Thomas Szasz

Formerly Professor Emeritus of Psychiatry, Department of Psychiatry, Upstate Medical University, State University of NewYork, Syracuse, NewYork

Thomas Szasz, arguably the most controversial psychiatrist, died on 8 September 2012 at the age of 92. He was a prolific author, writing over 300 articles and over 30 books. In his magnum opus, The Myth of Mental Illness, published over 50 years ago, he challenged the very concept of mental illness, which catapulted him to fame. This book has been translated into many languages and continues to be widely read and cited. Since no causal biological basis can be identified for psychiatric disorders, he argues, they should not be called diseases. What if one were to discover brain lesions, say, as the basis of schizophrenia? In response, Szasz would aver that that the condition would no longer be a mental disorder but rather a neurological disorder, and should be treated by neurologists or infectious disease specialists, as has happened with neurosyphilis. The title of his book should have been The Myth of Mental Disease, given the distinction made nowadays between disease, with demonstrable pathological lesions, and illness, largely determined by psychosocial factors giving rise to subjective distress. This continued to be the leitmotif in his subsequent books where he pointed out the consequences of labelling certain behaviours as diseases. The insanity defence and involuntary treatment of certain behaviours deemed by society as unacceptable or deviant were especially subjected to harsh criticism in his various books and articles in scientific journals as well as in popular periodicals.

His books are best read as works of a moral philosopher. It is not surprising that he is popular among non-physicians. He was a libertarian who argued for individual freedoms. When he railed against involuntary treatment, insanity defence or prohibition against suicides, he was adopting a largely uncompromising libertarian position. People should be free to make choices about life and death but are also responsible for their actions. One need not couple the two strands in his work: one could take a libertarian position, as he does, without questioning the concept of mental disease. In the past three decades laws in various states in the USA and elsewhere have been made more stringent and it has become more difficult to treat involuntarily patients with even severe chronic psychiatric disorders, largely owing to his influence.

Thomas Szasz was born in Hungary and emigrated to the USA, where he completed his medical education in Cincinnati, Ohio and his psychoanalytic training in Chicago. He joined the faculty at what is now the Upstate Medical University at Syracuse, New York, and remained there, eventually as an emeritus professor, until his death. His writings spawned an eponymous ideology: Szaszians view the concept of mental illness and the deprivation of individual civil liberties in the name of treating mental disorders as anathema. His aphoristic writing is full of acerbic wit and has been included in many anthologies of aphorisms. He left no doubt that he was passionate about his views. He was labelled as being an anti-psychiatrist, yet distanced himself from other anti-psychiatrists, such as R. D. Laing.

The ideal he espoused was a dyadic relationship between doctor and patient, without any interference from the state or third-party insurers. It is hard to imagine such an ideal situation now; assuming, of course, that it ever existed. In some ways, though, he seemed to favour the entrepreneurial psychoanalytical model espoused by Freud and his disciples where the psychoanalyst and the analysand entered into a contractual relationship. It is, therefore, easy to see why he was identified with rightwing conservatives. Indeed, he was once accused – wrongly, it turns out – of being sympathetic to the extreme rightwing John Birch Society. It is also well known that Scientologists often cited his work, and much to the chagrin of his admirers he did not explicitly repudiated Scientologists’ claims. Until his death, he continued to be a stick in the craw of established psychiatry; however, on the 50th anniversary of the publication of The Myth of Mental Illness, and on his 90th birthday, the Royal College of Psychiatrists honoured him by inviting him as a speaker at their annual convention in Edinburgh.

He was kind to his junior colleagues. This calls for full disclosure: as a house officer in England, I wrote to him inviting him to speak to us; he accepted the invitation with alacrity. We continued to correspond thereafter and I, eventually, joined the faculty in the Department of Psychiatry at Syracuse. For the past decade we shared an office, which allowed me to discuss, and often argue, with him about various matters. It is hard to know how posterity will judge him. It is truly difficult to agree with him on every issue he wrote about; but his true legacy may well be to caution us against rushing to medicalise all human follies and to give indiscriminate power to psychiatrists in courts of law.