Arkham Asylum, the world’s best-selling video game to date, and a major player in the very major Batman universe, includes a character named “Victor Zsasz,” also known as Mr. Zsasz or just plain Zsasz. Mr. Zsasz appears in the comics, in the TV show Gotham, in the film, Batman Begins, and in two other iterations of Arkham Asylum (for the Criminally Insane).

Mr. Zsasz is always a villain, and a vicious knife-wielding one at that. Zsasz never appears as a psychiatrist in the Batman universe and is never addressed with the honorific, “Doctor,” like the many other mean-spirited psychiatrists in the series. Yet Zsasz is clearly an anagram of the name of “Thomas Szasz,” the subject of this impressive collection of essays.

On the surface, Arkham’s approach to Zsasz/Szasz appear disrespectful and demeaning, but when we consider how badly Batman portrays psychiatrists overall (in retribution for the attacks by psychiatrist Fredrick Wertham, M.D., back in 1954), this approach can actually be conceived as a compliment. De-doctoring the man who unintentionally spearheaded the anti-psychiatry movement of the 1960s and 1970s with his 1961 publication of The Myth of Mental Illness is a salute to his stature in their eyes. As for the knives: Dr. Szasz certainly poked (impermanent) holes in sacrosanct psychiatric theories and practices, as this book explains. 

The mere fact that popular culture parodies a deceased psychiatrist whose ideas were dismissed by most practicing psychiatrists—but cherished by anti-psychiatry activists—attests to the enduring impact of this Hungarian-Jewish emigre doctor. Szasz’ family fled Europe once they realized that the Nazis were advancing and that the Reich might soon overrun Hungary. He received his medical education in the U.S., where he remained throughout his career.

This collection is edited by personal admirers of Szasz who did not necessarily concur with his theories. Fortunately for the readers, the editors explain the reasons behind their attraction to Szasz the person if not necessarily Szasz the professor and practitioner. They remind us that Szasz was revered by his residents—even though he superficially disparaged their specialty. The authors also explain the intricate reasoning behind Szasz’ opposition to the concept of mental illness and involuntary hospitalization and forced medication and the insanity defense, even if the NGRI defense is invoked by the self-identified “insane” accused perpetrator.

We learn that the seeds of Szasz’ ideas were sown in the Europe of his youth, before he studied medicine or psychiatry, but when he observed the totalitarianism of Nazi Germany from a safe distance. He based later ideas on his opposition to such fascism. One might say that Szasz was authoritarian about his opposition to authoritarianism and totalitarianism and fascism.

The essays explain that Szasz’ political ideology predated his psychiatric theories and practices and informed his ideas through and through. Even as a psychiatric resident, Szasz was so opposed to involuntary admissions that he refused to finish a program that required rotations through locked wards. So he completed his psychiatric training in a residency that did not expose him to seriously ill and psychotic patients who would ordinarily be committed to treatment involuntarily or transferred to state hospitals. For practicing psychiatrists who wonder how such an intelligent person denies the existence of psychosis, that factoid is invaluable information. Szasz did not see psychosis firsthand as a resident. Instead, he pursued psychoanalytic training and maintained an office-based practice as well as an academic appointment at SUNY.

In this book, we learn of another paradox: even though Szasz is associated with the left-of-liberal anti-psychiatry movement of the sixties, because of his 1961 book, he himself was by no means a radical and was a registered Republican. His preferred political and philosophical stance was libertarian, and libertarian ideas permeate his pronouncements about psychiatry.

In spite of his vast learning elsewhere, Szasz applied outdated ideas about diseases and lesions to his theories. Applying the approach of the 19^th century scientist, Robert Koch, who advanced the germ theory of disease, and thereby founded the science of bacteriology, Szasz insisted upon identifying a biological brain lesion before diagnosing “mental illness.” (He agreed that people do indeed having “problems of living” which sometimes benefit from psychiatric or psychoanalytic intervention, but he adamantly denied that “problems of living” are interchangeable with so-called “mental illness” or “mental disease.”)

Szasz might have been stymied by much later discoveries of prion disease, such as “mad cow” encephalopathy, which infects organisms without identifiable bacteria or virus. Yet perhaps he could argue that those prion diseases fall into the domain of neurology rather than psychiatry and so the rubric of “mental illness” is not relevant.

We could argue endlessly about Szasz’ arguments, as this collection attests. And it’s not only psychiatrists who debate his ideas. Philosophers are equally interested and are well-represented in this book. So why is it that Szasz continues to intrigue (as well as infuriate) so many? To paraphrase one contributor to this collection, “Szasz asked the right questions, even if he did not always have the right answers.” His questions endure and provoke even more questions. This book includes excellent resources and offers equally enduring responses.

          Thomas Szasz: An Appraisal of his Legacy is highly recommended for practicing and academic and forensic psychiatrists and for philosophers.

© 2019 Sharon Packer

Sharon Packer, MD is a psychiatrist who is in private practice in Soho (NYC) and Woodstock, NY. She is an Asst. Clinical Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. Her books includeDreams in Myth, Medicine and Movies (Praeger, 2002), Movies and the Modern Psyche (Praeger, 2007) and Superheroes and Superegos: The Minds behind the Masks (Praeger/ABC-Clio, 2010). In press or in production are Sinister Psychiatrists in Cinema (McFarland, 2012) and Evil in American Pop Culture (ABC-Clio, 2013, co-edited with J. Pennington, PhD.) She can be contacted at drpacker@hotmail.com .