a small courtroom at Bellevue,
was held to decide whether doctors could force Mr. Tarloff to take his
medication. . . . Justice John E. H. Stackhouse of State Supreme Court
in Manhattan granted the hospital’s request. . . . Ronald L. Kuby,
a defense lawyer, said medication was too often used to create a false
sense of sanity. “When the jury sees your client sitting there
calmly, peacefully, sort of blankly staring, that person then looks
sane,” Mr. Kuby said. “But that’s a chemically induced
stability designed to make the judicial railroad function.” .
. . “When somebody is in need of medication,” Mr. Konoski
[Tarloff’s principal attorney] said, “forcing them not to
have it, forcing them to deal with their demons instead of being able
to suppress them through the medication, that’s almost like torture.”
Voilà: The defendant who refuses to ingest a chemical straitjacket has
a medical need for the drug. Acceding to the defendant’s wish
to not be chemically restrained is torturing him. Only in the age of
psychiatry could people believe such brazen lies.
I was a trained physician and psychoanalyst before the advent of the
class of chemicals we call “psychiatric drugs.” I well remember
watching—1954 or 1955, when I was serving my required military
tour of duty at the National Naval Medical Center in Bethesda, Maryland—what
must have been one of the first films promoting chlorpromazine, patented
in the United States as Thorazine. The film showed monkeys, rendered
irritable and aggressive by starvation and crowding, being injected
with the drug and becoming “tranquilized.” The term was
new then. This, we were told, was the new cure for schizophrenia. I
did not like what I saw and immediately wrote the following: “The
widespread acceptance and use of the so-called tranquilizing drugs constitutes
one of the most noteworthy events in the recent history of psychiatry.
. . . These drugs, in essence, function as chemical straitjackets. .
. . When patients had to be restrained by the use of force—for
example, by a straitjacket—it was difficult for those in charge
of their care to convince themselves that they were acting altogether
on behalf of the patient. . . . Restraint by chemical means does not
make [the psychiatrist] feel guilty; herein lies the danger to the patient.”
This, then, was the glorious—but unacknowledged and unacknowledgeable—psychopharmacological
breakthrough: Restraint could be put in the patient instead of on him
and be defined as “drug treatment” (of and for the patient).
It was obvious from the start that neuroleptic drugs benefit psychiatrists,
not patients. Psychiatrists deal with this predictable result by attributing
it to a newly invented mental¬-brain disease they call “anosognosia.”
In 1931 Robert Frost (1874–1963) delivered a lecture at Amherst
College with the unexciting title “Education by Poetry.”
It is a profound meditation on, and warning about, uses and abuses of
metaphor. Long before I “discovered” the vast errors hidden
from us by the metaphor of mental illness, Frost wrote:
Health is another good word. And that is the metaphor
Freudianism trades on, mental health. And the first thing we know, it
has us all in up to the top knot. . . . What I am pointing out is that
unless you are at home in the metaphor, unless you have had your proper
poetical education in the metaphor, you are not safe anywhere. Because
you are not at ease with figurative values: you don’t know the
metaphor in its strength and its weakness. You don’t know how
far you may expect to ride it and when it may break down with you. You
are not safe with science; you are not safe in history. . . . They don’t
know what they may safely like in the libraries and galleries. They
don’t know how to judge an editorial when they see one. They don’t
know how to judge a political campaign. They don’t know when they
are being fooled by a metaphor, an analogy, a parable. And metaphor
is, of course, what we are talking about. Education by poetry is education
Paraphrasing that phrase, I suggest that education by psychiatry is
education by and with mendacity, a thesis I have maintained for more
than half a century.
Recent reports in the press exposed Dr. Joseph Biederman, professor
of psychiatry at Harvard Medical School, and his collaborators of failing
to report “at least $3.2 million dollars they had received from
drug companies between 2000 and 2007,” violating federal and university
research rules designed to police potential conflicts of interest.
Biederman is said to be “one of the most influential researchers
in child psychiatry, whose work has helped to fuel a controversial 40-fold
increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder,
characterized by severe mood swings, and a rapid rise in the use of
antipsychotic medicines in children.”
He is confident that the children whose behavior displeases their mothers
suffer from a brain disease that requires pharmacological treatment.
But is drugging children allegedly suffering from “pediatric bipolar
disease” analogous to vaccinating them against smallpox, as Biederman
suggests? Never mind that antipsychotic drugs are promoted as therapeutic
agents, not as prophylactics. Never mind that press reports routinely
refer to antipsychotic drugs as subduing involuntary subjects. And never
mind that the modern psychiatrists’ favorite “patients”
are persons who are powerless to resist being cast in that role: children,
prisoners, and old people in nursing homes.
If you are ignorant of metaphor, warned Frost, “You are not safe
with science; you are not safe in history . . . in the libraries and
galleries.” You are certainly not safe if you believe that psychiatrists
care for and cure sick people, when in fact they coerce and control
persons helpless to resist their violence.
Is Not Anti-Psychiatry
by Thomas Szasz
Freeman, 58: 26-27 (May, 2008)
The term "anti-psychiatry"
was created in 1967 by the South African psychiatrist, David Cooper
(1931-1986) and the Scottish psychiatrist Ronald David Laing (1927-1989).
Instead of defining the term, they identified it as follows: "We
have had many pipe-dreams about the ideal psychiatric, or rather anti-psychiatric,
community." The "we" were Cooper, Laing, Joseph Berke, and Leon
Redler, the latter two American psychiatrists and pupils of Laing.
"A key understanding of 'anti-psychiatry,'" explains British existential
therapist Digby Tantam, "is that mental illness is a myth (Szasz 1972)."
Alas, this is not true. While many antipsychiatrists pay lip service
to rejecting the "medical model" of psychiatry, they continue to conceptualize
certain human problems and efforts to resolve them in medical terms
and, even more importantly, do not categorically reject "therapeutic"
coercion and excuse-making.
Psychiatrists engage in many phony practices but none phonier than
the insanity defense. The antipsychiatrists have not addressed this
subject in their writings but Laing gave "expert psychiatric testimony"
in the famous case of John Thomson Stonehouse (1925-1988). Stonehouse,
a British politician and Labour minister, went into business, lost
money, and tried to bail himself out by engaging in fraud. When the
authorities were about to arrest him, he staged his own suicide. On
November 20, 1974, Stonehouse left a pile of clothes on a Miami beach
and disappeared. Presumed dead, he was en route to Australia, hoping
to set up a new life with his mistress. Discovered by chance in Melbourne,
he was deported to the UK and charged with 21 counts of fraud, theft,
forgery, conspiracy to defraud, and causing a false police investigation.
Stonehouse pleaded not guilty by reason of insanity, was convicted
and sentenced to seven years in prison. To support his insanity defense,
he secured the services of five psychiatrists, R. D. Laing among them,
to testify in court, under oath, that he was insane when he committed
his criminal acts. In his book, My Trial, Stonehouse writes: "Dr.
Ronald Laing ...gave evidence on my mental condition. He confirmed
... that in his report he had called it psychotic and the splitting
of the personality into or multiple pieces. He went on: 'The conflict
is dealt with by this splitting instead of dealing with it openly.
... It was partial reactive psychosis.'"
Laing did not know Stonehouse prior to his trial, hence could have
had no knowledge of his "mental condition" during the commission of
his crimes. Laing's "diagnosis" was classic psychiatric gobbledygook,
precisely the kind of charlatanry he pretended to oppose. Laing and
Stonehouse were both liars, plain and simple.
Laing's fame was closely connected with his role as Emperor of Kingsley
Hall, a "household" founded by him and by a group of his acolytes.
It was promoted as a place to which a person -- whom psychiatrists
would diagnose as schizophrenic -- could retreat, secure in the knowledge
that he would be neither coerced nor drugged. Day to day life in Kingsley
Hall was based on the fiction that all the "residents" are equal,
no one is a patients and no one is staff. The American psychiatrist
Morton Schatzman, who had chosen to live at Kingsley Hall for a year,
emphasized that "No one who lives at Kingsley Hall sees those who
perform work upon the external material world as 'staff,' and those
who do not as ‘patients.'" This is the lie that characterizes
antipsychiatry, much as the lie that deprivation of liberty is care
not coercion characterizes psychiatry.
The American writer Clancy Sigal (born 1926) went to London to be
Laing's patient. Soon, the "therapy" ended and they became friends
and LSD-using buddies. Sigal, one of the co-founders of Kingsley Hall,
eventually became disenchanted with the Laingian commune, especially
after he discovered that Laing and his cohorts preached nonviolence
but practiced violence.
After returning to the United States, Sigal wrote a devastating exposé
of Laing and his cult. Zone of the Interior, a roman a clef, was published
in the United States in 1976. Using the threat of British libel laws,
Laing prevented its publication in the United Kingdom. Only in 2005
did Zone of the Interior appear in a British edition. Sigal writes:
"In September 1965, during the Jewish High Holidays, I had a 'schizophrenic
breakdown' ... or transformative moment of rebirth. It's all in your
point of view. My ´breakdown' did not happen privately but acted
out in front of twenty or thirty people on a Friday shabbat night
at Kingsley Hall.... The notion behind Kingsley Hall was that psychosis
is not an illness but a state of trance to be valued as a healing
In an interview after the publication of Zone of the Interior in the
UK, Sigal described his folie a deux with Laing:
We began exchanging roles, he the patient and I the therapist,
and took LSD together ... Laing and I had sealed a devil's bargain.
Although we set out to 'cure' schizophrenia, we became schizophrenic
in our attitudes to ourselves and to the outside world. ... [One]
night, after I left Kingsley Hall, several of the doctors, who persuaded
themselves that I was suicidal, piled into two cars, sped to my apartment,
broke in, and jammed me with needles full of Largactil [Thorazine],
a fast-acting sedative used by conventional doctors in mental wards.
Led by Laing, they dragged me back to Kingsley Hall.... The last thing
I remember saying was, "You bastards don't know what you're doing."
Sigal escaped from Kingsley Hall, returned to the United States, and,
in 1975, published Zone Of The Interior. Publication in Britain was
stopped by Laing's threat of libel action. The Sigal saga ought to
be the last nail in the coffin of the legend of Laing as a psychiatrist
opposed to the practice of psychiatric coercion.
Had Sigal's book been published in Britain in 1976, Laing would have
been exposed and perhaps punished as a criminal (for assault and battery),
Kingsley Hall might have been shut down (as an unlicensed mental hospital),
and the legend of Laing the "savior of the schizophrenic" would have
been cut short. Shakespeare was right: "The evil that men do lives
The End of the Kingsley Hall Chaos
The chaos at Kingsley Hall endured for less than five years. The inhabitants
left the place "derelict and uninhabitable." Unfortunately, the imbecilic
term "antipsychiatry" survived, even though, ironically, Cooper and
Laing knew full well that it was mischievous and misleading. In an
interview toward the end of his life, Laing recalled having said to
Cooper: "'David, it is a fucking disaster to put out this term.'
But he'd a devilish side that thought it would just serve them all
right and confuse them. So let's just fuck them with it."
As a result of the antipsychiatrists's self-seeking sloganeering,
psychiatrists can now do what no other members of a medical specialty
can do: they can dismiss critics of any aspect of accepted psychiatric
practice by labeling them "antipsychiatrists." The obstetrician who
eschews abortion on demand is not stigmatized as an "antiobstetrician."
The surgeon who eschews transsexual operations is not dismissed as
an "antisurgeon." But the psychiatrist who eschews coercion and excuse-making
is called an "antipsychiatrist." The upshot is that every physician
-- except the psychiatrist -- is free to elect not to perform particular
procedures that offend his moral principles or procedures he simply
prefers not to perform.
Why is the psychiatrist de facto deprived of this freedom? Because
in psychiatry the paradigmatic practice -- coercing patients deemed
to be dangerous to themselves or others, called "civil commitment"
-- is the medico-legal "standard of care." Deviation from that standard
invites malpractice litigation and exposes the "deviant" psychiatrist
to forfeiture of his medical license.
Book review by Andrew Scull:
"Untruly Madly Deeply"
in The TLS, January 19, 2007
"MY MADNESS SAVED ME".
The madness and marriage of Virginia Woolf.
By Thomas Szasz
might be tempted to call Thomas Szasz the enfant terrible of modern
psychiatry, save for the fact that he is now eighty-six years of age:
obviously, enfant no longer applies. For years, Szasz was a Professor
of Psychiatry at the State University of New York Upstate Medical Center
at Syracuse. And yet, from 1961 onwards, he consistently proclaimed
that mental illness, the presumed object of the psychiatrist's attentions,
was a myth -a myth created and nurtured by self-interested professionals
acting as agents of social control, either on behalf of families or,
more sinisterly, the leviathan State. Disease was a predicate of bodies,
and "mental illness", having no demonstrable biological cause, could
only be metaphorically and mendaciously classified as a medical matter.
So far from being disinterested therapists seeking to assist and cure
their patients, psychiatrists were bad-faith con artists in the business
of oppressing their patients, stigmatizing them, damaging them with
drugs and electric shocks, depriving them of their liberty and their
basic human rights. Such false experts, who were no better than concentration-camp
guards, served routinely as agents of dehumanization and destruction.
patients were generally their victims, but the patients themselves might
also appear in different guises: as actors consciously or unconsciously
playing a role they had created for themselves, exploiting the category
of mental illness to obtain absolution from punishment for their crimes
and delinquencies; or using their mythical madness as a weapon with
which to disrupt and confuse those around them, all the while escaping
responsibility for their actions.
In "My Madness Saved Me", Thomas Szasz now takes his ideas in a literary
direction. He seeks to recast the accepted view of the life and death
of Virginia Woolf. He acknowledges that "Virginia's family, friends,
colleagues, and psychiatrists regarded her as having been mad all of
her life", and that this was "a view that, for the most part, she shared".
Succeeding generations have largely echoed these judgements (though
some critics have embraced a variant position, holding that Virginia
was a disturbed woman further victimized by her male psychiatrists,
her husband, or both). It is a consensus Szasz rejects: "My aim in this
study is radically different. I propose to examine how Virginia Woolf,
as well as her husband Leonard, used the concept of madness and the
profession of psychiatry to manage and manipulate their own and each
other's lives". Virginia was, he insists, no victim, but "an active,
goal-directed . . . intelligent and self-assertive person, a moral agent
who used mental illness, psychiatry, and her husband to fashion for
herself a life of her own choosing". It was not a life or a set of choices
that Szasz always finds particularly edifying or worthy of praise, but
he insists that it was her life, one for which she should be held responsible.
too, "used madness and psychiatry like an expert. He used it to deny
and cover up the phoniness of his marriage, to control Virginia, and
to avoid military service in World War ...". Virginia first became depressed
at the age of thirteen, following the death of her mother. Her nephew,
Quentin Bell, called this a "(nervous) breakdown".
denounces such an interpretation as "obtuse", but acknowledges that
it was one Virginia "never made a serious attempt to (reject). On the
contrary, she embraced the role (of mental patient) and made playing
it an integral part of her life strategy -to her profit as well as her
peril". Nine years later, her father, Leslie Stephen, the great man
of letters, to whom she was deeply attached, died of cancer after a
long illness, and once more she was grief-stricken, on one occasion
jumping from a window so close to the ground that she sustained no injury
-an action her family interpreted as a suicide attempt and as new evidence
of her susceptibility to insanity. Szasz insists that it was nothing
of the sort.
was "an uneducated, unhappy, confused adolescent (actually she was by
now twenty-two years of age) . . . faced with an empty and useless life,
terrified by the challenges of sex and adulthood", and her behaviour
was nothing more or less than "a non-verbal dramatization of her dilemma
if, in these years, mental illness was a label imposed on young Virginia,
then, as she grew to maturity, Szasz alleges, she came to use it as
both an excuse and a weapon. "Woolf students assume that Virginia had
no part in being identified as mad. This is not true. She played an
important part in being identified as a mental patient and she deliberately
exploited that role for her own purposes." Indeed, the more accurate
way to describe what happened is that she became "a user of madness-and-psychiatry
and a victimizer of her husband and those close to her. Hence the legend
of Virginia Woolf the mad genius".
notoriously fall under the spell of their subjects. Not Szasz. It becomes
clear in the course of his brief survey that he finds little to like
in both Virginia and Leonard Woolf, and much to loathe. About Virginia's
fiction, he has little of substance to say; about the lives and attitudes
of the couple, he is scathing and unsparing. Leonard is presented as
a snob and a social climber, a physically unattractive man consumed
with hatred and fury, who sought to marry up into the Stephen family,
only settling on Virginia when his first choice, her sister, Vanessa,
refused to have him. Autocratic and self-centred, and incapable of understanding
another human being, let alone someone as psychologically complex as
Virginia, he was a man of neither wealth nor personal distinction. Besides,
he was Jewish -a seemingly fatal flaw given that the spouse he sought
was an anti-Semite who viewed his Jewishness as "alien, alienating,
was -and for the arch-individualist and libertarian Szasz, it is hard
to conceive of a worse term of abuse -"at heart a social worker". Like
his wife, he was a twentieth- century Mrs Jellyby, "full of love for
mankind in the abstract . . . domineering, nasty, and snobbish (in daily
despite her attractive appearance, is portrayed as an equally unattractive
human being. Desperate to occupy the social role of married woman, she
chose a social inferior so she could marry on her own terms. Those terms
included a bar to physical intimacy, since intimacy of all sorts, and
heterosexual intimacy in particular, repelled her. Her future husband
revolted her, and she spent her married life chronically angry with
him. Her anger spilled out in vitriolic abuse that was explained away
by all sides as another symptom of her madness. Mad she was, Szasz would
have it, but mad in the sense of furious -furious with the choices she
had made for herself and with the dysfunctional relationship she had
entered into. Her subliminal anger was, he judges, the reason that "the
theme of Virginia's 'giving pain'" to Leonard recurs throughout her
marriage". On Szasz's account, Virginia was a coward, a conformist,
self-deceitful, gutless, inauthentic, and lacking in moral seriousness,
to say nothing of "disdainful and nasty . . . toward hired help" in
a fashion worthy of the way -another revealing Szaszian comparison -"Soviet
apparatchiks related to members of the expendable lower orders".
Szasz argues, Virginia and Leonard were "masters at deception and selfdeception".
Their marriage was a sham, but each gladly occupied roles that obscured
this reality from self and others: "one as madwoman-wife-writer; the
other as nurse-husband-manager". And as for Virginia's suicide, stones
in pockets, wading into the river to drown, "I surmise that she killed
herself, and killed herself as she did, to enhance her fame . . . a
lonely, aging woman . . . she feared for her future and escaped it".
Madness Saved Me" is a thorough demolition job. The unattractive features
Szasz discerns are so many and varied that one can only wonder at the
continuing fascination Virginia and Leonard seem to hold for readers
and authors alike. Vile creatures both, by now they ought surely to
have been cast into oblivion. Except that adherents of the Bloomsbury
cult (and admirers of Virginia in particular) seem oblivious to the
mismatch between their idealized image of their heroine and her actual
behaviour and beliefs -it is enough, for them, that she was intermittently
a fine writer; that she can be claimed for the feminist cause; that
she came from a privileged background (and exploited that privilege
for all it was worth, while criticizing others who did the same); and
that she was a martyr, for martyrdom insulates from criticism and creates
acolytes, as the life and death of the late Princess of Wales vividly
remind us -and except that so much of Szasz's version of the Woolfs'
lives depends on one's acceptance of his view of mental illness as myth,
and on one's willingness to follow him in relentlessly interpreting
the pair's words and actions in the worst possible light.
is not one of the good doctor's strengths. Nor is subtlety. The contrast
between mental and physical illness is, for Szasz, stark and complete.
There is black; and there is white. There is real and wholly unambiguous
physical illness, which is bereft of any contamination by the social
and the cultural; and there is a mere simulacrum invented by a demonic
profession and swallowed by the credulous and muddled masses. That neither
physical nor mental disease matches his crude representations wholly
his portrait of the Woolfs and their marriage reveals, Szasz is no better
at capturing the complexities of individuals and their relationships.
The people and intimate relationships with which I am familiar -all
of them -are a mix of kindness and cruelty, honesty and illusion, truth
and deception, altruism and self-interest, happiness and misery, and
that remains the case even when the men and women one is considering
are comparatively sane. Individuals, even mad or thoroughly unpleasant
ones, cannot plausibly be reduced to one-dimensional caricatures, as
Szasz so readily renders the Woolfs here.
Virginia claims that she is happy with Leonard, except when mentally
ill, Szasz insists that her words "ring hollow". On the brink of suicide,
she "may have sensed that Leonard . . . was getting tired of her. Perhaps
she was getting tired of writing". No evidence is offered for either
claim.) She chooses to die by drowning as a means "of dramatizing herself
to the end", and as a way of inflicting yet more pain on the odious
Leonard. If she acknowledges her madness, she is deceiving herself,
her husband and us, or manipulating her audience for nefarious reasons
that the omniscient Dr Szasz can reveal to us. He knows better because
"in my view" (a phrase that recurs throughout) . . . well, because he
simply knows better.
Online, 7 Feb. 2007, Letters: 'My Madness'
Sir, - In his review of "My Madness Saved
Me" by Thomas Szasz (January 19), Andrew Scull suggests that Szasz compared
psychiatrists to "concentration camp guards". Szasz's favoured analogy
has always been with slave owners, who believed their charges to be
incapable of independent lives, thus providing the perfect excuse for
their "cruel compassion". This telling analogy explains why Szasz, in
his ninth decade, remains a radical figure, feted by "survivors" of
psychiatric slavery worldwide.However indirectly, Szasz has helped these
supposedly "mad" people to find their own voice. Woolf appeared to have
little difficulty in making her voice heard. "My Madness Saved Me" offers
an intriguing reading of what Virginia might have been "saying" during
her periods of "madness". Scull also neglected to acknowledge that a
quarter of Szasz's book is devoted to two appendices, which unpack the
feminists' adulation of Woolf and also the "myth" of the "mad genius":
the book is worth reading for these challenging pages alone. As a historian
of the asylum trades, one might have expected Scull to applaud Szasz
as the arch "deconstructor" of psychiatric slavery, and its insinuation
into literary appreciation. Rather than judging the Woolfs, Szasz respects
them as persons; acknowledging their agency, something which psychiatric
apologists (and many feminists) have denied, by genuflecting at the
altar of the "myth of mental illness".
Trinity College Dublin, D'Olier Street, Dublin.
A Branch of the Law,"
The Freeman, 56: 18-20 (December), 2006.
and law are independent but intimately interacting social institutions.
Medicine guards its autonomy jealously and relates to the legal system
as an equal partner. Psychiatry, in contrast, submits slavishly to being
dominated by the law and obediently meets its demands. Herewith some
July 3, 2006, Orin Guidry, M.D., president of the American Society of
Anesthesiologists, appealed to his colleagues to refuse to assist the
states in carrying out a death sentence by means of lethal injections.
"Lethal injection," Guidry reminded anesthesiologists, "was
not anesthesiology's idea. American society decided to have capital
punishment as part of our legal system and to carry it out with lethal
injection. The fact that problems are surfacing is not our dilemma.
The legal system has painted itself into this corner and it is not our
obligation to get it out."
American Medical Association's code of ethics, Guidry continued, declares:
"A physician, as a member of a profession dedicated to preserving
life when there is hope of doing so, should not be a participant in
a legally authorized execution." Guidry urged the Association's
37,000 members "not to attend executions of death sentences by
lethal injection, even if called to do so by a court. The court cannot
modify physicians ethical principles to meet its needs".
many, perhaps most, American anesthesiologists reject rescuing the criminal
justice system from the consequences of its decision to deprive certain
persons of life. Depriving persons of liberty is only one rung down
the ladder of harms that the state may legally inflict on certain individuals.
Nevertheless, most American psychiatrists feel it is their professional
privilege to assist the justice system in depriving certain individuals
of liberty; indeed, they insist that loss of liberty under psychiatric
auspices constitutes a form of medical treatment for the imprisoned
individuals. In fact, the assertion of this claim -- as medical "fact"
-- was the very first resolution enacted in 1844 by the newly formed
American Psychiatric Association (APA; then more descriptively named
the Association of Medical Superintendents of American Institutions
for the Insane): "Resolved, that it is the unanimous sense of this
convention that the attempt to abandon entirely the use of all means
of personal restraint is not sanctioned by the true interests of the
since, psychiatrists have clung to their privilege to imprison innocent
persons like drowning men cling to life-preservers.
psychiatrists never tire of asserting and reasserting their right to
deprive people of liberty. In 2005 Steven S. Sharfstein, president of
the APA, reiterated his and his profession's commitment to coercion:
"We must balance individual rights and freedom with policies aimed
at caring coercion." The term "caring coercion" would
have fitted perfectly into the Nazi lexicon, along with Arbeit macht
frei ( "labor liberates") and Gnadentot ("mercy death").
Because the ideas about psychiatry I have been presenting in these columns
differ radically from what people read in the newspapers or see on television,
I always present the evidence for my view. The reader is free to judge
the information and come to his own conclusion. In support of my contention
that psychiatrists have an unappeasable appetite for assisting the legal
system in imprisoning individuals who irritate and upset society, I
offer the following evidence:
The history of mental health laws and of standard psychiatric practices
illustrates that psychiatric confinement has nothing to do with psychiatric
treatment. In 1851, the State of Illinois statute specified that "married
women ...may be received and detained at the hospital on the request
of the husband of the woman ... without the evidence of insanity or
distraction required in other cases."
the desire to psychiatrically incarcerate persons who are not committable
by the lawyers' and psychiatrists' own criteria looms large in connection
with the popular pressure and political need to keep so-called sex offenders
confined after they have served their sentences. In 1997 the U. S. Supreme
Court declared this practice to be constitutional. In Kansas v. Leroy
Hendricks, the Court declared: "States have a right to use psychiatric
hospitals to confine certain sex offenders once they have completed
their prison terms, even if those offenders do not meet mental illness
November 2005, New York Governor George Pataki made the headlines when
he initiated "an administrative program to commit sexual predators
to public psychiatric hospitals indefinitely." Pataki's order pulls
back the curtain. The state's mental health system is like an army.
The Governor is the general. The foot soldiers, the psychiatrist -are
expected to follow the orders of their superiors. "As citizens,
most of us would be comfortable seeing people properly incarcerated
if these are considered crimes," said Barry Perlman, M.D., president
of the New York State Psychiatric Association (NYSPA). "What we
are concerned about is using the mental health system to solve a problem
that seems to spill over to it because the criminal justice system cannot
adequately handle it."
acts as if he had just discovered that the mental-health system is an
arm of the criminal justice system. But even after discovering it, he
does not suggest that psychiatrists, individually or as a group, defy
the Governor's orders.
have no illusions about psychiatry; they know that it is an extension
of the state's law enforcement apparatus and use it as such. According
to one report, "The governor [Pataki] directed the Office of Mental
Health and the Department of Correctional Services to push the envelope
of the state's existing involuntary commitment law because he couldn't
wait any longer for the Assembly leadership to bring his legislation
to the floor for a vote... The state has begun to identify ‘appropriate
models for treatment' and to hire staff to treat these patients. ...
To date, 16 states and the District of Columbia have enacted laws to
allow authorities to confine violent sexual offenders in psychiatric
hospitals after their prison terms."
Hospitals as Prisons
important to note here that as far back as in 1988 the APA's Council
of Psychiatry and Law explicitly approved the use of mental hospitals
as prisons. In a document dated November 11-13, 1988, the Council declared:
"Psychiatric patients who no longer require active psychiatric
treatment or who are untreatable can still be best managed in a psychiatric
setting. ... Acquittees who are unable to be discharged to outpatient
status should remain under psychiatric care in a hospital environment."
Note that the psychiatric prisoner longing for freedom is treated as
if he has power over his own discharge but is "unable to be discharged."
Not surprisingly, psychiatrists resent being considered jailers. Confronted
with the reality that the mental hospital is a prison and that the psychiatrist
who works there is a jailer, they deceive themselves, no less than they
deceive the public, with a rhetoric of "care."
It is obvious that as long as law, psychiatry, and society define destructive
and self-destructive behaviors as mental diseases, assign the duty to
control persons who display such behaviors to psychiatrists, who eagerly
embrace that responsibility, "seclusion and restraint" --
in plain English, psychiatric coercion -- will remain a characteristic
feature of psychiatric practice.
definition of psychiatry as a medical specialty concerned with the diagnosis
and treatment of mental diseases is a monumental falsehood. Psychiatry
is a branch of the law, combining features of criminal, civil, and family
law: its primary function is to promote and ensure domestic tranquility.
The Pretense of Psychology as Science:
The Myth of Mental Illness in Statu Nascendi
I was profoundly shocked by the Varieties [of Religious Experience,
by WilliamJames], that was not because some of the facts described
in it were such as I would rather not hear about. They were, on the
whole, amusing. Nor was it because I thought James was doing his work
clumsily. I thought he did it very well. It was because the whole
thing was a fraud. . . . Psychology. . . regarded as the science of
the mind, is not a science. It is what "phrenology" was
in the early nineteenth century, and astrology and alchemy in the
Middle Ages and the sixteenth century: the fashionable scientific
fraud of the age. . . . There were, I held, no merely moral actions,
no merely political actions, and no merely economic actions. Every
action was moral, political, and economic.
(1889-1943; 1978: 93, 95, 149)
the Age of Faith, religion pretended to be a science, offering allegedly
empirical observations about God and his works. In the Age of Science,
psychology and psychiatry pretend to be sciences, offering allegedly
empirical observations about the functions and malfunctions of the human
mind. Much modern intellectual and political mischief rests upon this
false and pretentious claim. The epistemologically misleading character
of the two principal "mental sciences" is inherent in their
respective definitions. Wikipedia Encyclopedia identifies psychology
as "an academic and applied field involving the study of the human
mind, brain, and behavior. Psychology also refers to the application
of such knowledge to various spheres of human activity, including problems
of individuals' daily lives and the treatment of mental illness."
Interestingly, Wikipedia then describes how "Psychology differs
from anthropology, economics, political science, and sociology. . .
." and from "biology and neuroscience," but is silent
about how psychology differs from psychiatry.
Wikipedia tells us, "refers to the practice of medicine relating
to the mind and behavior. . . . It is a subspecialty of medical practice.
. . . While all clinicians encounter patients with mental illnesses
and any of them may treat it, psychiatrists specialize in these areas."
Missing from these definitions is acknowledgment that the most constant
and most characteristic element of so-called mental treatments is and
has always been the coercion of the "patient" by the "doctor."
be sure, many psychologists pursue work unrelated to mental illnesses
and mental treatments, and some psychiatrists deal with voluntary mental
patients. In this essay, however, I shall use the terms "psychologist"
and "psychiatrist" to refer to persons whose professional
roles are defined or shaped by mental health laws, that is, coercion.
Why do I emphasize the central role of coercion in psychology and psychiatry?
Because in my view voluntary mental health relations differ from involuntary
mental health interventions the same way as, say, sexual relations between
consenting adults differ from the sexual assaults we call "rape."
I maintain that it is essential - morally and politically - not merely
to distinguish between coerced and consensual"therapeutic"
relations, but to contrast them. The terms "psychology" and
"psychiatry" ought to be applied to one or the other, but
healing, qua psychology or psychiatry, resembles religion, not medicine
or science. Asserting that a respected social institution-such as religion,
psychology, or psychiatry-rests on a farrago of fables is disrespectful
of received opinion and dangerous. It took us, in the West, a long time
before we rejected coercion in the name of religion and punished instead
of praised the person who embraced violence in the name of God (Seager,
1933). I believe we ought also to reject coercion in the name of mental
health and condemn instead of commend the person who embraces violence
in the name of mental healing.
humoral theory of disease, let us remember, was alive and well a mere
150 years ago. As long as that theory prevailed, there was only one
kind of disease, humoral. The idea of two kinds of diseases-one bodily,
the other mental-is a product of the scientific revolution; more specifically,
of nineteenth century empirical-scientific medicine, based on anatomical
and physiological observation and measurement. I coined the term "myth
of mental illness" in 1960 to suggest that the distinction between
bodily illness and mental illness rests on a misuse of the term "illness."
If we restrict the use of the term "illness" (or "disease")
to observable biological-anatomical and physiological-phenomena, then,
by definition, the term "mental illness" is a misnomer or
metaphor. Mind is not matter, hence mental illness is a figure of speech.
great nineteenth-century neuropsychiatrists regarded this view as a
von Feuchstersleben (1806-1848): "The maladies of the spirit
Leiden des Geistes) alone, in abstracto, that is, error and sin,
can be called diseases of the mind only per analogiam. They come
not within the jurisdiction of the physician, but that of the teacher
or clergyman, who again are called physicians of the mind (Seelenärzte)
only per analogiam" (Feuchstersleben, 1903/1955: 412).
Meyner (1833-1892): "The reader will find no other definition
of 'Psychiatry' in this book but the one given on the title page:
Clinical Treatise on Diseases of the Forebrain. The historical term
for psychiatry, i.e., 'treatment of the soul,' implies more than
we can accomplish, and transcends the bounds of accurate scientific
investigation." (Meyner, 1884: v).
Hughlings Jackson (1835-1911): "Our concern as medical men
is with the body. If there be such a thing as disease of the mind,
we can do nothing for it" (Jackson, 1958, vol. 2: 59).
Kraepelin (1856-1927): "The subject of the following course of
lectures will be the Science of Psychiatry, which, as its name [Seelenheilkunde]
implies, is that of the treatment of mental disease. It is true that,
in the strictest terms, we cannot speak of the mind as becoming diseased
[Allerdings kann mann, streng genommen, nicht von Erkrankungen der Seele
sprechen]" (Kraepelin, 1901/1968: 1).
short, the proposition that there is no mental illness is not new. What
is new are the practical, political-economic consequences of affirming
or denying its existence.
Until the 1970s, the idea that mental illness is a nondisease-a medical
name for unwanted personal conduct-was accorded a measure of professional
and public recognition. Since then, the debate about the disease-status
of mental illness has been brought to a halt. Leaders in politics, jurisprudence,
medicine, neuroscience, psychology, and psychiatry allied with business
leaders, insurance executives, and journalists, declared that brain
and mind, bodily illness and mental illness are identical and must-as
a matter of law and justice-be treated as if they were the same.
House Fact Sheet on Myths and Facts about Mental Illness: "Research
in the last decade proves that mental illnesses are diagnosable
disorders of the brain" (White House Press Office, 1999).
C. Andreasen, professor of psychiatry at the University of Iowa:
"What we call 'mind' is the expression of the activity of the
brain" (Andreasen, 1997).
F. Klein, professor of psychiatry at Columbia University and Paul
H. Wender, professor of psychiatry at the University of Utah: "Biological
depression is common-in fact, depression and manic-depression are
among the most common physical disorders seen in psychiatry"
(Klein, D.F. and Wender, P.H., 1993: 4).
C. Dennett, professor of philosophy, Tufts University: "The
mind is the brain" (Dennett, 1991: 33).
J. Hobson, professor of psychiatry, Harvard University: "[T]he
brain and mind are one. They are one entity. . . . I use the hyphenated
term 'brain-mind' to denote unity" (Hobson, 1994: 6-7).
practice, none of this is true. Medicine and law continue to distinguish
between neurology and psychiatry, between laws regulating the rights
and duties of persons suffering from neurological diseases such as syringomyelia,
and the rights and duties of persons suffering from psychiatric diseases
such as schizophrenia. What accounts for this disjunction between academic-political
declarations about mental illness and the legal-social realities of
mental health practices? Answering that question fully requires a reprising
of the history of psychiatry. Here I limit myself to showing that the
idea of mental illness qua medical disease is a product of modern materialist-reductionist
modern history of the mind is a tapestry woven with two different strands,
one concerned with "mental healing," another with "mental
illness." At the dawn of the age of mental healing, the practice
was called "Mesmerism." Freud named it "psychoanalysis."
Stefan Zweig aptly dubbed it Heilung durch den Geist, "healing
by means of the spirit" (Zweig, 1962). We call it "psychotherapy"
or "talk therapy." The subject is important because controversy
regarding the nature and scientific status of mental healing antedates
and prefigures the controversy regarding the nature and scientific status
of mental illness, psychiatry, and psychology.
psychiatric historians, such as Henri Ellenberger and Gregory Zilboorg,
trace the origin of modern psychotherapy to the work of Franz Anton
Mesmer (1733-1815) (Ellenberger, 1970: 53; Zilboorg, 1941: 347). They
do so because he had established-or so Ellenberger and Zilboorg believe-that
suggestion ("hypnosis") is a genuine medical method of treating
bodily ailments. In my view, Mesmer's so-called therapeutic successes
prove the power of human gullibility, resting on man's ultimate helplessness
and quasi-religious need for dependence on benevolent (theological or
medical) authority. The power and universality of this need is aptly
expressed in the adage, "There are no atheists in foxholes."
Mutatis mutandis, there are no medical skeptics in operating rooms.
work must be situated in the context of his age. The eighteenth century
was a period of revolutions-political and scientific. Although the phenomenon
physicists call "magnetism" had been known since antiquity,
the fabrication and sale of magnets, mainly to scientific investigators
and terrestrial navigators, began only around 1740. The famous Leyden
Jar-a simple electrical capacitor that could be used to give a person
a sudden, albeit weak, shock and which quickly became a show-business
prop and sensation-was invented about 1745, by a Dutch physicist at
the University of Leyden. In 1752, Benjamin Franklin (1706-1790), invented
the lightning rod, a feat that made him the first modern "scientific
celebrity." Finally, in 1780, the Italian scientist Luigi Galvani
(1737-1798) discovered the electric current and what he mistakenly thought
was "animal electricity." It was in this atmosphere of scientific
discovery along with medical quackery and popular showmanship that Mesmer,
an Austrian physician, "discovered" what he thought was "animal
magnetism," a mysterious "force" and substance (fluidum)
to which he attributed vast therapeutic powers (Szasz, 1978/1988: 43-66).
twentieth century, too, has been a revolutionary period, in politics,
science, and medical quackery. In medicine, many important discoveries
and new treatments rested on novel uses of electricity and magnetism,
such as the x-ray, computerized axial tomography (CT scan), positron
emission tomography (PET scan), and magnetic resonance imaging (MRI),
not to mention radio, television, computers, and the Internet. It is
in this atmosphere that modern-day Mesmers discover near-miraculous
cures for mental illnesses making use of electrical-magnetic devices,
such as electroconvulsive therapy (ECT), vagus nerve stimulation (VNS),
deep brain stimulation (DBS), and transcranial magnetic stimulation
(TMS). Other "therapeutic breakthroughs" make use of pharmacotherapies
modeled after antibiotics, called "antipsychotic medications."
I am not concerned here with whether these interventions are considered
by some to be "effective." I list them only to set the stage
for my subsequent remarks about the alleged illnesses they supposedly
we live in an age of far greater scientific and technological sophistication
than did people in the eighteenth century, human gullibility remains
undiminished. Perhaps it is a kind of existential constant, drawing
its force from people's seemingly unappeasable need to believe in, and
submit to, authority. Today, people are especially credulous concerning
matters having to do with the "mind"-its alleged material
(anatomical, chemical, electrical) basis, its functions and malfunctions,
and, most pressingly, the supposed diseases to which it is subject and
the appropriate treatments for them. Social historians are familiar
with the roles that the great nineteenth-century psychiatrists and the
pioneer psychoanalysts played in exploiting this credulity. Less familiar
is the role in this story of William James (1842-1910), whose boundless
naïveté about mental matters is hidden by his stature as
America's greatest psychologist, one of the founders of the modern science
of psychology and of the American Psychological Association.
obituary in The New York Times was entitled, "William James Dies;
Great Psychologist, Brother of Novelist and Foremost American Philosopher
Was 68 Years Old." It summarized his work in these words: "Virtual
Founder of Modern American Psychology, and Exponent of Pragmatism and
Dabbled in Spooks. Long Harvard Professor" (James, 1910). James's
essay on religious belief, tellingly titled "The Will to Believe";
his famous book, Varieties of Religious Experience; and his credulous
participation in "spiritualism" all testify to his own deeply-felt
need "to believe," if necessary, in the sense of credo quia
absurdum est. ("I believe because it is absurd."
attributed to Tertullian, c. 160-220.) Less well-known, but of greater
interest to the subject of mental illness and psychiatric treatment,
is James's 1892 essay, "A plea for psychology as a natural science"
(pp. 146-153). His words are clear and need no extended exegesis. My
comments about them will be brief.
(1892) begins with a puerile statement:
wished, by treating Psychology like a natural science, to help her
to become one (emphasis in the original, p. 146).
The rest of the essay is naive scientism, ending with a lamentable
confusion and equation of scientific "control" with social
control, the "lawfulness" of natural events with the rule
of political despotism:
natural sciences aim at practical prediction and control, and in
none of them is this more the case than in psychology today. . .
. What every educator, every jail-warden, every doctor, every clergyman,
every asylum-superintendent, asks of psychology is practical rules.
Such men care little or nothing about the ultimate philosophic grounds
of mental phenomena, but they do care intensely about improving
the ideas, dispositions, and conduct of the particular individuals
in their charge (emphasis added, p. 148).
Note that James brackets the educator, jail warden, physician, clergyman,
and asylum psychiatrist as fulfilling essentially similar social
functions-controlling and improving individuals in his charge. The
statement brings to mind C.S. Lewis's warning:
We know that one school of psychology already regards religion as
a neurosis. When this particular neurosis becomes inconvenient to
the government, what is to hinder the government from proceeding
to "cure" It? Such "cure" will, of course, be
compulsory; but under the humanitarian theory it will not be called
by the shocking name of Persecution. No one will blame us for being
Christians, no one will hate us, no one revile us. The new Nero
will approach us with the silky manners of a doctor, and though
all will be in fact as compulsory as tunica molesta or Smithfield
or Tyburn, all will go on within the unemotional therapeutic sphere
where words like "right" and "wrong," or "freedom"
and "slavery" are never heard. And thus when the command
is given, every prominent Christian in the land may vanish overnight
into Institutions for the Treatment of the Ideologically Unsound,
and it will rest with the expert gaolers to when (if ever) they
are to emerge. But it will not be persecution. Even if the treatment
is painful, even if it is life-long, even if it is fatal, that will
be only a regrettable accident, the intention was purely therapeutic
(Lewis, 1953/1970: 293).
the posture of "doctor knows best," James charges ahead:
the fresh life that has come into psychology of recent years has
come from biologists, doctors, and psychical researchers. . . .
Cannot philosophers and biologists both become 'psychologists' on
this common basis? Cannot both forgo ultimate inquiries, and agree
that, provisionally at least, the mental state shall be the ultimate
datum so far as "psychology" cares to go? . . . Not that
today we have a "science" of the correlation of mental
states with brain-states; but that the ascertainment of the laws
of such correlation form the program of a science well limited and
defined (James, 1892: 149, 151).
James ends on a note that I interpret as an expression of his effort
to believe that his life-long confusions, fears, and "illnesses"
were not the meaningful manifestations of his persistently avoided
existential-moral problems but the meaningless symptoms of a medical
disease susceptible to medical treatment:
kind of psychology which could cure a case of melancholy, or charm
a chronic insane delusion away, ought certainly to be preferred
to the most seraphic insight into the nature of the soul. And that
is the sort of psychology which the men who care little or nothing
for ultimate rationality, the biologists, nerve-doctors, or psychical
researchers, namely, are surely tending, whether we help them or
not, to bring about (emphasis added, p. 153).
1892, William James had come out of the spiritualist closet. Here he
lists "biologists, nerve-doctors, and [or] psychical researchers"
as scientists of the same kind, all engaged in a quest for the material
cure of "chronic insane delusions" and not giving a whit about
"seraphic insight into the soul."
James was shockingly indifferent to the great controversies in psychology
and psychiatry raging around him. It was then even more obvious than
it is now that what sets psychiatry apart from medicine is coercion.
The incarceration of the insane was, and is, the proverbial 800-pound
gorilla in the room. Everyone knows it is there.
it is impolite to notice its presence. Not so in the 1890s. The following
is a brief excerpt from an address by Silas Weir Mitchell (1829-1914)-the
great American neurologist and founder of the American Neurological
Association-presented at the 1894 annual meeting of the American Medico-Psychological
Association (now the American Psychiatric Association): "You quietly
submit to having hospitals called asylums; you are labeled as medical
superintendents . . . I presume that you have, through habit, lost the
sense of jail and jailor which troubles me when I walk behind one of
you and he unlocks door after door. . . . You have for too long maintained
the fiction that there is some mysterious therapeutic influence to be
found behind your walls and locked doors. We hold the reverse opinion
. . . Your hospitals are not our hospitals; your ways are not our ways"
(Mitchell, 1894, pp. 414, 427, emphasis added).
and the psychologists and psychiatrists who joined his quest for the
material cure of "chronic insane delusions" without giving
a whit about "seraphic insight into the soul" got what they
wished for-and more: a "science of the mind" without soul
T., "The Pretense of Psychology as Science: The Myth of Mental
Illness in Statu Nascendi," Current Psychology, 25: 42-49 (Spring),
N.C. (1997). What is psychiatry? American Journal of Psychiatry,
R.G. (1939/1978). An Autobiography. Oxford: Clarendon Press/Oxford
D.C. (1991). Consciousness Explained. Boston: Little, Brown &
H.F. (1970). The Discovery of the Unconscious: The History and Evolution
of Dynamic Psychiatry. New York: Basic Books.
E. von. (1955). Medical Psychology. In Schreber, D. (1903/1955).
Memoirs of My Nervous Illness. Translated by Ida Macalpine and
Hunter. London: William Dawson and Sons.
A.J. (1994). The Chemistry of Conscious States: How The Brain Changes
Its Mind. Boston: Little, Brown.
J.H. (1958). Selected Writings of John Hughlings Jackson. Edited
by James Taylor. 2 vols. London: Staples Press.
W. (1892). A plea for psychology as a natural science. Philosophical
Reviews, 1: 146-153.
W. (1910). Obituary, August 27, 1910. http://www.nytimes.com/learning/
D.F., & Wender, P.H. (1993). Understanding Depression: A Complete
Guide to Its Diagnosis and Treatment. New York: Oxford University
E. (1901/1968). Lectures on Clinical Psychiatry. New York: Hafner.
C.S. (1953/1970). The humanitarian theory of punishment. In Lewis,
C.S., God in the Dock: Essays on Theology and Ethics. Edited by
Grand Rapids, MI: William B. Eerdmans.
T. (1884/1885). Psychiatry: Clinical Treatise on Diseases of the
Forebrain. Translated by B. Sachs. New York: G.P. Putnam's Sons.
S.W. (1894). Address before the Fiftieth Annual Meeting of the American
Medico-Psychological Association. Journal of Nervous and Mental
Disease, 21: 413-437.
R.H. Ed. (1993). The Dawn of Religious Pluralism: Voices from the
World's Parliament of Religions, 1893. LaSalle, IL: Open Court.
T. (1978/1988). The Myth of Psychotherapy: Mental Healing as Religion,
Rhetoric, and Repression. Syracuse: Syracuse University Press.
House Press Office (1999). "White House Fact Sheet on Myths
and Facts About Mental Illness."
and Facts about Mental Illness," New York Times, June 7, 1999,
G. (1941). A History of Medical Psychology. New York: Norton.
S. (1931/1962). Mental Healers: Franz Anton Mesmer, Mary Baker Eddy,
Sigmund Freud. Translated by Eden and Cedar Paul. New York: Frederick
Keynote Address, "Controversies in End of Life Care:
Terri Schiavo's Lessons"
kept my promise" (Schiavo, 2005a).
Theresa Schiavo's grave marker, June 20, 2005.
''I laid a red rose in her hand and said goodbye'' (Schiavo, 2005b).
Michael Schiavo, September 24, 2005.
1992, during a deposition in his malpractice suit against the physicians
who treated Terri Schiavo for infertility, Michael was asked how he
saw his future with his wife.
A: I see myself hopefully finishing school and taking care of my wife.
Q: Where do you want to take care of your wife?
A: I want to bring her home.
Q: If you had the resources available to you, if you had the equipment
and the people, would you do that?
A: Yes. I would, in a heartbeat.
Q: How do you feel about being married to Terri now?
A: I feel wonderful. She's my life and I wouldn't trade her for the
world. I believe in my marriage vows.
Q: You believe in your wedding vows, what do you mean by that?
A: I believe in the vows I took with my wife, through sickness, in health,
for richer or poor. I married my wife because I love her and I want
to spend the rest of my life with her (Schiavo, 2005c).
Schiavo made those statements, under oath, in 1992. In 2005, he had
inscribed on Terri's grave marker "February 25, 1990" as the
date she had "Departed this Earth."
Does Michael Schiavo's self-aggrandizing memorial to refer to his promise
of marital fidelity? For more than a decade he has lived with another
woman, to whom he refers as his fiancee and with whom he has two children.
his statement, "I kept my promise," refer to his promise to
Terri's parents, Mary and Robert Schindler, that Terri ‘s body
would not be cremated and her remains would be buried at a Schindler
family plot in Pennsylvania? Two days after she died, Terri was cremated
and her ashes were buried at Sylvan Abbey Memorial Park in Clearwater.
The Schindlers were notified only after the event.
what promise-keeping, then, does Michael Schiavo refer on his wife's
tombstone? Ghoulishly, he brags about his alleged pledge to kill her,
in her own best interest. The removal of Terri's feeding tube was, as
Joan Didion points out, "repeatedly described as ‘honoring
her directive.' This, again, was inaccurate: there was no directive.
Any expressed wish in this matter existed only in the belated telling
of her husband and two of his relatives" (Didion, 2005).
conflict between the Schindlers and Michael Schiavo was clear. The Schindlers
preferred a half-dead daughter above ground to a dead daughter in the
grave. Michael preferred a dead ex-wife in the grave to a half-dead
wife in a hospice. The Schindlers acknowledged that they wanted Terri
alive. Michael denied that he wanted his wife dead and instead attributed
the death-wish to Terri's desire to have her life terminated if she
were as disabled as she was. This is the fiction the courts upheld.
And this is the fiction Michael memorialized -- naively and narcissistically
-- with the inscription he chose to have engraved on Terri's grave marker.
"I kept my promise": Sartre could hardly have found a more
dramatic example of a husband's bad faith following his wife to her
Schiavo drama was a classic battle of words: he who controlled the vocabulary,
controlled the debate and was assured of victory. Apparently, the Schindlers
did not recognize this. They failed to emphasize that what Theresa Schiavo
allegedly wanted was unconfirmable, based totally on hearsay evidence,
and that, in doubtful cases, the long tradition of English and American
law and the Christian religion favors the preservation of life and liberty
over their forfeiture. (Michael Schiavo and the Schindlers are Catholics.)
The moral default position in the case of Terri Schiavo was clear: she
was not dead and killing her was an act of medical killing, a type of
it morally justified? In my opinion, it was not: 1) Terri had no living
will and there was no credible evidence about what she might have wanted
to happen to her half-alive body; 2) Terri's parents wanted to keep
her alive, while her husband, living with another woman, wanted her
dead; 3) Michael Schiavo's representations lacked credibility and hence
the courts erred in appointing him as Terri's guardian; and 4) assuming
that Terri Schiavo would have wanted her life ended, she would not have
wanted it ended by being alternately starved and fed, by having her
feeding tube repeatedly removed and reinserted over a period of months.
by medical ethicists, the mainstream media nevertheless defined the
case as a battle between "humanists" and "religious zealots,"
"rationalists" and "irrationalists." Didion observes:
"Yet there remained, on the ‘rational' side of the argument,
very little acknowledgment that there could be large numbers of people,
not all of whom could be categorized as ‘fundamentalists' or ‘evangelicals,'
who were genuinely troubled by the ramifications of viewing a life as
inadequate and so deciding to end it. There remained little acknowledgment
even that the case was being badly handled..." (Didion, 2005).
and science change and, in our day, change rapidly. Fundamental ethical
principles are enduring. Probably the most enduring principle is the
injunction against killing human beings, especially when the justification
for doing so is morally feeble.
Religion and law decree certain human bonds to be unbreakable, and many
people experience them as such. The paradigm of such a bond is that
between the pious Jew and his God. Christianity decreed the marriage
bond to be similarly unbreakable. This rule, long enshrined in civil
law, was repudiated only in recent times.
The principal issue in the Schiavo case -- besides the economics of
Terri's care -- was the conflict between two parties both claiming undying
love and loyalty to her: her husband who wanted her dead, and her parents
who wanted to keep her alive.
this circumstance, the commandment against killing should alone have
been enough to tilt the balance in the parents' favor.
Few moral dilemmas present us with truly novel conundrums. The Schiavo
case is not among them. To the contrary, the conflict between the Schindlers
and their son-in-law calls to mind the legendary case of the disputed
baby in the Old Testament. Two women live together and give birth to
babies at about the same time. One baby dies during the night. His mother
switches him with the other baby.
living child's mother discovers the deception and brings the dispute
to Solomon for arbitration. The Bible tells what happened this way:
Then came there two women... And the one woman said, O my lord, I and
this woman dwell in one house; and I was delivered of a child with her
in the house. ... And this woman's child died in the night; because
she overlaid it. And she arose at midnight, and took my son from beside
me .... and laid it in her bosom, and laid her dead child in my bosom
.... And the other woman said, Nay; but the living son is my son. ...
Thus they spake before the king. ... And the king said, Bring me a sword.
... And the king said, Divide the living child in two, and give half
to the one, and half to the other. Then spake the woman whose living
child was unto the king ... O my lord, give her the living child, and
in no wise slay it. But the other said, Let it be neither mine nor thine,
but divide it. ... And then the king answered and said, Give her the
living child, and in no wise slay it: she is the mother thereof (1 Kings
3: 16-27; King James Version).
Solomon would order both women to undergo psychiatric examination to
determine who would make a better mother and would then rule in accordance
with the psychiatric "findings," ratified by committees of
bioethicists. Herein lies the difference between the language of love
and life, and the language of envy and death; between the philosophy
of individualism and libertarianism, and the philosophy of collectivism
and statism; and between the ethics of justice and the sanctity of life,
and the ethics of bioethics and the justification for medical killing.
we might be tempted to glibly observe, had it easy because of the second
mother's gratuitous comment. Suppose she had said the same thing the
first mother said. How would Solomon have decided? We don't know. It
would have been a different case, both contending parties choosing life
over death. Ironically, Michael Schiavo's conduct reinforces the analogy
with the biblical case. In 1993, when he was ostensibly still trying
to keep Terri alive, Michael was asked what he had done with her jewelry.
He replied: "Um, I think I took her engagement ring and her...
what do they call it... diamond wedding band and made a ring for myself"
Terri died, he defined the date of her death as February 25, 1990, and
placed that date on his wife's tombstone. If that is when, in Michael
Schiavo's view, his wife died, then, after that date, he considered
himself wifeless, a widower who had no morally valid claim to Terri's
living body, and no legally valid ground for objecting to the Schindlers'
desire to assume caring for their daughter who was, de facto and de
jure, still alive. I shall abstain here from considering his financial
and other possible reasons for not divorcing Terri and fighting the
Schindlers' efforts to be her legal guardians.
Schiavo case has generated a vast literature, some in print, much of
it on the Internet. Most of this literature analyzes the case from the
point of view of the supposed "rights" of the main dramatis
personae. What would Terri have wanted had she anticipated her half-alive
state? Did feeding and hydration constitute "artificial life support"?
Who ought to be her legal guardian? Although the Schindlers's efforts
to keep Terri alive received much popular and professional support,
most of the debate was straitjacketed into medical terminology and dealt
with concepts and issues such as the patient's ability to feel pain,
recognize persons, respond to stimuli, permanent vegetative state, brain
death, prognosis, rehabilitation, and so forth.
this was shadowboxing. After more than a decade of being half-dead,
it required no sophisticated medical knowledge or technology to conclude
that, as a person, Terri Schiavo existed no longer, but that, as a human
being, she was still alive. That, after all, is why there had been a
long battle about the legitimacy of killing her. She had to be put to
death before she could be legally declared dead and her corpse buried
people who are not religious prefer to be completely dead rather than
half-dead. They usually assume that their closest relatives, the persons
who truly deserve the awkward appellation "loved ones," share
this choice. If they assume otherwise, they are likely to execute a
living will expressing their desire to be kept alive as long as possible,
regardless of circumstances or costs. The Schindlers themselves wished
to keep their daughter alive and believed, with good reason -- they
were all practicing Catholics -- that that is what Terri would have
wanted. I shall now briefly examine the Schiavo affair from what I imagine
was the Schindlers' point of view, and do so by reference to a justly
celebrated short story by William Faulkner.
Rose for Emily" is a Gothic tale set in a small town in the Old
South (Faulkner, 1935). Emily Grierson is the only daughter of one of
the small town's leading citizens. "The Griersons held themselves
a little too high for what they really were. None of the young men were
quite good enough for Miss Emily." Mr. Grierson dies, leaving Miss
Emily in genteel poverty, living alone in the big house. She becomes
a shadowy figure who, however, manages to dominate the town authorities.
Afraid to collect the taxes she owes on her home, they are one day confronted
with complaints by neighbors about a foul odor emanating from it. "That
was two years after her father's death and a short time after her sweetheart
-- the one we believed would marry her -- had deserted her. ... 'But
what will you have me do about it, madam?'," wailed the mayor.
"After a week or two the smell went away."
set the stage, Faulkner dispels the mystery. A few years after the death
of Miss Emily's father, a construction company comes to town, "with
riggers and mules and machinery, and a foreman named Homer Barron, a
Yankee -- a big, dark, ready man, with a big voice and eyes lighter
than his face. ... Presently we began to see him and Miss Emily on Sunday
afternoons driving in the yellow-wheeled buggy and the matched team
of bays from the livery stable." The construction company leaves
and Homer Barron is seen no more. The townsfolk assume that he left
with the company.
fact, Homer Barron rejected Miss Emily, and she poisoned him with arsenic.
The years pass. "Each December we sent her a tax notice, which
would be returned by the post office a week later, unclaimed. Now and
then we would see her in one of the downstairs windows --she had evidently
shut up the top floor of the house ... Thus she passed from generation
to generation -- dear, inescapable, impervious, tranquil, and perverse.
And so she died."
relatives come to bury her:
Already we knew that there was one room in that region above stairs
which no one had seen in forty years, and which would have to be forced.
They waited until Miss Emily was decently in the ground before they
opened it. The violence of breaking down the door seemed to fill this
room with pervading dust. A thin, acrid pall as of the tomb seemed to
lie everywhere upon this room decked and furnished as for a bridal:
upon the valance curtains of faded rose color, upon the rose-shaded
lights, upon the dressing table, upon the delicate array of crystal
and the man's toilet things backed with tarnished silver, silver so
tarnished that the monogram was obscured.
them lay a collar and tie, as if they had just been removed, which,
lifted, left upon the surface a pale crescent in the dust. Upon a chair
hung the suit, carefully folded; beneath it the two mute shoes and the
discarded socks. The man himself lay in the bed. ... The body had apparently
once lain in the attitude of an embrace, but now the long sleep that
outlasts love, that conquers even the grimace of love, had cuckolded
him. What was left of him, rotted beneath what was left of the nightshirt,
had become inextricable from the bed in which he lay; and upon him and
upon the pillow beside him lay that even coating of the patient and
biding dust. Then we noticed that in the second pillow was the indentation
of a head. One of us lifted something from it, and leaning forward,
that faint and invisible dust dry and acrid in the nostrils, we saw
a long strand of iron-gray hair.
Emily preferred the simulacrum of a husband to no husband at all. The
Schindlers preferred the simulacrum of a daughter to no daughter at
all. I believe their argument was fatally flawed by their failure to
acknowledge this and engaging instead in an ill-considered debate about
Terri's medical condition and "prognosis." Their claims that
Terri was responsive, that she was not in a vegetative state, that her
prognosis was not hopeless were counterproductive. Watching the case
unfold, my impression was that the Schindlers wanted their daughter
to be kept alive regardless of how badly damaged and hopeless her condition
was. They preferred a daughter half-dead or four-fifths dead to no daughter
at all. But they never said so. Nor did they offer to foot the bill
for caring for Terri.
the economic aspects of the cost of caring indefinitely for persons
in Terri's condition would require another essay or, rather, a substantial
monograph. Let me say only that I am not aware that the Schindlers ever
offered to pay for Terri's care or, for that matter, would have been
able to afford doing so. I assume (and I believe it is reasonable to
assume) that had the Schindlers been billionaires, they would have mounted
a very different kind of legal challenge against their alienated and
antagonistic son-in-law. They could have petitioned the courts -- in
a type of habeas corpus plea -- for the opportunity to care for Terri,
indefinitely and at no cost to the public, supported by appropriate
medical, nursing, and other help. In the absence of an advance medical
directive by Terri, I believe the courts would have found such a request
impossible to reject.
agree with Nat Hentoff that, since the law lets people execute advance
medical directives refusing life support should they become profoundly
incapacitated, they have the responsibility to prepare such directives.
"Absent that, the law should require the courts in contested cases
to give every reasonable benefit of the doubt to sustaining life and
not causing death by dehydration."
Having reported on the Terri Schiavo case for the past two and a half
years -- and having read all of the transcripts of court hearings --
I am certain of one dimension of this case: Terri Schiavo was fatally
denied due process because all the appellate courts, state and federal,
relied wholly on the rigid misunderstanding of the central facts of
the case by one Florida Circuit judge, George Greer. If this had been
a case of a prisoner on death row with an execution date, the ACLU and
a good many liberals would have demanded habeas review, from the beginning,
of all the facts in the case (Hentoff, 2005).
only does the problem of so-called "fruitless care" for the
terminally ill or severely disabled require serious consideration of
its economic implications, it requires also attention to the moral dilemmas
attending medical killing, with special reference to the legal-psychiatric
prohibition of drugs and suicide. I have written extensively about these
subjects and a few observations must suffice here. The Schiavo case
touches on many of the difficult economic, moral, legal, and social
dilemmas presented by the combination of advances in modern medical
technology, the national-socialization of heath care services, and the
war on autonomy and personal responsibility and autonomy disguised by
a preoccupation with so-called "medical ethics." I use the
term "national socialism" here in its precise descriptive
sense, to refer to state control of important sectors of the nation's
economy, not to the German National Socialist regime.
ethics, as I see it, must be one of two things -- the justification
and ratification of prevailing medical principles and political practices
or a critique and condemnation of such principles and practices. Since
the medical ethics industry is ideologically and economically parasitic
on -- is, indeed, a part of -- the same therapeutic state that supports
and justifies the medical and pharmaceutical industries, it functions,
in effect, as the propaganda arm of the therapeutic state. Hence, it
is both unable and unwilling to play the role of moral critic. Supported
by co-opted authorities on medical ethics, the Florida courts sidestepped
all the complex moral and political problems and chose to pretend that
the conflict between husband and parents in the Schiavo case ought to
be resolved on the basis of a fictitious autonomy plus a fictitious
advance medical directive that they attributed to Terri.
is self-government. It can be curtailed only by the self and the state.
We limit our own autonomy every time we make a promise or enter into
a contract, for example by marrying. The state limits our autonomy every
time it prohibits an act, especially the type of act which John Stuart
Mill aptly called "self-regarding," such as self-medication.
Our autonomy is now strictly limited by a political system I call the
therapeutic state (Szasz, 1963 / 1989).
when I was growing up in a not-very democratic Hungary and the world
was on the verge of a totalitarian nightmare, personal autonomy was
less limited than it is today in the United States. No one tried to
prevent individuals -- not even school children -- from killing themselves.
Opiates and sleeping pills were widely available and their possession
was not prohibited. Although traditionally a Roman Catholic country,
Hungary has long had, and still has, one of the highest suicide rates
in the world.
free man owns himself. He can damage himself with either eating or drinking;
he can ruin himself with gambling. If he does he is certainly a damn
fool, and he might possibly be a damned soul; but if he may not, he
is not a free man any more than a dog" (Chesterton, 1935). The
words are Gilbert K. Chesterton's. He was a devout Catholic and a passionate
conservative, not a liberal, much less a libertarian. Today, with the
whole "civilized" world waging wars on drugs and suicide,
few people agree with this statement.
especially psychiatrists, have been waging war on autonomy for more
than 200 years. As medical professionals acquired more knowledge about
the human body and its diseases, they sought increasing control over
it. Physicians attacked autonomy along three fronts, corresponding to
three basic human urges -- sex, drugs, and death. Supported by pseudoscience
and the state, they declared self-abuse, self-medication, and self-killing
diseases and punished them as offenses against the public health and
hence the public good. The free man owns himself. The therapeutic state
Schiavo had no right to kill herself when she was fully alive. "Suicidality,"
defined as a "symptom of depression," is the main justification
for civil commitment -- an act of depriving a person not only of autonomy
but of liberty. Nevertheless, so the story goes, Terri Schiavo had a
right to have her life terminated when she was only half-alive, because,
allegedly, that is what she would have wanted had she been able to express
her wants. We often believe X not because X is true, but because believing
X helps us to achieve our selfish purposes. We have no right to suicide,
yet we insist that respect for "patient autonomy" requires
that we have a right to physician-assisted suicide (Szasz, 1999 / 2001).
the basic facts of the case. For fifteen years Terri Schiavo's half-alive
body lay in bed. Ostensibly, during all this time, both her husband
and her parents wanted to "help" her. Initially, they helped
her to stay alive. No one then spoke of Terri's wish to be killed. Then
came a sudden reversal, when Michael "remembered" Terri's
alleged verbal living will. Michael now sought to help Terri by ending
her life as soon as possible, while the Schindlers helped her by preserving
her life as long as possible.
the same time -- characteristically for the times we live in -- neither
party was willing to assume real obligation to care for her; both parties
wanted to use the power and purse of the state to implement their wishes.
Michael wanted the state to end Terri's life. The Schindlers wanted
the state to keep Terri alive and pay for her care. (Only a small, initial
part of Terri's care was paid by the malpractice insurance money awarded
to Michael. By the end,
the taxpayer was paying the bills.)
truth is that the Schiavo case had nothing whatever to do with what
we fatuously call "patient autonomy." Instead, it had to do
with property rights and money -- specifically, with deciding, first,
who was the rightful "owner" of Terri's half-alive body, and
second, who was to pay for keeping her alive till she was pronounced
of the medical-technical term we choose to describe Terri's state --
coma, permanent vegetative state, severe and irreversible brain damage
-- two things are clear: that before her feeding tube was removed, she
was not dead; and that she was helpless and dependent on others for
survival in much the same way that a newborn baby is: she could breathe
and metabolize food, but needed to be fed, and hydrated, and cared for.
The difference between Terri and a baby was that Terri was destined
to remain totally disabled and dependent until she died.
is nothing unusual or uncommon about this sort of situation. On the
contrary, the problem is pervasive and perennial. But we must be clear
about whose problem it is, and what the true nature of the problem is.
The problem is not the patient's, just as the problem of abortion is
not the fetus's. Terri had no problem. She was the problem. For whom?
For her husband, for her parents, and for the agents of society charged
with protecting certain classes of dependents. Under the age-old legal
principle of parens patriae, incompetent human beings needing and deserving
care and protection were, in John Locke's words, "idiots, infants,
and the insane." Today, in addition to "idiots, infants, and
the insane," the category of such incompetents includes the aged,
the unconscious, and persons, like Terri, in a chronic vegetative state.
relations among family members are harmonious and some are willing to
care for a disabled person, they do so, and that is the end of the matter.
Many parents care for their severely handicapped children, and many
adult children care for their demented parents. If the persons responsible
for the dependent are wealthy, they typically delegate the task to others.
That is the way Joseph Kennedy, Sr. cared for his daughter Rosemary
who, after the lobotomy to which he had subjected her rendered her,
too, only half a person. Severely brain-damaged, Rosemary was sent to
a Catholic convent home in Wisconsin, lavishly endowed by Kennedy to
conceal his embarrassing deed and care for his damaged daughter. Out
of sight and out of mind, Rosemary "lived" there for more
than 60 years, until her death in 2005, at the age 86.
members may also agree on the opposite course, which they often do in
the kind of hopeless situation with which Terri's husband and parents
were faced. They then instruct medical personnel to desist from heroic
measures to prolong the dying process. This is one of the functions
of hospice care. It is worth noting in this connection that Terri Schiavo
did not qualify for such care.
the Schiavo controversy, the courts upheld the fiction that Terri's
autonomy required that she be medically killed, in her own best interest.
In view of the fact that we live in a country whose laws prohibit suicide
and often deny patients with terminal illnesses the pain-killers they
need, the doctors' and courts' sensitivities to patient autonomy were,
in this case, touching to say the least. Michael requested the court
to attribute to Terri the de facto right to physician-assisted suicide.
That this decision favored Michael's personal and financial interests,
and the taxpayers' economic interests, was purely coincidental.
Schiavo case -- like Shakespeare's Lear or Hamlet -- was and remains
great drama. It holds up a mirror, as it were, that reflects our selfishness,
our moral uncertainties and vanities, and, above all else, our boundless
hypocrisies about drugs, dying, medical care, and money.
physicians in the task of killing people, whether patients or enemies
of the state, is not a new idea. The fact that the Hippocratic Oath
prohibits medical killing suggests that physicians and their superiors
must have found it a temptation. The practice seems to have started
in Rome under Nero, who would send "doctors to those who hesitated
to execute his order to commit suicide, ... instruct[ing] them to 'treat'
(curare) the victims, for thus the lethal incision was called"
(Hoof, 1990). The guillotine and the gas chamber were developed by medical
doctors. The Nazi medical Holocaust was an unabashed euthanasia program
planned and carried out by physicians.
English literature, the earliest reference to death as treatment appears
in Sir Thomas More's Utopia. He wrote: "Should life become unbearable
for these incurables, the magistrates and priests do not hesitate to
prescribe euthanasia. ... When the sick have been persuaded of this,
they end their lives willingly either by starvation or drugs" (More,
practice of routinely referring to the ostensible beneficiary of physician-assisted
suicide (PAS) as a "patient," albeit seemingly harmless, prejudges
the act as medical and legitimizes it as beneficial ("therapeutic").
To be sure, a person dying of a terminal illness is, ipso facto, considered
a patient. However, dying is not a disease; it may, inter alia, be a
consequence of disease (or other causes, such as accident or violence).
More importantly, killing (oneself or someone else) is not, and by definition
cannot be, a treatment.
speaking, the phrase "assisted suicide" is an oxymoron. Suicide
is killing oneself. We ought to call it autohomicide, to distinguish
it from heterohomicide, which is the correct name of the act by which
Terri Schiavo's life was terminated. Neither autohomicide nor heterohomicide
is a medical matter. Both are legal, moral, economic, and political
matters (Szasz, 1999 / 2001).
A person has no need for another to perform a service that he could
perform for himself, provided, of course, that he wants to and is allowed
to perform the service. If a person knows how to drive but prefers to
be driven by someone else, he has no need for a chauffeur, he wants
a chauffeur. Such a person is not receiving "chauffeur-assisted
driving." The same is true for killing oneself.
us not forget that physicians have always been partly agents of the
state and are now in the process of becoming de facto government employees.
Hence, unless a person kills himself, we cannot be certain that his
death is voluntary; under no circumstances should such a death be called
"suicide." If a person is physically unable to kill himself
and someone else kills him, then we are dealing with a clear case of
heterohomicide (euthanasia, mercy killing, or medical murder, as the
case may be).
if a physician carries out the act, which is what happened in the Schiavo
case, then we cannot be sure that the patient did not want to change
his mind in the last moment, but could not or was not allowed to do
so. We know that many persons who prepare advance directives requesting
that physicians abstain from "heroic measures" to prolong
their dying change their minds when the time comes to honor their own
short, conjoining the terms "assisted" and "suicide"
is cognitively misleading and politically mischievous. The term "physician-assisted
suicide" is a euphemism, similar to terms like "pro-choice"
(for abortion) and "right to life" (for prohibiting abortion).
We ought to reject PAS not only as social policy but also as a conventionally
used phrase, especially so long as suicide remains, de facto, illegal,
prohibited by mental health law and punished by psychiatric agents of
are important. We must be careful about what we call the persons who
receive and deliver suicide assistance services. If we call the persons
who receive the services "patients" and those who deliver
them "physicians," then dying by means of such a service is,
ipso facto, a "treatment," and PAS becomes an approved cause
of death, like dying from a disease. In short, the legal definition
of PAS as a procedure that only a physician can perform expands the
medicalization of everyday life, extends medical control over personal
conduct, especially at the end of life, and diminishes patient autonomy.
us call a spade a spade. Terri Schiavo was killed: to be precise, she
was executed, in accordance with a legally valid court order, by starvation
and dehydration. Why? Because no one -- not her husband, not her parents,
not any philanthropist, not the American taxpayer -- was willing to
pay to keep her alive. The elephant in the room no one wanted to see
was money. Had Terri's parents been Melinda and Bill Gates, and had
they wanted to keep Terri alive, there would have been no "case."
If we believe that executing innocent people is wrong, then the Schiavo
case presents no ethical problem. It presents economic, political, and
of persons all over the world -- infants, old people, severely disabled
persons -- would die if they were not given food and water by others.
Tens of thousands of persons, whose quality of life is not measurably
better than Terri Schiavo's was, languish in nursing homes, tied to
wheelchairs and drugged with Haldol. Looking after them for seven years,
how many of their relatives could "remember" that the "patients"
chose to die when they fell into such a state? How many could produce
"credible witnesses" from among siblings or close friends
to testify that they heard the patients say that? Would this be sufficient
legal ground to starve them to death?
problem is obvious: dependency. Formerly, this was a problem for the
family and the church. Now, it is a problem for the state. Why? Because
the modern national-socialist state has assumed the social-economic
functions of the church, and is assuming more and more of the social-economic
functions of the family.
William Osler (1849-1919), perhaps the most celebrated physician in
the history of American medicine, foresaw the problem of mass dependency
in mass society and boldly offered a notorious recommendation. In 1905,
Osler resigned from John Hopkins Medical School, of which he had been
a founder, to accept the even more prestigious position of Regius Professor
of Medicine at Oxford.
fifty-six years old, contemplating his own aging, he delivered an address
titled The Fixed Period, declaring that "men over the age of sixty
were useless," that "the history of the world shows that a
very large proportion of the evils may be traced to sexagenarians,"
and that "peaceful departure by chloroform might lead to incalculable
benefits," for them as well as for society (Osler, 1905 / 1943).
Subsequently, Osler said, not very persuasively, that his proposal was
"whimsical." However, many people took it seriously. His supposed
spoof had temporarily enriched the language, generating the verb "Oslerize"
(meaning "euthanize"), used both in jest and in earnest.
Osler delivered his speech, he was a revered figure in American medicine.
Nevertheless, the press -- then still vigilant about protecting personal
freedom from medical statism -- was alarmed. An editorial in the New
York Times castigated his remarks and compared his proposal to the practices
of "savage tribes ... whose custom it is to knock their elders
on the head whenever the juniors find their elders in their own way"
days after the address was denounced in the papers, a Civil War veteran
shot himself to death. A clipping of Osler's address was found on his
desk. The story was front-page news in a report entitled "Suicide
Had Osler Speech." Undaunted, Osler angrily retorted: "I meant
just what I said, but it's disgraceful, this fuss that the newspapers
are making about it." In his hagiography of Osler, Harvey Cushing,
the famed Harvard neurosurgeon, stated: "Efforts were made in vain
to get him to refute his statement; and though there can be no question
that he was sorely hurt, he went on his way with a smile" (Cushing,
later disclaimers notwithstanding, Osler was serious. This conclusion
is supported by his favorable reference to John Donne's now forgotten
defense of suicide in Biathanatos (1646 / 1930), and also by the fact
that Osler's essay and title were inspired by Anthony Trollope's (1815-1882)
novel, also titled The Fixed Period (1882 / 1963). Trollope's tale,
cast in the mold of a futuristic utopia/dystopia, takes place on the
imaginary island, "Britanulla," where the human life span
is fixed at sixty-five years. At the end of their sixty-sixth year,
men and women are admitted to a college for a twelve-month period of
preparation for euthanasia by chloroform. Trollope was sixty-seven when
he wrote the novel. A year later he died, without benefit of chloroform.
Despite his stature as the giant of American medicine, Osler never lived
down his flirtation with medical killing.
September 24, 2005, Michael Schiavo traveled to the Twin Cities to speak
at a conference on medical ethics at the Hyatt Regency hotel honoring
Dr. Ronald Cranford, a Minneapolis neurologist who was one of his medical
advisors. "I never, in my entire life, thought I would be thrown
into such a national debate," said Michael. "All I wanted
to do was carry out my wife's wishes. ... Terri didn't die an awful
death. I laid a red rose in her hand and said goodbye." His address
was met by a standing ovation from the more than 200 people in attendance
from Singapore after hurricane Katrina, New York Times columnist Thomas
Friedman, an expert on medical ethics and everything else, opines: "There
is something troublingly self-indulgent and slothful about America today
-- something that Katrina highlighted and that people who live in countries
where the laws of gravity still apply really noticed. ... We let the
families of the victims of 9/11 redesign our intelligence organizations,
and our president and Congress held a midnight session about the health
care of one woman, Terri Schiavo, while ignoring the health crisis of
40 million uninsured" (Friedman, 2005).
befits the true Jacobin, Friedman self-righteously dismisses the rights
of the individual in the name of compassion for the masses. More than
two hundred years ago, Edmund Burke (1729-1797) -- alluding to Rousseau
-- delivered this priceless satirical portrait of the modern "humanist"-collectivist.
Benevolence to the whole species, and want of feeling for every individual
with whom the professors come in contact, form the character of the
new philosophy. ... He melts with tenderness for those only who touch
him by the remotest relation, and then, without one natural pang, casts
away, as a sort offal and excrement, the spawn of his own disgustful
amours, and sends his children to the hospital of foundlings.
bear loves, licks, and forms her young; but bears are not philosophers.
Vanity, however, finds its account in reversing the train of our natural
feelings. Thousands admire the sentimental writer; the affectionate
father is hardly known in his parish. ... As the relation between parents
and children is the first among the elements of vulgar, natural morality,
they erect statues to a wild, ferocious, low-minded, hard-hearted father,
of fine general feelings -- a lover of his kind, but a hater of his
kindred (Burke 1791 / 1961).
indeed. In 1993, while ostensibly trying to keep his wife, Terri, alive,
Michael Schiavo converts her engagement ring and wedding band into a
ring for himself; in June 2005, after Terri is cremated and her ashes
are buried, he defines the date of her death as February 25, 1990 and
uses her gravestone as a placard for congratulating himself on his self-proclaimed
moral fidelity to her; and now, while continuing to loudly disclaim
interest in publicity, he lectures on medical ethics.
Schiavo had a choice to relinquish the care of his half-dead wife to
her parents, who were begging him to let them assume that role and could
have avoided the ensuing publicity which he claims he abhorred. He refused
to do so. Cui bono?
- Burke, E. (1791 / 1961). Letter to a Member of the National Assembly.
In The Philosophy of Edmund Burke: A Selection from His Speeches and
Writings. Edited with an Introduction by Louis I. Bredvold and Ralph
G. Ross. Ann Arbor: University of Michigan Press, p. 249.
- Chesterton, G. K. (1935). Broadcast talk, 6-11-35. Quotations of G.
K. Chesterton. Http://www.chesterton.org/discover/quotations.html
- Cushing, H. (1925). The Life of Sir William Osler. London: Oxford
University Press, vol. 1, p. 669.
- Didion, J. (2005). The Case of Theresa Schiavo." New York Review
of Books, Volume 52, Number 10, June 9.
Donne, J. (1646 / 1930). Biathanatos. New York: Facsimile Text Society.
- Faulkner, W. (1935). A Rose for Emily. Http://xroads.virginia.edu/~drbr/wf_rose.html
- Friedman, T. (2005). Singapore and Katrina. New York Times, September
- Hentoff, N. (2005). "he legacy of Terri Schiavo for the Nonreligious:
The disabled sound the alarm. Free Inquiry. 25: 33-35 (August/September).
- Hooff, A. J., van. (1990). From Autothanasia to Suicide: Self-Killing
in Classical Antiquity. London: Routledge, p. 51.
- Johnson, H. A. (1996). Osler recommends chloroform at sixty. The Pharos.
- More, T. (1516 / 1984). Utopia and Other Writings. New York: New American
Library, p. 18.
- Lerner, M. (2005). Michael Schiavo speaks at local medical ethics
conference. Minneapolis Star Tribune. February 24. Http://www.startribune.com/stories/
- Osler, W. (1905 / 1943). The Fixed Period. In Osler, W., Aequanimitas:
With Other Addresses to Medical Students, Nurses and Practitioners of
Medicine, 3rd edition. Philadelphia: Blakiston, pp. 375-393.
- Schiavo, M. (2003). Quoted in http://www.sptimes.com/2003/webspecials03/schiavo/
- Schiavo, M. (2005a). Quoted in http://msnbc.msn.com/id/8299372/, June
21, 2005 (a).
- Schiavo, M (2005b). Quoted in Lerner, M., Michael Schiavo speaks at
local medical ethics conference. Minneapolis Star Tribune, September
- Schiavo, M., (2005c). Quoted in Didion, J.. The Case of Theresa Schiavo.
New York Review of Books, Volume 52, Number 10, June 9, 2005.
- Szasz, T. (1963 / 1989). Law, Liberty, and Psychiatry: An Inquiry
Into the Social Uses of Mental Health Practices. Syracuse: Syracuse
University Press, 1989, pp. 212-222.
- Szasz, T. (1999 / 2001). Fatal Freedom: The Ethics and Politics of
Suicide. Syracuse: Syracuse University Press.
- Trollope, A. (1882 / 1993). The Fixed Period. London: Penguin.
Rose for Emily,' a rose for Terri: The lifeless body as love object
and the case of
Theresa Marie Schindler Schiavo," Palliative and Supportive Care,
4: 159-167 (June), 2006.
Rose for Emily," a rose for Terri: The lifeless body as love object
and the case of
Theresa Marie Schindler Schiavo
Thomas Szasz, M.D., Department of Psychiatry, Upstate Medical University,
State University of New York, Syracuse, New York.
Mailing address: 4739 Limberlost Lane, Manlius, NY 13104. Tel. 315-637-8918.
Keynote Address, "Controversies in End of Life Care: Terri Schiavo's
Baystate Medical Center, Department of Psychiatry; Smith College School
of Social Work; Baystate Health Systems, Office of Continuing Education.
Smith College, Northampton, Massachusetts, October 10 and 11, 2005.
FEAR AND FOLLY
Bertrand Russell, C. S. Lewis, and the Existential Identity Thief
flies and the truth comes limping after; so that when men come to be
undeceived it is too late: the jest is over and the tale has had its
Jonathan Swift (1667-1745)
of the basic functions of living organisms is avoiding danger. In human
beings, the emotion of fear serves that function. Because feeling fear
is unpleasant, we try to escape it by seeking protection from danger,
typically by looking to a Protector to protect us. Tragically, this
longing -- be it for a deity, demagogue, dictator, or doctor -- is,
itself, a source of danger. "Necessity," William Pitt (1759-1806)
famously remarked, "is the plea for every infringement of human
is the argument of tyrants; it is the creed of slaves." (Pitt was
British Prime Minister, 1783-1801 and 1804-1806.) Fear of the insane
and the psychiatrist's role as society's protector from the risk he
allegedly poses is what has made the mere ascription of the label "insane"
a justification for depriving the bearer of liberty.
the idea of "the dangerous madman" is a bugaboo or a tautology
(because we redefine bad as mad, deviant as deranged), it has captivated
the contemporary mind -- secular and religious alike -- and has entrapped
some of the most admired modern intellectuals.
A History of Western Philosophy, Bertrand Russell (1872-1970), the great
atheist skeptic, tried to refute David Hume's sceptical empiricism and
concluded that he was unequal to the task:
It is therefore important to discover whether there is any answer to
Hume within the framework of a philosophy that is wholly or mainly empirical.
If not, there is no intellectual difference between sanity and insanity.
The lunatic who believes that he is a poached egg is to be condemned
solely on the ground that he is in a minority, or rather -- since we
must not assume democracy -- on the ground that the government does
not agree with him. This is a desperate point of view, and it must be
hoped that there is some way of escaping from it (Russell, 1945: 673).
"desperation" was inconsistent with his scepticism, expressed
earlier in his Sceptical Essays, where he had stated: "I wish to
for the reader's favourable consideration a doctrine ... that it is
undesirable to believe a proposition when there is no ground whatever
for supposing it true" (Russell, 1928: 1). Russell was sceptical
about religion, but not about psychiatry. Positing the existence of
a lunatic who believes that he is a poached egg is a perfect example
of believing "a proposition when there is no ground whatever for
supposing it to be true."
Staples Lewis (1898-1963), the celebrated Christian apologist, believed
in religion but disbelieved in psychiatry. Nevertheless, in
his famous "trilemma," he too used the imaginary poached-egg
man to support his reason for believing in the divinity of Jesus:
am trying here to prevent anyone saying the really foolish thing that
people often say about Him: "I'm ready to accept Jesus as a great
teacher, but I don't accept His claim to be God." That is the one
thing we must not say. A man who was merely a man and said the sort
of things Jesus said would not be a great moral teacher. He would be
either a lunatic -- on a level with the man who says he is a poached
egg -- or else he would be the Devil of Hell.
must make your choice. Either this man was, and is, the Son of God:
or else a madman or something worse. You can shut Him up for a fool,
you can spit at Him and kill Him as a demon; or you can fall at His
feet and call Him Lord and God. But let us not come with any patronising
nonsense about His being a great human teacher. He has not left that
open to us (Lewis, 1952: 40-41).
model lunatic as a person who believes himself to be a poached egg evidently
was fashionable among twentieth-century English academics, at least
at Cambridge. Let us scrutinize this modern psychiatric miracle.
a debate unrelated to matters psychiatric, Russell, the hard-headed
empiricist, would emphasize that we have no way of knowing what a person
believes himself to be. We can know only what he tells us about who
or what he is and have no grounds for treating his claim as, a priori,
ordinary English as well as in the idiom of psychiatry, we call a person's
claim that he is a poached egg a "delusion." I have seen many
persons with so-called delusions and have read about many more, but
have never seen or read of a poached-egg-man. In nineteenth-century
European asylums, the most popular delusion was being Napoleon. In modern
American mental hospitals, it is being Jesus. Whether or not the speaker
believes his delusion to be true is irrelevant. The simplest, most parsimonious
explanation for his speech act is that he is lying. In his Sceptical
Essays, Russell himself suggested this interpretation. He wrote:
man who has suffered some humiliation invents a theory that he is King
of England, and develops all kinds of ingenious explanations of the
fact that he is not treated with that respect which his exalted position
demands. In this case, his delusion is one with which his neighbors
do not sympathize, so they lock him up. But if, instead of asserting
only his own greatness, he asserts the greatness of his nation or his
class or his creed, he wins hosts of adherents, and becomes a political
or religious leader (Russell, 1928: 1).
often claim or pretend to be someone they are not. When a person does
this on the stage, we call his behavior "acting." When he
impersonates another for economic gain, defrauding others in the process,
we call his behavior "identity theft." We treat him as a criminal,
guilty of committing fraud, not as a lunatic harboring false beliefs.
When, however, an individual impersonates say, Jesus, we refuse to see
the self-evident method in his madness, the desire to gain existential
rather economic advantage, and dismiss his conduct as "meaningless
I submit that we ought to view such behavior as a type of "existential
identity theft," a phenomenon that presents no particular challenge
to either philosophy or theology. Yet, Russell and Lewis both regarded
the existential identity thief as presenting the grandest of philosophical
and theological problems. Russell spoke of it "a desperate point
of view, and it must be hoped that there is some way of escaping from
it." There is, as I just showed. Lewis declared, "Either this
man was, and is, the Son of God: or else a madman or something worse."
There is an obvious third choice.
man who says he is a poached egg is a liar, and that ought to be the
end of the matter, for theology, philosophy, and psychiatry alike.
If we prefer to cast Lewis's riddle in softer terms, we might say that
the man in Nazareth 2000 years ago who said he is the Son of God was
a god-obsessed Jew, using a figurative language fashionable at the time,
expressing and conveying a meaning to himself and others the exact signification
of which we have no way of recapturing.
as I admire Lewis the man and his many memorable books, his assertion
that -- "You can shut Him up for a fool, you can spit at Him and
kill Him as a demon; or you can fall at His feet and call Him Lord and
God. But let us not come with any patronising nonsense about His being
a great human teacher. He has not left that open to us" -- is simplistic
said that his aim was to show us why we ought to believe in the divinity
of Jesus. Accepting his own postulate, he asserted that this hypothetical
man-god had forbidden us to say "patronising nonsense" about
him and that we must obey his prohibition. In short, Lewis treated his
premise as proof of itself.
the man who says he is Jesus, his identity thievery is an existential
coup. For psychiatry, such as man -- Jesus or poached egg -- is an existential
and economic gold mine. The fact that modern societies choose to value
the products of this "salted mine" more highly than gold,
indeed that they revere it as the science and practice of psychiatry,
is another issue.
Finally, both Russell and Lewis compounded their mistaken reasoning
about the nature of Existential Identity Theft by assuming that individuals
or society need to sanction the Thief. Russell declared:
"The lunatic who believes that he is a poached egg is to be condemned
solely on the ground that he is in a minority, ... etc."
"You can shut Him [Jesus as liar] up for a fool... " These
are non sequiturs. There is no need for individuals or society to condemn
and punish the Existential Identity Thief. Severing relations with him
suffices for our self-protection.
Thomas Szasz, M.D., Professor of Psychiatry Emeritus, Upstate Medical
University, State University of New York, Syracuse, New York. Home address:
4739 Limberlost Lane, Manlius, NY 13104-1405. Tel.: 315-637-8918.
I thank Professor Robert Spillane, Graduate School of Management, Macquarie
University, Sydney, Australia, for calling my attention to this passage.
Lewis, C. S. (1952) Mere Christianity (New York: Macmillan).
Russell, B. (1928) Skeptical Essays (London: Allen & Unwin).
Russell, B. (1945) A History of Western Philosophy: And Its Connection
with Political and Social Circumstances from the Earliest Times to the
Present Day (New York: Simon and Schuster).
bogus Benjamin Rush quote:
contribution to the history of pharmacracy"
Rush (1746–1813), the ‘father' of American psychiatry, is
perhaps best known as the inventor of the ‘tranquilizing chair'.
In recent decades, political and psychiatric activists have attributed
a quotation to him in which he allegedly warned: ‘To restrict the
art of healing to one class of men and deny equal privileges to others
will constitute the Bastille of medical science.' The source of this
quotation cannot be found, and Rush's remarks about ‘medical despotism'
are inconsistent with the body of his work. Other examples are cited
to illustrate the thesis that false attributions, used to support and
advance particular ideological causes, are remarkably resistant to efforts
Keywords: Benjamin Rush; interest groups and their agenda; ‘medical
Rush (1746–1813) was a Professor of Physic and Dean of the University
of Pennsylvania medical school, physician general of the Continental
Army, and a signatory to the Declaration of Independence. In 1812 he
published Medical Inquiries and Observations upon the Diseases of the
Mind, the first American textbook of psychiatry (Rush, 1812/1962). Appropriately,
he is considered the father of American psychiatry: his portrait adorns
the official seal of the American Psychiatric Association.
is the fate of such men that activists and writers with an axe to grind
often falsely attribute statements to them in their quest to bolster
their own arguments. Such misattributions readily assume a life of their
own, in accord with the psychological law discovered by Mark Twain.
He wrote (Twain, 1882):
[The …] maxim that ‘Truth is mighty and will prevail' [is]
the most majestic compound fracture of fact which any of woman born
has yet achieved. For the history of our race, and each individual's
experience, are sewn thick with evidences that a truth is not hard to
kill, and that a lie well told is immortal. [...] How easy it is to
make people believe a lie, and how hard it is to undo that work again!'
abound. One of the most successful fabrications is H. L. Mencken's hilarious
hoax about the history of the introduction of the bathtub into the United
States. Written during the war-time Prohibition of 1917, the piece ostensibly
memorialized the fictitious seventy-fifth anniversary of this momentous
event. Fifty years later, Mencken (1917/1967: 592) commented:
The success of this idle hoax, done in time of war, when more serious
writing was impossible, vastly astonished me. It was taken gravely by
a great many other newspapers, and presently made its way into medical
literature and into standard reference books. It had, of course, no
truth in it whatsoever, and I more than once confessed publicly that
it was only a jocosity [...] Moreover, it was exposed and denounced
by various other men, for example, Vilhjalmur Stefansson, the arctic
explorer (and great connoisseur of human credulity) [...] But it went
on prospering and in fact is still prospering. Scarcely a month goes
by that I do not find the substance of it reprinted, not as foolishness
but as fact, and not only in newspapers but in official documents and
other works of the highest pretensions.
following bogus quotation attributed to Benjamin Rush is a recent example
of foolishness masquerading as fact and mistaken for it. This is, we
are told, what Rush said about the relations between medicine and the
we put medical freedoms into the Constitution, the time will come when
medicine will organize into an undercover dictatorship [...] To restrict
the art of healing to one class of men and deny equal privileges to
others will constitute the Bastille of medical science. All such laws
are un?American and despotic and have no place in a republic [...] The
Constitution of this republic should make special privilege for medical
freedom as well as religious freedom. (Grinspoon; 2003: 63; Lord,2 1994)
bogus quotation – without a scintilla of evidence to support it,
and with a plethora of evidence against it – has become a ‘fact.'
A search of the World Wide Web (Internet) with the search engine Google
reveals dozens of entries to it. But not a single author supplies a
verifiable source for it. Hence, I believe this false attribution, depicting
Rush as a medical libertarian, needs to be exposed as bogus.
is important to remember that this is not the first time ‘humanitarian'
hagiographers of psychiatry have repainted ugliness as beauty. Famed
psychoanalyst and historian of psychiatry Gregory Zilboorg recast Johannes
Weyer (1515–88) from medieval demonologist into a proto-psychiatrist
who allegedly ‘recognized' that witches were ‘mentally ill.'
According to Zilboorg (1941: 216), ‘He [Weyer] leaves no doubt
but that one conclusion is warranted: the witches are mentally sick
people'. With similar disregard for the truth, psychiatrists have created
the legend of Philip Pinel (1745–1826) as a ‘reformer' who
‘struck the chains off the insane.' In fact, what Pinel had done
is to medicalize the justification for incarcerating innocent persons
in insane asylums (Szasz, 1970/1997: 203–4).
my book, The Manufacture of Madness, I presented a review of Rush's
psychiatric principles and practices and showed that he was a zealous
advocate of the medicalization of personal and social problems and their
coercive control by means of ‘therapeutic' sanctions. In short,
he was a pioneer champion of pharmacracy and the therapeutic state (Szasz,
1970/1997, 2001/2003). Anyone familiar with the history of psychiatry
ought to recognize that the quotation in question is a fabrication.
In Rush's day, psychiatry was a newborn infant. Most mad?house keepers
were still clergymen, not physicians. Madness, as the term continues
to imply, was associated with anger, lack of self?control, murder and
suicide (‘self?murder'), in short, with behaviour regarded as sinful
(Szasz, 1999/2002: 1–28). In 1774, when Rush was only twenty?eight?years
old, he revealingly declared: ‘Perhaps hereafter it may be as much
the business of a physician as it is now of a divine to reclaim mankind
from vice' (Rush, 1774/1967).
distinguish himself from the doctor of divinity, the doctor of medicine
could not simply claim that he was protecting people from sin or, as
Rush put it, from vice.
Badness was still, after all, a moral concept. As medical scientist,
the physician had to represent badness as madness, and madness as a
bona fide medical malady. He had to demonstrate, by his language and
actions, that his object of study was not the immaterial soul, but a
material object, a bodily disease. That is precisely what Rush did.
In a letter to his friend, John Adams, he wrote: ‘The subjects
[mental diseases] have hitherto been enveloped in mystery. I have endeavored
to bring them down to the level of all other diseases of the human body,
and to show that the mind and the body are moved by the same causes
and subject to the same laws' (quoted in Binger, 1966: 281).
did not discover that certain behaviours are diseases, he decreed that
they are: ‘Lying is a corporeal disease. / Suicide is madness.
/ Chagrin, shame, fear, terror, anger, unfit for legal acts, are transient
madness' (Rush, 1810/1948: 350). Today, some of these and many other
unwanted human behaviours are widely accepted as real diseases, their
existence ostensibly supported by the modern science of neurobiology.
In addition to deploying the idea of insanity to rationalize the widespread
use of ‘therapeutic' coercion, Rush (1812/1962: 263–70) also
championed the insanity defence. He defined crimes as ‘derangements
of the will,' explaining: ‘I have selected those two symptoms [murder
and theft] of this disease (for they are not vices) from its other morbid
effects, in order to rescue persons affected with them from the arm
of the law, and render them the subjects of the kind and lenient hand
of medicine' (Rush, 1810/1948: 264).
example, Lester Grinspoon – a Professor of Psychiatry at Harvard
and a prominent advocate of so-called ‘medical marijuana' –
believes, and would have us believe – that Rush stated: ‘To
restrict the art of healing to one class of men and deny equal privileges
to others will constitute the Bastille of medical science' (Grinspoon,
2003: 63). In fact, Rush is on record stating the exact opposite.
the many mental illnesses Rush invented was the disease he named ‘derangement
in the principle of faith or the believing faculty'. Instead of defining
this ailment, he illustrated it with examples of two types of ‘patients':
‘[P]ersons who deny their belief in the utility of medicine, as
practiced by regular bred [trained] physicians, believing implicitly
in quacks; [and] persons who refuse to admit human testimony in favor
of the truths of the Christian religion' (Rush, 1812/1962: 273–4).
noted, Rush defined his own ‘medical' methods as ‘kindly.'
In fact, his ‘treatments' consisted of inflicting pain on the patient
and depriving him of liberty. The following passage illustrates his
mind-set: ‘Lying, as a vice, is said to be incurable. The same
thing may be said of it as a disease [...] Its only remedy is, bodily
pain, inflicted by the rod, or confinement, or abstinence from food'
(Rush, 1812/1962: 265–6). For good measure, he added: ‘Terror
acts powerfully upon the body, through the medium of the mind, and should
be employed in the cure of madness' (p. 211). Rush went so far as to
invent a new ‘therapeutic' device – actually, an instrument
of terror and torture – which he presciently called the ‘tranquilizing
chair.' It was but a short ideological step from the tranquilizing chair
to the tranquilizing drug, each ‘administered' against the will
of the patient.
his persona, Rush displayed all of the manifestations of psychiatric
megalomania that characterize modern psychiatric thought and practice
(Binger, 1966: 200). Not only did he oppose the kind of ‘medical
freedoms' the bogus quote attributes to him, he ‘diagnosed' the
‘excess of the passion for liberty' as a form of mental illness.
Lamenting this passion, ‘inflamed by the successful issue of the
[Revolutionary] war', he explained: ‘The extensive influence which
these opinions had upon the understandings, passions, and morals of
many of the citizens of the United States, constituted a form of insanity,
which I shall take the liberty of distinguishing by the name of anarchia'
(quoted in Boorstin, 1948: 182). Disappointed with his political efforts,
he declared: ‘Were we to live our lives over again and engage in
the same benevolent enterprise, our means should not be reasoning but
bleeding, purging, low diet, and the tranquilizing chair' (Rush, 1951:
letter dated xxxx, in Butterfield, 1951: 1092).
ascertain further the fabricated provenance of the quotation that is
the subject of this essay, I sought the help of the Library of Congress.
On 17 October 2003, I received the following reply, which requires no
Subj: Benjamin Rush quotation
Date: 10/17/03 3:40:42 PM Eastern Daylight Time
Dear Dr. Szasz:
This is in reply to your letter of September 24, addressed to the Reference
Referral Service, Library of Congress. We have not found the quotation,
attributed to Benjamin Rush, which you are seeking. Your suspicion that
it is bogus is supported by a look at some of its words in the Oxford
English Dictionary. The Dictionary records no use of ‘un?American'
until a few years after Rush's death. ‘Under?cover' as an adjective
meaning ‘operating in secret' does not appear until 1920.
stature in the history of American medicine alone justifies calling
attention to the bogus nature of the quotation in question. It is further
justified by the fact that many of the persons who cite it are academics,
politicians and psychiatrists who ought to know better. The following
list is merely a sampling of the individuals and organizations who make
use of this bogus quote.
American Association for Health Freedom and the Access To Medical Treatment
We strongly support the American Association for Health Freedom (web
site www.apma.net) in their effort to pass the Access To Medical Treatment
Act. This is a Federal bill that has been introduced in the House by
Representatives Peter DeFazio, Joe Barton, and Ron Paul [...] As things
stand now, those who hold one view of health care expect to be allowed
to decide what constitutes legal methods of healing. It is just this
kind of despotism that our Founding Fathers intended to prevent. Benjamin
Rush, MD, a signer of the Declaration of Independence and personal physician
to George Washington said: ‘Unless we put medical freedom into
the Constitution, the time will come when medicine will organize into
an undercover dictatorship to restrict the art of healing to one class
of men and deny equal privileges to others; the Constitution of the
Republic should make a special privilege for medical freedoms as well
as religious freedom' (American Association for Health Freedom, 2003).
Congressman Ron Paul is trained as a physician. He also supports legislation
for ‘medical marijuana' and physician-assisted suicide. The reference
to Washington is lamentably shameless. Bloodletting – Rush's panacea
– has often, probably rightly, been blamed for Washington's premature
death from what may have the flu.
So many massage therapists with so many kinds of training have massaged
so many people with so many contraindications so many times for so many
years with so many benefits reported in so many publications, but with
so few, if any, well?documented cases of harm. [...] Dr. Benjamin Rush,
one of the Signers of the Declaration of Independence and Surgeon General
of the Continental Army of the United States, believed: ‘The Constitution
of the Republic should make special provision for Medical Freedom as
well as Religious Freedom. To restrict the art of healing to one class
of men and deny equal privileges to others will constitute the Bastille
of medical science. All such laws are un?American and despotic. They
are fragments of monarchy and have no place in a republic'. (Schatz
and Brewster, 1999)
Healthcare Freedom [...] Read the reports on our links and proposed
Health Care Freedom Bill with an open mind. [...] ‘Unless we put
medical freedom into the Constitution, the time will come when medicine
will organize into an underground dictatorship [...] To restrict the
art of healing to one class of men and deny equal privileges to others
will constitute the Bastille of medical science. All such laws are un?American
and despotic and have no place in a republic [...] The Constitution
of this republic should make special privilege for medical freedom as
well as religious freedom.' Dr Benjamin Rush, signer of the Declaration
of Independence. (Citizens for Health Care Freedom, 2003)
‘The Constitution of this republic should make special provisions
for medical freedom as well as religious freedom. To restrict the art
of healing to one class of man and deny equal privileges to others will
constitute the Bastille of medical science. All such laws are un?American
and despotic.' Benjamin Rush, M.D., Leading Allopath During the Founding
of America. (OKHealthfreedom, 2001)
Thomas Jefferson and Dr. Benjamin Rush (who was George Washington's
personal physician and a signer of the Declaration of Independence)
both foresaw that the federal government might someday attempt to control
medicine. Dr. Rush gave this diagnosis: ‘Unless we put medical
freedom into the Constitution, the time will come when medicine will
organize into an underground dictatorship [...] To restrict the art
of healing to one class of men and deny equal privileges to others will
constitute the Bastille of medical science. All such laws are un?American
and despotic and have no place in a republic [...] The Constitution
of this republic should make special privilege for medical freedom as
well as religious freedom'. (Un Sacco di Canapa, n.d.)
Our Mission is the advancement of Hyperbaric Oxygen Therapy used in
traditional circumstances as well as the prevention and enhancement
aspects of your health. [...] ‘Unless we put medical freedom into
the Constitution, the time will come when medicine will organize into
an undercover dictatorship […] To restrict the art of healing to
one class of men and deny equal privileges to others will constitute
the Bastille of medical science. All such laws are un?American and despotic
and have no place in a republic […] The Constitution of this republic
should make special privilege for medical freedom as well as religious
freedom.' Benjamin Rush, M.D., Signer of Declaration of Independence,
Physician to President George Washington (Rapid Recovery Hyperbarics,
A World Without Cancer
[...] In order to abolish the FDA, or at least to restrict its operation,
we will need either legislation or a constitutional amendment. We should
pursue both. The possibility of a constitutional revision is not as
extreme as it may sound. In fact, Dr. Benjamin Rush of Philadelphia
– one of the signers of the Declaration of Independence, a member
of the Continental Congress, Surgeon?General of Washington's armies,
and probably the foremost American physician of his day – had urged
his colleagues to include ‘medical liberty' in the First Amendment
at the time it was drafted. He wrote: ‘Unless we put medical freedom
into the Constitution, [...]'. As quoted by Dr Dean Burk in The Cancer
News Journal, May/June, 1973: 4. (Griffin, 2003)1.
The reference is bogus as well. This author embellishes the quote by
claiming that Rush had ‘urged his colleagues to include "medical
liberty" in the First Amendment at the time it was drafted' (Griffin,
use by various ‘therapeutic' interest groups of the bogus quotation
by Rush illustrates that falsehood can serve expediency, but it cannot
serve liberty. The advocacy of so-called ‘medical marijuana' –
in plain English, marijuana by medical prescription – is a dramatic
case in point. It is a bad cause, argued with bad evidence and in bad
my part, I have long agreed with Gilbert K. Chesterton, the celebrated
Christian humanist-humorist-philosopher, who stated: ‘The free
man owns himself. He can damage himself with either eating or drinking;
he can ruin himself with gambling. If he does he is certainly a damn
fool, and he might possibly be a damned soul; but if he may not, he
is not a free man any more than a dog' (Chesterton, 1909: 32). Either
we have the right to poison and kill ourselves with food, alcohol and
drugs, or we do not. For nearly half a century I have opposed drug prohibition,
the growing power of the therapeutic state, and mistaken efforts of
‘reformers' to deal with drug prohibition by multiplying instead
of repealing regulations that treat drug use as a crime (and mental
one of his recent essays, Lester Grinspoon reprises the medicinal value,
as defined by the consumers, of smoking marijuana, and the objections
of the government against permitting physicians to dispense it by prescription.
His argument is paternalistic both in content and tone. He laments that
we are not moving towards a ‘regulatory system that would allow
responsible use of marijuana' (Grinspoon, 2003: 81). No totalitarian
authority objects to the ‘responsible use' of the press, sex, alcohol
or anything else. In Grinspoon's scheme, who – if not agents of
the government – would have the authority to define ‘responsible
use'? Grinspoon not only begins his essay with a strategic misattribution
to Rush, he also ends it by repeating Rush's non-existing opposition
to ‘medical fascism' – precisely the type of pharmacracy Rush
supported and Grinspoon (2003: 81) now supports:
the cynical attitude of the federal government toward patients who use
medical marijuana, its attempt to intimidate physicians [the intimidation
is a fact, not an attempt] [...] lends credence to Benjamin Rush's concern
about medical fascism, then the patients and the people who help them
in a variety of ways constitute a resistance movement against medical
is not a plea for medical liberty. It is the self-congratulation of
one medical statist seeking to replace the authority and power of his
opponent, defining his coercive regulations ‘to responsibly use
this plant' as helpful, and those of his opponent to do the same thing
as harmful (Szasz, 2003; also Szasz, 1992/1996).
facts, let me repeat, contradict the contents of Rush's bogus quote
and refute the arguments and claims of those who use them. Rush was,
quite literally, a prohibitionist. In a letter to Jeremy Belknap (1744–98),
a Congregational minister and amateur American historian in Boston,
Rush wrote: ‘In the year 1915, a drunkard I hope will be as infamous
in society as a liar or thief, and the use of spirits as uncommon in
families as a drink made of a solution of arsenic or a decoction of
hemlock' (quoted in Binger, 996: 201).
the individuals and organizations who make use of the bogus Rush quote
have no interest in separating medicine and the state. If they had such
an interest, they could use a genuine quote to support their cause –
not by Rush but by Jefferson, who, not by coincidence, considered Rush
to be a quack and a medical menace (mainly on account of his enthusiasm
for bloodletting). Alluding to the crucial importance of bodily self-ownership
as a political issue, Jefferson (1781/1944: 275) mocked would-be statist
meddlers into our diets and drugs by reminding his readers that ‘in
France the emetic was once forbidden as a medicine, the potato as an
article of food. [...] Was the government to prescribe to us our medicine
and diet, our bodies would be in such keeping as our souls are now'.
of Psychiatry (UK), 16: 89-98 (March), 2005.
State University of New York
1. For additional web sites citing the quote, see:
David Wallace Croft Compilation. http://www.alumni.caltech.edu/~croft/quotes.txt.
Copyright released to the Public Domain by the author, 2003?03?19.
2. Dr Nancy Lord Johnson is both a lawyer and physician. In 1992, she
was the vice presidential candidate of the Libertarian Party.
The American Association for Health Freedom (2003) TITLE?? [PO Box 458,
Great Falls, VA 22066, USA]. Retrieved from www.apma.net; http://www.citizenshealth.org/amta.htm
Binger, C. (1966) Revolutionary Doctor: Benjamin Rush, 1746–1813
(New York: Norton).
Chesterton, G. K. (1909) Orthodoxy (London: John Lane).
Citizens for Health Care Freedom (2003) Philosophy of Health Freedom
[PO Box 62282, Durham, NC, 2771–2282, USA]. Retrieved from CHF@nc.rr.com;http://www.
Griffin, G. E. (2003) A World without Cancer [Worldwithoutcancer.org.uk,
PO Box 2038, Leigh?on?Sea, SS9 2ZB, UK]. Retrieved from http://www.worldwithoutcancer.org.uk/aworldwithoutcancer.html
Grinspoon, L. (2003) The medical marijuana problem. Journal of Cognitive
Liberties, 4, 63–81.
Jefferson, T. (1781/1944) Notes on the State of Virginia . In
A. Koch and W. Peden (eds) (1944), The Life and Selected Writings of
Thomas Jefferson (New York: Modern Library).
Lord, N. (1994). Excerpts from closing argument in the trial of Alternative
Health Care Provider Rodger Sless versus The United States Food And
Drug Administration, Albuquerque, NM, USA. Retrieved from http://gos.sbc.edu/l/lord.html
Mencken, H. L. (1917/1967) A neglected hoax . In Mencken, H. L.
(ed.) (1967), A Mencken Chrestomathy (New York: Knopf).
OKHealthfreedom (2003). Religious and cultural issues impede attempts
to license natural healing arts in Oklahoma. 2001. Retrieved from http://okhealthfreedom.homestead.
Rapid Recovery Hyperbarics (2003) TITLE. Retrieved from http://www.hbot4u.com/introduction.html
Rush, B. (1774/1967) Letter to Granville Sharp (1774). Quoted by J.
A. Woods (1967) The correspondence of Benjamin Rush and Granville Sharp,
1773–1809. Journal of American Studies, 1, 8.
Rush, B. (1810/1948). Lectures on the medical jurisprudence of the mind
(1810). In G. W. Corner (ed.) (1948), The Autobiography of Benjamin
Rush: His ‘Travels through life' together with his ‘Commonplace
book for 1789–1812' (Princeton: Princeton University Press).
Rush, B. (1812/1962) Medical Inquiries and Observations upon the Diseases
of the Mind (Reprinted 1962, New York: Macmillan – Hafner Press).
Rush, B. (1951) TITLE. In L. H. Butterfield (ed.), Letters of Benjamin
Rush (Princeton: Princeton University Press).
Schatz, A. and Brewster, M. (1999) A declaration of independence for
massage therapists. Massage Law Newsletter, 7 (4), PAGES. Electronic
version, retrieved from http://www.healingandlaw.com/
Szasz, T. (1970/1997) The Manufacture of Madness: A Comparative Study
of the Inquisition and the Mental Health Movement (Syracuse, NY: Syracuse
Szasz, T. (1992/1996) Our Right to Drugs: The Case for a Free Market
(Syracuse, NY: Syracuse University Press).
Szasz, T. (1999/2002) Fatal Freedom: The Ethics and Politics of Suicide
(Syracuse, NY: Syracuse University Press).
Szasz, T. (2001/2003) Pharmacracy: Medicine and Politics in America
(Syracuse, NY: Syracuse University Press).
Szasz, T. (2003) Marijuana medicalization: bad cause, bad faith. Journal
of Cognitive Liberties, 4: 83–5.
Twain, M. (1882) Advice to youth. Retrieved from http://www.twainquotes.com/lies.html
Un Sacco di Canapa (date). TITLE. Retrieved from http://www.unsaccodicanapa.com/htmlpages/jdi.html
Zilboorg, G. (1941) A History of Medical Psychology (New York: Norton).
2005 Thomas Szasz
"Idiots, infants, and the insane":
mental illness and legal incompetence
to the second world war, most persons confined in insane asylums were
regarded as legally incompetent and had guardians appointed for them.
Today, most persons confined in mental hospitals (or treated involuntarily,
committed to outpatient treatment) are, in law, competent; nevertheless,
in fact, they are treated as if they were incompetent. Should the goal
of mental health policy be providing better psychiatric services to
more and more people, or the reduction and ultimate elimination of the
number of persons in the population treated as mentally ill?
conflict between mental patient and psychiatrist; psychiatric reform;
involuntary psychiatric intervention; legal incompetence; mental illness.
medicine and law define mental illness as an "illness like any other
illness".1 The person diagnosed as mentally ill (and dangerous to
himself or others) is, however, deprived of liberty, a procedure called
"civil commitment" in the US, and "sectioning" in
Dictionary defines incompetence as the "legal status of a person
who is unable or unfitted to manage his own affairs...and for whom, therefore,
a committee may be appointed".2 It is the function of the court (judge)
to appoint a legal guardian for the incompetent person; such a guardian
has clearly defined fiduciary duties to protect the best interests of
the mental patent is considered competent (until proven incompetent).
In practice, he is regularly treated as if he were incompetent and the
psychiatrist who asserts that he needs treatment is treated as if he were
the patient's guardian.3 This conflation of mental illness and legal incompetence,
and the concomitant transformation of the mental hospital patient into
ward and the psychiatrist into guardian, is a relatively recent phenomenon.
When I was
a medical student in Cincinnati in the early 1940s, there were no voluntary
patients in Ohio state mental hospitals. A person could no more gain admission
to a state mental hospital voluntarily than he could gain admission to
a prison voluntarily. Individuals civilly committed to state mental hospitals
were considered legally incompetent. They were released, however, if their
next of kin was willing to care for them.
In the UK,
too, until recently, the person confined in a mental hospital was assumed
to be legally incompetent. Prior to the English Mental Health Act 1983,
it was generally assumed that psychiatric detention automatically authorised
the psychiatrist to treat the patient without consent. The act explicitly
authorised the treatment of detained patients without their consent.
In the aftermath
of the second world war, American social attitudes toward mental hospitalisation
began to change, partly as a result of the extermination of mental patients
in Nazi Germany. Journalists compared state mental hospitals to concentration
camps and called them "snake pits". Erving Goffman's book, Asylums,4
and my book, The Myth of Mental Illness,5 challenged the moral and legal
legitimacy of psychiatric coercions, exemplified by involuntary confinement
in a mental hospital. Presidents of the American Psychiatric Association
and editors of psychiatric journals acknowledged the problem of chronic
mental patients becoming "institutionalised".
At this critical
moment, the psychiatrists' drugs miraculously appeared and saved the profession.
At least for a time. Politicians and the public quickly accepted the psychiatrists'
claim that mental illnesses were brain diseases ("chemical imbalances"),
and that neuroleptic drugs are effective treatments for such diseases.
Psychiatrists and politicians used this fiction as a peg on which to hang
the complexly motivated programme of emptying the state mental hospitals,
misleadingly called "deinstitutionalisation".6 In short, the
three events characteristic of modern psychiatry-the development of psychiatric
drugs, deinstitutionalisation, and the conflation of mental illness and
legal incompetence-occurred in tandem, each facilitating and supporting
the treatment of mental diseases is no more successful today than it was
in the past. Deinstitutionalisation did not liberate mental patients.
Some state mental hospitals inmates were transinstitutionalised, rehoused
in parapsychiatric facilities, such as group homes and nursing homes.
Others were imprisoned for offences they were prone to commit, transforming
jails into the nation's largest mental hospitals. Still others became
"street persons", living off their social security disability
benefits. Most idle, indigent, unwanted persons continue to be incarcerated
in mental hospitals-intermittently, committed several times a year, instead
of once for decades.
the powers of courts and mental health professionals were vastly expanded:
before the second world war, they could control and forcibly "treat"
only persons housed in mental hospitals. Armed with "outpatient commitment"
laws (in the US), psychiatrists can now control and forcibly "treat"
persons living in the community.
Medical practices rest on consent. Psychiatric practices rest on coercion,
actual or potential. It is the power and duty to coerce mental patients-to
protect them from themselves and to protect society from them-that has
always set, and continues to set, psychiatrists apart from other medical
practitioners. Nevertheless, the conflation of mental illness and legal
incompetence-redescribed as "protection of the patient's best interest"-is
widely regarded as an important advance in medical and psychiatric ethics.
In the old days of asylum psychiatry, the connection between mental illness
and legal incompetence was unambiguous. If a person was mad enough to
merit confinement in a madhouse, then he was manifestly incompetent. Whereas
if he was competent, then he was manifestly not a fit subject for incarceration
in an insane asylum.
second world war, the treatment of "mental illness" by psychoanalysis
and psychotherapy achieved sudden popularity. The introduction of neuroleptic
drugs into psychiatry created the illusion that mental illnesses, like
medical illnesses, were "treatable" with drugs. Doubt about
the benefits of long term mental hospitalisation was replaced by confidence
in the effectiveness of outpatient chemotherapy for mental illness. A
new class of mental patients thus came into being-persons who sought psychiatric
help, paid for the services they received, and were regarded as legally
competent. In these important ways, they resembled medical patients. This
development greatly enlarged the number of persons classified as mentally
ill, contributed to the false belief that legal competence is a psychiatric
issue, and confused the legal relations between psychiatrist and mental
facts continue to bedevil psychiatry and especially the increasingly important
field of forensic psychiatry-namely, that we lack objective tests for
both mental illness and mental (legal) competence. Competence and incompetence-like
innocence and guilt-are attributions, not attributes, judgments, not facts.
That is why traditionally they are rendered by lay juries, not professional
the psychiatric patient whose behaviour is socially deviant risks being
considered incompetent (as well as mentally ill). If-for example-the patient
kills herself or someone else, then, after the fact and simply for this
reason, she is considered incompetent and her psychiatrist's treatment
of her is judged to be "medically negligent": the psychiatrist,
viewed as the patient's guardian, is considered to have failed to fulfil
his "duty to protect" his ward. None of this was true as recently
as the 1960s.
of mental illness and legal incompetence entangles both patients and psychiatrists
in Alice in Wonderlandish encounters, as the following example illustrates.
On December 7, 1981, a man named Darrell Burch was found wandering along
a Florida highway, appearing to be disoriented. Taken to Apalachee Mental
Health Services (ACMHS) in Tallahassee, his evaluation form stated that:
"upon arrival at ACMHS, Burch was hallucinating, confused, and psychotic
and believed he was 'in heaven'".7 Burch was asked to sign forms
giving consent to admission and treatment and did so. Diagnosed as suffering
from paranoid schizophrenia, he was given psychotropic medication.
Burch was transferred to the Florida State Hospital (FSH) in Chattahoochee
and again asked to sign, and did sign, forms giving consent to hospitalisation
and treatment. At the FSH, a staff physician named Zinermon "wrote
a progress note indicating that Burch was refusing to cooperate and would
not answer questions" (Zinermon v Burch,7 p 119).
at the FSH as a "voluntary" patient for 5 months. After he was
released, he sued Zinermon and 10 other staff members of the FSH for having
deprived him of liberty without due process of law, because he was mentally
incompetent to consent to hospitalisation and treatment. The case was
appealed all the way to the United States Supreme Court, which ruled that
when Burch was admitted to the FSH, he was incompetent and hence had a
constitutionally protected right to a court hearing to determine whether
he should be committed and treated as an involuntary patient:
[T]he very nature of mental illness makes it foreseeable that a person
needing mental health care will be unable to understand any proffered
"explanation and disclosure of the subject matter" of the forms
that the person is asked to sign, and will be unable "to make a knowing
and willing decision" whether to consent to admission....The characteristics
of mental illness thus create special problems regarding informed consent.
Even if the State usually might be justified in taking at face value a
person's request for admission to a hospital for medical treatment, it
may not be justified in doing so, without further inquiry, as to a mentally
ill person's request for admission and treatment at a mental hospital
(Zinermon v Burch,7 pp 121 and 133, emphasis added).
ruling upset the psychiatric establishment. Bruce J Winick, a professor
of law at the University of Miami, complained that "the court's language
could have unintended antitherapeutic consequences" (emphasis added).8
This cliché assumes that the purpose of depriving insane persons
of liberty is therapy, which, given the dangerousness clause in commitment
laws, is patently false.
to conduct relations with individuals we do not know, we must make certain
presumptions about them. The automobile dealer must presume that his customer
is legally competent and responsible for his purchase. The physician whose
patient complains of blood in his stool must presume that the patient
has a disease. The Anglo-American legal system must presume that a person
accused of a crime is innocent until proven guilty, and competent until
We are proud
of our criminal justice system because it protects the accused from the
power of the state, a power we distrust because its avowed aim is to harm
the individual. Similarly, we are also proud of our mental health system,
because it protects the mentally ill person from the dangers he poses
to himself and others, a power we trust because its avowed aim is to help
arise, however, once the power of the state to "help" goes beyond
offering services (or money) and, instead, the state makes use of coercion.
The justification for psychiatric coercion is further weakened by resting
the requirement for commitment on "mental illness" and "dangerousness".
There are no objective criteria for either mental illness or dangerousness.
Thus psychiatric determinations and declarations of their presence or
absence are essentially oracular and rhetorical. Nevertheless, they fulfil
a very important function: they instruct the listener to assume a desired
attitude toward the "patient".9 The distinction between descriptive
and dispositive terms is crucial for understanding this conundrum.
a door as brown or white is descriptive. Characterising it as needing
to be opened or closed is dispositive. Descriptive characterisations can
be proved or disproved. Dispositive characterisations cannot, they can
only be obeyed or disobeyed. The difference between the situation of the
person accused of a crime and the situation of the person accused of mental
illness is illuminating. The defendant has a right to deny his crime and
disagree with his accusers. His insistence on his innocence is not interpreted
as evidence of his guilt. The person diagnosed as mentally ill loses this
right. His disagreement with the psychiatrist is interpreted as "lack
of insight into his illness" or "denial of his illness".
His insistence on his sanity is interpreted as evidence of his insanity.
use the term "competent" as if they were identifying a "mental
condition" in the designated person. That is why courts request the
psychiatrist to examine defendants for competence, as if they were looking
for and detecting (or not detecting) certain facts. Psychiatric "findings,"
however, especially in a forensic setting, are not facts but recommendations
for a course of action toward the defendant.
it is precisely because the American system of criminal justice is so
intensely concerned with protecting innocent persons from punishment that
it is especially vulnerable to corruption by excuses couched in terms
of psychiatric disabilities and coercions justified as psychiatric treatments.
The root of the problem lies largely in the concepts of mental illness
and dangerousness, and partly in the doctrine of mens rea, sound mind.
"mental illness" and "dangerousness" lack objectively
verifiable criteria, they are easily abused.9 The legal doctrine of mens
rea, sound mind, which holds that unlawful behaviour constitutes a crime
only if it is committed by an actor who possesses a "guilty mind"-that
is, whose "mind" can be held responsible (because it knows right
from wrong), also works to strip the person incriminated as mentally ill
of his rights. Since the Middle Ages and before, insane persons-perceived
as similar to "wild beasts"-have been regarded as lacking mens
rea. This is why "infants, idiots, and the insane"-in John Locke's
famous phrase, repeated unchanged ever since-are not prosecuted or punished
by the criminal law, but instead are restrained, as minors and as mad,
by family courts and mental health laws.
mentally ill persons as if they were like children fails to take into
account the many obvious differences between them. Minority is an objectively
defined (chronological) condition and a legal status. Mental illness is
neither. Children are, by definition, under tutelage. Few mental patients
are under tutelage and those that are, are in that status not because
they are mentally ill but because they are declared to be legally incompetent.
"mental patients" are not children and are not like children.
They are adults, entitled to liberty and responsible for their crimes.
I maintain that "mental illness" is not something the patient
has, it is something he is. The modern psychiatrist is likely to view
Lady Macbeth as insane, the victim of manic depressive psychosis, an illness
that renders her not responsible for her crimes. Shakespeare viewed her
as "Not so sick...as troubled with thick coming fancies", for
which she needs "the divine [minister, rather] than the physician".10
survival of psychiatry as a medical specialty depends on postulating and
perceiving "mental illness" as a disease, an entity "outside"
and separate from the patient as a moral agent, in the sense that, say,
malaria, in a European tourist returning from Africa, is "outside"
and separate from his persona.11
In an interesting
recent paper, Sadler and Fulford struggle with this issue and propose
that, in formulating criteria for psychiatric diagnoses (but not for medical
diagnoses), psychiatrists include the opinions of mental patients and
their relatives. They write: "Why should psychiatry involve patients
in diagnosis? A key part of psychiatric treatment, rehabilitation, and
recovery is helping the patient to distinguish between the features of
illness and the features of the self-to move patients from battling themselves
to battling their disorders" (emphasis added).12
years ago, psychiatric nosology was the province of the neuropathologists:
by definition, mental diseases were brain diseases, identified at autopsy
and demonstrated by histological evidence. The purpose of a diagnosis-medical
and psychiatric alike-was to convey scientific information. Since then,
without anyone quite realising it, neuropathological diagnostic criteria
were transformed into psychopathological diagnostic criteria, and the
reasons for making psychiatric diagnoses have expanded and now serve a
vast number of complex economic, political, social, and other non-scientific
Sadler and Fulford's therapeutic aim of "moving patients from battling
themselves to battling their disorders", it is necessary to note
that everyone harbours contradictory desires and thus everyone may be
said to be battling himself.
accentuate the metaphor of "inner battle", while they avert
their gaze from the bitter reality of the "outer battle", the
battle between the involuntary mental patient and "his" psychiatrist.
I dare say that that embarrassing spectacle is our profession's "elephant
in the room". The need to pretend that it is not there is the most
important unwritten rule of psychiatric etiquette.13
theory, mental illness and mental incapacity are separate issues. In psychiatric
practice, they are the same issue. In Re C (1994), the English High Court
held that detained patients were entitled to the presumption of competence:
a hospitalised patient with schizophrenia was considered competent to
refuse amputation of his gangrenous foot. Had the patient sought to refuse
drug treatment for schizophrenia, his decision could have been overruled
and he could have been medicated against his will.13
In a 1999 review article in the BMJ, Barbara Hewson, a London barrister,
concluded that: A person may remain competent even if detained under the
Mental Health Act 1983....Adults are presumed competent to refuse treatment,
even in an emergency; but it is not easy to judge in practice what factors
are capable of rebutting the presumption. Every case turns on its own
facts. The detention of incompetent patients for treatment...is controversial,
and likely to generate litigation under the Human Rights Act 1998....
the law in this area is complex.14
the law in this area is not just complex, it is not true law at all: absent
objective criteria for the key concepts, decisions about competence and
the right to reject psychiatric treatment, remain in the hands of psychiatrists.
This gives psychiatrists both too much power and too much responsibility.15
In a reply
to Hewson's article, a Canadian psychiatrist complained: "After reading
Hewson's article I was more confused than ever. No matter what is decided,
to treat or not treat, a doctor has the pleasure of looking forward to
an assault charge or wilful negligence. This entire debate is ludicrous.
The law should be changed so that a self harm is viewed as a declaration
of incompetence".16 This respondent can think of no better solution
than to revert to the "good old days of psychiatry": restore
absolute medical power over mental patients to psychiatrists, complemented
by legal immunity for the consequences of their decision.
In a 2002
editorial in The Psychiatric Bulletin, Vanessa Raymont, an English psychiatrist,
Although the notion of informed consent was recognised in medical practice
as early as the 1700s, it was not until the advent of the voluntary boarder
status in the Lunacy Act 1890 and the voluntary patient in the Mental
Treatment Act 1930 that the issue of capacity and consent for psychiatric
treatments was first raised in non-detained patients....The Mental Health
Act 1983 allows treatment without consent in psychiatric illness, but
not physical illness.17,18
by the European Court of Human Rights (ECHR) regarding complaints of psychiatric
deprivations of human rights further illustrate the discrepancy between
legal theory and psychiatric practice. A woman in the Netherlands voluntarily
entered a psychiatric hospital. A month later, a judge, without notifying
the patient, confined her to the hospital for 6 months without holding
a hearing. The ECHR ruled that the defendant/patient's "right to
a speedy trial or hearing applies to both criminal arrests and psychiatric
detentions and hence the patient's rights were violated".19
It is inevitable
that many persons in society-infants and young children, severely retarded
individuals, demented and unconscious patients-must be treated as legally
incompetent. This is not true for mental patients.
motive behind recent so called mental health reforms has been the desire
to free the mental patient from anachronistic, authoritarian psychiatric
controls. Certain crass psychiatric coercions-such as indefinite involuntary
mental hospitalisation, beatings, and cold showers-have become unfashionable.
Yet, changes in mental health policy have failed to increase the mental
patient's responsibility to care for himself, to be accountable for his
everyday behaviour, and to be legally answerable for his criminal conduct.
On the contrary, today more people than ever are defined as mental patients
and are "treated" without their consent, as if they were incompetent.
More worryingly, the coercive practice of commitment, formerly confined
to the mental hospital, has metastasised: outpatient commitment has turned
all of society into a kind of mental hospital.
make progress in mental health care policy until we clarify and agree
on what we mean by progress. Psychiatrists and politicians mean by it
making more and better mental health services available to more and more
people. I consider that to be not progress, but a plan to turn more people
into "consumers of mental heath services". There can be only
one humane goal for mental health care policy, namely, reducing and ultimately
eliminating the number of persons in the population treated as mentally
ill. We cannot attain this goal - indeed, we cannot even begin to pursue
it-as long as we cling to the notion that "mental illness" is
a disease that the patient "has".
may look like an illness and may be called an illness, but it is not a
true illness. Similarly, mental health law may look like law and may be
called law, but it is not true law. Anglo/American criminal law is a shield
to protect the person accused of crime from the power of the state. Anglo/American
mental health law is a weapon to protect the state from the person denominated
as "mental patient" (as well as the "patient" from
years ago, Montesquieu (1689-1755) warned: "There is no more cruel
tyranny than that which is perpetrated under the shield of law and in
the name of justice".20 This is perhaps even truer today, when tyranny
is perpetrated not in the name of justice, but in the name of therapy.21
I thank Professor
Phil Fennell for his helpful suggestions.
Mental illness is like any other sickness <http://www.mindpub.com/art110.htm>
(accessed 22 Jul 2004).
- Black HC. Black's law dictionary. St Paul, MN: West, 1968:906.
- NY keeps forced mental health treatment. New York Times 17 Feb 2004.
- Goffman E. Asylums: essays on the social situation of mental patients
and other inmates. Garden City, NY: Doubleday Anchor, 1961.
- Szasz T. The myth of mental illness: foundations of a theory of personal
conduct. New York: Hoeber-Harper, 1961.
- Szasz T. Cruel compassion: the psychiatric control of society's unwanted.
New York: Wiley, 1994.
- Zinermon v Burch, 494 US 113, 1990:118.
- Winick BJ. Voluntary hospitalization after Zinermon v Burch. Psychiatr
Ann 1991;21:584-9 at 584.
- Szasz T. Psychiatry and the control of dangerousness: on the apotropaic
function of the term "mental illness". J Med Ethics 2003;29:227-30.
- Macbeth act 5, Scene 3, lines 38-39 and scene 1, line 69. In: Harbage
A, ed. The tragedy of Macbeth. Baltimore, MD: Penguin, 1956.
- Szasz T. Insanity: the idea and its consequences. New York: Wiley, 1987.
- Sadler JC, Fulford B. Should patients and their families contribute
to the DSM-V process? Psychiatr Serv 2004;55:133-8.
- Iglehart JK. The mental health maze and the call for transformation.
N Engl J Med 2004;350:507-14.
- Hewson B. The law on managing patients who deliberately harm themselves
and refuse treatment. BMJ 1999;319:905-7.
- Szasz T. Liberation by oppression: a comparative study of slavery and
psychiatry. New Brunswick, NJ: Transaction, 2002.
- Osmun T. Damned if you do, damned if you don't. Rapid responses to Hewson
B 1 Oct 1999 http://bmj.bmjjournals.com/cgi/eletters/319/7214/905#4793
22 Jul 2004).
- Raymont V. "Not in perfect mind": the complexity of clinical capacity
assessment. Psychiatr Bull R Coll Psychiatr 2002;26:201-4
<http://pb.rcpsych.org/cgi/content/full/26/6/201> (accessed 22
- Fennell PWH. Treatment without consent: law, psychiatry, and the treatment
of mentally disordered people since 1845. London: Routledge, 1996.
- Van der Leer v The Netherlands. (series A, no 170: application no 11509/85).
European Court of Human Rights (1990) 12 EHRR 567, 7 BMLR 105.
- Montesquieu C.The spirit of the laws [trans Nugent T]. New York: Hafner
Press, 1949; <http://www.geocities.com/Athens/Forum/1327/qjustice.html>
(accessed 22 Jul 2004).
- Szasz T. Pharmacracy: medicine and politics in America. Westport, CT:
A new form of insurance for an eternal problem
patients both take risks when they do business together. The physician
(for the most part), only puts his wealth is at risk: He protects himself
by means of malpractice insurance. But for the patient, both wealth and
physical health are at risk. At present, the patient can protect himself
only against the risk of incurring a ruinous financial cost for the diagnosis
and treatment of his illness: He protects himself by means of health insurance.
How do we create an insurance regime that provides a form of protection
neither of these policies can provide?
a new form of medical insurance for the patient: protection against the
risks of diagnostic and therapeutic procedures that may or may not be
due to bona fide medical negligence—that is, "malresult insurance."
When a patient
suffers an undesirable outcome as a result of medical care, the harm may
or may not be the physician's fault. More often than not, the "malresult"
is an "act of God." Nevertheless, malresults are now often attributed
to and treated as cases of medical malpractice (negligence). Making medical
malresult insurance available and expecting patients to use it would be
a step toward more fully recognizing the commercial aspects and risks
of the medical situation.
choose to buy a house purchase home owner's insurance. People who choose
to drive purchase (are compelled by law to purchase) automobile insurance.
Similarly, people who choose to undergo diagnostic and therapeutic procedures
ought to be able, and be expected, to purchase medical malresult insurance.
commercial relations, premiums for insurance depend on the demonstrated
behavior of the insured. Drivers with a good record pay a lower premium
than drivers with a record of traffic violations. In medical malpractice
insurance, this fundamental principle is largely inoperative.
and neurosurgeons pay a much higher premium for malpractice insurance
than do ophthalmologists and pediatricians. Why? Not because they are
more prone to practicing medicine negligently than physicians in other
specialties, but because the procedures they perform are more hazardous
than those performed by ophthalmologists and pediatricians. Accordingly,
patients who submit to high-risk procedures especially need insurance
to protect themselves from malresult, just as physicians who perform such
procedures especially need insurance to protect themselves from malpractice.
all medical encounters are risky. The chance of dying during or after
general anesthesia is one in 10,000. The risk of perforation of the colon
during diagnostic colonoscopy is 0.2 to 0.4 percent; it increases to between
0.3 and 1.0 percent if it is combined with polypectomy; the overall death
rate from the procedure is about one in 12,500. The chance of a pregnant
woman dying as a result of her pregnancy is approximately 1 in 12,000
(in the U.S.).
who chooses to become pregnant incurs risks similar, in principle, to
the risks an entrepreneur incurs who chooses to engage in an activity
that may be dangerous to others or himself, say, transporting gasoline.
The pregnant woman exposes herself to the risk of having an abnormal baby
or becoming the victim of a medical complication (for example, a stroke).
It is reasonable that she bear the cost of insuring herself against these
If an obstetrician
delivers an abnormal infant, regardless of whether he is innocent or guilty
of malpractice, juries are likely to find him liable for large damages.
If the expectation for the purchase of insurance for malresult were as
firmly established as is the expectation for the purchase of insurance
for malpractice, pregnant women would be expected to protect themselves
by purchasing such insurance. Obstetricians could then restrict their
practices to women who have such insurance (the cost of which would be
negligible compared with the cost of raising a child). As a consequence,
their exposure to malpractice litigation would shrink to a fraction of
its present size.
and treatment of disease is dangerous for the patient economically as
well as medically. At present, the patient protects himself from the economic
harm of the medical situation by health insurance, and expects to be protected
from the medical harm by the physician's malpractice insurance. This arrangement
fails to distinguish between injury the patient suffers as a result of
the nature of his illness and treatment, and injury the physician inflicts
on him as a result of improper care.
To the victim
of a medical catastrophe, it makes little difference why such a calamity
befalls her or him. Delivering an infant with spina bifida or becoming
quadriplegic as a result of a hazardous spinal cord operation irrevocably
changes the life of the mother and neurosurgical patient. Perhaps largely
for that reason, tort law does not adequately recognize the difference
between medical "malresult" that happens through no fault of
anyone, and medical malpractice, that is, bona fide medical negligence.
The result is that, in a suit for malpractice brought by a poor, disabled
patient against a rich insurance company (and healthy physician), the
jury is more likely to base its judgment on compassion for the sufferer
than on the merits of the case (that is, on the question of the physician's
culpability or lack of it for the patient's injury). Awarding a large
sum to the plaintiff-victim "feels" like the "right thing
to do" and makes members of the jury feel better.
cannot restore health irrevocably lost, much less bring back the dead.
All it can do is take money from the insurance company (and/or the physician)
and give it to the victim or his family (and his lawyers). Adding a market
in patient insurance for malresult to the market in physician insurance
for malpractice would accomplish two important goals. It would guarantee
compensation for the injured patient, more expeditiously and securely
than malpractice insurance does, and it would protect the physician innocent
of malpractice from having to settle claims against him. (Insurance companies
could establish a schedule of specified diagnostic and therapeutic malresults
similar to the schedule of bodily injuries specified in policies for accidental
bodily injury and death.)
to the American Medical Association, 20 states now face a full-blown medical
liability crisis. Data from the National Association of Insurance Commissioners
shows a 750 percent increase nationally in malpractice insurance premiums
since 1975. For some specialists, such as obstetricians, the annual insurance
premium exceeds $200,000.
premiums cause physicians to restrict their practices or retire early,
and lead medical students to avoid going into lawsuit-magnet specialties
like obstetrics and neurosurgery. While the risk of malpractice litigation
affects all physicians, those most affected are specialists whose patients
are most likely to suffer devastating injuries. Similarly, while all patients
need malresult insurance, those who need it most are obstetrical and neurosurgical
not go skiing to break a leg. If they do so, they are, as a rule, responsible
for paying the cost of their treatment or for having insurance to pay
it. People do not consult physicians to become disabled or die. If they
do, they ought to be responsible for the financial consequences or have
insurance to compensate them for their loss, unless the physician commits
later, we shall have to confront our inconsistent expectations from modern
medical technology. We demand, as a "right," the accurate diagnosis
and effective treatment of disease; but when, in the process, we suffer,
we feel medically and legally wronged and take to the courts. Rights and
responsibilities cannot be disjoined forever. It is a delusion to believe
that we can continue to assume medical risks without assuming responsibility
for the harms we suffer as a consequence. The availability of insurance
for malresult would radically change the medical tort litigation scene:
it would place some of the responsibility for risks inherent in medical
diagnoses and treatments on patients, where it rightfully belongs
Contributing Editor Thomas Szasz, a professor of psychiatry emeritus at
the SUNY Upstate Medical University in Syracuse, is the author, most recently,
of Faith in Freedom: Libertarian Principles and Psychiatric Practices
2005 © Thomas Szasz,
emeritus professor of psychiatry
Department of Psychiatry, Upstate Medical University, State University
of New York, Syracuse, NY 13210, USA Correspondence to: 4739 Limberlost
Lane, Manlius, New York, NY 13104, US
(Let the Buyer Beware)
Why do some
people seek psychiatric help and find psychiatric harm? Whose fault is
it? Although I consider psychiatry's responsibility for misinforming people
and mangling their lives self-evident, I also hold the victims partly
responsible for their fate. Why? Because I believe it is every person's
responsibility to inform himself, to the best of his ability, about the
world he lives in. "A popular government without popular information,
or the means of acquiring it," warned James Madison, fourth President
of the United States (1809-1817), "is but a prologue to a farce,
or a tragedy, or perhaps both. Knowledge will forever govern ignorance;
and people who mean to be their own governors, must arm themselves with
the power which knowledge gives."
remarks about political self-government apply with even greater force
to personal self-government, especially in a modern society in which the
manipulation of information is of paramount importance. The less a person
knows about the social institutions of his government, the more he must
trust those who wield power over them. The more he trusts those who wield
such power, the more vulnerable he makes himself to becoming their victim.
In the case of "voluntary" commitment, both the psychiatric
victimizer and his victim must share the blame - though not necessarily
in equal proportion - for the injury the former inevitably inflicts on
the latter. Unlike the typical victim of psychiatric despotism who comes
to love his oppressor and believe in his goodness, a minority of people
escape from psychiatric slavery, and shed their illusions about the benevolence
of jailers and poisoners who masquerade as doctors.
of psychiatry - epitomized by the practice of incarcerating persons innocent
of crimes in buildings deceptively called "hospitals" - has
always been dangerous to the welfare of its inmates. It had never been
the purpose of psychiatry to help the inmates rendered powerless by psychiatric
imprisonment. Psychiatry's aim has always been, and still is, to help
a relatively powerful person - primarily the denominated patient's parent,
spouse, or other relative - by disqualifying the less powerful kin whose
behavior troubles him as "troubled", which is to say mad, and
by incarcerating the victim defined as a patient in a madhouse. While
this has always been true, people today are more misinformed and more
gullible about the true nature of psychiatry than ever. Accordingly, it
is imperative that men, women, and children learn to protect themselves
from the dangers of psychiatry. As adolescents must learn not to climb
mountains during a thunderstorm, lest they be struck by lightening, they
must also learn, when their lives are stormy, to avoid psychiatrists and
stay away from mental hospitals.
have power are ipso facto dangerous to others. Because of the obvious
connections between power and evil, only the corrupt seek power. Psychiatrists
have a great deal of power. Because they are utterly corrupted by the
pretense of helping the so-called patients while in fact acting as agents
of social control on behalf of the patients' familial and social antagonists,
it is imperative that potential consumers of psychiatric services be familiar
not with what mental health professionals say, but with what they do.
I do not
doubt that the desire to help is often genuine. The problem is that if
the Other's affliction lies in his soul rather than in his body, then
the urge to help him cannot be satisfied without establishing a bond of
intimacy with him. Inevitably, the very attempt turns into a disaster,
into an opportunity for existential cannibalism. I use this term to denote
encounters officially defined as therapeutic that, in fact, consist of
the malefactor de-meaning his maleficiary - by destroying the meaning
that he, the nominal beneficiary, has given his own existence. There are
many ways of practicing existential cannibalism. In our society, the most
popular form is to give one's "beneficiary" a psychiatric diagnosis
and impose on him a psychiatric treatment, neither of which he wants.
This enables the "benefactor" to claim that he is helping and
strengthening his beneficiary, while in fact he is harming him and rendering
him more powerless.
We can and
must oppose the mental health industry's massive campaign of disinformation,
essential for maintaining the practice of cannibalism. For every patient
psychiatrists claim to have helped, there are others who assert to have
been harmed. Against every glamour story about the therapeutic powers
of neuroleptic drugs, electroshock, and incarceration in insane asylums
told by psychiatrists, psychiatric survivors can pit a horror story about
the noxious powers of psychiatrists exercised by means of their deceptive
vocabulary and pseudo-medical interventions.
now requires that cigarettes carry a warning label, cautioning the buyer
about the risks he assumes if he uses the product. It is not a new idea.
Dante depicted the entrance to Hell as emblazoned with the warning, "All
hope abandon, ye who enter here." Not until the same warning is prominently
displayed over the office door of every mental health professional who
has not forsworn therapeutic coercion, and over the entrance to every
mental hospital, will persons who seek psychiatric help be in a position
to give informed consent to their social stigmatization and spiritual
has been condensed and adapted with permission by the author from the
Foreword to Madness, Heresy, and the Rumor of Angels, The Revolt Against
the Mental Health System, by Seth Farber, Open Court, Chicago, 1993. The
adaptation is by Mira de Vries, Chairman of MeTZelf. MeTZelf thanks Dr.
Szasz for his kind permission to use his work.
core libertarian principle of self-ownership implies that we have a right
to commit suicide: the state has no right to forcibly prevent us from
The core psychiatric practice of suicide prevention implies that we have
no right to commit suicide: the state -- through its mental health laws
and psychiatric agents -- has the "duty" to forcibly prevent
us from killing ourselves.
That is not all. "Suicide prevention" -- a euphemism for incarceration
in a mental hospital -- is preventive detention, par excellence. From
a civil rights viewpoint, depriving a person of liberty because he might
commit an act in the future is anathema. Doing so because he might commit
an act that is not a crime is an outrageous injustice. Mental health laws
authorize and obligate the psychiatrist to incarcerate his patient if
he deems him to be "mentally ill and dangerous to himself or others."
Marcia Goin, president of the American Psychiatric Association for 2003,
states: "We can make contracts with builders, insurers, and car dealers,
but not with patients." (Marcia Goin, "From the President,"
Psychiatric News, 38: 3 & 27 [July 18], 2003. http://pn.psychiatryonline.org/cgi/content/full/38/14/3.)
Goin offered her unqualified rejection of contracting with mental patients
in the context of the so-called "no suicide contract." That
absurd term refers to the psychiatrist's promising the "suicidal"
patient that he will forego committing him, provided the patient promises
that, as long as he is under the psychiatrist's care, he will not kill
Whether such a "contract" is or is not effective in preventing
suicide does not concern me here. What concerns me, instead, is the psychiatric
premise that the patient has no right to kill himself; the psychiatrist's
professional duty to prevent the patient from killing himself; and the
incompatibility between this psychiatric practice and the libertarian
principle of self-ownership.
Both de facto and de jure, once a person enters into a professional relationship
with a psychiatrist, he forfeits his right of self-ownership, and the
psychiatrist acquires the fiduciary duty of protecting the person -- henceforth
"mental patient" -- from himself (and of protecting others from
the patient). Should the psychiatrist, in his judgment,
deem the patient to be a danger to himself (or others), he is professionally
obligated to initiate violence against him, called "civil commitment"
and "suicide prevention." If the psychiatrist fails to do so
and the patient injures or kills himself (or others), the psychiatrist
can expect to be the defendant in a tort action for medical negligence
("failure to prevent harm to self or others").
There is no evidence that suicide prevention prevents suicide. The rate
of suicide among psychiatrists is at least two or three times that among
the general public. Psychiatrists and psychiatric hospitals are regularly
found liable for patient suicides (and for harm to others).
Given these circumstances, why do psychiatrists assume -- indeed, demand
to shoulder -- such a risk? As I show in my book, Fatal Freedom, therein
lies the answer to why psychiatry cannot be reformed and must be abolished.
Suffice it to say here that, from its earliest beginnings in the late
seventeenth century, psychiatry (formerly "mad-doctoring") was
synonymous with the control of the patient by the psychiatrist. It still
and the Abolition of Contract
English jurist Sir Henry Sumner Maine (1822-1888) aptly observed: "The
movement of the progressive societies has hitherto been a movement from
Status to Contract." In other words, in liberal (free) societies,
the law treats persons as contracting individuals, not as members of status
groups (men / women, sane / I insane).
Modern psychiatric ethics has declared war on this principle, as Marcia
Goin's reaffirmation of the psychiatrist's unyielding commitment to coercion
illustrates. She asserts that psychiatrists cannot makes contracts with
the persons they call "patients." Builders, insurers, and car
dealers make contracts with such persons. Why can't psychiatrists make
contracts with them? Because contracting implies two (or more) legally
equal parties, each putting his cards on the table. It implies mutual
obligations, each party having legal power to compel his partner to fulfill
the contract or compensate him for failure to do so.
Such mutuality is contrary to psychiatric ethics. Specifically, psychiatrists
reject the ethics of commerce in favor of the "loftier" ethics
of care. The seller of plumbing services is obligated to deliver only
that which his customer has requested and he has promised to provide.
The seller of psychiatric services is obligated to deliver something more:
he must protect the customer from himself, even at the cost of depriving
him of liberty.
In contrast to such control-command relationship between psychiatrist
and patient, modern psychotherapy, exemplified by psychoanalysis, was
characterized by a cooperative-contractual relationship between therapist
and client. Yet, psychoanalysts never emphasized this essential element
of the enterprise. Worse, the integrity of the analytic contract was,
almost from the start, eagerly compromised by Freud and his followers.
In one breath, Freud declared, "With the neurotics, then, we make
our pact: complete candor on one side and strict discretion on the other."
In the next breath, he took it all back: "I make use of his [the
patient's] communication without asking his consent, since I cannot allow
that psychoanalytic technique has any right to claim the protection of
A contract is an agreement equally binding on both parties. Psychiatrists
reject contracting with patients. They refuse to be bound by agreement.
Instead, they claim, and the law grants them, the power to impose unwanted
(suicide prevention) "services" on patients, whenever they,
the psychiatrists, decide that depriving the patient of liberty serves
"his best interests."
Of all the complex issues of social policy that we face, probably the
most vexing -- and undoubtedly the most neglected -- is the conflict between
libertarian principles and psychiatric practices.
The Freeman, 54: 23-24 (March), 2004.
who changed the view of homosexuality as a mental disorder.
the Latin proverb, "De mortuis nil nisi bonum," enjoins us that
"Of the dead, we should speak kindly or not at all," giving
Marmor credit for the idea that homosexuality is not an illness is undeserved.
In fact, he deserves blame for knowingly borrowing this idea from Thomas
Szasz, and claiming it as his own.
In the first
edition of the book on homosexuality that he edited, Sexual Inversion:
The Multiple Roots of Homosexuality, (New York: Basic Books, 1965), Marmor
included a chapter by Szasz. In that chapter, published 5 years after
his paper titled "The myth of mental illness" (later the title
of his book), Szasz set forth his case against viewing homosexuality as
a mental illness. Revealingly, Marmor, in his Introduction to the volume,
wrote: "Is homosexuality an 'illness,' or is it merely a different
‘way of life'? Most of the psychoanalysts in this volume (except
Szasz) are of the opinion that homosexuality is definitely an illness
to be treated and corrected" (p. 15).
parenthetical phrase, "except Szasz," clearly indicates that
Marmor, also a psychoanalyst, did not then share this view. (He never
ceased his bitter opposition to Szasz's views.) In that book, Marmor never
asserted that homosexuals are not mentally ill and regularly referred
to them as "patients."
in his definitive Homosexuality and American Psychiatry: The Politics
of Diagnosis (New York: Basic Books, 1981), wrote: "It was Thomas
Szasz who attempted to shift the terms of discussion to a conceptual level,
focusing his attack on both the underlying ideological assumptions of
psychiatry and the power of the profession in contemporary society. ...
For Szasz the fundamental self-serving error of psychiatry was its effort
to claim that deviations from behavioral norms were illnesses..."
Szasz did not simply assert that homosexuality is not an illness, he asserted,
and showed why, none of the (mis)behaviors psychiatrists classify as mental
illnesses are illnesses. This, as Bayer recognized, was too much for psychiatry
to stomach: Szasz's "far-reaching critique could not serve as the
basis for the transformation of psychiatric thinking on homosexuality.
To follow Szasz would have required a radical rupture with the deepest
commitments of contemporary psychiatry" (p. 60).
that Marmor's 1965 views on homosexuality were "seen by contemporary
homosexual critics as supportive of the dominant pathological view [of
mental illness]" (p. 61). Unlike Szasz, Marmor was a loyal psychiatrist,
always ready to defend the profession from its critics.
Marmor rescued psychiatry from its commitment to labeling and persecuting
homosexuals as sick, while at the same time he carefully preserved the
profession's privilege to label and persecute as mentally ill other deviants,
such as drug abusers and transsexuals. For this, organized psychiatry
was duly grateful to him.
Szasz, T. The myth of mental illness.
American Psychologist 1960 Feb; 15: 113-118
Szasz, T. The myth of mental illness: foundations of a theory of personal
conduct. New York: Paul B. Hoeber, 1961.
Szasz, T. Legal and moral aspects of homosexuality. In, Judd Marmor, ed.,
Sexual inversion: the multiple roots of homosexuality. New York: Basic
Books, pp. 124-139, 1965.
Bayer R. Homosexuality and American psychiatry: the politics of diagnosis.
New York: Basic Books, Inc., 1981.
interests: None declared
with the permission of the Author:
Jeffrey A. Schaler, Ph.D.,
Assistant Professor, Department of Justice, Law and Society,
School of Public Affairs, American University, 4400 Massachusetts Avenue,
N.W., Washington, D.C. 20016-8043 U.S.A.
First published in Britisch Medical Journal
2004;328:466 (21 February).
psychiatric protection order
for the "battered mental patient"
patients are routinely treated against their will. Legally enforceable
psychiatric protection orders would protect patients from coercive psychiatric
desires of patients and doctors conflict more often in psychiatry than
in any other branch of medicine. People known as "mental patients"
are routinely subjected to "diagnostic" and "therapeutic"
interventions against their will. Many such people see being committed
(sectioned) and treated against their will as a personal violation—a
"psychiatric abuse"—and want to protect themselves from
future involuntary psychiatric hospitalisation and treatment. At present,
former psychiatric patients, even when legally competent, have no means
to defend themselves from such a contingency. Mental health laws—reflecting
the point of view of psychiatrists and society—protect (or are said
to protect) mentally ill patients from the dangers they pose, because
of their illness, to themselves and others. Many mental patients view—and
have always viewed—psychiatrists as posing a danger to them. Respect
for the self defined interests of such patients requires that the law
protect them from further unwanted psychiatric interventions.
recognise the validity of "psychiatric wills" (psychiatric advance
directives) only when they prospectively authorise treatment; courts do
not recognise them when the "psychiatric testator" rejects psychiatric
"help."1 To remedy this defect, especially when patients are
released into the community after a period of involuntary treatment for
mental illness, I propose a new legal safeguard: the psychiatric protection
order. Such an order, similar to the protection order used in domestic
conflicts, would make it a criminal offence to impose involuntary psychiatric
interventions on people protected by the order. In free societies only
psychiatric patients are routinely treated against their will. (Public
health laws explicitly serve the interests of the public, not the therapeutic
needs of particular persons.)
patients with uraemia are not treated against their will and can use a
"medical will" to protect themselves from undergoing dialysis.
If psychiatry were like any other medical specialty competent patients
with schizophrenia would not be treated against their will and could protect
themselves with a psychiatric will from being treated.2 But they cannot:
neither psychiatrists nor the courts recognise the validity of the psychiatric
will. Mental health laws trump psychiatric advance directives. Not by
coincidence the history of psychiatric interventions forcibly imposed
on patients is long and depressing.
In a letter
he wrote to me in 1988 Karl Menninger summarised the history of psychiatry
with these sad words: "Added to the beatings and chainings and baths
and massages came treatments that were even more ferocious: gouging out
parts of the brain, producing convulsions with electric shocks, starving,
surgical removal of teeth, tonsils, uteri, etc."3 To this list Menninger
might have added the use of straitjackets, tranquillising chairs, confining
chairs, cold baths, emetics, purgatives, Metrazol shock, inhalations of
carbon dioxide, and neuroleptic drugs.
from enforced psychiatry
the beginnings of the specialty, psychiatric patients have had no opportunity
to free themselves from their protective-oppressive relationship with
psychiatrists. In this brief paper I focus on a single issue: the desire
of some psychiatric patients to free themselves, once and for all, from
what they regard as an abusive relationship with the psychiatric profession.
The Anglo-American legal system has always denied this option to these
patients. This denial resembles the denial of slaves' opportunity, in
a slave society, to leave their master; of the wife's opportunity, in
traditional marriage, to leave her husband; and of citizens' opportunity,
in the modern totalitarian state, to leave their country and its rulers.
These people may enjoy all manner of benefits and privileges, but they
cannot, without the permission of the repressive authority, leave the
system for good.
and American legal systems maintain the fiction that the relationship
between a family member responsible for committing a "loved one"
and the incarcerated individual—as well as that between psychiatrists
and involuntarily detained patients—is always one of "care"
and "treatment." It can be otherwise only in "unfree,"
"totalitarian" countries; such was the case in the Soviet Union
and is now the case in China. That self serving rationalisation is at
the core of the problem facing us. Anglo-American law assumes, as a matter
of fact, that the relationship between a person and a legal agent of the
state is adversarial. Justice Potter Stewart of the US Supreme Court famously
remarked: "To force a lawyer on a defendant can only lead him to
believe that the law contrives against him."4
The law student
is taught the duties and roles of both prosecuting attorney and defence
attorney. Both jobs are legitimate and proper. In contrast Anglo-American
psychiatry assumes, as a matter of law and psychiatry, that the relationship
between a person and a psychiatric agent of the state is therapeutic.
Forcing psychiatrists on mental patients is routine practice, and the
patient who protests is likely to be given a diagnosis of paranoia. The
medical student is taught only the duties and roles of the psychiatrist
making diagnoses and providing treatment. The psychiatrist has no other
legitimate duties or roles; only the job of the coercive psychiatrist
is legitimate and proper. The psychiatrist who tries to help the coerced
"patient" to reject the patient role is ostracised, or worse.
are hypocrites if we ignore who the parties are that support the enactment
of mental health laws and deny patients the option of rejecting psychiatric
services. Everywhere the supporters of mental health laws are psychiatrists
and the relatives of so called mental patients. In the United States the
relatives are now also in control of a powerful lobby, the National Alliance
of the Mentally Ill, that legitimises the abuse of family members (mainly
adult children) as the care of "loved ones." Organisations of
former psychiatric patients—who call themselves "victims of
psychiatric abuse"—are not among the parties clamouring for
more psychiatric coercions or "services." People subjected to
involuntary psychiatric hospitalisation and treatment often feel victimised
in much the same way as do wives (less often husbands) who are abused
by their spouses. Until recent times women had no effective protection
from their abusers, whom the law defined as their protectors. In many
parts of the world women are still in that situation. Similarly, in the
days of Dickens children were not protected from abuse by their parents.
treatments may have changed since this 1818 drawing, but psychiatric patients
are still forced to undergo unwanted interventions
We in the
West now recognise that the family is not just the primary locus of affection,
care, and security for its members: it is all too often also the source
of the most insidious danger to their physical and spiritual wellbeing.
We acknowledge this unhappy fact and accordingly speak of "battered"
children, spouses, parents, and grandparents. In the conflicts that often
arise between adults living together as married couples or lovers, legal
separation, divorce, and the so called protection order exemplify the
legal system's acknowledgment of the problem and the need for legally
sanctioned and enforceable mechanisms to remedy it.
order mandates physical separation between the parties and makes it a
criminal offence for the denominated threatener to impose their mere presence
on the threatened person. I suggest that we similarly acknowledge the
unhappy fact of "battered mental patients" and the need to protect
them from their batterers. In the absence of a protection order the power
relations between psychiatrist and involuntary patient will continue to
generate "psychiatric abuse," rationalised as protection and
treatment. Indeed, it is precisely because psychiatrists reject advance
psychiatric directives authorising abstinence from further treatment (a
request that non-psychiatric doctors accept) that makes a legal mechanism
such as the psychiatric protection order necessary.
"divorce" between psychiatrists and patients
object to efforts to treat patients as responsible moral agents and cite
the prevention of harm as a basic social mandate of psychiatry. Typically,
they argue that people who would have committed suicide but for their
involuntary detention would thereby have been deprived of the option of
changing their minds once they had recovered from depression. A similar
argument could be made against last wills or, indeed, any decision that
profoundly affects one's future, such as marriage or having children.
The standard psychiatric justification for "therapeutic" coercion
either ignores the familiar conflict between liberty and security or,
more often, equates (involuntary) psychiatric treatment with ("true")
I have examined and discussed this and related problems in great detail
and proposed reconciling psychiatry with liberty.6 7 Human memory is notoriously
short and selective. We have forgotten that until recently—even in
the United Kingdom and the United States—people could not divorce.
In some countries women still cannot divorce their husbands. For a long
time the law, supported by religion, ranked the sanctity of marriage more
highly than the need to protect the wife from her abusive husband and
so prohibited divorce. To make matters worse, the law deprived her of
her voice. The history of the "marriage" between mad people
and their doctors shows a similar pattern. Since the beginning of mad
doctoring in the 18th century, the law, supported by medicine (psychiatry),
has ranked the "health" of mad people more highly than the need
to protect them from the abusive psychiatrist and prohibited them from
divorcing their psychiatrist. This is still the case. (The psychiatrist
is free to leave the patient, typically by forcibly "marrying"
the patient to another psychiatrist.) And again the law deprived, and
still deprives, the victim of his or her voice. Only writers were, and
are, willing to face the realities of psychiatry, illustrated for example
by James Thurber's miniature masterpiece, The Unicorn in the Garden.8
psychiatric patients are denied the right to refuse treatment they don't
wills" are recognised by courts only when patients use them to authorise
treatment, not when they use them to reject the possibility of treatment.
orders that protect wives from abusive husbands, "psychiatric protection
orders" would protect patients from coercive psychiatric interventions
politicians, and journalists assert that mental illnesses are real diseases
and that psychiatrists are regular doctors. If that were true there would
be no need for psychiatric protective orders.
interests: None declared.
Szasz T. Liberation by oppression: a comparative study of slavery and
psychiatry. New Brunswick, NJ: Transaction, 2002.
Szasz T. The psychiatric will: a new mechanism for protecting persons
against "psychosis" and psychiatry. Amer Psychol 1982;37: 762-70.[ISI]
Menninger, K. Reading notes. Bull Menninger Clin 1989;53: 350-1.
Stewart, P Faretta v California, 422 US 806 ( 1975), p 834.
Satel S. For addicts, force is the best medicine. Wall Street Journal,
1998 January 7: 6.
Szasz T. Insanity: the idea and its consequences. New York: Wiley, 1987.
Szasz T. Pharmacracy: medicine and politics in America. Westport, CT:
Thurber J. The unicorn in the garden . In: Fables for our time.
New York: Harper & Row, 1968.
2003;327:1449-1451 (20 December), doi:10.1136/bmj.327.7429.1449
emeritus professor of psychiatry
Department of Psychiatry, Upstate Medical University, State University
of New York, Syracuse, NY 13210, USA Correspondence to: 4739 Limberlost
Lane, Manlius, New York, NY 13104, USA
newest book "Szasz
Under Fire" is soon to be released and can be pre-ordered
Szasz (email@example.com) was professor of psychiatry emeritus at SUNY
Upstate Medical University in Syracuse. His latest books, both from
Syracuse University Press, are The Medicalization of Everyday Life:
Selected Essays and Psychiatry: The Science of Lies.
anniversary edition of the epochal book by Thomas Szasz "The Myth
of Mental Illness" is launched in February 2010. Read
the new foreword by Thomas Szasz here.
thanks Thomas Szasz for the permission to republish his text in "The Szasz
column"! We will regulary update it with a newer text.