[acb-hsp] The Man Vs. the Therapeutic State

[peter altschul]

The Man Versus the Therapeutic State
  Jacob Sullum Sep 19, 2012
  The New York Times obituary for Thomas Szasz, who died this 
month at the age of 92, says his critique of psychiatry "had some 
merit in the 1950's ...  but not later on, when the field began 
developing more scientific approaches." That's a paraphrase of 
historian Edward Shorter, whose judgment reflects the 
conventional wisdom: Szasz called much-needed attention to 
psychiatric abuses early in his career but went too far by 
insisting on a fundamental distinction between actual, biological 
diseases and metaphorical diseases of the mind.
  In fact, however, Szasz's radicalism, which he combined with a 
sharp wit, a keen eye for obfuscating rhetoric, and an 
uncompromising dedication to individual freedom and 
responsibility, was one of his greatest strengths.  Beginning 
with "The Myth of Mental Illness" in 1961 and continuing through 
35 more books and hundreds of articles, the maverick 
psychiatrist, driven by a "passion against coercion," zeroed in 
on the foundational fallacies underlying all manner of 
medicalized tyranny.
  The idea that psychiatry became scientifically rigorous soon 
after Szasz first likened it to alchemy and astrology is hard to 
take seriously.  After all, it was not until 1973 that the 
American Psychiatric Association (APA) stopped calling 
homosexuality a mental disorder.
  More often, psychiatry has expanded its domain.  Today it 
encompasses myriad sins and foibles, including smoking, 
overeating, gambling, shoplifting, sexual promiscuity, pederasty, 
rambunctiousness, inattentiveness, social awkwardness, anxiety, 
sadness and political extremism.  If it can be described, it can 
be diagnosed, but only if the APA says so.  Asperger's, for 
instance, will cease to exist when the fifth edition of the APA's 
Diagnostic and Statistical Manual of Mental Disorders (DSM) comes 
out next year.
  As Marcia Angell, former editor of The New England Journal of 
Medicine, observed last year in The New York Review of Books, 
"there are no objective signs or tests for mental illness -- no 
lab data or MRI findings -- and the boundaries between normal and 
abnormal are often unclear.  That makes it possible to expand 
diagnostic boundaries or even create new diagnoses in ways that 
would be impossible, say, in a field like cardiology." In other 
words, mental illnesses are whatever psychiatrists say they are.
  How "scientific" is that? Not very.  In a 2010 Wired interview, 
Allen Frances, lead editor of the current DSM, despaired that 
defining mental disorders is "bullsinininininin." In an online 
debate last month, he declared that "mental disorders most 
certainly are not diseases." Then what exactly are they? For more 
than half a century, Szasz stubbornly highlighted the hazards of 
joining such a fuzzy, subjective concept with the force of law 
through involuntary treatment, the insanity defense and other 
psychiatrically informed policies.
  Consider "sexually violent predators," who are convicted and 
imprisoned based on the premise that they could have restrained 
themselves but failed to do so, then committed to mental 
hospitals after completing their sentences based on the premise 
that they suffer from irresistible urges and therefore pose an 
intolerable threat to public safety.  From a Szaszian 
perspective, this incoherent theory is a cover for what is really 
going on: the retroactive enhancement of duly imposed sentences 
by politicians who decided certain criminals were getting off too 
lightly -- a policy so plainly contrary to due process and the 
rule of law that it had to be dressed up in quasi-medical, 
pseudoscientific justifications.
  Szasz specialized in puncturing such pretensions.  He 
relentlessly attacked the "therapeutic state" -- the unhealthy 
alliance of medicine and government that blesses all sorts of 
unjustified limits on liberty, ranging from the mandatory 
prescription system to laws against suicide.  My own work has 
been powerfully influenced by Szasz's arguments against drug 
prohibition, especially his discussion of its symbolism and its 
reliance on a mistaken understanding of addiction, and his 
criticism of paternalistic interventions, such as New York Mayor 
Michael Bloomberg's recently approved soda serving ceiling, that 
conflate private and public health.
  I will always be grateful for Szasz's courage and insight, and 
so should anyone who shares his passion against coercion.