Thomas Szasz (was Re: Anti-Depressants)

Yoshie Furuhashi furuhashi.1 at
Wed Aug 30 04:02:41 PDT 2000

Kelley wrote:

>well, i harbor, like a lot of good ole americans, the can-do, pull
>myself up by the bootstraps, don't need no stinking drugs or help to
>get over my problems attitude. so, i'm resisting some of the
>discussions of the uniqueness and indeed existence of Depression .
>more so, i'm having a hard time b/c i'm somewhat familiar with
>thomas szasz's work on mental illness
>and, btw, arguments like that of szaz's were considered *very*
>radical and *very* left a few decades ago. szaz's work, for ex, was
>one of the factors behind changing the classification of
>homosexuality as a psychiatric illness.

If Thomas Szasz is a "radical," he is a radical _libertarian_. (And as a libertarian, he may very well support sexual freedom of consenting adults, just as Hayek, for instance, supported such freedom.) Was Szasz ever considered to be a "leftist" &, if so, by whom? Nowadays, he's mainly lionized by the Reason magazine (, the Daily Objectivist (, the Church of Scientology, and the like. And no wonder, given Szasz's fervent belief in the freedom of individual contracts & the separation of the state & psychiatry.

***** ...The contractual conception of psychotherapy requires that the client / patient pay the therapist. Accordingly, most contemporary psychotherapeutic practices, based on the therapist's being paid by an insurance company or other "third party," preclude the practice of such "autonomous psychotherapy." If the client/patient does not obtain psychotherapeutic help by paying for it with money, then he will find himself in a situation of having to pay for it by producing symptoms.

Correlatively, if the therapist does not get paid for service by the client/patient, then he will find himself in a situation of having to receive reimbursement for it by producing diagnoses. The result is a deceptive, intrinsically anti-therapeutic collusion between patient and therapist....

...Psychotherapy aimed at enlarging the patient's liberty and responsibility requires that the therapist and the patient view themselves as existentially equal moral agents, each responsible for his own conduct and self-control....

...Most contemporary psychotherapists cling to the concept of mental illness and reject limiting their discretionary powers to interfere in the life of the patient. This vitiates what I regard as a requirement for "autonomous psychotherapy" and for the maintenance of the therapist's role integrity. The plumber does not install wiring and the ophthalmologist does not remove appendices. The psychotherapist who professes to heal with words ought not to prescribe drugs, prevent suicide, or otherwise interfere with the patient's life. Today, this kind of therapeutic self-restraint is professionally censured as "withholding essential treatment" from the patient and is rendered de facto illegal by tort law.... (Thomas Szasz, "On the Future of Psychotherapy," at *****

As you can see, if we accept his view, we have no justification for national health insurance that covers mental health (nor do we have an argument for compelling HMOs & insurance companies to treat mental & other illnesses & injuries equally).

It is Szasz's libertarian view of individual autonomy & responsibility that animates his claim that mental illness is a myth; he appears to believe that the idea of mental illness (or the medical model in general), being an idea of materialist determinism contrary to free will, negates the dignity & liberty of the individual moral agent. (There should be no right to treatment in psychiatry, no insanity defence in criminal justice, no such thing as addiction, & no state [& professional] regulation of drugs, according to Szasz.) His conception of liberty is a very narrow one -- it's basically an idea of negative freedom (freedom from the paternalistic state interference) & nothing more.

Political & other abuses & errors in psychiatry & other helping professions should be criticized, but criticisms have to come from theoretical frameworks other than Szasz's.


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