Sunday, October 19, 2014

Keeping Tom Szasz's ideas alive

John Breeding is concerned about the legacy of Thomas Szasz in his article in SAGE open. He rightly emphasises Szasz's focus on "greater autonomy and higher levels of personal responsibility". As John Breeding points out, Szasz never really wanted to be a doctor. Instead he trained to be a psychoanalyst. Szasz practiced autonomous psychotherapy, although he didn't like the term 'therapy'. I understand how John Breeding as a counsellor sees that he can 'practice Szasz'.

That's fine for patients who have mental capacity. People decide to undertake psychotherapy and counselling. However, people who are psychotic may not make the most rational of decisions because of their mental illness. Society might have a role to intervene and psychiatrists manage madness on behalf of society. Psychotherapists and counsellors don't need to undertake these murky responsibilities.

Hence, using quotes from the article, Tom Szasz thought that, "A person should be deprived of liberty only if proved guilty of breaking the law". To reiterate, he said, "if the 'patient' is not a criminal, then he or she has a right to liberty; and if the patient is a criminal, then he or she ought to be restrained and punished by the criminal law, like anyone else". Essentially, Szasz didn't think society should have mental health legislation.

I suppose it could be said I'm only defending my role as a psychiatrist, but I don't agree with Szasz on this point (see previous post). He was also pretty scathing about the Critical Psychiatry Network of which I'm a founding member (see another previous post). I'm sure I could learn to be clearer in expressing my views, like him, although I do accept uncertainty and perspectives may not always be as black and white as he often argued. However, his critique of the biological basis of mental illness will survive.

(With thanks to Around the Web item on Mad in America)

4 comments:

Anonymous said...

Why is the President of the college of psychiatry so afraid of engaging in 'open' debate? ) In last weeks web site debate with Clare Gerada on Pulse Med. Mag Simon Wellsely made the facetious remark 'whose turn is it to bring in the dry cleaning'...later tweeted by Laura Evans as 'literally airing dirty linen in public'. Several contributors raised issues around mental health includiing that of doctors yet he made no comment to those. Just as the outgoing president seemed unable to openly respond honestly to Kevin Heally in a website debate when he raised the issue of the massive increase in labelling children with illness labels. The state of mental health services are shameful but covring that up is just as shameful

Mark p.s.2 said...

Szasz claimed that neither the pro-drug psychiatrists or the anti-drug psychiatrists treats the
patient-subject as a responsible moral agent.

The flaw in Szasz's argument is that the drugs DO affect the mind, so his/her ability to be a "moral agent" is severely impaired.

Anonymous said...

"That's fine for patients who have mental capacity. People decide to undertake psychotherapy and counselling. However, people who are psychotic may not make the most rational of decisions because of their mental illness. Society might have a role to intervene and psychiatrists manage madness on behalf of society."

With typical psychiatric arrogance, you call, view, and see everyone, every stranger to you, in the world, as a potential 'patient' whether they want to be your 'patient' or not. If someone hasn't agreed to be your 'patient', they are not your patient, they are your detainee.

A legitimate doctor/patient relationship cannot be established by force. It is as absurd as a rapist calling his victim his 'lover'. As absurd as the people force feeding hunger striking detainees in Guantanamo Bay, calling themselves that person's 'Chef'. You begin this paragraph by mindlessly categorizing these people as 'patients', which is indicative of your presumed ownership over them, and your presumed 'right' to exercise your domination over someone and forcibly define their status in their relationship to you as 'patient'.

You are the one with the brute force of the state in your hands, so you shall prevail in setting the terms, defining this alleged 'reality', that the person is in 'fact', according to you, a 'patient'. What they see themselves as, has become irrelevant, for their humanity is deleted in this equation.

"That's fine for patients who have mental capacity. People decide to undertake psychotherapy and counselling. However, people who are psychotic may not make the most rational of decisions because of their mental illness. Society might have a role to intervene and psychiatrists manage madness on behalf of society."

"Mental capacity", ah, that unmeasurable, psychiatrist divined, psychiatrist unilaterally declared, with no objective test, alleged quality, that is religiously believed by you to be either "present" or "not present". Using your... what? best guess? With your Nero's thumb, you dub any and all strangers dragged kicking and screaming before you against their expressed human will, either in possession of "it" or not, and consequently they'll have to like it or lump it, when you rip from them all their citizenship rights and human rights, behind closed doors, without judicial oversight in Britain, by simply raising your pen to a form and with a slight wiggle of your wrist, deploying that nuclear weapon, your signature, which means no amount of begging and pleading can now save that person from becoming your 'patient', owned, lock, stock, and barrel, held at the barrel of syringe point, backed up by every psychiatrist's small army of strong-arm goons, masquerading as 'nurses', ready, willing and able, to reduce a human being to nothing but a neuroleptized zombie, after the necessary violent struggle.

Anonymous said...


"However, people who are psychotic may not make the most rational of decisions because of their mental illness."

Oh! "people who ARE PSYCHOTIC", oh, the unquestioned, unexamined mindless introduction of the sheer assumption that because psychiatry originated and deploys the word "psychotic" that it's some agreed upon "fact" that someone "is", "psychotic" if a psychiatrist divines that they "are". And the circular logic, you've gotta love it, so cute, "may not make the most rational decisions because of their mental illness". A causal little alleged explanation that has no real explanatory power...

Why is he not making the most "rational" decisions?

Well... you see... "because of his mental illness".

How do you know he has a "mental illness?"

Well... "because he is not making the most rational decisions!"

Pure unmitigated quackery, that would be merely laughable and pitiable if we weren't forced to live in fear of your fearsome power and willingness to use and initiate force and violence to meddle in our lives.

Just as on any given day there are numerous people cowering before psychiatrists and their goon squads of 'nurses', many will continue to cower and hide from ever even reaching out to psychiatry for help, because of the brutality you reserve the right to employ.

It's all very well to claim that people won't reach out and seek help "because of their mental illness". There are many who won't go anywhere near a state empowered psychiatrist, because doing so, is to face the very real and grave risk, of winding up in a situation where forced psychiatry bares its terrible teeth, and once you've seen what these wolves are capable of, many will live in fear for the rest of their terrorized lives.

I personally would never, ever, trust you and open up to you about the content of my thoughts and feelings in a time of need. This is not because of my alleged "capacity" or otherwise. It is because I learned, the unforgettable way, that you people always reserve the right, to initiate violent aggression whenever you deem it "necessary".

Like so many of Szasz's critics, you don't seem to understand how repellent your willingness to violently dominate is, to the stated goal of encouraging help seeking.

You claim to know that nobody in a certain state of mind would seek out help, "because" their state of mind allegedly precludes this decision being made. It's the standard "we have to have coercive powers because without them, they'd never come to us for help" type argument.

Never does a psychiatrist admit that it is these very powers, that cause so many to avoid reaching out to these "services".

The shattered, mangled and even ended lives, that are the collateral damage of psychiatrists' insistence on using violence to break the will of those they choose to coerce, are always propagandized away in favor of spotlighting the "success stories".

No psychiatrist who has chosen to work as government's agent, can honestly say they haven't got victims.

Szasz's signature never signed somebody else's life away. His signature never set off a chain reaction of brutality that killed anybody's faith in humanity. His signature never decimated anybody's feeling of safety and security. His pen never wriggled around on a piece of paper in some back room of a 'ward', in a pretend 'hospital' that was filled with the screams of tortured, begging, pleading detainees. His pen never erased the humanity of another. With his pen, he chose to write books and reaffirm the humanity of psychiatry's victims. And because of this, he died with a clear conscience.

I pity the psychiatrists that won't.