European Association of Psychoanalysis
on the Liberal Tradition
Thomas Szasz has long been the
foremost critic of involuntary psychiatric commitment, and his many books on
psychiatric tyranny have won for him a well-deserved reputation as a champion of
liberty. He supports his condemnation of involuntary commitment by means of a
radical thesis: mental illness is a myth. Illness, as an objective term, should
be confined to physical ailments; so-called mental illnesses are in reality
types of behavior that other people do not like. Schizophrenics and others
diagnosed as beyond the pale by conventional psychiatrists, should, so long as
they are not incapacitated, be treated as normal adults.
To say that Szasz's view is controversial is a mild understatement, but I do not here propose to concentrate on its merits and defects. His opinions on these matters have amply been set forward numerous times before; but what we have here is something new. In Faith in Freedom, Szasz subjects to withering scrutiny famous classical liberals, including John Stuart Mill and Bertrand Russell. He judges each person by his attitude toward psychiatric commitment, to him the supreme libertarian issue.
I have, of course wrongly, sometimes been suspected of undue harshness toward various authors. However bilious I have been, my attempts at the acerb are as nothing compared to Szasz's. He is a true master of invective, from whom we all can learn. And there is even better on offer. He subjects to mordant scrutiny many of the great names of contemporary libertarianism, including Ayn Rand and Robert Nozick.
Before I get to the fun, though, the essence of our author's case against mental illness needs to be set out, so that readers can understand the background he assumes in his critical essays. His contention that mental illness does not exist rests on a surprising premise: the mind does not exist as a separate substance. "Later, influenced by [George Herbert] Mead, I [Szasz] came to adopt the view that there is no mind; that, like mental illness, the term `mind' is itself a metaphor; hence that the mind cannot be healthy or sick; and that instead of thinking and speaking about minds as entities, we ought to think and speak of selves, persons, and moral agents engaging in actions" (p. 167).
An example will clarify Szasz's position. Suppose someone claims to be Napoleon. Since there is no "mind" that can be ill, Szasz will not treat him as the helpless victim of a mental illness, much less someone suffering from an impairment of the brain or nervous system. (The theory that mental problems are caused by neurological defects is one of our author's pet aversions.) As Szasz sees matters, what we have here is interpersonal behavior of a certain sort, and social interaction cannot suffer from disease. Thus, Szasz will say that the person is playing a game: he finds it convenient for his purposes to lie. (Szasz takes for granted that the person knows he is not "really" the French Emperor; I think this needs more support than Szasz provides.)
Here I venture to suggest that Szasz has missed an opportunity. Can the view that mind is not a substance really be sustained? Indeed, can one properly speak of responsibility at all, on Szasz's view of mind? Murray Rothbard raised precisely these issues, in a review written in 1962 of Szasz's The Myth of Mental Illness.
Clearly rankled by Rothbard's criticism, Szasz replies that his entire position affirms responsibility. "Rothbard's criticism-epitomized by the charge that my argument `eliminates the whole possibility of moral responsibility for
actions'-was not merely erroneous, it stood the thesis of the book on its head" (p. 173). He naturally prefers to stress Rothbard's later praise for his work, most notably in a speech that Rothbard delivered in his honor in 1980.
But of course Rothbard did not deny that Szasz affirms moral responsibility: his question was whether this affirmation is consistent with the denial of mind as substance. Szasz ought to have presented a defense of his contention; instead, he gives us irrelevant anecdotes about Rothbard and medical doctors.
Even those unable fully to accept Szasz's view of the mind cannot deny his prowess as a critic. One might have guessed that Szasz would view John Stuart Mill with unstinting admiration. Not only did Mill defend individual autonomy; he specifically denounced in On Liberty the practice of stigmatizing eccentrics as madmen.
Szasz does not quote the relevant part of On Liberty; he cites instead a letter of 1858 in which Mill denounces the "frightful facility" with which someone can be committed without trial for lunacy. Instead, Mill thought that no one should be committed without inquiry by jury, though he recognized that juries "are only too willing to treat any conduct as madness which is ever so little out of the common way" (p. 84, quoting Mill).
For Szasz, this is not nearly good enough. Mill has not rejected in principle "psychiatric imprisonment"; instead, he insists on procedural safeguards in commitment hearings. "Here begins the slippery slope. Once we grant power to the medical agents of the state to coerce innocent persons . . . there is no practical way, to prevent them, and their social superiors, from 'abusing' the law" (pp. 84-85).
Szasz carries his criticism of Mill deeper. He fastens on a passage in On Liberty in which Mill says that the doctrines of that work do not apply to a society "in its nonage," i.e., one that has not sufficiently developed historically to benefit from a regime of liberty.
Szasz, with his key topic always in mind, pounces. If a society in its nonage can be governed in a non-libertarian way, why not treat certain individuals in a historically developed society as also in their nonage? Mill denies full liberty to children, a view with which Szasz does not quarrel; but once Mill allows the term "nonage" to be used in a non-literal way, the door lies open for psychiatrists to claim that the mentally ill should be treated as children.
Perhaps Mill has an escape. He might claim that whether a society is fit for liberty depends on the presence or absence of certain institutions and traditions, not the mental state of particular individuals within a society. If so, he could consistently hold that once a society met his criteria, every adult in it must be treated in a way that respects his rights. But Szasz is entirely correct that Mill in the "nonage" passage dangerously compromised his liberalism.
Mill emerges not altogether a hero, but he fares far better than Bertrand Russell. Szasz offers a devastating portrait of Russell, presenting him as an enemy of liberty. Our author notes that Russell, with great acuity, recognized a problem with the usual concept of mental illness. No objective way exists to separate mentally deranged views from similar opinions not generally taken to be insane: "Men who allow their love of power to give them a distorted view of the world are to be found in every asylum: one man will think he is Governor of the Bank of England, another will think he is the King, yet another will think he is God. Highly similar delusions, if expressed by educated men in obscure language, lead to professorships of philosophy; and if expressed by emotional men in eloquent language, lead to dictatorship" (p. 99, emphasis removed, quoting Russell).
Despite articulating this Szaszian view, Russell endorsed exactly the psychiatric theory of crime and punishment it is Szasz's principal aim to condemn. Criminals should be "cured" rather than punished. As this were not enough, Russell also supported sterilization of the "unfit." "By "unfit," Russell meant persons suffering from mental deficiency and mental illness or "insanity" (p. 98). Russell held on to his views in deadly earnest, going so far as to make repeated efforts to have his own son committed as mentally ill.
Szasz's final verdict on Russell is unsparing: "In the trajectory of Russell's life, we can trace the transformation of a young man full of zeal for reason and liberty, yet with a soul corrupted by an excess of vanity and self-love, into an old man full of hatred for mankind" (p. 110).
Mises and Hayek emerge relatively intact, though Szasz offers criticisms of both. Szasz finds very much to his liking Mises's contention that all action is, from the point of view of the actor, rational: praxeology has nothing to say about the rationality of ends, and a person always chooses means he thinks best fitted to attain whatever ends he has. "If all human action is rational, then no action is irrational or, as psychiatrists and their admirers like to put it, 'senseless'. It is only a short step from Mises's assertion that human action is always rational, to my [Szasz's] assertion that mental illness is a myth" (p. 152). Unfortunately, Mises sometimes fell from grace by speaking of mental illness as though it were real; but he was a great man nonetheless.
In like fashion, Hayek's insistence on the rule of law has implications that Szasz finds congenial. The rule of law, as Hayek conceives it, requires that legislation group people in objective categories. Absent this, they stand vulnerable to the arbitrary acts of government agents. If one accepts Szasz's view that there are no objective criteria of mental illness, it at once follows that the law can take no account of it. Hayek declined to draw this conclusion, and Szasz has no patience with his acceptance of the "doctrinal claim" that those diagnosed as mentally ill bear no responsibility for their actions (p. 160).
Szasz has neglected one instance in which Hayek recognizes the dangers of psychiatric abuse. Szasz quotes a notorious remark from Brock Chisholm, a pretentious psychiatric bigwig who called for "the reinterpretation and eventual eradication of the concepts of right and wrong" (p. 7). As one might anticipate, Szasz does not view this remark with full enthusiasm. But Hayek also condemned exactly the same passage, in his essay "The Errors of Constructivism," reprinted in New Studies in Philosophy, Politics, and the History of Ideas (University of Chicago Press, 1978).
Szasz admires Mises and Hayek, but he has no use for Robert Nozick, who stands condemned for his failure to denounce involuntary psychiatric commitment. "Nozick asserts that we ought to accord rights to animals. He does not say that we ought to accord rights to persons psychiatrists diagnose as mentally ill" (p. 179).
I think that Szasz here goes altogether too far. He is perfectly within his rights to criticize those who adopt views of mental illness he thinks mistaken. But should a writer be excoriated just because he fails to mention Szasz's central topic? Szasz, pushing his single-mindedness to near absurdity, assails Nozick for citing favorably the psychiatrist Viktor Frankl. He engaged, Szasz tells us "in psychiatry's most loathsome practices, including lobotomy" (p. 181). But Nozick's reference to Frankl has nothing to do with coercive psychiatry.
Not only has Nozick ignored the key libertarian issue of our time; his philosophy, Szasz claims, is pretentious nonsense. This is a harsh verdict, and to my mind Szasz has not been able to support it.
Quite the contrary, he often misunderstands Nozick, or dismisses what he says without consideration. He claims that Nozick wrongly ignores the bearings of free will on responsibility: "The concept of free will implies responsibility and the options of punishing or forgiving persons for actions we deem to be bad or criminal" (p. 180). But all that Nozick says in the relevant passage from Philosophical Explanations is that his own concern with free will does not stem from the problem of responsibility. Far from rejecting responsibility, though, he offers in the chapter from which Szasz quotes an elaborate account of retributive punishment.
Again, when Szasz claims that Nozick is "profoundly ignorant about the vast psychoanalytic literature on the symbolic meaning of seemingly irrational behaviors" (p. 187), he has once more misread him. Nozick was well aware that psychoanalysts equate the symbolic with what it stands for; the "equation" he mentions in the passage that Szasz discusses deals with a specific hypothesis of Nozick's own.1)
I shall leave it to readers of the book to discover for themselves the details of Szasz's discussion of Ayn Rand. Suffice it to say that he praises her skeptical attitude toward psychoanalysis but finds flaws in her character. These are as nothing compared to what he has to say about Rand's one time disciple and later bitter foe, Nathaniel Branden. I commend his chapter on Branden to all admirers of negative criticism.
One cannot finish this spirited book without admiration both for Szasz's devotion to liberty and his acuity in its defense. I close with two minor points: When David Kahneman and Richard Thaler speak of "irrational" choices, they do not use the term in a way relevant to Szasz's concerns. They mean by it, roughly, "choices not in accord with decision theory" (p. 49). And I do not see why he calls David Shapiro's Neurotic Styles "a technical text" (p. 182). n MR
1) Although Nozick did not discuss Szasz's views in print, he was in
conversation dismissive of them.
Edited and written by David Gordon, "Szasz on the Liberal Tradition", Faith in Freedom: Libertarian Principles and Psychiatric Practices. Thomas Szasz, Transaction Publishers, 2004, xvi + 264 pgs.