Dissertation Yes Mum

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The Heresy of Thomas Szasz
It’s Philosophical, Moral and Political Dimensions
Can they be taken as a consistent and coherent whole?
Abstract
The Journal of Psychiatry and Law claimed in 1987 that ‘Arguably, Szasz has had
more impact on the actual practise of psychiatry in this country than anyone since
Freud’. He has undoubtedly been the most controversial figure in psychiatry. Ever
since he embarked on a crusade to discredit institutional psychiatry’s foundation as de
facto medical healers of the ‘mentally ill’ almost forty nine years ago he has made
numerous enemies but also many passionate supporters. His work has often been
misunderstood and his sharp polemic often deters readers. However behind his witty
façade, there is clear philosophy that has been formed from the ideas of a wide range
of philosophers and thinkers from many different disciplines and periods, which are
then applied, to psychiatry. It is the aim of this paper to clearly formulate and
critically assess the three distinct philosophical parts of his denunciation of
institutional psychiatry. The analytical and semantic philosophy, the moral and ethical
philosophy and finally the political philosophy constitute these three parts. This paper
will assess the importance of each and will then calculate whether these three parts
form a coherent and consistent whole.

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“What is implied in the line of thought set forth here is something quite different. I do
not intend to offer a new conception of "psychiatric illness" nor a new form of
"therapy." My aim is more modest and yet also more ambitious. It is to suggest that
the phenomena now called mental illnesses be looked at afresh and more simply, that
it be removed from the category of illness, and that it be regarded as the expressions
of man's struggle with the problem of how he should live.” Thomas Szasz (The Myth
of Mental Illness (1960)).
Thomas Szasz’s work is about the profession, practise and concepts of psychiatry by a
former professional psychiatrist, yet it is first and foremost a philosophical work and
will be approached as such. Firstly, by claiming that ‘mental illness is a myth’, Szasz
was presenting an analytical/semantic argument in the tradition of Immanual Kant.
This paper will therefore present his argument in this vein. Secondly, by seeking to
replace ‘mental illness’ with ‘problems with living’, Szasz was presenting a
existential and ethical philosophy to confront and understand mans problem of
broadly how he should live in the face of the essential tragedy of life.
This paper will argue that these two parts are immutable. They constitute core part of
Szasz’s aim as presented above. Despite this, it can also be said that in a strict
philosophical sense the analytical argument partly fails. This is because the analytic
argument is heavily dependent on the verbal conventions that underlie the meaning of
the analytic propositions. So the preposition ‘a disease is a structural or functional

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abnormality of cells, tissues, organs or bodies”, is only analytically true if you apply
by the definition of disease as disease as “the structural or functional abnormality of
cells, tissues, organs or bodies”. This is a contentious issue, as is the whole concept of
analytic truth as argued by W.V Quine, which will be explored in this paper. This
paper will conclude that Szasz’s “analytic” argument may not necessarily be analytic
but is it is still a necessary foundation of his moral philosophy and his criticism of
psychiatry as a whole.
Finally Szasz’s political ideology will be addressed. This essay will address two
opposing viewpoints against Szasz’s right-libertarian political ideology. The first
viewpoint was expressed by the ex-editor of the magazine Radical Psychology Rob
Brown, who said that there was a contradiction between Szasz’s political view and his
criticisms of psychiatry. Peter Sedgwick responded by saying ‘Szasz’s politics are not
an aberration, and in no sense contradict the positions he has taken on psychiatric
issues’.1 This paper will argue that Szasz’s political prescriptions can be kept separate
from his criticisms of psychiatry. This is justified because one of Szasz’s most
consistent criticisms of psychiatry is from a libertarian viewpoint. However there are
different political strands of libertarian thought and so a libertarian critique of
psychiatric practises like Szasz’s does not commit you do following a definitive
strand of political liberalism. Also there are examples of psychiatrists who apply
broadly Szasz’s criticisms of psychiatry but have distinctly different political views.
The paper will begin with a historical overview of the changes in mainstream
psychiatry since Szasz was first published up until the ten years ago.
1
Sedgwick, P. (1982). Psycho Politics. (1st ed). Pluto Press Limited.p158
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In the context of the Psychiatric profession
To contextualise Thomas Szasz’s work as a critique and response to the methods and
conceptual definitions of mainstream psychiatry, it is important to provide a brief
summary of the APA2 (American Psychiatric Association) definitions and criteria of
mental illnesses or disorders as provided in their DSM (Diagnosis and Statistical

3
Manual). In addition to this, it is necessary to provide a brief account of the change in
mainstream treatment provided by psychiatrists to the most severe mental disorders
prevalent throughout the last fifty years. This paper has as its paradigm six of Szasz’s
books.4 The first chronologically “The Myth of Mental Illness” published eight years
after the first DSM, DSM-I in 1952, and the last chronologically ‘The Meaning of
Mind, Language, Morality and Neuroscience’ published just two years after the fourth
major revision, DSM-IV in 1994.
Since the publication of the first DSM (DSM-I) and the fourth major revision (DSM-
IV), there have been 191 additionally added disorders, from 106 disorders in 1952 to
297 in 19945. In the DSM-IV, the manual defines a mental disorder as:
“ A clinically significant behavioral or psychological syndrome or pattern that occurs
in an individual and that is associated with present distress (A painful symptom) or
disability (Impairment in one or more important areas of functioning) or with a
significantly increased risk of suffering, pain or disability.”6

2
The APA (American Psychiatric Association) was created in 1844 under different names until 1921.
The latest DSM, It is now used widely across institutional America: by the court system, social
services, the Government, schools, prisons and insurance companies. APA website,
http://www.dsmivtr.org
3
The International Variant of the DSM-I at that time was the ICD-6, Published by the World Health
Organization.
4
The six books in chronological order are. The Myth of Mental Illness (1960), Schizophrenia(1974)
Manufacture of Madness(1977).Insanity:The Idea and Its Consequences(1987). Meaning of Mind
(2006).
5
From “Separating Psychiatric Disorder from the Medicalisation of “Something else- A Psychiatric
Into A DSM-IV diagnosis’-Dr Howe Synnot-Psychiatrist Micoa.
6
From the DSM-IV, Fact Sheet, presented here http://www.healthsystem.virginia.edu/internet/psych-
training/seminars/apa-dsm-iv.pdf.
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Amongst additions to the manual there have also been examples of retractions. For
example, Homosexuality described as ‘homodsyphilia, homosexual conflict disorder,
and ego-dystonic homosexuality’7 in its various apparent dysfunctional manifestations
was deleted in 1974 under pressure from various homosexual support groups.8
The APA stresses the change in how new disorders are established. The early DSM
manuals in 1952 and 1968 had little empirical data foundations, in contrast to the
present day when ‘the overall driving force in the decision to include or exclude a
potential diagnosis from the DSM is the availability of scientific data’.9 This empirical
data seems to take the form of a variety of structural interviews and rating scales
applied to a large number of data sets. Yet the initial stage of diagnosis still largely
depends on ‘common sense and clinical experience in judging the number and type of
characteristic symptoms’.10
The introduction of the anti-psychotic drug chlorpromazine in 1954, and the eventual
marketing of a host of anti-psychotic drugs, described by Roy Porter as a
‘psychotropics revolution’11 introduced a lengthy process of de-institutionalization of

state asylums to be replaced by ‘community care’. Andrew Scull, however, claims to
the contrary that anti-psychotic drugs did not cause de-institutionalization but it was
an inevitable result of the tight fiscal budgeting of advanced capitalist countries
towards traditional welfare policies that generally started before large-scale
advancements in anti-psychotic drugs.12 Despite disagreements in the causes, in the
7
Shorter, E A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. 1st ed. John
Wiley and Sons.p301. (1997)
8
Ibid, p301.
9
DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders,
http://www.dsmivtr.org/index.cfm
10
DSM-IV sourcebook: http://www.dsmivtr.org.
11
Porter. R. Madness: A Brief History. 1sted. Oxford University Press.p207.(2003).
12
Scull, A Decarceration. 2nd ed. Rutgers University Press. p 23. (1984)
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United States from 1955 until 1988 there had been a decrease of 80 percent of patients
in state and county asylum hospitals.13
Apart from the advancement of anti-psychotic drugs, other organic treatments had
become prevalent in the 1950s onwards, such as ECT, insulin comas and brain
surgery. In ‘Social Class and Mental Illness’, Hollingshead and Redlitch demonstrated
that the types of treatment, length of stay and likelihood of re-admission largely
depended on class. Thus unskilled or semiskilled workers of poor education were
more likely to receive organic treatment (ECT, Drugs etc), receive longer
hospitalization, increased likelihood of re-admission and little active treatment. While
Class II, containing professionals executives and, managerials, were treated
predominantly with talking therapy and considerable active treatment.14 Despite this, a
1975 New Haven study described a number of important changes in styles of therapy,
most notably that drug treatment had become part of the therapeutic mix of all
classes.15
Finally and most notably, there is increasing belief amongst psychiatrists that severe
mental illnesses such as schizophrenia are brain diseases, with a demonstrative
biological course deducible from results from brain scans, and research gathered from
twin studies.16 While there has always been a suspicion in modern psychiatry and
hence the prevalence of the medical model, there is now more confidence in proving
and demonstrating this.
13
p280. Shorter, E A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. 1st ed
John Wiley and Sons.p301. (1997)
14
Hollingshead, A.B and Redlich FC. Social Class and Mental Illness. New York (1958)
15
Sedgwick, P. Psycho Politics, Pluto Press Limited. P191 (1982)
16
Work done on the Biological basis: Schizophrenia and Manic-Depressive Disorder: The Biological
Roots of Mental Illness as Revealed by a Landmark Study of Identical Twins (senior author), with
Irving I. Gottesman, Edward H. Taylor, Ann E. Bowler, Perseus Books Group
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For example, the psychiatrist E. Fuller Torrey has spent a large amount of time
investigating the brain tissue of diseased mental patients since 1989 when he set up
the Stanley Medical Research Institute. Torrey claims that they are close to finding
evidence of a virus that releases toxins into the nervous system causing
schizophrenia.17 Despite a lack of conclusive evidence he confidently states that
"schizophrenia is a disease of the brain in the same sense that Parkinson's disease and
multiple sclerosis are diseases of the brain.”18
In summary, during the 49 years since Szasz’s ‘The Myth of Mental Illness’ was
published the organs of mainstream Psychiatry have acknowledged and defined
considerable more mental disorders. In addition, they have expressed further the
empirical, biological bases of severe mental illnesses, and have generally accepted
neuroleptic drugs as the primary treatment available for people suffering from mental
illnesses. Thus in short the medical model is clearly the predominant model of
Psychiatry.
Now it is important to explain Szasz’s main theory, started in the ‘Myth of Mental
Illness’, that relates to the practices and concepts of the mainstream psychiatric
profession described above.
Tracing Szasz’s thoughts-The argument from analytic and semantic reasoning

17
Stanford Magazine. Brain Storm Article on E. Fuller. Torrey. by Tom Nugent
http://www.stanfordalumni.org/news/magazine/2003/janfeb/features/torrey.html [Accessed 11th of
April 2009]
18
Thomas Szasz takes on his critics: is mental illness an insane idea?
http://findarticles.com/p/articles/mi_m1568/is_1_37/ai_n13593350/pg_8/ [Accessed 15th of April 2009]
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The ‘Myth of Mental Illness, Foundations of a Theory of Personal Conduct’,
published in 1958, and written during Szasz’s early tenure as a psychiatrist, was
influenced by what Szasz saw as the ‘vague, capricious and generally unsatisfactory
character of the widely used concept of mental illness and its corollaries, diagnosis,
prognosis and treatment’.19 For Szasz the use of the term mental illness makes
historical sense because of the historical tradition of integration between Psychiatry
and Medicine, yet it does not make rational sense.
The term ‘mental illness’ as it is commonly used in psychiatry and amongst the lay
public expresses the belief that personal, social, and ethical problems in living are
medical problems. Being also that the experienced and expressed psychiatric
symptoms of these ‘problems in living’ are seen as similar to bodily diseases, it is
argued that they must be treated within a medical conceptual framework.20 Yet, for
Szasz, this is a semantic error, in which a word is attributed to a state literally, when it
is actually used metaphorically. So for Szasz in ‘The Myth of Mental Illness’, mental
illnesses are not the same as bodily illnesses, they are instead behavioral and
psychological manifestations of ‘problems in living’ non reducible to biological

processes. Accordingly to assert that someone is ‘mentally ill’ is a semantic fallacy
that has grave consequences for the person diagnosed in respect to viewing and
treating them as a free acting and responsible moral agent .21
To reassert, for Szasz, the logical use of the term ‘mental illness’ is metaphorical:
mental illnesses are like bodily illnesses. In this metaphorical use of the term, one can
only say that minds can be “sick” in the sense that economies are “sick” or jokes are
“sick”. To use the term literally is to commit a categorical error first established by
19
. Szasz, T. S. The myth of mental illness: foundations of a theory of personal conduct (Rev. ed.). New
York: Harper & Row. xiii. (1960/1974).
20
Ibid. p.262
21
Szasz, T. S. Insanity,: 7he idea and its consequences. New York: John Wiley & Sons. p23. (1987).
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the philosopher Gilbert Ryle, who described a myth as ‘the presentation of facts
belonging in one category in the idioms appropriate to another.’22
Thus for Szasz, the presentation of the fact that there are behavioral and psychological
symptoms of ‘problems in living’ is erroneously categorized as belonging to a
category of disease. This does not imply that a ‘myth’ is something that is fabricated,
and as a consequence Szasz denies the psychological and sociological existence of
problems that ‘Mental Illness’ refers to, as psychiatrist and other academics have
argued.23 This simply implies that Szasz wishes to, in the Rylian term, place “mental
illnesses” outside the category that relates only to bodily diseases and in a new
category described broadly as ‘problems in living’. As a consequence they should be
treated as a moral, ethical and political problem and not a medical problem. Hence
Szasz belief that he desires to ‘re-ethicize’ and ‘re-politicize’ psychiatry’.24
Two terms have been introduced here, ‘disease’ and ‘problems in living’, which must
be adequately defined before one can establish a full understanding of Szasz major
philosophical argument against the term ‘mental illness’ and the practices it justifies.
Firstly, the definition of disease that Szasz adheres is most competently addressed in
“’Insanity, the Idea and Its Consequences’. In this book Szasz makes it clear that he
defines disease as ‘the pathologist defines it - as the structural or functional
abnormality of cells, tissues, organs or bodies’.25
Thus disease is a medical enterprise which is committed to physicialism and natural
scientific methods of study.26 ‘Problems in living’, is, for Szasz, is related to the realm
22
Ryle. G The Concept of Mind. (rev.ed) Hutchinson. - p10. (1966)
23
Micale M.S, Porter R Discovering the History of Psychiatry. (1st ed) Oxford University Press.p321
(1994)
24
Szasz Review/Interview conducted by Ross Levatter, (1983) http://www.szasz.com/Levatter.htm
25
Szasz, T. S. Insanity: 7he idea and its consequences. New York: John Wiley & Sons..p12. (1987).
26
Cresswell, M. Szasz and His Interlocutors: Reconsidering Thomas Szasz’s “Myth of Mental Illness”
thesis. Journal of the Theory of Social Behaviour vol38. p24 (2008)
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of how humans conduct themselves and relate to societal norms. This essentially
evolves around “sign using, rule-following, and games playing…in terms of human
relationships and social arrangements promoting certain types of learning and
values’27 underpinned by free will. While disease is a deterministic medical enterprise
relating to ‘natural scientific methods of study’ and ‘physicalism’, the way humans
conduct themselves in society belongs in the social sciences, such as psychology,
sociology, philosophy and anthropology28. The error therefore, that Psychiatrists
commit is a process of mechanomorphism, where man “modern man ‘thingifies’
persons”.29
The question that arises from this injunction is that, is it not possible to
Mechanomorph the mind? Do we not speak of the mind as a noun, an entity reducible
to the brain? This question has arisen from the current assimilation of neuroscience
theories of the mind with psychiatrists’ biological explanations of the causes of severe
mental illnesses such as Schizophrenia and Bi-Polar disorder. This is epitomized, by
the Neuroscientist Dr Carla Shatz’s quote, “Basic brain research is seeking answers
that may ultimately help guide social policy’.30
In the “Meaning of Mind”, Szasz explores the historic use of the word mind as both
noun and verb. Before the sixteenth century, there was no existence of the noun mind,
as people had souls and not minds, the word “mind’, therefore, meant minding in its
verbal sense. The concept of the mind as we now understand it is the symptom of the
modern and scientific age and not the medieval religious age. Szasz believes that
today we misuse the verb ‘to mind ‘with the noun ‘mind’ denoting an observable
27
. Szasz, T. S. The myth of mental illness: foundations of a theory of personal conduct (Rev. ed.). New
York: Harper & Row. 263 (1960/1974).
28
thesis. Journal of the Theory of Social Behaviour vol38. p25 (2008)
29
Szasz, T. Ideology and Insanity: Essays on the Psychiatric Dehumanisation of Man. (rev ed) Anchor
Books.p 195. (1970).
30
Quoted in Szasz T.S. The Meaning of Mind, Language, Morality and Neuroscience. (1st ed)
Greenwood Publishing Group.p.143. (1996)
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material structure like the brain. As Szasz puts it, ‘we misunderstand “minding” as
using our ‘mind’. But we have no minds. Instead, we, qua living persons, mind. How
and what we mind is who we are. Minding is quintessentially our own business’.31
Szasz, for the development of his theory of mind, learnt a lot from the American
Pragmatists George Herbert Mead (1863-1931), who believed that the self was
intimately tied to the development of language. Language being a social tool Mead
argued ‘It is absurd to look at the mind simply from the standpoint of the individual
human organism; for, although it has its focus there, it is essentially a social
phenomenon; even its biological functions are primarily social’.32
Where neuroscience and psychiatry differ, therefore, is that they deal with two
different conceptual categories, ‘The brain is a bodily organ and part of a medical
discourse. The mind is a personal attribute and a part of the moral discourse.’33 Finally
it is important to note, that Szasz is not a Cartesian Dualist in the traditional sense of
the word, as he does believe that there can be no existence of self or thought processes
without a material structure. He believes simply that the use of the noun mind, should
be understood as dependent on language and how we interact with other people, and
cannot be understood from a material and biological reductionism stance.34
Now that we have acquired the clarity of how Szasz defines the concept ‘disease’,
‘mind’, ‘brain’ and ‘problems in living’ we can delve more deeply into the
philosophical structure of Szasz’s key argument that we have already touched upon.
Szasz’s theory can broadly be placed now in the philosophical tradition of
distinguishing between analytic and synthetic propositions as argued by Immanuel
31
Szasz T.S. The Meaning of Mind, Language, Morality and Neuroscience. (1st ed) Greenwood
Publishing Group.p.17(1996)
32
Cook, Gary A., George Herbert Mead, The Making of a Social Pragmatist, Urbana: University of
Illinois Press. (1993),
33
Ibid. p92.
34
Ibid p94.
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Kant.35 The core of analytic and synthetic statements is semantic, referring to do what
makes a preposition true or false. Accordingly the basic definition an analytic or
synthetic statement is this.
p is analytic = df p is true solely in virtue of the meanings of its constituent
terms36
p is synthetic = df p is not true or false solely in virtue of the meanings of it
constituent terms.37
As Szasz’s argument is based in analytical philosophy, it is now necessary to look
solely at analytic propositions.
“All ophthalmologists are doctors” is an example of a proposition that is true in virtue
of the meanings of its constituent terms, being that the definition of ophthalmologist is
‘doctor’.
The basic definition of an analytic statement can also be edifies in terms of
entailment.38 For example with the hypothetical preposition
Premise 1. If all men are mortal
Premise 2. And Socrates is a Man
Conclusion 1. Socrates is mortal.

In this example Jonathan Harrison, explains that it ‘analytic if and only if the
antecedent ‘All men are mortal Socrates is a man’ entails the consequent ‘Socrates is
mortal’. This is because analytical statements follow.
either p or not p
not (p and not p) 39 (Where p means ‘Any Proposition’)
35
Although, this presentation of Kant’s initial argument is a widened version as shown by Georges
Dicker and Jonathan Harrison
36
Dicker, G. Kant’s Theory of Knowledge and Analytical Introduction (1st ed) Oxford University Press.
p9.(2004)
37
Ibid, p9
38
Harrison, J. Our Knowledge of Right and Wrong (1st ed) Routledge p39. (2004)
39
Dicker, G. Kant’s Theory of Knowledge and Analytical Introduction (1st ed) Oxford University Press.
p11.(2004)
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Presently we now can formulate Szasz’s theory as an analytic proposition, which is
‘true solely in virtue of the meanings of its constituent terms’ or in which the
antecedent entails the consequent.40 Hence:
Premise 1. If Disease is a predicate of material (human) bodies.
Premise 2. And the noun “the mind” is materially non-reducible and non-
observable.
Conclusion 1.The mind cannot both be materially non- reducible and non-
observable and be diseased (Ill)--The mind therefore can be ill only in a metaphorical
sense.
Conclusion 2. Mental Illness is a myth.41
What we have established is that the statement articulated above ‘the mind cannot
both be materially non-reducible and be diseased’ is true in virtue of its ‘conceptual
truths’. For the concept ‘disease’, defined as “the structural or functional abnormality
of cells, tissues, organs or bodies” and ‘predicated of the body’, and the concept of
“the mind” defined as “a non material entity” it follows logically that ‘the mind
cannot both be materially non-reducible and diseased.’ This is the same as the way
that ‘something cannot be both round and square’- which is true in virtue of the
concept ‘round’, defined as “having no angles”, and square as defined as a
‘rectangular with four angles’.42 This, therefore, potentially debunks the psychiatric
medical model diagnostic term ‘mental illness’.
However, as Kant argued ‘analytic judgements are very important, and indeed
necessary, but only for obtaining…clearness in the concepts’.43 So while analytic
statements are important in clarifying concepts, they tell us nothing else that relates to
40
Ibid,p11.
41
A myth here is defined as Gilbert Ryle defined. As it was on page9.
42
Indebted to Dicker for this example, page 11.
43
Kant, I Critique of Pure Reason. Translated by Norman Kempt Smith (1st ed) Read Books. P51
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reality of our world outside these concepts. Thus from the proposition ‘Mental Illness
is a Myth’ we cannot ascertain anything about the practice of psychiatry. This must be
done through experience i.e. synthetically. We will now turn: to the moral and ethical
dimension criticisms of the practice of psychiatry.
The Moral and Ethical Dimension.
‘...The aim of a life can only be to increase the sum of freedom and responsibility to
be found in every man and in the world. It cannot, under any circumstances, be to
reduce or suppress that freedom, even temporarily’ Albert Camus, “The Wager of
Our Generation”44
Szasz’s argument is not just a clever analytical endeavor, it is an endeavor steeped in
moral and ethical philosophy. Szasz’s resolutely held belief that humans are moral
autonomous agents that conduct themselves and express themselves both
meaningfully and freely is incompatible with both the conceptual definitions and
treatments held and practiced throughout the history of psychiatry. As Szasz puts it “I
have objected and continue to object to psychiatric diagnostic terms not because they
are meaningless, but because they are used to stigmatize, dehumanize, imprison, and
torture those to whom they are applied’.45
As Szasz indicates, the analytical argument just formulated seemingly forces one to
commit to the belief that mental illness is meaningless in an analytical/semantic
sense. Due to the redundancy of the term ‘mental illness’, it is now necessary to
44
Albert Camus- “The Wager of Our Genration” Resistance, Rebellion, and Death, translated by Justin
O,Brien (New York university press)(1960) Quoted at the beginning of Szasz’s Law, Liberty and
Psychiatry.
45
Szasz, T. Law, Liberty and Psychiatry (1st ed) x,iii Routledge(1974).
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explore what the diagnosis of certain ‘mental illnesses’ are for Szasz, if they are not
scientific medical discoveries. As Szasz argues ‘The claim that some people have a
disease called schizophrenia (and that some, presumably, do not) was based not on
any medical discovery but only on medical authority’.46 It follows that if they are not
the result of scientific work or empiricism then they must be the products of ‘political
and ethical decision making’.47 Yet how and by what criteria are these ‘political and
ethical decisions are made and by whom and for what reason?
Sylvia Nassar states that in Schizophrenia, the main symptom is the ‘profound feeling
of incomprehensibility and inaccessibility that sufferers provoke in other people’.48
Szasz would concur with this view arguing that a difference between physical illness
and mental illness, is that while in physical illness one seeks help because of pain, in
mental illness one makes others suffer, so people seek help for you.49 It is the
abnormal pronouncements and deviant behavior which often annoying and upsetting
that causes psychiatric intervention or, ‘confronted with the overwhelming powers
aligned against the person, they may elect to seek psychiatric help.50 .
As Szasz says about the founders of the “illness” schizophrenia, Emil Kraepelin and
Eugen Bleuer succeeded in moving so called medically based diagnosis from
histopathology to psychopathology, essentially ‘from abnormal bodily structure to
abnormal personal behavior.’51 This is an argument heavily documented by
sociologists, regardingg social control of deviance through labeling. (Scheff 1967)
46
Szasz, T. Schizophrenia; The Sacred Symbol of Psychiatry (rev ed) Syracuse University Press.p3.
(1974)
47
Ibid,p25
48
Nasar, Sylvia. A Beautiful Mind. (1st ed) New York: Simon and Schuster. (1998).
49
Szasz, T. S. Insanity: 7he idea and its consequences. New York: John Wiley & Sons p43.(1987).
50
Ibid, p39
51
p12 (1974)
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Szasz, however seeks, to go further arguing that the way this problem is masked is to
account for human behavior in two ways, normal behavior being motivational, and
abnormal behavior being causal. This inevitably leads to the assumption prevalent in
the medical model of psychiatry that mental illness is something that people have,
when for Szasz it is something people act or do.52 For Szasz this is entirely
unnecessary. He believes that there should be just one account of all human behavior,
as motivated, goal directed and meaningful to the agent.
The view that man is free acting and responsible agent come from a dual
understanding of man, one based on libertarianism, and the other the concept of the
responsible ‘moral man’, based on work by Albert Camus, Jean Paul Sartre and in its
broad sense existential. This paper will explain the two and explain the connection.
The libertarian in Szasz, equates liberty as the highest and natural pre-condition of
human nature more than health.53 His belief is that autonomy and self-ownership of
one’s body and mental faculties are clear natural rights, as is the right to be free from
physical coercion from others. Involuntary hospitalization is consequently the anti-
thesis of this ideal, as you lose the self-ownership of your body and are physically
coerced in the process. The act of involuntary hospitalization forms the main pillar of
Szasz’s attack on psychiatry. In 2002, Szasz claims in the United States alone, there
were approximately one million civil commitments per year, that is, more than 2,500
per day and that this practice is common in all advanced societies.54
In contrast Szasz expresses the consensual nature of physician based practices as
enshrined in the Hippocratic oath as an example of the extremity of the psychiatrists’
position. Depriving a person of liberty for what is said to be his own good is immoral.
52
Szasz, T. S. Insanity: 7he idea and its consequences. New York: John Wiley & Sons p352 (1987).
53
Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum. For Reason online(2000)
http://www.reason.com/news/show/27767.html
54
Time Magazine reported in 1991. August 26. Involuntary hospitalisation of teenagers has increased
from 16,000 to 263,000 from 1971 to 1991.( http://www.antipsychiatry.org/due-proc.htm). Szasz quote
found in ibid.
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Just as a person suffering from terminal cancer may refuse treatment, so should a
person be able to refuse psychiatric treatment. In an analogy to law, he argues that
involuntary hospitalization is the opposite to the assumption ‘innocent until proven
guilty’, is now ‘insane until proven sane’.55Thus involuntary hospitalization is akin to
incarceration.
The existentialist thought in Szasz lies not just in understanding the responsibility that
comes with being a free moral agent, but in explaining that the idea that life is
meaningless, which for Szasz is difficult if not impossible for people to accept.56 He
quotes Shakespeare when he says ‘life is tale told by an idiot, full of sound and fury
signifying nothing’57. In the face of the essentially meaningless of life and the
hardship it entails Szasz takes a rather strong view of sanity as the ‘confronting of
conflict, with modesty and patience, acquired through silence and suffering’.58 This is
resembles the Camus quote, “Freedom is not a reward or a decoration that is
celebrated with champagne...Oh no! It's a...long distance race, quite solitary and very
exhausting.”59 Szasz claims that insanity as defined as an illness, is the foregoing of
this struggle for freedom and liberty, and a subjection to the paternal dominance of
psychiatrists.
The connection of responsibility of a moral agent as believed by Camus and Sartre
and libertarian is key for Szasz. Responsibility is morally speaking anterior to liberty.
Szasz says “So if a person wants to gain more freedom—in relation to his fears, his
wife, his work, etc.—he must first assume more responsibility (than he has been)
55
Szasz. T.S. The Second Sin.(1st ed) Routledge (1974) p40
56
This is explicit in the work of Jean Paul Sartre, the phrases ‘existence proceeds essence’ So for Sartre
and Szasz we just find ourselves existing , and then have to decide what to make of ourselves. More on
Sartre can be found in Stevenson, L. Seven Theories of Human Nature. (2nd ed) Oxford University
Press.P81 (1974)
57
Szasz as a Humanist. In Jan Pols Critical Analysis of Thomas Szasz
http://www.janpols.net/Contents.html
58
p83 (1974)
59
Camus. A. The Fall, Translated by O’Brien J .Vintage Books. p46 (1991)
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toward them; then he will gain more liberty in relation to them.”60 The modern
Psychiatrist that utilises the medical model deprives responsibility and therefore the
liberty of the patient to resolve these issues.
Finally the prevalence of the medical model, for Szasz has a clear agenda behind it
other than attempting to help the patient. The medical model for Szasz means that
‘the upshot is the professional credo of mental health professionals: that mental illness
is like medical illness, and mental treatment like medical treatment’.61 There is a clear
existential benefit to presuming the role of the medical psychiatrist. The apparent
expertise that comes with ‘scientific’ foundations and how this appears to others is an
important factor for Szasz in the prevalence of the medical model.
In conclusion, the moral dimension of Szasz’s work is predominantly about
responsibility and liberty. This facet cannot be understood as independent from the
analytical and semantic argument previously given. It has to be seen as inextricably
linked. For Szasz the use of the term ‘mental illness’ leads to an assumption of man
and human nature that is the anti-thesis of Szasz’s view on liberty and the
responsibility of man in the face of the tragedy of life. The medical model therefore
encompasses the denial of both the analytic and moral dimension just presented.
60
Wyatt C.R. Thomas Szasz, Liberty and the practice of Psychotherapy Journal of Humanistic
Psychology.vol 44.p71-85 (2004)
61
Szasz, T. S. The myth of mental illness: foundations of a theory of personal conduct (Rev. ed.). New
York: Harper & Row. p249 (1960/1974).
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Analytical and Semantic Dimension revisited
The medical model is implicit in the diagnostic term ‘mental illness’, and this term
has been shown to be semantically redundant and the actions related to it morally
suspect. This means that the burden of proof falls on supporters of mainstream
psychiatry and critics of Szasz to provide evidence to reclaim the use of the term
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‘mental illness’ and its implications. To begin with, supporters of the medical model
must address the analytical and semantic argument first articulated at the beginning of
this paper. Hence:
Premise 1. If Disease is a predicate of material (human) bodies.
Premise 2. And the noun “the mind” is materially non reducible, non
observable
Conclusion 1.The mind cannot be both materially non-reducible, and non
observable and be diseased (Ill)--The mind therefore can be ill only in a metaphorical
sense.
Conclusion 2. Mental Illness is a myth.
As we noted earlier, the proposition ‘the mind cannot be both materially non-
reducible and be diseased’ is analytically logical, seemingly in the same way that
‘something cannot be both round and square’, due to the conceptual definitions of
‘round’ and ‘square’, when one defines the concept round as “having no angles”, and
square as defined as a ‘rectangular with four angles’.
The problem with the statement ‘the mind cannot be both materially non-reducible
and be diseased’ unlike the proposition ‘something cannot be both round and square’,
is that the definitions of the concepts in the former proposition are open to
controversy. While it is indeed difficult to define ‘round’ as something different to
‘having no angles’, it is much easier for people to differ on how they define disease.
The same can also be said of the definition of the mind as ‘ materially non-reducible
and non-observable’, the noun ‘mind’ similar to ‘disease’ seems to be as semantically
divisive. Definitions are a matter of human verbal conventions, and verbal
conventions can easily be altered.

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Many authors have argued against Szasz’s belief that only symptoms from physical
lesions are legitimate indicators of disease.62
Other opponents of Szasz’s definition of disease argue that it is more cogent to look at
the similarities between physical diseases and mental illnesses. 63 A different approach
to disease is therefore formulated in the claim that there is a broad spectrum of
contingent conditions that are predicates of both mental and physical diseases. This is
a spectrum according to quantity, in the sense that mental diseases are, as of yet, less
explicitly biological, in contrast to physical diseases, though they share many
common elements despite this.
R.E Kendell argues that in reality, there is little difference in the characteristics of
mental illnesses from physical illnesses in either symptomatology or etiology. This
blurring of etiology or symptomatology exists when mental states such as fear and
emotion play an important role in the genesis of hypertension, asthma and other
somatic illnesses and when bodily changes and somatic lesions occur in so-called
‘mental illnesses’ such as weight loss. In addition, Kendell claims biological
dysfunctions underlie most of the main groups of so called mental disorders.

However, as he admits, this is not the case for all; hence the quantitative aspect to the
difference between somatic and psyche illnesses.64 This blurring of the line between
somatic and mental disease has been termed by Mark Cresswell as an argument from
psychosomatic holism.65 There is a large tradition of thought supporting this
psychosomatic holism.66
62
All these raise question Szasz’s conceptual definition of ‘Brown and Ochberg (1971), Moore (1975),
Pies (1979),Mindham et al. (1992),
63
Begelman (1971), Engelhardt Jr. (1981), Kendell (2004),
64
Schaler, A.J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. (1st ed) Open Court
Publishing.p32.(2004)
65
thesis. Journal of the Theory of Social Behaviour vol38. P32. (2008)
66
Work done here by Canguilhem,1991:Goldstein, 1939:Leriche,1939, (Brown, 1985, Pies, 1979.
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Thus an inevitability of psychosomatic holism for Kendell is that, ’neither minds nor
bodies suffer from diseases only people (or in wider context organisms) do so, and
when they do both, mind and body, psyche and soma, are usually involved’.67 This
psychosomatic holism therefore presents a genuine problem to the first premise of the
analytical argument, namely, ‘Disease is a predicate of material (human) bodies.’
Being that Kendell’s concept of disease is a quantitative spectrum of various
conditions (suffering, disability, biological causes, psychiatric and bodily symptoms,)
shared to a lesser or greater extent by both sufferers of mental illness and physical
illness, and which happen to people as whole persons and not disparate bodies.
For Szasz there are three replies to the Kendell’s psychosomatic holism. The first two
relates to the definitions of his analytic argument so will be addressed first, while the
third is moral and will addressed in due course.
Szasz argues in response that physical illnesses are usually identified by observing the
patients body, i.e. fever, vomiting blood, in contrast to mental illnesses which are
identified by observing the patients speech i.e. claiming to be God. Secondly that
there are ‘objective, physical-chemical markers to ascertain whether someone has a

particular brain disease..for example subdural hematoma’68 this however is lacking for
mental illnesses such as schizophrenia. Thirdly and finally, physical diseases are
treated with informed consent (unless the patient is incompetent, i.e. unconscious etc),
while mental illnesses are often treated without the person’s consent i.e. independent
of their own beliefs and desires. 69
67
68
Ibid p39
69
Ibid p40
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For Szasz, although Kendell presents a formidable argument he essentially ignores
what Szasz’s aim is in proposing that ‘mental illness’ is a myth. Szasz does not
believe that there are no such things as brain diseases or that there is no suffering in
“mental illness”. He believes that suffering from a brain disease is a problem for
neurologists and not psychiatrists, while suffering without a biological disorder is a
problem in life, and how one should live. As he readily admits, that there is always a
chance that schizophrenia will be identified as a brain disease, yet for the time being
the evidence is unflattering.70As Szasz says ‘a laboratory technician can blindly make
a diagnosis of anaemia 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 in the way that neurosyphilis was
recognised as a brain disease.’71
Ironically this is view echoed by mainstream psychiatry. Two prominent psychiatrists,
E. Fuller Torrey and Julius Ledd, who although believing that Schizophrenia is a
brain disease, claim "there is no single abnormality in brain structure or function that
is pathognomonic for schizophrenia”72 and “there is no pathological test for
schizophrenia”73, respectively. This view is also expressed in the APA, DSM-IV,
2000 re-edition.74
70
Szasz, T. S. Insanity: 7he idea and its consequences. New York: John Wiley & Sons p78 (1987).
71
Curing the Therapeutic State: Thomas Szasz interviewed by Jacob Sullum. For Reason
online(2000) http://www.reason.com/news/show/27767.html
72
Szasz takes on his critcs: Mental illness is an insane idea.
http://findarticles.com/p/articles/mi_m1568/is_1_37/ai_n13593350/pg_8/
73
Szasz T.S. The Meaning of Mind, Language, Morality and Neuroscience. (1st ed) Greenwood
Publishing Group.p.87(1996)
74
Caplan, B. The Economics of Thomas Szasz: Preferences, Constraints and Mental Illness Rationality
and Society Aug2006 vol.18 Issue 3 p335
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It seems, consequently that the quantitative gap between physical illness and mental
illness is much wider than Kendell believes. There is as of yet “no pathological test
for schizophrenia”. Despite this, suffering which is another one of Kendell’s criteria is
as he describes himself “insufficient on its own”75, for this would, as Kendell
shrewdly observes make poverty etc an illness, which it clearly is not. This leaves
now the belief that somatic illnesses involve psychiatric symptoms and vice versa.
While the above is undeniably true the diagnosis of a mental illness is not based on
the its physical symptoms primarily, but as Szasz says ‘verbal pronouncements’ of the
patient. This also ignores an important part of diagnosis, while symptoms are often a
subjective complaint by the person, there is an additional concept of objective
validation of the symptom between patient and physician. There is no pathological
validation in the subjective diagnosis of ‘thought disorder’, explaining the often
strange idiom of schizophrenics for example, apart from a non-medical one.76
In short, therefore, expressing the similarities of characteristics between physical and
mental diseases merely leads one instead to re-acknowledge the main difference. This
is that mental illness unlike physical illness cannot be described as ‘the pathologist
defines it- as the structural or functional abnormality of cells, tissues, organs or
bodies’ because whatever other similarities might suffice such as symptoms they
cannot be objectively validated. Therefore psychosomatic holism is true only in
subjective symptoms but not in objective causes. Finally if somatic causes can be
found in mental illness, then this will mean that they would be officially classified as
75
76
Szasz, T. Schizophrenia; The Sacred Symbol of Psychiatry (rev ed) Syracuse University Press. p123
(1974)
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brain diseases, and thus out of the scope of psychiatry and into the scope of
neurology.
Morgan and Kleinman have attempted to bridge this problem by arguing that ‘illness’
is how people respond to the condition socially, and ‘disease’ is the biological
disorder.77 However this misrepresents how the term ‘illness’ is used in practise.
Amongst psychiatrists the two words have become interchangeable and both denote in
many cases the use of medical treatment.
In conclusion, although it seems that the way that diseases are discovered (in terms of
bodily diseases) is very different to how mental illness are discovered, concerning
Szasz’s analytic/semantic argument there is still need to explore why a supposedly
analytical argument is open to derision. It seems relatively arbitrary, that the analytic
truth is ‘true solely in virtue of the meanings of its constituent terms’ when matters of
meaning seem to be about the deliberate conventions with which the word is used?
The philosopher W.V Quine argued doggedly against the analytic/synthetic
distinction in “Two Dogmas of Empiricism”. Quine argued that our beliefs of the
world form a web. Some of our beliefs at the centre of the web seem unrevisable i.e.
what we perceive to be analytic truths. Yet Quine would argue that if given intractable
evidence through experience we would be forced to give up these so-called analytic
truths78. Importantly these beliefs face the test of experience collectively and not
77
These two works are separate Morgan (1975) and Kleinman (1980), though for a summary of both
positions see Bowers, L. The Social Nature of Illness (1st ed) Routledge. p151. (2000)
78
For example, having the belief that the earth is flat.
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separately. So Quine argues ‘our statements about the external world face the tribunal
of sense experience not individually, but only as a corporate body’79.
In addition to this Quine, argues that we cannot understand analytic statements by
defining it using other terms such as synonymy or definitions or meaning because
together this forms a circular chain of concepts, none of which are actually explained.
Therefore the conceptual definition of disease as “the structural or functional
abnormality of cells, tissues, organs or bodies”, presupposes or stipulates a synonymy
but doesn’t help us understand what an ‘analytic truth’ is.80 So Szasz proposing this
analytic statement does not capture “the meaning” of an expression. Instead he
‘explicates or proposes a theory of the referential features he is interested in
preserving.’81 While Szasz is interested in preserving a theory of disease as having a
certain conceptual definition, this is still just a theory and must be treated as such, and
the same can be said of Szasz’s critics.
Hence we can propose primarily that we temporarily bracket the assumption that
Szasz has made mental illness a conceptual myth or alternatively that his critics have
disproved him, and strip down both Szasz and Szasz’s interlocutors to their moral
framework.
Moral and Ethical Dimension Revisited
79
Quine W.V.O (1951) Two Dogmas of Empiricism http://www.ditext.com/quine/quine.html
80
Ibid.
81
Craig, E. Routledge Encylopedia of Philosphy Taylor and Francis.p11(1998)
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We have seen that Szasz’s analytical and semantic argument is open to objection yet
remains strong. It is now appropriate to present an analysis of the criticisms of the
moral aspects of the use of the terms ‘illness’ and ‘disease’.
To reiterate we have seen that the term ‘mental illness’ for Szasz is a moral and
political decision that denotes a value-laden system that is applied to people against
their will. This is as opposed to ‘bodily disease’, which is an objective and value-
neutral diagnosis of a pathological lesion etc and is consensual.
However the value-neutral aspect of physical illness is greatly contested by
academics, most notably here by Fulford, Sedgwick and Illich.82
Fulford attempts to blunt the effect of Szasz warnings over the value-laden diagnosis
of mental illnesses by placing value-laden decisions into a larger context of value-
based medicine (VBM). In short, value judgements are a necessary condition of all
diagnosis and treatments behind all illnesses, physical or mental. The second,
complimentary factor in diagnosis for Fulford is (EBM), evidence based medicine,
which is the factual basis behind treatments and diagnoses responding to ‘the growing
complexity of facts relevant to decision making in all areas of healthcare’.83
Relating to (VBM), for Fulford the difference in value-laden decisions between
physical illness and mental illness occurs because the values of parties involved in the
diagnosis and treatments of physical illness are closer aligned, while in mental illness
they often greatly diverge, thus presenting a conflict of interest.84 A conflict that has
intended to favour the strong (The psychiatrist) over the weak (the patient) throughout
the past. Suffice it to say that for Fulford conflict would also occur in physical illness
diagnosis and treatment and decisions, if there were differing values between those
82
Fulford (1994) Sedgwick(1982),Illich (1976)
83
Publishing. p94. (2004)
84
This train of though is influenced primarily by R.M Hare, and his work in The Language of Morals
(1952) and Freedom and Reason (1963)
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concerned.85 So Fulford writes, ‘in psychiatry we are concerned with ‘emotion,
desire, affect, motivation and belief, all of which are areas of human experience in
which our values differ widely and legitimately.’86
Therefore for Fulford, it is the prophetic mission of psychiatrists understanding VBM,
to acknowledge the differing equally valid values in psychiatric decisions between the
patient, the patient’s family, the psychiatrist and negotiate and compromise to satisfy
the values of all concerned. This he argues differs to bio-ethics, which is a hierarchy
format of ‘quasi legal ethics (that) prescribes right values’.87
Ivan Illich in ‘Limits to Medicine’, would disagree with Fulford about the extent of
the value-laden element in physical illness. Illich might however have been grateful
for an appreciation that medical treatment is all value-laden since he argues that Szasz
as well as other “anti-psychiatrists”, are ‘rendering it more and not less difficult to
raise the same kind of question about disease in general. ”88 Yet he would disrepute
Fulford’s belief that in physical illness, values converge and thus conflicts are
avoided. This is because for Illich, Fulford has missed the point, as in Fulford’s view
patient irresponsible passivity falsely masquerades as acceptance and physician’s

dominance falsely masquerades as benevolence and expertise. So Illich argues the
danger with modern medicine, is that ‘a passive public that has come to rely on
superficial medical house-cleaning’.89
The consequence of this is that ‘society has transferred to physicians the exclusive
right to determine what constitutes sickness, who is or might become sick, and what
shall be done with such people’.90 While Szasz describes ‘the medicalisation of
85
Publishing. p94. (2004) P68
86
Ibid. p66
87
Ibid.p67
88
Illich, I. Limits to Medicine. Medical Nemesis: The Expropriation of Health. (2nd ed) Penguin
Books.p172 (1976).
89
Ibid.p173
90
Ibid p173
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problems in living’, Illich has replaced it with the ‘the medicalisation of life’. Where
for Szasz psychiatrists rob mental patients of their responsibility to change their own
situation in society, for Illich physicians rob the lay man of responsibility and mastery
of his health in order to preserve modern technology and means of production that
underlie the profession. Thus medicine indoctrinates people to believe that ‘they can
be discharged from any political responsibility for having collaborated in increasing
the sickening stress of high intensity industry’.91
The political dimension here, however, is where Szasz and Illich differ sharply, for
whereas for Szasz responsibility means adapting and hence coping with one’s
changing environment, for Illich, it means actively seeking and inciting change of that
environment to precipitate good health. For Illich, the physician, a member of the
dominating classes, judges that the individual does not fit into an environment ‘that
has been engineered and is administered by other professionals, instead of accusing
his colleagues of creating an environment into which human organisms cannot fit’.92
Not only would Szasz disagree with the subjectivity of physical illness, he would
abhor the political Marxist analysis of dominating classes coupled with Illich’s anti-
industrial standpoint, which has been described by Timothy Reagan as a ‘medieval

ideal of society’.93
The final important objector of viewing physical illness as value neutral is Peter
Sedgwick in both Psycho Politics and reiterated in (Illich 1976). Sedgwick argues that
‘all illness, whether conceived in localised bodily terms or within a larger view of
human functioning, expresses both a social value judgement (contrasting a person’s
condition with certain established norms) and an attempt at explanation (with a view
of controlling the disvalued condition”.94
91
Ibid, p175
92
Ibid, p176
93
Raegon. T.The Foundations of Ivan Illich’s Social Thought Educational Theory. Vol.30.Issue 4.
p297 (2007)
94
Sedgwick, P. Psycho Politics. (1st ed). Pluto Press Limited.p26. (1982).
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E.J Damman, argues that all these objections actually miss Szasz’s point. Szasz does
not believe that diagnoses cannot be social constructions affected by certain societal
values. Instead Szasz is emphasising that the actual disease itself is ‘independent of
theses social norms’ and that is why, for example ‘a physical disease, such as
pneumonia, exists independently of the prevailing societal norms, while a supposed
mental disease, such as homosexuality, does not’.95
Aside from this, the act of involuntary hospitalisation rears its ugly head again. Szasz,
therefore, says ‘illness qua illness, is never a justification for depriving an ill person of
their liberty. An institution of person cannot leave, legally or physically, should not be
called a hospital’96
In conclusion after presenting two dimensions of Szasz thought (the analytic
semantic/ dimension and the moral dimension) it is important to see that for Szasz
they are immutable. The wrongful use of the term mental illness leads to a view of
man and woman that is morally dubious. Yet despite this academics such Bowers and
Engelhardt Jr., conclude that Szasz’s argument is solely a moral argument, and that an
analytic truth cannot be derived logically from the way we speak and act.97
Yet to refer back to Kant, Szasz’s analytic argument does succeed in “clarifying
concepts”. It has meant that the definition of disease and the mind is re-assessed in the
95
Damman E.J. The “Myth of Mental Illness”. Continuing Controversies and there Implications for
Mental Health Professionals. Clinical Psychology Review. Vol.17 p738(1997)
96
Publishing. P65 (2004)
97
Bowers, L. The Social Nature of Illness (1st ed) Routledge. p146. (2000), and Schaler, A.J Szasz
Under Fire: The Psychiatric Abolitionist Faces His Critics. (1st ed) Open Court Publishing. P65 (2004)
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psychiatric profession, and this can only be a good thing, even though there is as of
yet or possibly never will be consensus. Yet it is still true that the analytic argument in
a wider philosophical sense, following Quine, is dubious just in the nature of it being
an analytic argument. However if we decide that instead of an analytic truth it is a
subjective formation of Szasz’s theory of disease, then we can see that together the
analytic argument and the moral argument that compliments it present a logically
consistent and constantly compelling whole.
After acknowledging that the moral and analytic dimensions form a coherent
argument in tandem, it is now important to present Thomas Szasz’s political views as
a third part of his criticisms of institutional psychiatry.
The Political Dimension.
This paper will now turn for its final part to the political thought of Thomas Szasz.
His right-libertarian political thought is inherent in his prescriptions of how the future
of an ethical and moral psychiatric would work within society. This paper will explore
Szasz’s pure ideological views and will contrast these with the political reality of
mainstream and alternative psychiatric practice in Britain and the U.S. Finally there
will be an attempt to define Szasz’s political thought as not a necessary aspect of his
philosophical critique of psychiatry. This will essentially separate his philosophical
critique from his political thought. It is a response to Peter Sedgwick, who in an

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extensive critique of Szasz, argued that ‘Szasz’s politics are not an aberration, and in
no sense contradict the positions he has taken on psychiatric issues’.98
Szasz describes himself broadly as a ‘classical libertarian’.99 Concerning psychiatry he
believes that the term “libertarian psychiatrist” is quite simply an oxymoron, since he
believes that individual liberty is a more important value than mental health. As has
previously been mentioned involuntary hospitalisation, which is essentially
psychiatric coercion against individual liberty, is incompatible with his interpretation
of libertarianism.
Concerning his political thought he defines himself as ‘what in the 19th century, was
called liberalism. Today is called “classical liberalism’.100 Although liberalism comes
in a variety of different political guises, it has it concurrent ideals in both freedom
(liberty) and equality.101 These two ideals have, however, provided a spectrum of
different political beliefs such as libertarian, libertarian socialist, anarcho-capatlist,
which differ in the prescriptions of how best to achieve these states. Szasz is confident
that freedom and equality can only be achieved through traditional libertarianism or
right-libertarianism.
(He defines his political philosophy as aligned with the writings of Ludwig von Mises
and Friedrich von Hayek.102 Hayek, a successor of Mises and a supporter of his ideas,
believed deeply in the free market as the economic system that is most productive and
most conducive to individual liberty. Key to this individual liberty is the belief in
private property and a minimal rule of institutional law to protect the right to private
98
Sedgwick, P. (1982). Psycho Politics. (1st ed). Pluto Press Limited.p158
99
100
. Schaler, A.J Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. (1st ed) Open Court
Publishing. P113 (2004)
101
Edgley, A.(2000) The Social and Political Though of Noam Chomasky. (1st ed) Routledge.p44
102
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property.103 Hayek disagrees with any form of state redistribution of wealth, or a
Rawlsian position of redistribution, because this ultimately compromises freedom.
Hayek states ‘inequality is undoubtedly more readily borne, and affects the dignity of
the person much less, if determined by impersonal force, than when it is due to
design.’104
These ideas are for Szasz important in his development of libertarianism. He claims
‘Economists and epidemiologists have shown, beyond a shadow of a doubt, that the
two variables that correlate most closely with good health are the right to property and
individual liberty i.e. the free market’.105 In this vein, the role of the state for Szasz
should be limited to national defence, the police, and certain public works such as the
water supply and litter disposal. Healthcare should of course be private. Even adding
chemicals to the water or bread, is going too far for Szasz.106 Szasz views can be
expressed clearly by the maxim that ‘people pay for what they value, and value for
what they pay for’. Now lets approach this adage from the confines of psychiatric
practice.
In ‘the Myth of Mental Illness’, Szasz defines two different possibilities of social-
economic circumstances in which two opposite and distinct therapeutic practises can
operate. These are the political and economic ethics of individualism and collectivism,
thus implying a sharp capitalist-communist dichotomy. A therapeutic practise in a
collectivist society for Szasz means that ‘privacy cannot be maintained, and is even
officially devalued, in communist-collective societies’107. While alternatively ‘the
development and safeguarding of therapeutic privacy are, closely tied to the
individualistic-capitalist socio-economic system’’108 (Ibid), this is due to the belief that

103
Ebenstein, A.O (2003) Hayek’s Journey. (1st ed) Palgrave Macmillan p65
104
Hayek, F.A. (1944) (1986/ The road to serfdom, london. Routledge and Kegan Paul.p32
105
Interview by Randall C. Wyatt. http://www.psychotherapy.net/interview/thomas-szasz.
106
Szasz’s Political Theory. In Jan Pols Critical Analysis of Thomas Szasz
http://www.janpols.net/Contents.html
107
York: Harper & Row. p51 (1960/1974).
108
Ibid,p55
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the physician is ultimately responsible to no third parties, just to the interests of the
patient. In between this sharp dichotomy, Szasz places social insurance as a situation
when the ‘physician may sometimes be for the patient and sometimes against him.109
In line with Szasz’s political ‘classical liberalist’ thoughts he defines the ideal
situation between a patient and a therapist as contractual in which the patient hires a
therapist to assist him according to the goals the patient defines which the therapist is
free to accept or deny. Thus ‘The relationship between contractual psychiatrist and
patient is based on contract, freely entered into by both and, in general, freely
terminable by both’.110 This is essentially a market based solution to mental
healthcare, in which perspective patients “shop’ around the various therapeutic
alternatives with guidelines clearly defined by the therapist according to the patient’s
own desires and financial capabilities.
In conclusion for Szasz you can separate private practise from the social insurance
practise of therapy in these ways, firstly the number of patients are kept to two in the
private practice, while it can fluctuate to a several people in insured practises.
Secondly the agent of the therapist in the private practice is only the patient, while in
insured practices there are three often conflicting agents, namely, the patient’s agent,
society’s agent, and the therapist’s agency (where he tries to maximise his own gains).
Thirdly there is little difference between the sources and nature of the therapist’s
rewards, the only clear difference is that the financial reward from social insurance
comes from the system or state. This however relates back to the conflict of interests
between the therapist and the patient and the therapist as a state worker. 111
109
Ibid,p56
110
Szasz, T. (1977) The Manufacture of Madness (2nd ed) Harper and Row.p215.
111
York: Harper & Row. p51 (1960/1974).p58
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Szasz’s right-libertarian views have caused much confusion to supporters of his
criticisms of Psychiatry.112 A telling example is when a group of New Left students
went to applaud a speech he made at the University of Michigan, to be consequently
lampooned and told from the platform that they were a pack of reds and should got
back to Moscow.113 This distinctly separates him from the others brushed by the Anti-
Psychiatry brush such as R.D. Laing who Szasz believes ‘as communist seek to place
the poor above the rich, so anti-psychiatrist (Laing) seek to place the sane above the
insane’.114 So for Szasz while psychiatrist see patients as villains and psychiatrists as
heroes, the Anti -Psychiatrist inverse these terms, and inadvertently diminish the
responsibility of the patient.
Peter Sedgwick in his book ‘Psychopolitics’ wishes to expose these elements of
Szasz’s political belief and to discredit Szasz’s by claiming his philosophical views on
psychiatry contain his political views explicitly. His aim therefore is to relocate Szasz
as the ‘doyen of the movement of mental health revisionism and the herald of the
newer orthodoxy’s of right wing thought on welfare in the post collectivist epoch of
Ronald Reagan and Margaret Thatcher.115
Sedgwick in order to emphasise right libertarian thought in Thomas Szasz traces
Szasz’s political views as a continuation of Herbert Spencer’s. Sedgwick argues that
they both start from very simple and similar first premises: ‘the supreme value of the
individual competition in a race whose course and progress is to be traced by the
record of evolution’.116 Sedgwick therefore emphasises each authors attempt to
highlight the essential struggle of existence: for Szasz this is masked by psychiatry as
the institutional denial of tragedy. For Spencer it is the myth that ‘all social suffering
112
The Editor of Radical Psychiatry, Phil Brown, argued that ‘There is a contradiction between his
political views and his condemnations of psychiatry’ Radical Psychiatry, New York, 1973, pp.xxi, 4.
113
Sedgwick, P. Psycho Politics. (1st ed). Pluto Press Limited.P158 (1982).
114
Kotowicz. Z.R.D Laing and the paths of Anti-Psychiatry.Routledge (1997)
115
116
Ibid p161
5849238
is removable, and that it is the duty of somebody or other to remove it.’117 As a result,
for Spencer state help for the needy through poor laws and other state measures is
worthless unless we come to understand the long-term evolutionary effects of these
acts. This is akin to Szasz’s warning that the Christian charitable ethos just like
psychiatric meddling fosters and deepens the ‘ethic of helplessness’ in the needy.
Concerning free enterprise Mark Goldstein, like Sedgwick, believes that Szasz is
woefully naïve, arguing that ‘he overlooks the fact entrepreneurial fee for service
medicine is also tied historically and functionally to the government and other
institutions’.118Steven (1971) and Berlant (1975) have both explored the accumulation
of private power with use of government apparatus. The reality of a contractual
psychiatry and supposed ‘free enterprise’ would leave the most unequal in society to
suffer, ‘the old and the indignant are hardly in a position to compete, in the therapy-
purchasing market with clients who are as their peak of economic capacity’.119 Thus
the unadulterated cash nexus that Szasz speaks of and the individualism it supports is
an idealism that as its most harmful consequence feeds the ‘post collectivist epoch’ of
welfare reductions.
In conclusion Goldstein like Sedgwick believes that ‘ideologies that claim to be
humanistic through offering the individual as the basis unit of social life can provide
justifications for dehumanising policies and practises’.120 The individualistic capitalist
ideology rightfully has been criticised as ignorant of many social problems and social
inequalities that deny the ability for true liberty. These criticisms of the implications
of the libertarian philosophy as a political criticism throughout Szasz’s work are
cogent and strong. Yet libertarianism as a political view has different strands and
117
Spencer.H. The man versus state, (3rd ed) Caxton Printers. p23 (1945)
118
. Goldstein, M. The Politics of Thomas Szasz.:The Sociological View. Journal of Social Problems.
Vol 27. No.5. p576. (1980)
119
120
Goldstein, M. The Politics of Thomas Szasz.:The Sociological View. Journal of Social Problems.
Vol 27. No.5. p582. (1980)
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these must be discussed in order to differentiate libertarian principles as a criticism of
psychiatry from right-libertarianism as a political and social prescription.
Social libertarianism is an alternative political variant of libertarian principles. For
libertarian socialists freedom is not true freedom without equality: as Bakunin said
‘Liberty without socialism is privilege, injustice; socialism without liberty is slavery
and brutality’.121 As such libertarian socialists believe that contractual capitalist
relationships are not truly free if these exist within a society that is inherently unequal.
Inequality is maintained through the private means of production and wage slavery.
On the under hand equality could be founded on the principle that labour must be
freely undertaken and under the control of the producer.122 Thus this reading of
libertarian political ideology falls in line with Sedgwick’s and Goldstein’s criticism of
the contractual private therapeutic relationship as disadvantaging the unequal, ‘the
contact merely formalises and legitimises the difference in money, power,
knowledge.’123
Despite this, this paper takes Szasz libertarian principle at its most consistent when it
attacks psychiatric practises, namely, involuntary hospitalisation. In spite of

libertarian socialism and right-libetarians profoundly disagreeing in political
prescriptions both would agree that liberty involves the right not to be coerced by
others, as well as self-ownership of the body. So Szasz’s criticism of involuntary
hospitalisation comes from a Libertarian sentiment that is neither specifically
conservative nor socialist. Therefore the statement by Geoff Pearson that ‘the
conservative theory which is largely implicit and unstated) in Szasz’s work and the
121
Bakunin- Federaism, Socialism Anti-Theologism,
http://www.marxists.org/reference/archive/bakunin/works/various/reasons-of-state.htm
122
This is a common assumption amongst Libertarian socialist see Noam Chomsky, Bakunin, etc in
Edgley, A.(2000) The Social and Political Though of Noam Chomasky. (1st ed) Routledge.p44
123
Goldstein, M. The Politics of Thomas Szasz.:The Sociological View. Journal of Social Problems.
Vol 27. No.5. p577. (1980)
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libertarian sentiments (which are worn boldly on his sleeve) never meet up’ seems to
be an equally valid conclusion to come to.124
However this is not all. Involuntary hospitalisation is just one aspect of Szasz’s
critique of psychiatry. It is important not to forget the main tenet of Szasz theory, that
the term ‘mental illness’ implies a literal disease when it is only a metaphorical
disease. And that to truly radicalise psychiatry for Szasz, would mean that the term
‘mental illness’ and the treatments it justifies would be given up immediately.
For Sedgwick this is dangerous because without a blanket term ‘mental illness’
clumsy and ill defined as it is, it would be difficult to make demands on the health
service.125 Because of the denial of the term ‘mental illness’ Sedgwick argues that
Szasz and other “anti-psychiatrists” could be used as a justification for further cuts in
welfare spending. This has already happened, when Governor Jerry Brown after
cutting California’s mental health budget by 40 percent partly justified his action by
claiming ‘I didn’t have any confidence it could be spent well….I’m aware of Thomas
Szasz’.126
As an alternative, at the end of Sedgwick’s book, he appeals for organised and
socialised welfare similar to the therapeutic culture of the Belgian town Geel, in
which mental patients board and live in the community with other people without
stigma.127 Sedgwick celebrates this type of therapeutic community where the
caregivers in Geel know no science, or the ‘medical details of schizophrenia’, and
many of the patients do not take medicine and ‘have not seen a doctor in years’.128
124
Review of Law, Liberty and Psychiatry by Thomas Szasz by Geoff Pearson.
http://www.jstor.org/stable/pdfplus/1409792.pdf
125
Sedgwick, P. Psycho Politics. (1st ed). Pluto Press Limited.p40 (1982).
126
New York Times ‘Brown Study’III. As quoted from Goldstein, p282.
127
Sedgwick, P. Psycho Politics. (1st ed). Pluto Press Limited.p256 (1982).
128
Ibid,256
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This image of Geel is revealing because it shows a conflict in Sedgwick’s thought.
For on one side he calls for a more humanitarian and non-medical approach to people
with ‘mental illness’ as in the example of Geel, while on the overhand he believes that
the term mental illness should be kept to keep funding for helping people with mental
illnesses. However if one looks at this through the work of Thomas Szasz there is an
obvious inherent contradiction here. This is because the term ‘mental illness’
throughout the history of Psychiatry implies a medical problem. Mainstream
Psychiatrists sees themselves as having medical authority. Thus a situation where
‘people know no science’ or aren’t on medication becomes increasingly difficult when
‘medical illness’ is widely used as a literal term, and Psychiatrist treat this as a
medical problem.129
These concerns are partly borne out in a British group called The Critical Psychiatry
Network based in Bradford that started in 1999. In an article explaining their beliefs
Phil Thomas says ‘It is often difficult to work in the biomedical model in a way that
really respects and engages with the patient's beliefs and preferences.’ In line with the
Szasz view of making Psychiatry a moral, political and ethical practise, they state
‘The biomedical model locates distress in the disordered function of the individual's
mind/brain, which relegates social contexts to a secondary role.’130 And ‘(We aim)to
introduce a strong ethical perspective on psychiatric knowledge and practice…and to
politicizes mental health issues.’ Tolerance of the diversity of human life and respect
for people’s autonomy is key to the ethos of Critical Psychiatry. Similarly this phrase
could be straight out of one of Szasz’s books, the ‘process of medicalisation of
deviant behaviour conceals complex political issues about the tolerance of diversity,
129
The medical model can be seen here in The limits of psychiatry
Duncan Double, consultant psychiatrist The number of antidepressants has increased twofold in seven
years, similarly the number of consultant psychiatrist has doubled in 22 years.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1122838
130
Critical Psychiatry Network. Critical Psychiatry Clinical Psychiatrists. Phil Thomas and Joanna
Moncrieff http://www.critpsynet.freeuk.com/healthmatters.htm
5849238
the control of disruptive behaviour and the management of dependency.’. As well,
like Szasz, they also understand that if there is a case for involuntary coercion i.e.
violence etc than this is a legal problem and not a medical problem.131
The approach of the Critical Psychiatry group provides an interesting answer to the
question of whether Szasz political persuasions are a necessary component of his
broader theory. For as a group of Psychiatrists they are a living and practising
embodiment of Szasz’s criticism of Psychiatry. They deny the necessity of a medical
model, the term ‘mental illness’ and involuntary hospitalisation and seek to treat their
patients as morally responsible and meaningfully acting agents. Yet despite this they
work, as Szasz would have it, “as agents of the state”. Their political convictions are
radically different to Szasz, in their belief that Psychiatry can only be radically
transformed if the political and social system changes. Also in the belief that social
inequalities increase both ‘problems in living’, but also problems in how society treats
and defines deviant behaviour. Therefore just as for Szasz responsibility is anterior to
liberty, for the Critical Psychiatrists social equality is anterior to liberty.
To conclude it seems that there are criticisms of psychiatry proposed by Thomas
Szasz and the Critical Psychiatrists that are very similar. Yet they both lead to
different political conclusions. This is important as it shows that Thomas Szasz’s
work does not have to be seen through a prism of a political ideology only. It is
essentially at its core humanistic. This means his theories sole aim is to help mental
patients, increase their autonomy, responsibility and liberty as much as possible. This
is a solution that is moral in nature and not medical. This is the most important part of
131
Another Critical Psychiatry article. http://www.critpsynet.freeuk.com/sound.htm
5849238
Szasz’s theory, and one which people of all political persuasions would be wise to
take head of, if they decide to challenge the dominance of institutional psychiatry.
In conclusion this paper has attempted to assess whether Thomas Szasz’s theory of
‘The Myth of Mental Illness’, comprised of an analytical/semantic philosophical,
moral argument and political argument forms a coherent and consistent whole. It has
shown with the philosophy of Kant and the moral philosophy of libertarianism and
existentialism that the analytic/semantic and moral aspects do form a coherent and
logical argument. This is because despite important queries made by Quine into the
nature of analytic arguments in general, that even with this view in mind, Szasz’s
argument is not just a moral endeavour. This is because his analytical argument is still
important in showing how Szasz defines what constitutes a disease and what
constitutes a ‘mental illness’. The fact that this definition as part of a ‘web of belief’ is
potentially revisable from empirical experience does not detract from the strength of it
as a workable definition which results in a logical conclusion i.e. mental illness is a
myth. It is also because his moral argument serves to undermine other possible
definitions of ‘disease’ and ‘the mind’, that means together they both form a
formidable and coherent argument that ensures psychiatrists have to seriously re-
examine their concepts and treatments.
In addition to this, the political dimension of Szasz’s work has been shown to be
separate of his main analytic and moral argument. Peter Sedgwick’s belief that
Szasz’s political ideology in no way contradicts his views on psychiatry is true in one
sense, but most importantly, his views on psychiatry do in no way explicitly support
5849238
his political views. This is because the libertarian though that encompasses his work
could potentially manifest itself in a different strand of Libertarian political thought.
This means that the criticism that Szasz offers of psychiatry does not necessarily
commit one to his political conclusions, in fact in the case of the Critical Psychiatry
movement it can lead one to altogether different political conclusions and
prescriptions.
Bibliography
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Dicker, G. (2004) Kant’s Theory of Knowledge and Analytical Introduction (1st ed)
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5849238

The Heresy of Thomas Szasz

It’s Philosophical, Moral and Political Dimensions

Can they be taken as a consistent and coherent whole?

since he embarked on a crusade to discredit institutional psychiatry’s foundation as de

critically assess the three distinct philosophical parts of his denunciation of

form a coherent and consistent whole.

of Mental Illness (1960)).

was presenting an analytical/semantic argument in the tradition of Immanual Kant.

existential and ethical philosophy to confront and understand mans problem of

the analytic propositions. So the preposition ‘a disease is a structural or functional

by the definition of disease as disease as “the structural or functional abnormality of

opposing viewpoints against Szasz’s right-libertarian political ideology. The first

an aberration, and in no sense contradict the positions he has taken on psychiatric

consistent criticisms of psychiatry is from a libertarian viewpoint. However there are

different political strands of libertarian thought and so a libertarian critique of

In the context of the Psychiatric profession

conceptual definitions of mainstream psychiatry, it is important to provide a brief

summary of the APA2 (American Psychiatric Association) definitions and criteria of

mental illnesses or disorders as provided in their DSM (Diagnosis and Statistical

Manual). In addition to this, it is necessary to provide a brief account of the change in

mainstream treatment provided by psychiatrists to the most severe mental disorders

major revision, DSM-IV in 1994.

“ A clinically significant behavioral or psychological syndrome or pattern that occurs

in an individual and that is associated with present distress (A painful symptom) or

disability (Impairment in one or more important areas of functioning) or with a

significantly increased risk of suffering, pain or disability.”6

example, Homosexuality described as ‘homodsyphilia, homosexual conflict disorder,

and ego-dystonic homosexuality’7 in its various apparent dysfunctional manifestations

marketing of a host of anti-psychotic drugs, described by Roy Porter as a

‘psychotropics revolution’11 introduced a lengthy process of de-institutionalization of

an inevitable result of the tight fiscal budgeting of advanced capitalist countries

towards traditional welfare policies that generally started before large-scale

advancements in anti-psychotic drugs.12 Despite disagreements in the causes, in the

in state and county asylum hospitals.13

depended on class. Thus unskilled or semiskilled workers of poor education were

hospitalization, increased likelihood of re-admission and little active treatment. While

Class II, containing professionals executives and, managerials, were treated

mental illnesses such as schizophrenia are brain diseases, with a demonstrative

and demonstrating this.

schizophrenia.17 Despite a lack of conclusive evidence he confidently states that

multiple sclerosis are diseases of the brain.”18

published the organs of mainstream Psychiatry have acknowledged and defined

profession described above.

Tracing Szasz’s thoughts-The argument from analytic and semantic reasoning

The ‘Myth of Mental Illness, Foundations of a Theory of Personal Conduct’,

historical sense because of the historical tradition of integration between Psychiatry

and Medicine, yet it does not make rational sense.

symptoms of these ‘problems in living’ are seen as similar to bodily diseases, it is

psychological manifestations of ‘problems in living’ non reducible to biological

treating them as a free acting and responsible moral agent .21

belonging in one category in the idioms appropriate to another.’22

symptoms of ‘problems in living’ is erroneously categorized as belonging to a

and as a consequence Szasz denies the psychological and sociological existence of

category described broadly as ‘problems in living’. As a consequence they should be

Szasz belief that he desires to ‘re-ethicize’ and ‘re-politicize’ psychiatry’.24

defines disease as ‘the pathologist defines it - as the structural or functional

abnormality of cells, tissues, organs or bodies’.25

Thus disease is a medical enterprise which is committed to physicialism and natural

relationships and social arrangements promoting certain types of learning and

values’27 underpinned by free will. While disease is a deterministic medical enterprise

conduct themselves in society belongs in the social sciences, such as psychology,

sociology, philosophy and anthropology28. The error therefore, that Psychiatrists