Interviewed by Jacob Sullum
Simply having one of Thomas Szasz's books on your shelf can
lead to an argument. Explaining his most familiar contention--that
there is, strictly speaking, no such thing as "mental illness"--almost
invariably does. And the very mention of his name has been known to
provoke a heated response from certain people. I once asked a psychiatrist
I knew if he was familiar with Szasz's work. "Oh, he's crazy!"
he exclaimed, inadvertently illustrating Szasz's point that such labels
are often used to stigmatize people who offend or disturb us.
I don't think this psychiatrist was ready to have Szasz committed;
he was expressing an intellectual rather than a clinical judgment.
But Szasz's critique of psychiatry suggests that such distinctions
are ultimately arbitrary. A psychiatrist could, if he were
so inclined, diagnose as mentally ill someone with whose worldview
he disagreed--which is essentially what it means to say that a person
is "suffering from delusions." If the psychiatrist could make a case
that the "patient" might harm himself or others (a prediction that
many psychiatrists privately concede they are ill-equipped to make),
he could have him confined and forcibly "treated."
In Szasz's view, this should not be possible. For decades, what he
calls his "passion against coercion" has driven him to denounce involuntary
mental hospitalization, while his insistence on individual responsibility
has made him a dedicated opponent of the insanity defense. If someone
commits a crime, Szasz says, he should be punished, not "treated."
But if he has not violated anyone's rights, he should be left alone,
no matter how bizarre his behavior.
As unpopular as such ideas are now, they were even more heretical
when Szasz started to express them in the late 1950s. Born in Budapest
in 1920, he immigrated to the United States in 1938 and attended the
University of Cincinnati, where he majored in physics as an undergraduate
and earned an M.D. in 1944. After a residency in psychiatry, he underwent
psychoanalytic training at the Chicago Institute for Psychoanalysis,
where he remained as a staff member for five years. In 1956 he took
a position as a professor of psychiatry at the State University of
New York in Syracuse, where he is now a professor emeritus. Shortly
thereafter, he began to publish articles that questioned the basic
premises of his profession, work that would lead to his classic The
Myth of Mental Illness in 1961.
"I became interested in writing this book approximately ten years
ago," he wrote in the preface, "when I became increasingly impressed
by the vague, capricious, and generally unsatisfactory character of
the widely used concept of mental illness and its corollaries, diagnosis,
prognosis, and treatment. It seemed to me that although the notion
of mental illness made good historical sense--stemming as it
does from the historical identity of medicine and psychiatry--it made
no rational sense." Szasz's bold attack on a concept that most
people took for granted (and still do), bolstered by the efforts of
civil libertarians and other social critics, encouraged skepticism
about the justification for coercive psychiatry. That uneasiness led
to legal reforms in the 1960s and '70s that made it harder to lock
up people deemed to be crazy.
"Mental illness is a myth whose function is to disguise and thus
render more palatable the bitter pill of moral conflicts in human
relations," Szasz wrote in "The Myth of Mental Illness," a paper that
appeared in American Psychologist the year before his book
of the same name was published. "In asserting that there is no such
thing as mental illness, I do not deny that people have problems coping
with life and each other." Likewise, Szasz has never denied that organic
conditions--say, Alzheimer's disease or untreated syphilis--can have
an impact on thought and behavior. But he insists on evidence of an
underlying physical defect, and he emphasizes that behavior itself
is never a disease. "Classifying thoughts, feelings, and behaviors
as diseases is a logical and semantic error, like classifying the
whale as a fish," he writes on his Web site (http://www.szasz.com/).
This error has serious consequences, Szasz argues: "The classification
of (mis)behavior as illness provides an ideological justification
for state-sponsored social control." As he put it in his 1990 book
Untamed Tongue, "What people nowadays call mental illness, especially
in a legal context, is not a fact, but a strategy; not a condition,
but a policy; in short it is not a disease that the alleged patient
has, but a decision which those who call him mentally ill make about
how to act toward him, whether he likes it or not."
The collaboration between government and psychiatry results in what
Szasz calls the "therapeutic state," a system in which disapproved
thoughts, emotions, and actions are repressed ("cured") through pseudomedical
interventions. Thus illegal drug use, smoking, overeating, gambling,
shoplifting, sexual promiscuity, pederasty, rambunctiousness, shyness,
anxiety, unhappiness, racial bigotry, unconventional religious beliefs,
and suicide are all considered diseases or symptoms of diseases--things
that happen to people against their will. Szasz believes this sort
of thinking undermines individual responsibility and invites coercive
paternalism. A prime example is drug prohibition, an area where his
work--especially his penetrating 1974 polemic Ceremonial
Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers--has
had an important influence.
As Szasz marks his 80th birthday this year, the misuse of the medical
model and the literalization of the disease metaphor are rampant.
But skeptical voices, often those of Szasz admirers, can be heard
on issues such as criminal responsibility, the nature of addiction,
and the reality of the mental disorder du jour. Szasz himself continues
to drive home the dangers of surrendering our autonomy to physicians
acting as agents of the state. Last year he published Fatal
Freedom: The Ethics and Politics of Suicide (Praeger), in which
he warns that "relying on physicians to prevent suicide, prescribe
suicide, and provide suicide...is an evasion fatal to freedom." When
I interviewed him by telephone in February, he was completing a book
on the evolution of the therapeutic state. After that, he said, he'd
like to write "a history of psychiatric misdeeds, from its beginning
to the present."
Szasz, a REASON contributing editor whose work has also appeared
in publications ranging from The Lancet to Playboy,
has produced some 700 articles and two dozen books, including Law,
Liberty, and Psychiatry (1963), The
Ethics of Psychoanalysis (1965), The
Manufacture of Madness (1970), The
Myth of Psychotherapy (1976), The
Therapeutic State (1984), and Our
Right to Drugs (1992). Asked if he was working on a new book,
he said, "What else can I do?" Asked if he had plans for another one
after that, he said, "Always."
Reason: You've said that true brain diseases are the province
of neurologists, not psychiatrists. I gather that what people call
mental illness, which you understand as problems in living, would
be something for psychotherapists to handle. Do psychiatrists have
any legitimate role as physicians who specialize in psychological
Thomas Szasz: That entirely depends on what sort of arrangement
society allows and the economic system permits. There is no reason
why physicians should be prevented from talking to people.
Reason: Do you see any benefit from having an M.D. in doing
that sort of work?
Szasz: Yes, but not as a requirement. There are two aspects
of life without which it's very difficult to [manage], and those are
medicine and law. Knowing how the body works is beneficial for anyone.
That could help you as a therapist because there are all kinds of
personal complaints, and people who come to you may very well also
be sick. [A knowledge of medicine] helps you in the same sense that
it helps if you are familiar with law, because people are entangled
in all kinds of legal problems too.
Reason: How would you describe your approach to therapy?
Szasz: I see psychoanalysis as a contractual conversation
about a person's problems and how to resolve them. I tried to avoid
the idea, which seemed to be particularly pernicious, that the therapist
knows more about the patient than the patient himself. That seems
to me so offensive. How can you know more about a person after seeing
him a few hours, a few days, or even a few months, than he knows about
himself? He has known himself a lot longer!
To me the whole idea of calling it "therapy" is crippling. So there
was a kind of understanding between the other person and me that we
were having a conversation about what he could do with his life. That
obviously involves adopting different tenets of sorts--different ways
of relating to his wife, his children, his job. The premise was that
the only person who could change the person was the person himself.
My role was as a catalyst. You are making suggestions and exploring
alternatives--helping the person change himself. The idea that the
person remains entirely in charge of himself is a fundamental premise.
Reason: You were trained as a psychoanalyst. How have your
views on Freud's theories changed over the years?
Szasz: Freud had a very good idea which was very quickly abused.
Bertrand Russell said that Christianity is a wonderful idea--it's
too bad it's never been tried. That is my view of psychoanalysis.
Freud had a wonderful idea, namely, that he was going to have a completely
private, confidential, one-to-one conversation with another human
being about his or her life. There's no coercion. It's entirely contractual.
The patient pays. But as soon as he developed this, he sacrificed
it by betraying confidentiality, by creating training analysis, by
creating child analysis, and so on. It immediately became a thing
where the premise was that the therapist knows more about the patient
than the patient himself. There was a kind of manipulation, exploitation
My feeling all along was that there was something wrong with the
authoritarian, top-down stance. At the same time, I was very much
impressed that this was a radical departure from "psychiatry," which
was based entirely on an involuntary relationship. Traditionally,
there is no such thing as a voluntary psychiatric patient. That's
an oxymoron. If you are crazy, then you are locked up in a state hospital.
So Freud's great departure was that, within medicine, you could go
and talk about your problems and not be considered crazy, not be locked
Reason: In the 1960s people like R.D. Laing and Michel Foucault
agreed with you that psychiatry was a form of social control, a way
of stigmatizing and punishing unwanted behavior in the guise of therapy.
Both of them identified themselves as men of the left, whereas you
allied yourself with classical liberalism. What would you say are
the basic differences between their views on psychiatry and yours,
and how are those related to political ideology?
Szasz: Although we agreed on the criticism of traditional
psychiatry, they somehow never made it clear that bodily diseases--pneumonia,
cancer, and so on--are real, but mental diseases are metaphoric diseases,
in the sense of a "sick" joke. They are problems, but they are not
medical problems in that they do not involve somatic, organic etiologies
and are not amenable to a somatic, organic resolution. They are essentially
conflicts within oneself and conflicts between oneself and other people.
So that would be the first distinction.
Secondly, Laing in particular was completely inattentive to the legal
aspects, so he never really distinguished between involuntary and
voluntary psychiatry. Here my classical liberal convictions are crucial,
in that I firmly believe that there should be no interference in voluntary
relationships between psychiatrists and patients. If the patient wants
a drug, fine. If the patient wants electric shock, fine. If the patient
wants a lobotomy, fine. Now that doesn't mean that I like it, any
more than I would if the patient wants to have an abortion just because
it's inconvenient to have a baby. I don't think that's a good idea
either. But I don't think the law should interfere with it.
By contrast, with involuntary psychiatry, under no circumstances
do I consider it permissible. Neither Laing nor Foucault made this
clear. They offered a kind of a blanket condemnation of psychiatry
which smacked of a socialist, left-wing indictment of capitalism.
[In their view,] the whole thing is no good. Of course, in some ways
the whole thing is no good, in that it's misconceptualized, but so
is religion if you don't believe in religion. Yet you don't want to
forbid it or interfere with it.
Reason: Since The Myth of Mental Illness appeared,
it seems that more and more areas of life have been medicalized. But
at the same time it seems that people are more willing to question
the authority of psychiatrists and of physicians in general. On balance,
do you think psychiatrists and physicians have more or less power
than they used to?
Szasz: I think they have much, much more power, but it has
become increasingly covert and subtle. If you focus on psychiatrists
per se, then perhaps they have a little less power, but the power
has been diffused among "mental health professionals": school psychologists,
grief counselors, drug treatment specialists, and so on. It pervades
society. Sixty years ago, when I went to medical school, this kind
of activity was limited entirely to psychiatrists.
So traditional psychiatrists may have less power. They certainly
don't have the feudal slave estates of the old state hospitals, where
the patients were washing their cars. That's gone. On the other hand,
there is a Tocquevillean kind of oppression--a softer kind of totalitarianism.
Reason: In some respects people do seem to be more skeptical
than they used to be of psychiatry's attempts to medicalize behavior.
Psychiatrists themselves often acknowledge that the Diagnostic
and Statistical Manual of Mental Disorders is increasingly arbitrary
and unscientific. It also seems that the use of the term disorder,
as opposed to disease or illness, is designed to fudge
the question of whether these conditions have a biological basis.
Meanwhile, journalists are increasingly alert to controversies over
what constitutes a bona fide disorder, as in the case of "multiple
personality disorder," which has fallen into disrepute. Is this skepticism
Szasz: Without seeming excessively pessimistic, my view is
that this whole development subtly reinforces the basic error and
the basic authority of psychiatry. People are saying that, of course,
multiple personality disorder and social phobia are excesses, but
schizophrenia, depression, and so on are real diseases and therefore
justify involuntary hospitalization, outpatient commitment, wholesale
drugging of children, of people in nursing homes, and so on.
I have always challenged the "psychoses." Why don't you have a right
to say you are Jesus? And why isn't the proper response to that "congratulations"?
Reason: Since you criticized involuntary hospitalization in
the '60s, legal reforms have changed the standards for locking people
up. To what extent have those changes been in line with what you wanted
Szasz: They have been diametrically opposite. This whole deinstitutionalization
process was just as involuntary as the institutionalization process.
First the patients were placed in the institutions against their will.
Then they were kept there for a long time, and generally they became
desocialized. They had no way of making a living, and their families
didn't want them; they had no particular place to live. Instead of
being allowed to stay in the hospital, which the majority of them
probably considered their home, they were forcibly evicted and placed
in other institutions run by the state but which are no longer called
hospitals. So this is a huge deception. The number of people who are
now maintained by the state as mental patients is probably no smaller
than it used to be.
Reason: Where are they now?
Szasz: They're in so-called transitional living quarters,
in group homes, in nursing homes, in prisons, on the street, maintained
on Social Security. In the old days, you didn't get money for being
schizophrenic. Now you get a lot of money for it. They are now maintained
like pets rather than being locked up in a zoo.
Reason: The deinstitutionalization of mental patients has
been criticized for putting helpless people, sometimes dangerous people,
on the streets. How would you have handled it differently?
Szasz: There are two things that I would have done very differently,
and they really have to do with my passion against coercion, especially
unnecessary coercion and especially coercion outside of a due-process
legal system. The first thing I would have done is to stop all further
involuntary psychiatric interventions. This is unthinkable stuff,
because this means stopping the fundamental social function of psychiatry,
which is partly to relieve society, families, physicians of unwanted
people and partly to "prevent suicide." "Dangerousness to self": This
to me is the keystone in the Roman arch. Until it is knocked out,
it's impossible to destroy the edifice. People should not be protected
from themselves by involuntary psychiatric interventions. Psychiatrists
should play no more of a role in this than priests do.
Reason: And after involuntary psychiatry was ended, people
would have been free to leave mental hospitals, but they would not
have been forced to leave?
Szasz: They would have been free to leave, and they would
have been free to stay. They could have simply got room and board.
That option was never given to anyone. I wouldn't give that to anyone
except those who have already been victimized. They should be given
every chance to get out insofar as they want to get out.
By the way, this brings us back to the old, pre-war system, when
there were as many as 15,000 patients in a single state hospital.
Nothing was easier than escaping from these places; they were not
surrounded by barbed wire. In fact, escape--"elopement"--was the standard
way of being discharged from the hospital. The hospital didn't go
after you. But the fact that most people didn't leave indicated that
they had no place to go, and that in fact this place was not all that
bad for them, especially before there was any treatment.
Reason: When a crime is committed by a homeless person who
has been diagnosed as a schizophrenic, critics of deinstitutionalization
say it's too hard nowadays to commit people to mental hospitals. They
say the standard of dangerousness to yourself or others is too demanding.
Are they right?
Szasz: No, they are not right. But this brings us back to
what else I would have done: Not only would I have stopped on day
one all further involuntary mental hospitalization--commitment--I
also would have stopped on that same day the insanity defense. The
psychiatrist simply would not be allowed in the court to give expert
testimony, any more than a priest is allowed to give testimony about
heaven or hell.
So I would have stopped both of these [commitment and the insanity
defense], as a result of which, I think, 99 percent of the people
who now commit crimes would be and should be in jail and punished,
probably by long prison sentences. Because in every one of these cases
we learn that the person who has committed the crime--let's say this
fellow who pushed the woman under a subway train in New York--has
a long record not only of mental hospitalization but of violence.
Typically, what people call severe mental illness begins with some
sort of violence in the family: A 17- or 18- or 19-year-old boy attacks
his mother with a kitchen knife. Well, he should go to jail for five
years, right away. This is a potentially fatal attack on a person.
But these things are usually swept under the rug via diagnosis. And
then people wonder five years later what happened.
Reason: What about people who haven't actually committed violence
but are simply behaving in a bizarre and perhaps threatening way?
Last year I was walking with my wife and daughter in Manhattan, and
we saw this guy in camouflage pants who was running down the street,
holding a piece of concrete pipe over his head, pumping it up and
down, and cursing at nobody in particular. What, if anything, can
you do about someone like that?
Szasz: This is a political question: In a relatively open
society, what kind of communication can people give off, both verbally
and nonverbally? How many earrings can you have in your nose, on your
ears, in your belly button? I think this is a question of social control;
it has nothing to do with medicine, nothing to do with psychiatry
except as social control. And I have no particular answer to this
other than my own preferences. I don't like this any more than you
do, and this is how people segregate themselves. I avoid places where
people are like this. In a free society, I think that's how it would
be. If a city allows enough of this, maybe people would avoid it and
it would go into economic decline.
Reason: Alternatively, a disruptive person could be arrested
for menacing people or for something like disturbing the peace?
Szasz: Or for disorderly conduct. Any of those things. The
law is a disciplining agent. Just like with illegal parking. There
are lots of things which are a relatively small nuisance for which
people get disciplined.
Reason: Since you first called for abolishing the insanity
defense, lawyers have become increasingly creative at devising excuses
to absolve their clients of responsibility. Yet to judge by the kind
of criticism and ridicule you hear from commentators, comedians, and
people on the street, skepticism about such excuses also is increasing.
Are people finally listening to your warnings?
Szasz: That's not for me to say, but my feeling is that the
inconsistency does not impede the spread of this practice, as illustrated
by the cases of John Hinckley and Ted Kaczynski. People were skeptical,
but [the insanity defense] is so convenient that I know of no serious
pundit--no George Will or William Safire--who denounces it as a general
practice, on principle. They may say that in this particular case
it's wrong to use it, but in general they think it's a fine thing.
The Kaczynski case was a wonderful example, where he was begging
not to be called insane, and that was interpreted as being crazy!
He refused to recognize his problem. Now he is petitioning to be retried,
so he can be executed. But that's buried in the back pages. And of
course that will be interpreted as further evidence that he's crazy--he
wants to be killed.
Reason: The psychiatrist E. Fuller Torrey has written that
"studies using techniques such as magnetic resonance imaging and positron
emission tomography scans have proved that schizophrenia and manic
depressive illness are physical disorders of the brain in exactly
the same way as Parkinson's disease or multiple sclerosis." Is that
true? If not, what do these studies actually show?
Szasz: Most educated people, if they think about it, know
how real disease is diagnosed. Take anemia. If a person comes in and
says he is tired, he has no energy, and he looks very pale, the physician
may think he is anemic. But the diagnosis is not made until there
is a finding in the laboratory that he has a diminished blood count,
a diminished hemoglobin level. Conversely, a laboratory technician
can blindly make a diagnosis of anemia simply on the basis of vials
of blood submitted to him or her--without having any idea of whose
blood it is. As soon as that can be done with schizophrenia, it will
be a brain disease, exactly as neurosyphilis was recognized as a brain
Reason: In other words, you would need to be able to look
at the scan and say, "This is a schizophrenic."
Szasz: Or this is not a schizophrenic....My skepticism is
infinitely high, because I actually lived through a time when a man
got the Nobel Prize for discovering that excessively activated electrical
circuits in the frontal lobe cause schizophrenia. The cure for that
was lobotomy. Or consider electric shock treatment: The rationale
was that epileptics don't get schizophrenia, which was complete nonsense.
There has been a long series of claims like these.
And the idea of schizophrenia as a brain disease negates the justification
for involuntary treatment. The diseases that Torrey mentions--Parkinson's,
multiple sclerosis--can under no circumstances be legally treated
without the consent of the patient. This is really just propaganda
for coercion. It does not stand the least scrutiny. But you see, they
don't have to be right; they have power.
Reason: Is it possible that some of the people who are now
diagnosed as schizophrenics do in fact have some kind of neurological
Reason: If that could be demonstrated, would it change your
view of mental illness?
Szasz: No, because they would then simply have a disease with
which they would have to live, just like Stephen Hawking has to live
with amyotrophic lateral sclerosis. In other words, having a disease
does not define everything that you do.
Reason: But people with certain kinds of brain diseases--Alzheimer's,
for example--might reach a point where they're no longer able to take
care of themselves, and they could legally be declared incompetent.
Should that same sort of procedure be possible with some of the people
now diagnosed as schizophrenics, if they do in fact have a brain disease?
Szasz: In principle, that should be possible, but the judgment
of whether you can or cannot take care of yourself ought to be a common-sense,
empirical one, not an esoteric, psychiatric one. Also, the old Roman
principle of cui bono should be the guiding light. Charges
of incompetence used to be brought by greedy children against their
rich, elderly parents--especially if the father, say, wanted to marry
a young woman. The charge is also brought after someone dies, to contest
the person's last will. So here the issue of competence is really
tied to the motives of the person who is raising the question.
Reason: You may have seen the TV commercials in which drug
companies urge people suffering from "social anxiety disorder" or
"generalized anxiety disorder" to ask their doctor for a certain brand
of pill. These ads reinforce the idea that anxiety and other kinds
of psychological problems are medical issues, and they highlight the
physician's role as pharmacological gatekeeper. But they could also
be seen as empowering individuals by encouraging them to be assertive
with their doctors. On balance, do you see this kind of message as
a positive or a negative development?
Szasz: This phenomenon illustrates what I call the creeping
therapeutic state. I see it as insidious, especially given the cooperation
between the government and the media. This is allowed on television.
But advertising Scotch, a legal drink, is not allowed. This subtly
undermines the rule of law, the principle that if something is legal,
then it's legal, and if it's illegal, then it's illegal. A prescription
drug is illegal; pharmacists cannot sell it to you unless you have
a prescription. These are illegal drugs, but nobody calls them illegal
drugs. So I see this as pernicious, as an example of what F.A. Hayek
and Ludwig von Mises talked about--that the opposite of freedom is
not brutal tyranny but capriciousness.
Reason: Suppose someone feels depressed, and he finds that
when he takes Prozac he feels better. Or suppose he's anxious, and
he finds that he calms down when he takes a Xanax. He can get these
pills from his doctor. Is he doing anything wrong by taking these
Szasz: I don't think he's doing anything wrong, except I think
he should be able to buy these drugs in the free market so he can
compare them to opium, marijuana, or other drugs. There is no competition
now between the prescription drugs and the traditional drugs which
people took when they felt bad. After all, people have medicated themselves
since time immemorial. I suspect that opium in small doses is safer
over a long period of time than these complicated organic compounds.
Reason: In recent years, we're told, this country has been
hit by an epidemic of "attention deficit hyperactivity disorder."
What are the roots of this epidemic?
Szasz: I would first say that the epidemic doesn't exist.
No one explains where this disease came from, why it didn't exist
50 years ago. No one is able to diagnose it with objective tests.
It's diagnosed by a teacher complaining or a parent complaining. People
are referring to the fact that they don't like misbehaving children,
mainly boys, in the schools. The diagnosis helps tranquilize the parent,
tranquilize the school system. It offers them the sense that they
are doing something about the problem, that they are dealing with
it in a rational, scientific way. It's a kind of pharmacological magic.
Reason: What do you think the consequences of prescribing
Ritalin for all of these kids will be?
Szasz: We may not know all of the medical consequences for
another 20 or 30 years. In social terms, it gives the impression to
people that behavioral problems are medical and should be handled
with drugs; it imposes a certain stigma on the child, possibly on
the family. It medicalizes educational and child- rearing problems,
and it may cause biological problems in the person taking the drug.
I don't know if the average person on Main Street realizes that if
a 30-year-old man has a pocketful of Ritalin, he can go to jail for
years. This is called "speed." And this is what they give as a treatment
to schoolchildren when there's absolutely no laboratory or medical
evidence that they are sick.
Reason: Recently we've heard Tipper Gore and other people
say that health insurers should be forced to cover mental health treatment
on the same terms as medical treatment. What do you think the consequences
of such "parity" will be?
Szasz: We are talking about a situation where the government
is mandating that an ostensibly private insurance company provide
coverage for a disease which doesn't exist. There is so much to say
about it, I don't know where to begin. The people who clamor for this--mainly
politicians and psychiatrists--want parity for mental illness, but
they don't want parity for the mental patient, because ordinary patients
can reject treatment.
They don't mean therapy; they mean getting a foot in the door for
involuntarily treating people and having these huge bowls of money
going into psychiatry and psychiatric drugs. Again, cui bono:
Who profits from this? It finally came out that Eli Lilly is a big
donor to the National Alliance for the Mentally Ill, and they have
millions of dollars to propagandize their views. The critics don't
have any money to propagandize their views. This is a completely one-sided,
Reason: Alan Leshner, the director of the National Institute
on Drug Abuse, says "Drug addiction is a brain disease." Is there
any scientific basis for that claim?
Szasz: As far as I know, there is not one iota of evidence
for this. When people take drugs and get "hooked," this is simply
another way of saying it becomes a habit, which makes the drug more
difficult to abandon than if you haven't got the habit. But it's no
different from speaking English or Hungarian. Any habit is difficult
to change. And of course you can also become chemically habituated
to drugs, so that you have withdrawal symptoms when you stop. Of course,
taking a drug can make you sick, but a therapeutic drug can also make
you sick. It's a question of dosage, what you take, and why you take
Reason: In the area of drug policy, you've criticized the
idea of shifting from a criminal justice approach to a "medical" or
"public health" model, which you say would only reinforce the therapeutic
state. But if a drug offender who might otherwise go to jail can instead
undergo "treatment"--which is now the case in Arizona, for example--isn't
he better off, even if the treatment is bogus?
Szasz: He may be better off in the sense in which a Jew in
15th-century Spain may have been better off converting to Christianity
than being tortured. But I reject the dilemma. One of these so-called
treatment options may be less punitive for the subject. But the side
effect is that it reinforces the legitimacy of this kind of medical
Reason: Another reform pushed by advocates of a "public health"
approach is needle exchange programs. What do you think of them?
Szasz: I am unqualifiedly opposed to this kind of piecemeal
reform. I keep falling back on the slavery analogy. You cannot prettify
the plantation. You either have slaves as a legal arrangement or you
don't. Either you have access to empty syringes just like you have
access to guns, or you don't have access.
Reason: A simple way of addressing that issue would be to
make the needles available without prescription and to stop penalizing
people for possessing them. That's not exactly a fundamental reform
in terms of drug policy, but is that the kind of reform you could
Szasz: I think that would be fundamental, because the message
it would send is that this is a problem only because the government
has made it a problem. The American people don't realize that a very
large proportion of the AIDS cases in America are government-manufactured,
in the sense that the government has prohibited needles. People talk
about iatrogenic--doctor-caused--diseases. People never talk about
government-caused diseases. There is no Latin word for that.
Reason: Another so-called harm reduction reform is to make
methadone more readily available to current opiate users or to make
heroin available by prescription. Do either of those suggestions make
any sense to you?
Szasz: They make a great deal of sense, in the sense that
they strengthen the establishment which is causing the problem. I
am bitterly opposed to all of these autocratic medicalizations. All
of these glorify the punitive state and the punitive doctor and debase
the citizen for exercising his free choice. It's as simple as that.
Reason: You take a similar view when it comes to medical marijuana,
that it reinforces the therapeutic state, since the doctor gets to
say whether you can have it or not. But from the point of view of
somebody who is sick and who finds that marijuana relieves his pain,
his nausea, or his muscle spasms, a measure like California's Proposition
215 means that he's less likely to be arrested and prosecuted. Isn't
that an improvement?
Szasz: I see this as analogous to leaving Soviet Russia. You
could appeal to Stalin and say, "My father is living in America, and
he is 80 years old. Won't you let me out?" And then Stalin might say,
"OK. I'll let you out, because that really would be a good thing for
you, because of your father." The patient is getting a special exception
from a general rule, which I find totally unacceptable.
Reason: The general rule or the exception?
Szasz: I find the general rule unacceptable, and the exception
is simply doing one particular favor to one particular person or group
Reason: But the people to whom the exception applies are better
off. Is equal enforcement of a bad law better than making exceptions?
Szasz: This is one of those classic problems where if you
leave the bad law in place long enough, then maybe it will be repealed,
whereas making exceptions prolongs its life expectancy. I am not opposed
to being nice to particular groups of people as a humanitarian gesture,
obviously. If somebody who is undergoing anti-cancer treatment has
nausea and benefits from marijuana, it would be a nice thing for this
person to have it. How can I be opposed to that? But that's like smuggling
Jews out of Nazi Germany with the help of a Gestapo agent. Wouldn't
it be better not to persecute them in the first place?
Reason: The question of whether people may use marijuana to
treat various kinds of symptoms seems to be a small part of the drug
policy debate. Yet the medical marijuana movement has drawn a very
strong response from the federal government. Why do you think people
like the drug czar, Barry McCaffrey, get so upset about attempts to
legalize the medicinal use of marijuana? Does that reaction suggest
that maybe the medical marijuana activists are on to something, that
they've found an effective way of undermining prohibition?
Szasz: Probably the reason why the drug warriors are so upset
is that they think this will have a kind of a domino effect, that
we have to fight the enemy here; otherwise he is going to move somewhere
else. I personally think that they are wrong. The drug warriors are
the victims of their own ideology. They really believe their own propaganda.
I don't think medical marijuana would particularly weaken them, any
more than it weakens them that people can smoke cigarettes and relieve
their anxiety that way. I think prohibition would be strengthened
by making these exceptions. The rationale would be, "See, we leave
these relatively harmless ones alone. But by golly, we have to really
strike hard at the drug lords if we can find them."
Reason: People who support physician-assisted suicide claim
that giving terminally ill patients a legal way to obtain lethal drugs
will enhance their autonomy. You disagree.
Szasz: This is the same question as medical marijuana: Anything
that people want is being made contingent on getting it from a doctor.
Reason: In Fatal Freedom, you say the debate over physician-assisted
suicide ignores the roles of drug prohibition and psychiatric coercion.
Why are those factors important?
Szasz: They are fundamental. First of all, if there were no
drug laws, then they wouldn't need doctors to give suicidal people
drugs to commit suicide with; after all, they don't give patients
guns or ropes. Second, people seem oblivious to the fact that doctors--psychiatrists--are
given the job both of preventing suicide and of providing suicide.
To me these are symptoms of the galloping therapeutic state, where
increasingly we are giving away our existential choices and responsibilities
to doctors--and therefore to the state, because they're really not
talking about doctors as healers; they're talking about doctors as
agents of the state.
Reason: You say that the very term physician-assisted suicide
is misleading. How so?
Szasz: "Physician-assisted suicide" can be one of two things.
The physician can give the patient a drug--let's say a barbiturate--and
then the patient takes the drug and dies. But that's simply suicide,
a person killing himself. If you buy a rope in a store, you don't
talk about "merchant-assisted suicide." On the other hand, what can
also happen is that the physician helps a person to die--in effect,
speeds his death or kills him. This is how many old people have died
in the past and continue to die. They are going to live another few
days or weeks; they are in heart failure and can't breathe. The physician
gives them a little extra morphine, and they stop breathing. This
is how Sigmund Freud died. But this is not suicide. As I emphasize
in my book, it's rather significant that the physician-assisted suicide
legislation in Oregon specifies that dying in this way is not suicide.
Reason: Looking back at your career, what do you see as your
Szasz: It's really two very simple propositions: that there
is no mental illness, and that if you are incarcerated in a mental
hospital, you are in prison. You are not treated or cured.
Now as far as the greatest impact, there's no question that "the
myth of mental illness" and the idea of the therapeutic state are
terms and concepts that are widely copied, and often used in ways
quite different than I have used them. There's a third idea that hasn't
caught on quite as much, though I've seen it used in English publications:
"pharmacracy," which I used in Ceremonial Chemistry. It refers
to the substitution of medical controls for legal and religious controls.
We are pharmacratizing everything, including the control of unruly
children. Attention deficit disorder is a perfect example of pharmacratic
control of a social problem: how to educate children.
Reason: You seem generally pessimistic. Can you cite any encouraging
Szasz: I should correct that. Intellectually, I am very pessimistic,
but temperamentally I am an optimistic person. I am pessimistic because
I see the trend as a progressive evasion of personal responsibility.
Reason: But have you seen any encouraging developments since
you first started talking about these issues?
Szasz: Yes. The encouraging development is essentially the
uprising of the slaves, the increasing protestation by ex-mental patients,
many of whom call themselves victims. Through all kinds of groups,
they have a voice now which they didn't have before. We should hear
from the slaves. Psychiatry has always been described from the point
of view of the psychiatrist; now the oppressed, the victim, the patient
also has a voice. This I think is a very positive development.
More generally, I see the American political system as infinitely
elastic and hopeful. And of course there's the Internet, which is
a huge opening of information, giving people access to what the establishment
doesn't want them to hear, not only politically but especially medically.
I was quite intrigued to learn fairly recently that my Web site was
blocked by filtering software at a library in Indiana. Why it was
blocked, God only knows. But I was struck by the fact that someone
was complaining about it.