The work of Thomas Szasz has been
important in provoking people to scrutinize and explore the foundations of
psychiatry.  While probably the majority
of psychiatrists are hostile towards his views, surprisingly many clinical and research psychologists admire his adversarial stance towards psychiatric theory and
practice.  Szasz has gained most
publicity for his opposition towards any form of compulsory treatment in
psychiatry or any form of psychiatric excuse for antisocial behavior, and this may be where many agree with him.  More bizarre is his claim that there is no such thing as
mental illness, which is one of the foundations of his denial that patients should
ever be forced into treatment.  As a
libertarian, Szasz believes that people should be free to do whatever they
want, including taking whatever drugs and medications they want, or engaging in
any form of treatment, but he argues that it is a conceptual mistake to believe
that there is a disease of the mind, except as some kind of metaphor. 

Szasz himself has been a prolific
author, and even though now in his mid eighties, he continues to publish at an
astonishing rate.  The bibliography of
his works at the end of Szasz Under Fire is 28 pages long, listing works
from 1947 to 2004.  Yet since his most
influential work at the end of the 1950s and during the 1960s, when some
prominent psychiatrists offered replies to Szasz’s arguments, mainstream
psychiatry has largely ignored him.  Given that his ideas continue to influence writers in clinical psychology, it
seems that it is important for theorists to engage with his views, and even if
they disagree, it would be helpful to see the dialog between the two
sides.  However, this sort of exchange
has rarely happened, and while the vast majority of theorists have not been
convinced by Szasz’s attack on the concept of mental illness, his work has been
of mainly historical interest.  Some thinkers have followed in a tradition
of suspicion of medical approaches in mental health, such as those who identify
themselves under the banner of “critical psychiatry,” but they tend to take
little from the work of Szasz himself, and tend to follow the lead of thinkers from different traditions,
such as Michel Foucault.  This situation
has meant that the work of Szasz has occupied the odd position of being
influential yet mostly irrelevant to the current debates in the conceptual and
ethical foundations of psychiatry. 

So the arrival of Szasz Under
Fire could have had the potential to bring Szasz back to the center of
philosophy of psychiatry.  It contains
eleven papers on the work of Szasz, some by highly respected philosophers,
bioethicists and psychiatrists.  They
take his ideas seriously and make the effort to engage with them, attempting to
identify those parts of his arguments that are plausible and to show which
parts are weak.  Each paper gets a reply
by Szasz, and several are longer than the original articles. There is also an autobiographical chapter in which Szasz explains his intellectual origins.  While there are points where he is gracious and careful, Szasz’s replies are mostly bad tempered,
defensive, didactic, pompous, and uncharitable in their interpretation of the
original authors.  They don’t provide
much additional insight into his thought, but they do suggest why people have
been so reluctant to engage in dialog with him over the last four decades.  Szasz seems incapable of true debate where
responds to the ideas of other people: instead, he simply repeats himself,
insisting that he is right and the other person is mistaken. 

A few examples will illustrate this
verdict.  In his reply to Richard
Bentall’s article "Schizophrenia as Construed by Szasz and the
NeoKraepelians," Szasz writes "Bentall calls my assertion that mental
illness is a myth my conclusion. 
That is an error: it is my premise."  Szasz seems to fail to understand the
distinction between a premise and a conclusion, since he goes on to repeat his
tired argument that it is an analytic truth that diseases are of the body not
of the mind, so that there can be no such thing as mental illness.  If the claim that mental illness is a myth
is no more than a premise, those who disagree can simply dismiss Szasz as
starting from a mistaken claim.  The
only way to understand large portions of Szasz’s work is as an attempt to prove
his claim that mental illness is a myth, so if he were successful, it would be
a conclusion from his claims about the meaning of disease. 

In his reply to "Szasz’s
Misleading Perception of Physician-Assisted Suicide," by Margaret Battin
and Ryan Spellecy, Szasz says they misunderstand him when suggesting that he
has a genuine insight into the ethical issues in physician-assisted
suicide.  He counters that his interest
stems from a more general belief in the importance of suicide and the power of
medicine.  It is very hard, again, to
see what is really at issue.  One gets
the impression that Szasz simply likes disagreeing with people even when there
is no substance to disagree on.  Not
only is he a disagreeable debating partner, but also he clouds the issues by
discussing points that make no contribution to the debate.  In short, his reply does not further the
dialog at all.

Szasz insists time and again that it is part
of the meaning of illness that it is physical rather than mental, and his
critics simply point out that this claim is false, yet he keeps refusing to
accept their use of language.   He does
not provide any new argument for his claim. So Szasz’s replies to his
interlocutors hardly merit anything more than a quick look. 

The papers by Szasz’s critics and
admirers are mixed in their style and quality. 
Some are more academic, while some are more casual and narrative in
form.  For example, Stanton Peele
discusses famous cases of addiction (such as Elvis Presley), the coverage of
addiction in the popular press, and the correspondence he receives through his
website.  Peele sets out his view that
he has explained at length in other publications and provides no new defense.
So for those already familiar with Peele’s views, this contribution will hold
little interest.  For another example,
Rita Simon writes just over two pages simply asserting her view that the
insanity defense is reasonable and that Szasz’s attack on it is wrong.  Bizarrely, Szasz spends nearly 22 pages
saying why Simon is mistaken both in her interpretation of him and why the
insanity defense should be abolished, including portions of his testimony in
the Cromer case in 1980.  It is hard to
know why Simon bothered writing her contribution. 

On the other hand, some of the
contributions are excellent and deserve careful reading.  Bill Fulford gives an account of his
important project of setting out values based medicine, which he sees as an
approach to be used side by side with evidence based medicine.  Its relation to the work of Szasz may seem
somewhat tangential, but Fulford makes a connection.  The piece by Battin and Spellecy on physician-assisted suicide
makes a strong case for the reasonableness of the practice and addresses the
concerns that Szasz has expressed. 
Tristram Engelhardt makes a convincing argument that the approach of
Szasz is best (re-)interpreted as methodological and moral rather than
empirical or metaphysical.  These pieces
are valuable contributions to the literature.

So on the whole Szasz Under Fire
is rather disappointing because of the mixed quality of the contributions and
the failure of Szasz to rise to the occasion and really consider the ideas of
his critics.  However, the book will
still be of great interest to the many people who admire the work of Szasz and
those who want to get clearer why it is mistaken. 

© 2005 Christian Perring. All rights reserved. 

Christian Perring, Ph.D., is Academic Chair of
the Arts & Humanities Division and Chair of the Philosophy Department at
Dowling College, Long Island. He is also editor of Metapsychology Online
Review.  His main research is on philosophical issues in medicine,
psychiatry and psychology.

Categories: Philosophical